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Activity Instruction
In this discussion, you will gain experience in identifying the biological, molecular, and genetic factors related to chronic and infectious diseases.

Read the following case study and respond to the questions at the end.

Emergency Room (ER) doctor Andy Loeb had an ominous feeling as he walked into the packed ER waiting room. Scattered among the usual collection of cuts, broken bones, and respiratory problems were approximately 16 people clustered around the restrooms. Despite their pale appearance and frantic dashes to the restrooms, they were all talking to each other—not a usual behavior for a group of strangers in the ER. Several others held young children.

His discussion with the ER staff revealed some peculiar findings of those 16 people. The majority of complaints and symptoms had been abdominal pain, vomiting, and bloody diarrhea. Most of the adults are just a bit uncomfortable. The kids have it the worst. Four little ones came in around midnight with the same symptoms—only worse. Two are in pediatric intensive care. The other two are already on dialysis.

The physician called the county health department and alerted the epidemiologist. The first patient Andy consulted disclosed that her daughter and at least 10 other neighborhood children had been sick at school and the parents had dismissed it as flu. When Andy returned to the ER staff room, the county epidemiologist was already reviewing chart records.

“Okay, we have 28 patients admitted, all under age 10. Their parents and any older siblings have some intestinal distress, but mild compared to the admissions. The children are all showing symptoms of some kind of hemolytic anemia. There are bruises and small hemorrhages visible in the mucosal lining of the mouth. Red blood cells, hemoglobin, and platelet counts are all way down. And the youngest are beginning to show signs of kidney failure,” stated the epidemiologist.

Initial laboratory (stool and blood samples) demonstrated no major parasites, a few pinworms, but nothing unusual. One screen did find positives for 026:H11, usually associated with enterohemorrhagic E.coli.

1) What is the most common source of contamination with E.coli?

2) Are there molecular or genetic factors to consider with E.coli ?

3) At this point, can you make some preliminary guesses as to the source of the infection?

1) What information should the epidemiologist gather (through communication) from the victims and their families to build support for public health strategies to minimize additional E.coli cases?

2) What are the best approaches in communicating the infection to the sick families?

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