i need help on 6 & 7 CASE The patient was a previously healthy 11-year-old femal
ID: 200140 • Letter: I
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i need help on 6 & 7
CASE The patient was a previously healthy 11-year-old female who came to the emergency department (ED) in mid-September with a 2-day history of bloody diarrhea. Three days previously he had the onset of fever, headache, and lower abdominal pain. Her diarrhea began as watery and became increasingly bloody. She denied any recent travel but reported that her brother also had bloody diarrhea. In her history, she said she had eaten a hamburger at a school picnic prior to the onset of diseasc, as well as having consumed spinach. There was no family history 3 of inflammatory bowel disease or bloody stools. On physical examination, the patient's vital signs were normal and the physi cal findings were unremarkable except for severe abdominal pain. Her stool was hemoccult positive and showed 2+white blood cells (WBCs). A complete blood count was within normal limits except for a WBC of 14,900/ul, with an absolute neutrophil count of 1 3,500/1. She was given morphine in the ED for her abdom inal pain. An abdominal ultrasound ruled out acute appendicitis but revealed thickened bowel loops consistent with colitis. During the first week of her hospital course she continued to have bloody diarrhea and severe abdominal pain. Her final stool submitted to the laboratory on hospital day 7 was consistent with a blood clot. During her hospital course she developed low urine output and hematuria, with a serum creatinine of 2.1 mg/o on hospital day 5. Her renal symptoms were treated with fluids and her renal function was closely monitoréd. In addition, on hospital day 6 she had a platelet count of 16,000/pl and a hemoglobin level of 7.2 mg/dl. She received a unit of packed red blood cells on the 6th, 7th, and 11th hospital days. By discharge on the 13th hospital day her serum creatinine, blood urea nitrogen, and platelet count had returned to normal and her hemoglobin had stabilized at 10.2 mg/dl Culture of her stool on sorbitol MacConkey agar is seen in Fig. 30.1 1. What organism is infecting this patient? 2. What two virulencc factors does this organism produce, and what are their roles in the gastrointes- tinal disease seen in this patient? Explain why multiple serotypes of this organism can produce 1 these virulence factors. 3. Was the clinical course of her illness consistent with infec tion caused by this organis? Figure 30.1Explanation / Answer
Answer:
6) Give atleast two reasons why large outbreaks caused by this organism are being recognized with increasing frequency?
Based on the given case description, the causing organism is Diarrheagenic Escherichia coli ( O157:H7) and infection appears to occur due to consumption of undercooked or contaminated hamburger.
7) In the laboratory, three different techniques are used to detect this organism. What are they, and what are their strength and weaknesses?
1) PCR detection (5P PCR method, Real Time PCR method):
2 Commercial method like RIMTM E. coli O157:H7 latex test
3) Pulsed Field Gel Electrophoresis (PFGE):
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