pearljam59
Forum Guru
Topics: 120
Posts: 273
|
A 22-year-old woman comes to the physician because of abdominal cramping and bloody diarrhea for 24 hours. She works as a kindergarten teacher, and several of the children at her school have had a gastrointestinal illness in the past week. She takes no medications. Physical examination shows increased bowel sounds. Which of the following is the most likely causal organism?
A. Bacillus anthracis
B. Bacillus subtilis
C. Clostridium difficile
D. Clostridium perfringens
E. Listeria monocytogenes
F. Salmonella typhi
G. Shigella flexneri
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
G?
___________________
The Key to Succeed is Patience.
|
| yasmeen
Forum Guru
Topics: 67
Posts: 936
|
F? ITS FOOD POISONING
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
F does not cause bloody diarrhea
___________________
The Key to Succeed is Patience.
|
| pearljam59
Forum Guru
Topics: 120
Posts: 273
|
Salmonella ans shigella BOTH can cause bloody diarrhea and they can both be a cause of outbreaks in day care center. The big differenc eis their incubation period. Salmonella is 8-48hrs while Shigella is 1-8 days. But it is difficult to determine the culprit because although she has had the symptoms for 24 hours it "could've" been in her the past week since that is when the kids showed symptoms.
|
| skyhigh
Forum Guru
Topics: 105
Posts: 561
|
Salmonella lasts 3-5 days and can resolve spontaneously, whereas Shigella lasts 4-7 days and it's spread can be reduced via antibiotics. Still hard to decide.
|
| yasmeen
Forum Guru
Topics: 67
Posts: 936
|
|
| pearljam59
Forum Guru
Topics: 120
Posts: 273
|
|
| pawan.dr
Forum Junior
Topics: 5
Posts: 26
|
i think shigella would be a better choice as abdo cramping and bloody diarrhoea are much more common in shigella. salmonella MIGHT cause diarrhoea but constipation is more common, and bloody diarrhoea is certainly points to shigella.
|
| zaidsuror
Forum Elite
Topics: 61
Posts: 238
|
G BLOODY,CRAMPY DIARRHIA
THE GIVE OUT HERE IS THE FACT THAT IT HAS SPREAD AMONG CHILDREN.WE SHOULD ALWAYS THINK SHIGELLA WHEN A PLACE LIKE DAY CARE CENTRE OR KINDERGARDEN IS MENTIONED BECAUSE THE INFECTIOUS DOSE IS AS LITTLE AS 1-10 ORGANSIMS SO IT SPREADS UNCONTROLLED.
___________________
footsteps on the sands of time are not made by sitting around.
|
| webjeee
Forum Guru
Topics: 99
Posts: 349
|
how about listeria?
|
| young_doc
Forum Guru
Topics: 55
Posts: 732
|
zaidsuror wrote:
G BLOODY,CRAMPY DIARRHIA
THE GIVE OUT HERE IS THE FACT THAT IT HAS SPREAD AMONG CHILDREN.WE SHOULD ALWAYS THINK SHIGELLA WHEN A PLACE LIKE DAY CARE CENTRE OR KINDERGARDEN IS MENTIONED BECAUSE THE INFECTIOUS DOSE IS AS LITTLE AS 1-10 ORGANSIMS SO IT SPREADS UNCONTROLLED.
The infectiouse does of Salmonella is also small, so i don't think that's the clue:
http://www.cfsan.fda.gov/~mow/chap1.html
The clue is the daycare setting, and the fact that most Salmonella infections are due to food poisoning, rather than transmitted from person to person. Whereas Shigella is highly infectious and is readily transmitted by the fecal-oral route.
http://www.cfsan.fda.gov/~mow/chap19.html
Also like someone previously said, Salmonella RARELY causes a BLOODY diarrhea, whereas it's common with Shigella.
Shigella
___________________
First Aid is my Bible...
|
| bactitech
Forum Elite
Topics: 25
Posts: 494
|
I have the dubious distinction of having had both Shigella flexneri (in 1982) and Salmonella B (not typhi) in 2005 that I contracted from working on cultures. Believe me, Shigella gives you bloody mucus stools. S. flexneri caused the worst _dysentery_ (calling it mere diarrhea is a joke) that I have ever experienced. I was unable to work for two weeks. I had incredible tenesmus that was only relieved with a hot water bottle. I was unable to eat anything but soda crackers and Ramen noodles. I lost 15 pounds in 2 weeks. My doc at the time did NOT give me antibiotics. I have learned since then that they could have reduced my symptoms and length of illness. I do not go to this guy any more. I carried the S. flexneri in my stool for a few months, as I had to be monitored until my stools cleared for hospital work. I was not allowed patient contact until it was gone.
The Salmonella came on with diarrhea which was not bloody. I was amazed that the smell was like burnt sulfur matches. I believe this is because Salmonella is an H2S producer. I think this is a big clue and will always remember this. It might be a good question to ask the patient, I don't know - I'm just speculating. I felt absolutely lousy and missed two days of work but was not debilitated like I was with S. flexneri. Please realize, however, that the severity of symptoms with Salmonella depend upon the strain. It took me about a week to come back to normal. I did not take antibiotics for this. I had my stool cultured and the substrain matched the one I had worked on. The onset of the Salmonella was somewhat delayed, which is why I didn't suspect it at first. I believe it was over three days, if not four, before I came down with diarrhea. This flies in the face of everything you read about Salmonella onset.
