Question

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. The patient noted multiple watery, loose stools without blood, crampy abdominal pain, and vomiting. She presented with a temperature of 38.2 degrees C, pulse rate of 90/min, respiration rate of 20/min, and blood pressure of 116/53mm Hg. Her white blood cell count was normal, but a large number (53%) of immature polymorphonuclear cells were seen. Physical examination, electrolytes, liver enzymes, and lipase were all within normal limits.

What organism was causing the womans diarrhea?

What in her history was a predisposing factor for her development of this infection? How did it predispose her?

Why is this organism particularly problematic as a nosocomial pathogen?

Describe the disease spectrum seen with this organism.

What virulence factors does this organism produce, and what roles do these factors play in the pathogenesis of disease?

Discuss three different types of therapeutic strategies that can be used to treat this disease.

Answer 1

1.Most probably the offending organism must be Clostridium difficile

2 In the situation it has been mentioned that she has been taking oral cephalhexin..it happens that diarrhea may last upto 14 days after the patient stop taking antibiotics.Sometimes taking an antibiotic eliminates the good bacteria,making it possible for the harmful ones to freely roam about insidethe bowel,producing hatmful chemicalss which could damage the bowel wall and trigger inflammation,resulting in colitis.As a result the patient exhibits the above said symptoms..

3 Elderly and people with debilitating illness are prone to the C.difficile infections.This one of the hospital-acquired infection and can be spread from not following adequate handwashing by health care providers.This could cause infections in patients and when they take the antibiotics such as cephalhexins,it becomes easier for the C.difficile to harbour.

4 Asymptomatic carrier spectrum of illness is from asymptomatic carriage to fulminant,relapsing and fatal colitis.The onset of symptoms maybe days or months.Diarrhea can be mild or severe.Usually colonized with C-diff,but does not cause infection.Upto 20% in hospitals,rate increases in long term care facilities.

Symptomatic carrier- non-severe cases is characterized by diarrhea,low grade fever,abdominal pain,abdominal cramping.Severe cases is marked by leukocytosis,high grade fever,colitis,toxic megacolon,bowel perforation,ileus or death.

5 The virulence factors are endotoxin A causes fluid in colon and endotoxin B causes leukocytosis.