malinda
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A 23-year-old man develops explosive watery diarrhea with blood, fecal leukocytes, and mucus approximately 3
days after eating chicken that was improperly cooked. Comma-shaped organisms were found in the fecal smear
along with red blood cells and leukocytes. Which of the following pathogens is the most likely cause of these
symptoms?
A. Campylobacter jejuni
B. Enterotoxigenic E. coli
C. Shigella sonnei
D. Staphylococcus aureus
E. Vibrio cholera
plz comment on two choices=A and E
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| skyhigh
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it's A, Campylobacter jejuni, b/c of diarrhea due to poultry. it multiplies in the small intestine. invades epithelium resulting in inflammation and RBC AND WBC in stools
Vibrio cholera does not cause bloody diarrhea, only watery diarrhea which results from water, and food.
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| roopashri
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Its A.. a g- rod, comma shaped, asso with eating undercooked food or direct contact with infected animals , pts will have bloody diarrhea, fever, pain abd. Fecal leukocytes indicate its an invasive infection
E... is not invasive, it causes secretory diarrhea , pt will ahve painless, watery diarrhea(large qty), no blood
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| bactitech
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Campylobacter jejuni is the most common cause of infectious diarrhea. It is present in about 70% of chickens available in your grocery store and is not influenced by which grocery store you shop in. It is extremely important that you treat raw chicken with care and wash your hands, counter tops, etc. thoroughly when you are done working with it. It must be cooked to at least 140 degrees, preferably higher, to kill the organism.
While V. cholera is very occasionally isolated in the US, it is usually associated with epidemics and salt water. If Vibrio infections are suspected, the lab can set up a differential plate for this group of organisms (TCBS agar). I am in the midwest, so we do not routinely isolate Vibrios. I would imagine that labs in the Gulf Coast area and along the Atlantic and Pacific coast lines use this agar much more often as they see these bugs more routinely.
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| reet
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thanks fr good info bactitech
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| coolmavs
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Guys what are the features we are looking at when we consider the case of shigella sonnei?
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| reet
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shigella--non lactose fermenter..---transmitted by FOOD, FINGERS,FECES,FLIES. causing bloody diarhea
shigella more virulent than samonella. shigella --fecal smear fr leukocyes+ve.
salmonella --non lac fermentr-- MOTILE
CAMPYLOBActr jejuni--- gm - ve comma shaped ,oxidase positive causing bloody diarhea
entaemeba hystolytica-cause bloody diahrea- stool culture--ova,parasites
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| bactitech
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I had Shigella flexneri PERSONALLY back in 1981. Here was my onset:
I had worked on a culture that was positive for S. flexneri (Shigella group B) on a Saturday. Very early Monday morning, about 4 a.m., I was awakened with diarrhea. I went back to bed but started feeling lousy. By 12 noon (8 hours later) my temperature was up to nearly 104 degrees! I knew I was very sick. Shortly after this my stools became nothing but blood and mucus, and this continued for upwards of two weeks. I suspected that I had gotten Shigella and cultured myself. I called my doctor and told him of my suspicions. He didn't put me on Ampicillin because he told me that would also cause diarrhea. I've since found out that it could also have shortened my symptoms (I don't go to him any more). Interestingly, many species are now resistant to Ampicillin so that's not the first choice in treatment.
I had SEVERE tenesmus every time I tried to eat anything. I had to use a hot water bottle in the middle of a sweltering summer heat wave to give myself relief from these gripping cramps. I existed on soda crackers and Ramen noodles for about two weeks (what little I could eat) and lost 15 pounds. I never ever want to go through anything like that again. Other techs I've known have had S. sonnei (group D - most common one), which seems to last about 4 days. Another tech I knew had S. flexneri, and her symptoms lasted around two weeks, like mine. I've never seen the other two groups in culture here in the US.
Please do realize that Shigella, however serious, usually does not cause sepsis, while Salmonella, depending upon the strain, CAN become invasive and very serious. Many Salmonellas are self-limiting - a few days of diarrhea and that's the end of it. However, I have seen Salmonella show up in sputum cultures, blood cultures, and shoulder fluid (besides stools) over the years. I have only ever seen Shigella in stool specimens. The inoculum size for Shigella is very very small - ten rods. It is easily acquired in the laboratory. I personally know at least 4 other techs who've gotten it from working on cultures.
Moral of the story - if you're working with anyone you suspect of having this, WASH YOUR HANDS. Talk seriously about hand and bathroom hygiene with these patients. The positive culture WILL be reported to the State Health Department. My daughter was 11 months old when I got sick. I was deathly afraid she would contract it and end up in the hospital. I kept the bathroom door shut, had my own towels, bleached the tub every time I used it, and bleached the toilet and sink, too. She never got sick. My husband did not, either.
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| bactitech
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For the record, microscopic Campylobacter morphology is referred to as "curved rods" whereas Vibrios are referred to as "comma shaped." There is a slight difference microscopically. Campy must be grown on a special media at 42 degrees C with special atmosphere. Most labs culture for it nowadays, but check with your lab to make sure they are.
Also, E. histolytica is not found in a stool culture; it is detected via an Ova and Parasite examination.
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| coolmavs
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Great work BActitech, especially the part about V.cholera being comma shaped and C.jejuni being G- curved rods. Also the facts about salmonella and shigella infections and even sharing your personal experience.
Edited by coolmavs on 01/29/06 - 08:28 AM
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| bactitech
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You're welcome. Glad I could help you out. If you're learning micro, you may as well learn the correct lingo 
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| Natasa
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Thanks a lot bactitech,that was more than helpful.
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| Ig F
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good work bacitech...u make micro sound really easy......
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