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Summary of the public health management of a suspected case of VTEC infection Summary of the early clinical management of suspected VTEC infection The public health management of a suspected case of VTEC infection is complicated and has so many variables that it cannot be addressed in detail in an algorithm. It is beyond the scope of an algorithm to describe even the early clinical management of suspected VTEC infection in detail. This algorithm should therefore be used in conjunction with HPS’ “Guidance on the Public Health Management of Infection with verotoxigenic Escherichia coli O157”. In particular, the Glossary in the Guidance may be helpful in defining, for example, the different categories of “case”. The Guidance should be consulted for: This algorithm should therefore be used in conjunction with HPS’ “Guidance on the Public Health Management of Infection with verotoxigenic Escherichia coli O157”. The threshold for suspicion of VTEC infection should be low, and the diagnosis seriously considered when there is acute bloody diarrhoea. Specialist advice should be sought when this symptom occurs in an especially vulnerable person. Guidance for the Public Health Management of Infection with Verotoxigenic Escherichia coli (VTEC) Quick Reference Guide Health Protection Network Scottish Guidance Revised February 2013 •Activities that should be carried out at all stages of the public health management, including communications with microbiological colleagues and HPS, and the provision of appropriate infection control advice to cases, contacts, and others. •The management of potential outbreaks, including the investigation of potential common exposures, and the subsequent management of the suspected source. 3 2013 Edition Health Protection Network Supported by Health Protection Scotland Health Protection Network site: http://www.hps.scot.nhs.uk/about/HPN.aspx © Health Protection Network 2013 See full guidance document for further copyright information: http://www.hps.scot. nhs.uk/giz/guidelinedetail.aspx?id=39336 Designed and typeset by: Graphics Team, Health Protection Scotland No No No No further action on asymptomatic contacts No Yes Exclude until microbiologically clear Exclude until 48 hours symptom free Yes No Is confirmed case or highly likely case in Groups A-D? Yes Is suspected case, asymptomatic contact or associated suspected case microbiologically confirmed? Monitor until confirmed, highly likely or recovered No Is suspected case or associated suspected case highly likely? No No further action on associated suspected cases No Are there any? Are there any? Yes Seek microbiological confirmation (of suspected case, asymptomatic contact and associated suspected cases) Yes Seek associated suspected cases Treat as early clinical management algorithm Manage potential outbreak as in Guidance Significant likelihood of VTEC but less likely to develop HUS – treat as clinically indicated Unlikely to be VTEC – treat as clinically indicated Almost certainly not VTEC – treat as clinically indicated Seek asymptomatic contacts Suspected case of VTEC infection Summary of public health management of a suspected case of VTEC infection Treat as medical emergency. Consult specialist clinician (ID physician/paediatrician)on need for admission or clinical management and investigation e.g. monitoring of blood parameters Yes OR Over 60 years of age OR Suffering severe abdominal pain Under 16 years of age Is the patient: Send stool and report to HPT Antibiotics/anti-motilities/NSAIDs/opiates are contra-indicated Yes Is stool grossly bloody/uniformly blood-stained? Yes Consider sending stool. Enquire about associated cases and biologically plausible exposures. Provide advice on hygiene Yes Is this likely to be infectious? Yes Patient presents with acute diarrhoea Early clinical management of suspected infection