A woman in her late 60s came into the emergency room with profound fatigue and shortness of breath that persisted for a full day.

Her medical history was very complicated. She had insulin-dependent diabetes, heart failure, coronary artery disease (she had a cardiac stent placed a month before), and chronic obstructive lung disease requiring home oxygen and steroids.

In the emergency room, she also was found to have atrial fibrillation, a type of irregular heart rhythm. We gave her medicines to bring down her rapid heart rate, and admitted her to the intensive-care unit.

The next day, she complained of watery diarrhea. Her initial stool tests were unremarkable, so we thought perhaps the cardiac medicines were causing the diarrhea. We changed those medicines, but it didn't stop her diarrhea.

After a week in the hospital, her blood sugars dropped and she complained of nausea and worsening fatigue. Her serum white blood cell count and lactic acid levels were elevated, both of which could be signs of developing sepsis, an immune response to infection.

Blood cultures were ordered to determine whether she had an infection, and we started her on broad-spectrum antibiotics as part of a sepsis treatment protocol.

A CT scan showed an obstruction in her small bowel. Her heart rate increased after several days of being under control. So that her gastrointestinal tract and bowels could rest, she was asked not to eat anything. A nasogastric tube was placed to decompress the bowel obstruction.

She still had diarrhea, so we repeated the stool tests. Her blood cultures revealed a bacterial infection. The following day, the microbiology laboratory called us to report that both the stool and blood cultures were growing the same organism.

Solution

Her blood and stool cultures were growing salmonella typhimurium, a food-borne bacterium commonly known as salmonella. It typically leads to symptoms such as abdominal pain, diarrhea, fevers, nausea and vomiting.

The patient told us she lived alone, did not have any pets, never ate out, and always prepared her own food. The day before she felt ill, she had eaten baked chicken with a salad.

Upon further questioning, she remarked that the chicken may not have been fully cooked.

In healthy patients, this infection resolves itself without medical intervention. However, in patients with a compromised immune system, salmonella can cause complications, such as an infection in the bloodstream and heart. Our patient's older age, underlying diabetes, and use of steroids made her immune system vulnerable. Her severe fatigue and rapid heart rate were most likely complications of the salmonella infection.

Our patient cleared the infection quickly with antibiotics. Her echocardiogram did not show any evidence of heart infection, and her diarrhea resolved within a few days.

There are many ways to avoid contracting salmonella. To protect yourself, be sure to:

  • Cook meat and eggs well.
  • Wash fruits and vegetables thoroughly.
  • Wash hands before and after cooking, after using the bathroom and changing diapers or taking out the trash.
  • Make sure to keep your refrigerator temperature below 40 degrees Fahrenheit,
  • Avoid drinking unpasteurized milk or dairy products.

In addition, reptiles and amphibians such as turtles, lizards and frogs carry salmonella. It is highly recommended that you wash your hands after handling these animals.

Gul Madison, M.D., is an infectious-disease specialist at Mercy Philadelphia Hospital.