Reference no: EM132415254

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.

1. What organism was causing the womans diarrhea?

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

3. Why is this organism particularly problematic as a nosocomial pathogen?

4. Describe the disease spectrum seen with this organism.

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

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