Colonic malignancy with recurrent bacteraemia presenting as pyrexia of unknown origin

E. coli Sepsis: Red Flag for Colon Carcinoma-A Case Report and Review of the Literature

We present an atypical case of newly diagnosed colon cancer and provide insight into the infectious predispositions of E. coli bacteremia to the development of colon adenocarcinoma. A 66-year-old female was admitted to the hospital with one-week symptoms of subjective fevers, chills, and lower back pain. Upon initial evaluation, her temperature was 101 degrees Fahrenheit with a white count of 12,000 K/mm³. Initial septic workup was positive for E. coli bacteremia. The patient was started on Aztreonam. Repeat blood culture 48 hours later was negative for any growth. However, later during hospital stay blood culture was repeated due to SIRS, which was positive again for E. coli. CT scan of the chest/abdomen/pelvis with contrast revealed no signs of colitis. Without clear etiology for recurrent E. coli bacteremia ultimately colonoscopy was performed which showed an ulcerated mass in the cecum. Biopsy showed moderately differentiated adenocarcinoma. E. coli strains B2 and D produce cyclomodulin toxins as part of their virulence, which interferes with the cell cycle regulation, promoting chromosomal instability, and increasing susceptibility to cancer. In patients with recurrent E. coli bacteremia with an unknown source, colonoscopy should be done to look for colon cancer.

Primary care physician compliance with colorectal cancer screening guidelines

OBJECTIVE

To assess self-reported compliance to colorectal cancer (CRC) screening guidelines among primary care physicians (PCPs) and to assess physician and practice characteristics associated with reported compliance.

METHODS

Survey data from 984 PCPs in Arizona were used. Self-reported CRC screening practices, recommendations, and compliance with guidelines were assessed. Physician and practice characteristics associated with guideline compliance were also evaluated.

RESULTS

While 77.5% of physicians reported using national screening guidelines, only 51.7% reported recommendations consistent with the guidelines. Younger physicians were significantly more likely to report compliance with screening guidelines (OR = 1.50, 95% CI = 1.07-2.10) as were female clinicians (OR = 1.46, 95% CI = 1.11-1.92). Physicians practicing in solo (OR = 0.33, 95% CI = 0.19-0.58), group (OR = 0.36, 95% CI = 0.21-0.62), or community health centers (OR = 0.37, 95% CI = 0.17-0.81) were significantly less likely to report following guidelines as compared to those in academic practice. Guideline compliance was higher for fecal occult blood test (FOBT) (65.0%) than colonoscopy (56.7%); overuse of screening for these modalities was reported among 34.4% of physicians.

CONCLUSIONS

PCPs are not adequately following CRC screening guidelines. Further studies are needed to clarify the reasons for this lack of compliance, especially as guidelines become more complex.