Seven Sick Patients and an Elusive Suspect: A Medical Whodunit

Albert B. Lowenfels, MD

Disclosures

January 07, 2014

Description of Cases

The index patient was a young man who had enjoyed good health until about 10 days after arriving for a visit with friends who had rented a suburban home for the summer. He became quite ill with fever and gastrointestinal symptoms, but recovered, and there were no other reports of illness in family members or their servants.

Within a few years, 6 members of well-to-do families or their servants were struck with a similar illness. Five of the 7 index patients were young girls, half of whom were servants. One of the 7 patients died, for a case fatality rate of 14%. In addition to the initial 7 index patients, 19 family members became ill with the same disease. All of these patients had similar complaints which included some, but not all, of the following symptoms and signs: elevated temperature to 103°-104° F, malaise, anorexia, abdominal cramps, diarrhea, headache, and neuropsychiatric symptoms. Some of the patients had a rash characterized by flat, rose-colored spots covering the chest and abdomen. The duration of illness was typically about a few weeks.

Eventually a single person was found to be directly responsible for all of the illnesses in these families.

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