On the morning of March 11, the Texas Department of Health (TDH) in Austin received a telephone call from a student at a university in south – central Texas. The student reported that he and his roommate, a fraternity brother, were suffering from nausea, vomiting, and diarrhea. Both had become ill during the night. The roommate had taken an over – the – counter medication with some relief of his symptoms. Neither the student nor his roommate had seen a physician or gone to the emergency room. The students believed their illness was due to food they had eaten at a local pizzeria the previous night. 

1. Several agents can cause vomiting and diarrhea. What further information about their symptoms would be helpful in making a diagnosis?  

2. Do you think this complaint should be investigated further? Why? TDH staff were skeptical of the student’s report but felt that a minimal amount of exploration was necessary. They began by making a few telephone calls to establish the facts and determine if other persons were similarly affected. The pizzeria, where the student and his roommate had eaten, was closed until 11:00 A. M. There was no answer at the University Student Health Center, so a message was left on its answering machine. A call to the emergency room of a local hospital (Hospital A) revealed that 23 university students had been seen for acute gastroenteritis in the last 24 hours. In contrast, only three patients had been seen at the emergency room for similar symptoms from March 5 – 9, none of whom were associated with the university. At 10:30 A.M., the physician from the University Student Health Center returned the call from TDH and reported that 20 students with vomiting and diarrhea had been seen the previous day. He believed only 1-2 students typically would have been seen for these symptoms in a week. The health center had not collected stool specimens from any of the ill students. 

3. Do you think these cases of gastroenteritis represent an outbreak at the university or the wider community as a whole? Explain your answer. (1 point) Further Information: On March 11th, TDH staff visited the emergency room at hospital A and reviewed medical records of patients seen at the facility for vomiting and diarrhea since March 5th. Based on the records, symptoms among the 23 students included vomiting (91%), diarrhea (85%), abdominal cramping (68%), headache (66%), muscle aches (49%), and bloody diarrhea (5%). Oral temperatures ranged from 98.8o F to 102.4o F. Complete blood counts, performed on 10 students, showed an increase in white blood cells. Stool samples were collected from 17 students, which tested positive for a gram – positive, spore forming bacteria. 

4. Based on the information provided, what is the most likely cause of this illness? What information helped make the diagnosis? 

5. Is this a reportable disease? If so, who must you contact? If not, why?