Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 162: A 73-Year-Old Woman with Fever and Altered Mental Status
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Sep 4, 2025 A fascinating case of a 73-year-old woman grappling with fever and altered mental status unveils the complexities of sepsis. The discussion pivots around foodborne illness, particularly disseminated listeria, and how it can escalate dangerously, especially in the elderly. Insightful treatment strategies and the vital role of patient history in identifying listeria transmission are explored. The high stakes of appropriate antibiotic interventions underscore the urgency of responsive healthcare.
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Start Resuscitation And Empiric Antibiotics Fast
- For a hypotensive, febrile, and altered patient suspect sepsis and start volume resuscitation and broad workup immediately.
- Send labs and cultures and initiate prompt empiric antibiotics while obtaining history.
Taco Salad Triggered Family Gastroenteritis
- The patient and her family all developed acute gastroenteritis after a taco salad meal about 10 days earlier.
- The grandmother later deteriorated while others recovered, suggesting delayed invasive disease in an older adult.
Listeria Sources Beyond Deli Meats
- Common food sources include soft cheeses, raw produce, and packaged salads, not only deli meats.
- Listeria outbreaks have shifted after regulatory changes, but incidence remains steady.
