The patient was a female in her eighties with pulmonary hypertension requiring c

Question

The patient was a female in her eighties with pulmonary hypertension requiring chronic oxygen by nasal cannula. She had a hospital admission previously for worsening shortness of breath, dyspnea on exertion, and chest pain. Chest radiograph was consistent with right middle lobe pneumonia. She was given a 14 day course of levofloxacin and discharged to a skilled nursing facility. Three weeks later she had the onset of loose, watery stools, which increased in frequency to more than 10 times per day. She had generalized weakness and diffuse abdominal pain and was unable to walk. She also was unable to eat, with several episodes of nausea and vomiting. Her family and social history was significant only for her having moved to a nursing home. On re-admission, approximately three weeks into her diarrheal disease course, she had fever, chills, malaise, myalgia, and dizziness. She had lost five pounds since her prior admission. She was dehydrated with hypotension (82/40). Bacterial cytotoxins were found upon fecal testing. On examination her abdomen was soft, diffusely tender, and mildly distended. She had decreased bowel sounds and an abdominal radiograph showed grossly dilated bowels (megacolon). She was judged to be a poor surgical risk. Over the next four hospital days, her white blood cell counts went up progressively from 29,000/mL to 127,000/mL. On the fourth day of hospitalization, the patient passed away. Upon autopsy, pseudomembranous colitis lesions were observed on the surface of the colon. (12 points total)

Knowing surgery was not an option for this patient, what other non-antibiotic treatment options could be available for this infection? (1 point)

Describe three factors that predispose this patient to infection with this organism.  (1.5 points)

What precautions should the facility’s personnel do to ensure the safety of other patients and before admitting a new patient into her room? (1 point)

What bacterial structure makes this organism particularly difficult to eliminate?

What antibody is most likely produced to neutralize this infection? (1 point)

Explanation / Answer

1. Pseudomembranous colitis is the inflammation of the colon associated with an overgrowth of the bacterium Clostridium difficile. The overgrowth of C. difficile is most often related to recent antibiotic use. In literature, no non-antibiotic treatment is mentioned. However, by keeping the healthy bacteria growth in check, with the use of prebiotics and probiotics, could be prove helpful
2. Factors that may increase risk (predisposing factors) of pseudomembranous colitis include:

Taking antibiotics

Staying in the hospital or a nursing home

Increasing age, especially over 65 years

Having a weakened immune system

Having a colon disease, such as inflammatory bowel disease or colorectal cancer

Undergoing intestinal surgery

Receiving chemotherapy treatment for cancer

3. Clostridium difficile infection is spread by bacterial spores found within feces so the surfaces may become contaminated with the spores with further spread occurring via the hands of healthcare workers which should be taken care of.
Secondly, strict enteric precautions whenlooking after patients with diarrhoea; and meticulous cleaning of clinical areas also kept in consideration.
4. the bacteria produce the resistant spores that are able to tolerate extreme conditions and survive in clinical environments for long periods. Because of this, the bacteria may be cultured from almost any surface. Once spores are ingested, their acid-resistance allows them to pass through the stomach unscathed. Upon exposure to bile acids, they germinate and multiply into vegetative cells in the colon.
5. The IgG antibody response mainly involved in case of this bacteria.

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