Coleville, a small farming community in western Iowa, needs your help. In the past week, a large number of town residents have fallen ill. This illness has afflicted almost segment of the town’s population: children, adults and the elderly. Young children and the elderly seem to be the worst sets of patients. Complicating local officals’ investigation is the fact that almost every resident of the town was at last week’s bicentennial celebration picnic. Therefore, almost every resident would have been exposed to any readily contagious illness that could be spread from person-to–person or any contaminant present at the celebration. Symptoms include severe diarrhea and abdominal cramping, as well as some cases of vomiting. Most patients are running a fever, as well. Four patients have died. Treatment has been limited to intravenous fluids to control dehydration.
Residents of a neighboring town, Slawton, are also starting to turn up in local hospitals and clinics with similar symptoms. Few of these patients were at the bicentennial celebration last week, however they all were in attendance at a wedding held Friday night. The caterers and waiters for that reception were from a Coleville-based company, suggesting that they may also be infected with the disease. These workers have been quarantined and are been observed closely. Health officials are interviewing all afflicted patients in order to determine any common links between the patients aside from the celebration.

Day one: afternoon

You have received blood, urine and CSF samples from one of the case patients. Additionally, this patient’s stool has been cultured and the plate has been sent over for you.

Day two: morning

There are five more fatalities today, all senior citizens bringing the total to 9 dead and 60 ill. Now, patients are not only complaining of gastrointestinal symptoms, but also are beginning to complain of headaches and stiff necks, especially in children. One child has experience seizures and about 6 patients at a nearby nursing home who had displayed flu-like symptoms with gastrointestinal disease have become severely disoriented and confused this morning. All are complaining of severe headaches. MRI results from one patient showed swelling of the brain and spinal cord. A lumbar puncture was performed and a cerebral spinal fluid sample was sent to you this morning.
Healthy adults appear to be recovering better from the disease than children and older adults. Only about 1/3 of the potentially exposed adults have been diagnosed with severe symptoms but, upon interview, many more have reported mild diarrhea or upset stomachs. Ironically adult patients who took antacids have reported much stronger symptoms.

Day two: afternoon

It has been determined that the catering company that catered the wedding reception was also responsible for catering a large portion of the bicentennial celebration picnic. The menu included hot dogs, sausages, veggie burgers, and hamburgers with all the fixings (lettuce, tomato, cheese, onions, peppers, mushrooms, condiments). They also served boxed chips and snack foods, fruit salad, coleslaw, Italian pasta salad, three bean salad, cookies, brownies, and homemade ice cream. The wedding reception menu included chicken or vegetarian lasagna, green beans almandine, buttered corn, garlic and chive mashed potatoes, cake, and homemade ice cream.

Day three: morning

15 women in the town were pregnant at the time of the bicentennial celebration. Only one reported symptoms severe enough to require hospitalization, although eleven others reported varying degrees of mild illness. The hospitalized woman lost her baby to miscarriage this morning. Further inquiry with the local obstetrician revealed that four of the women had given birth in the past week and three of the infants were severely ill. Two other women were being observed, as their fetuses appeared to be in serious distress. The doctor has not had recent contact with the other nine women and is unaware of the status of either the mothers or fetuses.
A conversation with an obstetrician in Slawton has revealed one miscarriage, one stillbirth, two potentially distressed fetuses and one ill newborn. All five mothers were at the wedding reception.