Question

Jabari an 84-year-old man is hospitalized for a course of intravenous clindamycin to treat an infected tooth following a root canal procedure. A week later the patient develops profuse diarrhea: no blood is visible in the stool, but lab test was positive for blood. He is running fever with temperature of 101.9⁰ F. Physical examination reveals substantial abdominal tenderness and distension. White Blood Cells are elevated (Neutrophils 91%, monocytes 7%, lymphocytes 2%). THE microbial agent is enterotoxigenic escherichia coli.

1. What is the microbial agent? Describe the morphology (shape, arrangement, gram reaction) and cultural properties (O2 requirement, biochemical requirements, motility, etc.) for this microbe.
2. Explain the spread or the occurrence for this infection (cause and transmission) and pathogenicity (virulent factors) of this agent relevant to this case study.
3. Describe the diagnoses (source of specimen, lab tests, and results that confirm your microbe) and treatment (name of Rx, what it targets, why/how does it work against this microbe) also include the general management of this patient

Answer 1

The microbial agent is Enterotoxigenic Escherichia coli is a type of Escherichia coli and type of leading bacterial causes of diarrhea in the todays world, the most common cause of travelers' diarrhea. A number of pathogenic isolates are termed ETEC, but this type of bacteria are expression of enterotoxins and presence of fimbriae used for attachment to host intestinal cells.

Morphology of bacteria:

• GRAM-NEGATIVE RODS
• MOTILE
• NON-SPORE-FORMING
• CATALASE: POSITIVE
• OXIDASE: NEGATIVE
• FACULTATIVELY ANAEROBIC
• .E. coli is a facultative anaerobe, which means it does not require oxygen, but grows better in the presence of oxygen.
• Biochemical requirements are-

• Capsule Capsulated

  Catalase Positive (+ve)

  Citrate Negative (-ve)

  Coagulase Negative (-ve),Flagella Flagellated

  Gas Positive (+ve)

  Gelatin Hydrolysis Negative (-ve)

  Gram Staining Negative (-ve)

  H2S Negative (-ve)

  Hemolysis Negative (-ve)

  Indole Positive (+ve) ,Motility yes.

• spread or the occurrence for this infection (cause and transmission) of e.coli are mainly coli infection is by eating contaminated food,Certain strains of E. coli, such as O157:H7, O104:H4, O121, O26, O103, O111, O145, and O104:H21, produce potentially lethal toxins. Food poisoning caused by E. coli can result from eating unwashed vegetables or poor butchered and undercooked meat.Clinical presentation: symptoms last 3–4 days

  Watery diarrhea

  Abdominal cramping

  Nausea and possibly vomiting

  Fever

  Decreased appetite

• In the laboratory, infection with ETEC is diagnosed when the bacteria are cultured from samples of stool. The techniques necessary to identify ETEC are not widely available, and physicians may make the diagnosis based on a patient's history and symptoms. Human or animal wastes (e.g., feces) are the ultimate source of ETEC contamination. In the laboratory, infection with ETEC is diagnosed when the bacteria are cultured from samples of stool.

• Treatment is

  for ETEC infection includes rehydration therapy and antibiotics, although ETEC is frequently resistant to common antibiotics. Improved sanitation is good.

  Bismuth subsalicylate compounds may decrease the frequency of bowel movements.

  Antibiotics may shorten the duration of symptoms from several days to one or two. #prevention are---

• Practice good food and water safety
• Prophylactic antibiotics are not recommended for most travelers.
• Prophylaxis may be considered for pregnant women, immunocompromised patients, and travelers.