Case 1
A 19-year-old male college student presents to the student health department with abdominal pain, diarrhea, and fever. He say that his symptoms started 1 day ago. He has had 10 stools in the past day and has noted blood mixed in with the stool on several occasions. He usually eats at home but reports having eaten chicken in the college cafeteria days ago. He has no history of gastrointestinal (GI) disease. On examination he has a temperature of 37.8°C and appears to be in pain. His abdomen has hyperactive bowels sounds and is diffusely tender but without rigidity, rebound tenderness, or guarding. A stool sample tests positive for blood and fecal leukocytes. Stool cultures are sent and subsequently positive for a pathologic organism. The causative agent recovered from feces was a slightly curved, gram–negative rod.
1. What is the most likely pathogenic organism?
2. What is the term used to describe the type of atmospheric environment best suited for this organism?
Case 2
A 30-year-old dairy farmer was in good health until the day prior to admission, when he felt chilled and feverish. He developed nausea, vomiting, diarrhea, and lower abdominal discomfort and presented to the emergency room, where he was noted to be lethargic. His vital signs included, temperature of 40°C. His physical examination was remarkable for lower abdominal tenderness to palpation bilaterally. A rectal examination revealed occult blood in the stool the patient was lethargic but had no focal neurological deficits. Of note, his 3-year-old child had been discharged from the hospital 2 days previously with a similar history.
The patient underwent a lumbar puncture because of his altered mental status and fever. Laboratory studies of cerebrospinal fluid (CSF) were within normal limits, and a bacterial culture of CSF was negative.
A stool examination for fecal leukocytes was positive, and stool culture was diagnostic. Biochemical examination of the organism revealed it to be a lactose nonfermenter on MacConkey agar, H2S negative, urea negative, and nonmotile at both 25 and 37°C.
3. What was the most likely source(s) of infection?
4. On the basis of the biochemical reactions, which organism do you think this is?
5. Did the person have meningitis?
Case 1.
1. Option B is correct as this is the case of the Campylobacter jejuni infection, a major food poisioning pathogen in the US
2. Microaerophilic is the best term suited for Campylobacter jejuni as the atmospheric environment is concerned
Case 2
1. Option D is correct as contaminated and unpasteurized milk products are main source of contamination.
2. Option B is correct as this is the case of the Shigella sp. on the basis of the biochemical observation like lactose nonfermenter on MacConkey agar, H2S negative, urea negative and nonmotile nature
3. Option B is correct No as the patient had full nerve, spinal cord, and brain function. “No focal neurological deficits”, therefore he did not have meningitis.
Case 1 A 19-year-old male college student presents to the student health department with abdominal pain,...
Case 2 A 30-year-old dairy farmer was in good health until the day prior to admission, when he felt chilled and feverish. He developed nausea, vomiting, diarrhea, and lower abdominal discomfort and presented to the emergency room, where he was noted to be lethargic. His vital signs included, temperature of 40°C. His physical examination was remarkable for lower abdominal tenderness to palpation bilaterally. A rectal examination revealed occult blood in the stool the patient was lethargic but had no focal...
A 30-year-old dairy farmer was in good health until the day prior to admission, when he felt chilled and feverish. He developed nausea, vomiting, diarrhea, and lower abdominal discomfort and presented to the emergency room, where he was noted to be lethargic. His vital signs included, temperature of 40°C. His physical examination was remarkable for lower abdominal tenderness to palpation bilaterally. A rectal examination revealed occult blood in the stool the patient was lethargic but had no focal neurological deficits....
Case 3 A 48-year-old man presents to the emergency department with 2 days of crampy abdominal pain, nausea, vomiting, diarrhea, and fever. He has not had any blood in his stool. He denies contact with anyone with similar symptoms recently. He has not eaten any raw or unprocessed foods recently. The only food that he did not prepare himself in the past week was a breakfast of eggs “sunny side up” and bacon that he had at a diner the...
A 18-year-old male present to the outpatient clinic for evaluation of diarrhea and abdominal discomfort. The patient noted mild abdominal discomfort and 3 watery bowel movements per day. Abdominal exam was notable for mild lower abdominal tenderness. Fecal exam demonstrated a greenish, watery stool, negative for occult blood. Stool for fecal leukocytes was positive. The causative agent recovered from the feces was a slightly curved, gram-negative rod. What is the probable etiological agent? How is the organism cultivated? How is...
A 4-year-old male was admitted to the hospital with vomiting, prolonged bloody diarrhea, abdominal cramping and recent anuria. The patient appeared pale and his vital signs indicated he was hypertensive. Upon questioning, the boy’s father reported that their family had experienced acute self-limiting diarrhea earlier this week. The physician ordered a stool culture and the following laboratory results were reported three days later: Direct Stool exam: Fecal leukocytes: Negative Stool Culture: Negative for Salmonella, Shigella, and Campylobacter species The physician...
A 48-year-old man presents to the emergency department with 2 days of crampy abdominal pain, nausea, vomiting, diarrhea, and fever. He has not had any blood in his stool. He denies contact with anyone with similar symptoms recently. He has not eaten any raw or unprocessed foods recently. The only food that he did not prepare himself in the past week was a breakfast of eggs “sunny side up” and bacon that he had at a diner the day before...
Case Study #2 A 59-year-old man presents with a one-day history of fever, abdominal cramps and diarrhea. His symptoms began six hours after the onset of the "runs" in two of his grandchildren and their mother all of whom had been visiting from their dairy and poultry farm in Wisconsin. The day before becoming ill all had eaten a meal consisting of Caesar salad, pasta with stir fried vegetables, bread and apples. His wife prepared her popular homemade mayonnaise. Other than...
Case Study #2 A 59 year old man presents with a one day history of fever, abdominal cramps and diarrhea. His symptoms began six hours after the onset of the "runs" in two of his grandchildren and their mother all of whom had been visiting from their dairy and poultry farm in Wisconsin. The day before becoming ill all had eaten a meal consisting of Caesar salad, pasta with stir fried vegetables, bread and apples. His wife prepared her popular...
The patient was an 80-year-old female who 10 days previously had a cystocele repair performed. At the time of that hospital admission, a urine culture was ontained that revealed > 100,000 CFU/ml of an Escherichia coli strain that was suusceptible to all antimicrobial agents against which it was tested. Postoperatively, she began a 7-day course of oral cephalexin. She was discharged after an uneventful postoperative courser of 3 days. Ten days postoperatively, she presented with a 3-day history of diarrhea....
The patient was an 80-year-old female who 10 days previously had had a cystocele repair performed. At the time of the hospital admission, a urine culture was obtained and revealed >100,000 CFU/ml of an Escherichia coli strain that was susceptible to all antimicrobial agents against which it was tested. Postoperatively, she began a 7-day course of oral cephalexin. She was discharged after an uneventful postoperative course of 3 days. Ten days postoperatively, she presented with a 3-day history of diarrhea....