I remember distinctly, however, that with the Shigella, I had worked on the culture I got it from on a Saturday. I awoke around 4 a.m. on the following Monday with severe diarrhea and cramping. By 12 noon I had a 104 degree temperature and severe bloody diarrhea. I was extremely ill. My husband had to come home from work to take care of our daughter, who was 11 months old at the time. I was extremely worried that she would get it, and I knew the minute I saw the bloody diarrhea what I had contracted. Culture confirmed it. I used separate towels, bleached the sink and tub every time I used the bathroom, and kept the door shut as she was crawling by then. She never got it. Neither did my husband.
Please remember that Salmonella can become systemic, whereas Shigella usually does not. Salmonella that is self contained, i.e. not systemic, is not usually treated with antibiotics because this can induce a carrier state. Again, this is not carved in stone but is taken on a case by case basis. I have seen Salmonella in sputum, shoulder fluid, blood and feces over my thirty year career in microbiology. It can be a nasty nasty bug. I've only ever seen Shigella in feces.
Bloody diarrhea can also be caused by E. coli O157:H7, which is the causative agent in the spinach outbreak. I cannot tell you how many times I have seen docs order O&P and/or C. difficile testing on bloody mucus diarrhea stools and NOT order a culture. WHAT are they thinking???? If the patient does not have a travel history or antibiotic history, wouldn't you go with the stool culture first, or at least along with the culture????
ALWAYS take a history when patients present with diarrhea. Travel history and length of diarrhea is very important. If over a month, with camping, well water, out of the country travel, then O&P testing is probably warranted. A Giardia antigen is the best place to start unless they've been out of the US. I've seen stools come in with the diagnosis of diarrhea that are rock hard. Ask the patient to describe their stool. I know it's gross, but many people don't really know what diarrhea is, obviously. Or, they had diarrhea last week and finally get the specimen into the lab 1-2 weeks later, when everything is over with and it doesn't do much good (except to the insurance company or the lab billing office). Make sure they collect the specimen when symptoms are acute. Make SURE they collect with the correct transportation devices for the test ordered. Don't send one rectal swab and expect the lab to do everything from that. Don't send specimens in a diaper.
My sermonette is finished. Hope you enjoyed it :-) :-).
___________________
Clinical Microbiology since 1974
|
| twesting2173
Forum Senior
Topics: 7
Posts: 65
|
oh wow...i hope you get tons and tons of q's re shigella and salmonella on your test..you will get them all right---and you deserve to given the crap (he he) you'e gone through.
|
| bactitech
Forum Elite
Topics: 25
Posts: 494
|
I'm not a med student - I just frequent this board to help you guys out. I'm a medical technologist who's been in the micro biz for nearly 30 years.
Yes, I have gone through a lot of crap during that time (literally and figuratively)....
___________________
Clinical Microbiology since 1974
|
| klimt
Forum Guru
Topics: 27
Posts: 605
|
well then thank you - good job!- and see u around!
___________________
Traveler, there are no roads. Roads are made by walking.
|
| jsknetsdude
Forum Junior
Topics: 4
Posts: 63
|
G. Shigella flexneri
___________________
JSK .. O Lord !! Increase my capacity to Absorb knowledge ..
|
| ManuNastai
Transilvanian..
Topics: 55
Posts: 838
|
hey bactitech thaks a million for your interventions. it's a great aid in identifying a disease if you had it. and your help is apreciated.
now, as a joke, I read your other post here when you said you had some other illness and I was thinking "why the hell doesn't this guy wash his hands or fry his food??"  (just as a joke) now I got it..
thanks for your interventions. 
___________________
"Love is the only inflamation of the heart that drains in the vagina" (translation after Dr Petre Florescu, Professor of Pathology, UMF "Iuliu Hatieganu", Cluj Napoca
|
| bactitech
Forum Elite
Topics: 25
Posts: 494
|
Ah, but I'm not a guy :-)......
I've known a handful of techs who have come down with Shigella over my 30+ years in the lab. We have to work with large concentrations of organism in order to perform serotyping. All you need is one minute splash on your lip and you're in for it.
I've gone over and over in my mind through the years how I ended up with Shigella. Back then we used an enrichment broth for all stool specimens, and we had to subculture these on the first day. I may have splashed some on my hand and didn't know it. We are not required to use gloves at the bench; just when setting up the specimens. I've always tried to be careful not to put my hands near my mouth (you get used to that early on in the game) and we are not allowed to eat or drink in the lab.
That being said, one of the dumber things I did years ago was follow the lead of a coworker who bragged about putting candy in his "clean pocket" of his lab coat. He kept wrapped candy in this pocket and only went into it with his "clean" hand, carefully unwrapped it without touching the candy, and put it in his mouth. I seem to remember trying this about the time I got sick. That may have been my downfall. I never did that again.
When I got Salmonella a year or so ago, I wasn't doing any of that. All I can think of is that I somehow splashed myself when setting up the sensitivity (we have to emulsify some of the bug in a predispensed saline solution so that the automated sensi can be performed off the tube) or I did it while serogrouping it somehow.
So, from someone who knows.....WASH THOSE DIRTY HANDS after you go into any patient's room, change dressings, touch any part of a patients' body, pick up specimens, etc. You will be doing lots of that soon, I guarantee. Docs are the worst at compliance with hand washing and probably spread more Staph. infections than anyone else (see my topic on handwashing....).
___________________
Clinical Microbiology since 1974
|
| imeln313
Forum Junior
Topics: 20
Posts: 45
|
Thanks bactitech,
That was a good explanation.
hyperactivity of intestine, bloody diarrhea, cramps (shigella) vs constipations in salmonella (based on Kaplan LN).
So,
What is it??? Any other ideas?
___________________
Never let yesterday's disappointments overshadow tomorrow's dreams.
|
|
| |
| | | | | | | | | | | | | | | | | | | | |
