Case StudyPathogenic Bacteriology2009.ppt

Case StudyPathogenic Bacteriology2009 Case 26 Tsung-Han Hsieh Omar Ahmed Rochelle Songco Case Summary Patient: 80-year-old female had a cystocele repair performed. She was give a 7-day course of oral cephalexin but stopped the course after 3days. Symptoms: 10 days postoperatively, she had diarrhea (multiple, watery, loose stool w/o blood) for 3days. She also had crampy abdominal pain, vomiting, and mild fever. Case Summary Blood cell count was normal, but 53% of immature polymorphonuclear cells were seen. Urine culture revealed 100,000 CFU/ml of E. coli which was susceptible to all antimicrobial agents Cultures for Salmonella, Shigella, Yerinia, and Campylobacter spp were all negative. Enzyme immunoassay (EIA) showed positive for bacterial toxin in the stool sample. Physical examination, electrolytes, liver enzymes, and lipase were within normal range. Key Information Pointing to Diagnosis 100,000 CFU/ml of E. coli in the urine culture - CFU/ml greater than 100,000 is significant Watery diarrhea without blood - the organism is not invasive EIA showed positive for bacterial toxin in the stool sample - the organism produces enterotoxin The Diagnosis for Case #26 The causative organism was enterotoxigenic E. coli (ETEC) Cystocele repair is predisposing factor. Since E. coli is a major cause of urinary tract infection, and the cystocele repair involves urinary tract, the organism could have the chance to get into the patient and cause diarrhea and other symptoms. EIA was performed to specify which types of E. coli was causing the disease. Classification,Gram Stain Results, and Microscopic Appearance of ETEC Family: Enterobacteriaceae Genus: Escherichia Gram-negative bacilli Facultative anaerobes Picture was taken from /graphics/e_coli.jpg Diseases and Pathogenesis of Disease Caused by ETEC Disease E. coli is a major cause of urinary tract infection, gastroenteritis, neonatal meningitis,