Question

Patient 1 is a 45 year-old male. He presented in the ER (with his wife) and was suffering from a high fever (>103°F) and severe diarrhea (more than 7 unformed stools/day) that started ~3 days ago. The stools contained blood and mucus. The patient was also severely dehydrated. The attending physician felt that the diagnosis of infectious bacterial colitis is likely and sent a stool culture to the pathology laboratory for diagnosis. The patient was given saline (IV) and anti-diarrhea drugs, with broad-spectrum antibiotics and was admitted to the hospital ICU for observation.

The patient had a liver transplant 5 years ago and has been on low doses of immunosuppressant drugs (10 mg sirolimus/daily) ever since. He closely follows all of his liver transplant treatment regimens, and abstains from smoking, drinking alcohol, and using illicit drugs. The results of his last physical (2.5 months ago) showed normal BP, normal heart and lung activity, normal liver and kidney function, normal blood panels and no significant health problems. His regular doctor found no reasons why Patient 1 couldn’t travel as long as he took normal precautions (only drink bottled water and not eat raw food). Patient 1 and his wife (Patient 2) had recently traveled to Los Bacterialstan for holiday (returned to the USA 4 days ago). They stayed at the Motel Americano Del Coca Cola, a luxury resort, but on the last day of their trip they took a boat ride into the jungle to see some native villages.

Patient 2 is a 42 year-old female. She presented in the ER (with her husband) and was suffering from high fever (101.6 °F) and diarrhea (passage of more than 5 unformed stools per day) that started a little after her husband’s symptoms started. Her stools contained only trace amounts of blood and mucus. Patient 2 was moderately dehydrated. The attending physician felt that the diagnosis of infectious bacterial colitis is also likely and sent a stool culture from her to the pathology laboratory as well. Patient 2 was given saline (IV) and anti-diarrhea drugs, with broad-spectrum antibiotics and was released from the ER with instructions to follow up with her normal doctor in the next 2-3 days if symptoms get worse.

Patient 2 is also in good health but slightly overweight. The results of her last physical (2.5 months ago) showed normal BP, normal heart and lung activity, normal liver and kidney function, normal blood panels and no significant health problems. She has 1 adult child from a previous marriage who resides in Los Bacterialstan. She frequently traveled (1/year) to visit her family who live in Ecolina, the capital of Los Bacterialstan, but this trip was the first since her wedding about 5 years ago. She has drinks a glass of wine for dinner and sometimes smokes marijuana to relax (~2x/month).

Both patients probably have infectious disease (suspect bacterial) that was acquired during travel to Los Bacterialstan. Patient 1 was very careful to only drink the local water, but also drank fruit juice for breakfast and said he fell into a river when visiting a local native village in the jungle. Patient 2 took no special precautions with food or water, as she felt that growing up in Bacterialstan, she was “used to the local water and food” and never had diarrhea or nausea when visiting or returning from her family in Bacterialstan in the past.

Patient 1’s brother also traveled with the couple but shows no symptoms. He is 31 years old and is currently on active duty in the USMC and has traveled extensively throughout the tropics. This was his first visit to Los Bacterialstan and he went to the same places and participated in the same activities as Patient 1 and 2. He has regular medical check ups and the military keeps him up to date on all shots and vaccines. He states that he only drinks bottled water or beer when he travels, and will not eat anything that isn’t cooked (no raw meats, fish, fruit, or vegetables).

Question:

What reasons could explain why Patient 1 has worse symptoms than his wife? On the other hand what reasons could explain why was his wife was less affected? what is a difference in their lab resualt?

Answer 1

Patient 1 has worse symptoms because of his health history who has underwent liver transplant and is on immunosuppressive drugs.When the infection occurred the patient immune system was so week which has aggressed the symptoms.

Patient 2 had a good immune function so that she has overcome the infectious disease effectively which has led to decrease in sympt

The difference in their lab results are

1. Patient 1 was severely dehydrated and patient 2 as moderately dehydrated
2. Te husband had 7 bowel movement while wife had five bowel movement
3. Patient 1 stool had blood and mucus while it was in traces  for patient 2