Question

The patient was an 80-year-old female who 10 days previously had had a cystocele repair performed. At the time of the hospital admission, a urine culture was obtained and revealed >100,000 CFU/ml of an Escherichia coli strain that was susceptible to all antimicrobial agents against which it was tested. Postoperatively, she began a 7-day course of oral cephalexin. She was discharged after an uneventful postoperative course of 3 days. Ten days postoperatively, she presented with a 3-day history of diarrhea. The patient noted multiple watery, loose stools without blood, crampy abdominal pain, and vomiting. She presented with a temperature of 38.2 degrees C, pulse rate of 90/min, respiration rate of 20/min, and blood pressure of 116/53mm Hg. Her white blood cell count was normal, but a large number (53%) of immature polymorphonuclear cells were seen. Physical examination, electrolytes, liver enzymes, and lipase were all within normal limits.

Cultures for Salmonella, Shigella, Yersinia, and Campylobacter spp. were all negative.
What organism was causing the woman’s diarrhea?

What in her history was a predisposing factor for her development of this infection? How did it predispose her?

Why is this organism particularly problematic as a nosocomial pathogen?

Describe the disease spectrum seen with this organism.

What virulence factors does this organism produce, and what roles do these factors play in the pathogenesis of disease?

Discuss three different types of therapeutic strategies that can be used to treat this disease.

Answer 1

Noro virus and campylobacter are the most common causes of nosocomial gastroenteritis. Since in this patient the latter is negative. The most probsble cause might be due to Norovirus.

Infection can be acquired in hospital, nursing home, rehabilitation facility, outpatient clinic or other clinical settings and is spread to the susceptible patient in the clinical setting by various means. In some cases the microorganisms originate from the patients own skin microbiota most probably becoming opportunistic following surgery or other procedures that compromise the protective skin barrier.

Though the patient have got the infection from her own skin the infection is considered nosocomial since it develops in health care setting.

Noro virus is a RNA virus and us the most common form of viral gastroenteritis in adults and presents with abdominal cramps, watery diarrhea and vomiting and usually lasts about 1-3days and is often a course of institutional infection.