Question

Ch. 20- Gastrointestinal Infections The patient is a 4-year-old male who presented to the emergency room with a 2 hour history of vomiting, diarrhea, fever, iritability, and lethargy. The child had gone to sleep on the living room couch at 23:00. His grandmother found him on the floor at 03:00 covered with feces. When she picked him up to carry hin to the bath tub, she noticed he was febrile (showing signs of fever). She bathed him, and brought him to the emergency room. The patient's medical history was significant for his being in group day care In the emergency room, he had two episodes of vomiting. His temperature was 38.9C, with a pulse of 160 BPM. He was also noticeably dehydrated. His stool contained bloody streaks, and a methylene blue stain of his feces is shown in Figure 1. Other laboratory studies included CSF exmination (dtue to his lethargy), which was normal. A peripheral WBC count was performed yielding 13,200 cells u, with 85% neutrophils. His blood culture was negative for organism. His stool sample was negative for parasitic ova. Figure 2 shows a MAC plate with the growth of the recovered organism. The organism was found to be non-motile, urease negative, indole negative, and a TSI slant showed no fermentation of sucrose or lactose, with no hydrogen sulfide production Figure I: Methylene blue stain of Figure 2: Organism grown on the child's feces MAC after 18 hour incubation.

Answer 1

Answer: There were WBC in child's stool due to the inflammatory bowel which causes diarrhoea.

According to laboratory results and findings, the E.coli bacteria is the causes of the diarrhoea which causes the frequent bowel disturbance.

The child feels lethargic as due to increase bowel motion the dehydration caused which leads to Electrolyte imbalance.

The child should get electrolyte balance therapy which will prevent further dehydration as well as antidiarrheal medications to stop the diarrhoea.