#1 1. Clinical History: A 28-year old man has been taking Clindamycin/Vancomycin while hospitalized for nearly 2 weeks. He recently started to experience abdominal cramping and watery diarrhea. The attending physician decided to discontinue antibiotics to see if the diarrhea would resolve on its own. a. What organism might cause this? Explain. C-Diff Case #2 1. Clinical history: A 49-year-old man with chronic gastritis is tested for infection with a 'urease breath test after complaints of sharp burning pain, 'nighttime' pain when lying down, and low-grade fever. He was recently put on medication for his acid reflux and is a pack-a-day smoker and above-average alcohol consumer. Because his test is 'positive' he is put on a course of doxycycline, metronidazole, bismuth subsalicylate, and omeprazole. a. What is the most likely causative microorganism? Explain. Gastritis and Gastritis ulcers which can lead to stomach cancer Case #3 1. Clinical History: An 18-year-old male is seen at the health clinic with complaints of painful burning urination and a milky discharge. Examination of the purulent discharge reveals many immune cells containing internal organisms. The patient was treated with ceftriaxone and provided with doxycycline to be taken orally twice a day for 7 days. a. What is the most likely diagnosis? b. In this patient, what is the mostly likely causative microorganism? Explain. gonorrhea
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The patient was a 46-year-old male who presented with complaints of fever. Ten days previously the patient had returned from a holiday trip during which he visited his family in Guatemala. He was both in urban areas and at the Caribbean coast. He received many mosquito bites and did not take malaria prophylaxis. He had one episode of diarrhea during his visit, but that resolved within 1 day. One week prior to presentation he began to develop malaise, headache, and fevers with some sweating and chills. Over the 3 days prior to presentation he had fevers throughout the day to 39.0°C with drenching sweats. He also complained of intermittent headaches. He did not complain of stiff neck, diarrhea, or abdominal pain. His urine appeared somewhat darker than normal to him. He had normal oral intake. On physical examination his temperature was 38.5°C, his blood pressure was 133/85 mm Hg, and his pulse was 145 beats/min. He had no nail bed hemorrhages and no petechial lesions. The remainder of his physical examination was within normal limits. He had a white blood count of 13,500 cells/μl with 10,000 neutrophils/μl. A peripheral blood smear is shown in Fig. 55.1. Figure 55.2 shows a triple sugar iron (TSI) slant of the organism that was recovered from the patient's blood. 1. Given his travel history, name three organisms that are likely to have been responsible for his fever. How do his peripheral blood smear and the TSI slant in Fig. 55.2 help to narrow the list? What about his physical examination rules out one of the pathogens? 2. How did this patient likely become infected with this organism? 3. This infection typically occurs in individuals who return from foreign countries or are immigrants from those countries. What countries are the most common source for this infection for patients in the United States?
Sri K.
Match the microorganism that causes food- or water-borne disease with the unique characteristic that describes it. Norovirus Staphylococcus aureus Clostridium perfringens Clostridium botulinum Bacillus cereus Campylobacter jejuni Salmonella spp. Enterotoxigenic Escherichia coli Enterohemorrhagic Escherichia coli Enteropathogenic Escherichia coli (EPEC) Listeria monocytogenes Shigella spp. Salmonella typhi Vibrio cholerae A. One of most common bacterial foodborne causes of gastroenteritis, with more than half of all cases from consuming improperly prepared poultry. Rarely associated with Guillain-Barre Syndrome (GBS). B. Causes typhoid fever from fecal-oral transmission via food or water. Organisms are shed from gallbladder reservoir via intestinal tract from human carriers. 'Typhoid Mary,' a food handler (cook), was first human carrier identified for any disease. C. Causes bacillary dysentery from contaminated water or food sources via fecal-oral transmission. Very low infectious dose with ingestion of only 10-100 bacterial cells capable of causing disease. Humans are primary reservoir. D. Most common cause of foodborne intoxication. E. Produces potent neurotoxin causing flaccid paralysis and death; often associated with home canning. F. More than half of all cases caused by consumption of improperly prepared poultry or raw eggs. Often causes large, common source outbreaks. G. Major cause of infant diarrhea and mortality in underdeveloped/developing countries. H. Most common foodborne pathogen in the U.S. I. Causes frequent epidemics and pandemics of cholera, a water or food-borne disease. Loss of fluids and electrolytes, although easily treatable, often leads to death from hypovolemic (low blood volume) shock, and metabolic acidosis (pH imbalance), due to loss of bicarbonate buffer. J. Foodborne intoxication usually caused by consumption of contaminated meat. K. Most common cause of traveller's diarrhea. L. Pathogen capable of growth at refrigerator temperatures (4°C), and thus subject to frequent food recalls. Immunocompromised and pregnant women are particularly susceptible. Commonly associated with soft cheeses, luncheon meats, or hot dogs. M. Causes two different forms of foodborne disease: i) Emetic intoxication from ingesting contaminated and improperly refrigerated rice; ii) Diarrheal infection from ingesting contaminated meat or vegetables. N. May cause hemolytic uremic syndrome (HUS) and death. Often associated with ingestion of undercooked ground beef.
Your patient was five years old when he was referred to the Children's Hospital with a severe acute infection of ethmoid sinuses. His mother reported that he had recurrent sinus infections since he was one year old. He had pneumonia from an infection with Pneumocystis carinii when he was 3 years old. These infections were treated successfully with antibiotics. While he was in the hospital with ethmoiditis, group A ̢̣-hemolytic streptococci were cultured from his nose & throat. Despite the presence of the bacterial infection his white blood count was 4200 cells /̢̣l (normal count 5000-9000 cells/̢̣l). 26% of his white blood cells were neutrophils, 56% lymphocytes, & 28% monocytes. Seven days after admission to the hospital, during which time he was successfully treated with antibiotics, his serum was tested for antibodies to the streptococcal antigen were found, his serum immunoglobulins were measured. The results are in the table below: Immunoglobulin (mg/dl) | Patient Levels (mg/dl) | Normals (mg/dl) IgG | 25 | 600-1500 IgA | 0 | 150-225 IgM | 210 | 75-150 A lymph node biopsy showed poorly organized structures with an absence of secondary follicles & germinal centers His peripheral blood lymphocytes were examined by FACS analysis & the results are shown below: Lymphocyte Cell Surface Marker | % Positive Cells | Normal/Abnormal CD3 | 87% | Normal CD56 | 2% | Normal CD19 | 11% | Normal All his B cells had surface IgM & IgD & none were found with surface IgG or IgA. Nor did his activated T cells bind to fluorescently labeled soluble CD40. He was treated with intravenous gamma globulin each month & labeled subsequently remained free of infection. He has an older brother & sister. They are both well. There is no family history of unusual susceptibility to infection.
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