This 18 year old male presented to the outpatient medical clinic for evaluation

Question

This 18 year old male presented to the outpatient medical clinic for evaluation of diarrhea and abdominal discomfort.The patient first noted mild abdominal discomfort and three loose bowel movements per day 1 week prior to evaluation.Two days prior to evaluation he noted internittent,cranky abdominal pain.He has had goats milk and cheese when stopped at a farm that the farmer made in his farm& using his animals milk directly.On examination,the patient had normal vital signs.The abdominal examination was noted for mild lower abdominal tenderness.The examination demonstrated a greenish watery stool that was negative for blood cells.Examination fp the feces microscopically was remark for the prescence of white blood cells.The organism causing his illness was gram-be coccobacilli.Blood culture showed no results in 48 hours.
1. On the basis of the laboratory findings,what are the likely causative agents of this patient's diarrhea?
2. What factor other than lab results may lead to your choice above?
3. What method will you use to identify the bacteria &why?
4. What precautions can be taken to prevent it's spread &why?

Explanation / Answer

Ans 1.

White blood cells appear in feces when a patient is suffering from inflammatory diarrhea. This disease can be caused by many bacteria. But since you have to find out gram negative rods with slight curve, therefore the bacteria can be:

a) Campylobacter jejuni: The disease caused by this bacteria is Campylobacteriosis. This is one of the most common causes of diarrhea. This bacteria is a gram negative rod, having spiral shape.

b) Vibrio cholerae: In severe cholera, WBC may appear in stool. V. cholerae is a gram negative, curved rod shaped bacteria.

Yes, finding of WBC is consistent with recovery ofCampylobacter, and Campylobacter’s confirmatory test should come positive. Please note that in V. choleraeinfection, the bacteria is rarely seen in the stool. It is rare to find the bacteria even in severe cholera. Therefore, finding of WBC is non consistent with V. cholerae.

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