Case 2 History

 

An 8 year old boy was admitted to the Pediatric Service with edema and high blood pressure. He had been well until 8 days prior to admission when he developed severe abdominal  pain, nausea, vomiting and diarrhea. On the second day the diarrhea became bloody. The diarrhea continued but had lessened in amount, remaining bloody. The mother did not report any fever. On examination he appeared pale and had mild facial edema. Temperature was 37.6'C pulse 104 and regular and the blood pressure was 140/95.  His abdomen was tender. Chest x-ray was clear. Abdominal x-ray disclosed edema of the transverse and descending colon with thumbprinting. Laboratory studies included the following.

 

Hemoglobin                              8.5 gm/dl

Peripheral smear              Schistocytes present

WBC                                       17.5x103/mm3

Platelet count                            42,000/mm3

Creatinine                                 5.4 mg/dl

Lactic dehydrogenase               485 IU/ml

Fecal leukocytes                       Absent

Stool culture                             Sorbitol-negative

                                                Escherichia coli

 

 

Case 2 Questions

 

1. What enteropathogenic type of Escherichia coli is causing this infection?   Answer

 

2. What complication of E. coli enteritis did this patient develop?  Define the complication.  Answer

3. List the virulence characteristics of E. coli that are responsible for this syndrome?  Answer

4. Describe the pathogenic process. In your response address how the infectious microorganism might be responsible for hemorrhage, anemia, and renal failure.   Answer

5. How is the infection acquired? Include in your answer an explanation of how the most common vehicle of transmission is likely to cause large outbreaks.  Answer

 

6. What are the other mechanisms by which E. coli is able to cause diarrhea?  Answer

 

7. Should the child be isolated in the hospital?  Answer

 

8. How does one diagnose the infection?  Answer

 

9. Should antibiotics be used to treat the child? If so, which ones are used?  Answer