Microbiology Fundamentals 2nd Edition by Jennifer Bunn,Marjorie Kelly Cowan

Exercise 1

C A S E F I L E

"Blood and Guts"
I was working as an LPN in a rural facility when Peter came into the emergency room one evening. My supervising RN and I realized almost immediately that Peter was very ill, and we worked together quickly to obtain Peter's history and vital signs. Peter stated that he had been ill since the morning, when he woke up earlier than normal with diarrhea. He stated that he had been well the night before when he went to bed and had awoken in the morning with severe abdominal cramping. The diarrhea started almost immediately after the cramps began. Peter estimated that he had had approximately 20 bouts of watery, foul-smelling diarrhea throughout the day. He also stated that there was fresh blood present in his stool.
I took Peter's vital signs. He had a fever of 38.4°C (101°F). He was tachycardic with a heart rate of 118 beats per minute. His blood pressure was low at 100/50 mmHg. He was pale and diaphoretic (sweaty) and complained of chills and a headache. He also complained of intermittent severe cramping. His abdomen was tender in all four quadrants on palpation and his bowel sounds were hyperactive on auscultation. His mucous membranes were dry and he complained of thirst. His skin turgor was poor.
My supervising RN called the physician to report Peter's symptoms and vital signs. The doctor stated that he would be coming in right away and to notify the lab. He asked us to start an intravenous on Peter.
We inserted a large-bore IV and started an infusion of normal saline at 250 mL/hour to rehydrate Peter. The physician and lab technician arrived almost simultaneously, and blood was drawn by the lab tech while the physician examined Peter and asked about his symptoms. Peter was asked to provide a stool sample for culture and an ova and parasites test (O P test), which he was able to provide in a short time. The physician asked if Peter's wife and daughter were ill and if they had eaten the same food as Peter had in the last few days.
Peter's blood work came back. His white blood cell count was elevated and his potassium level was low. Peter was admitted to the hospital for rehydration and was started on broad-spectrum intravenous antibiotics for full coverage of potential pathogens while he awaited the stool culture results. The doctor felt that Peter likely had bacterial food poisoning.
Peter's stool cultures came back, revealing that Peter had Shigella, which was sensitive to sulfamethoxazole/trimethoprim and ciprofloxacin. Peter had an allergy to ciprofloxacin, so he was started on sulfamethoxazole/trimethoprim in oral form twice a day and IV fluids were continued. After 5 days in the hospital, Peter had recovered enough to go home. He continued the antibiotic therapy for another week and eventually fully recovered. The source of the infection was never determined.
• How is Shigella transmitted?
• How can Shigella be prevented?