42

CASE 42


A 67-year-old man presented with fever, abdominal cramping, and frequent diarrhea (six to nine bowel movements per day) for 4 days.


Three weeks before the current episode, he had undergone a hip replacement and was rehabilitating in an orthopedic unit. During that hospitalization, he developed a nosocomial pneumonia and was treated empirically with cefuroxime and clindamycin. He gradually improved and was discharged a week before his current presentation, with maintenance oral antibiotics, to recuperate at home. His wife had no similar symptoms.



PHYSICAL EXAMINATION



VS: T 39°C, P 114 /min, R 18/min, BP 94/50 mmHg

PE: The patient appeared confused and very pale. He could not answer questions about his current condition. His skin showed decreased turgor, and his oral mucosa was dry.


LABORATORY STUDIES



Blood



Hematocrit: 45%

WBC: 12,800/μL

Differential: 71% PMNs, 24% lymphs

Blood gases: Normal

Serum chemistries: BUN 28 mg/dL, creatinine 1.5 mg/dL


Imaging


Sigmoidoscopy revealed erythematous and friable colonic mucosa.



Diagnostic Work-Up


Table 42-1 lists the likely causes of illness (differential diagnosis). A clinical diagnosis of antibiotic-associated diarrhea or colitis was considered based on diarrhea (more than five bowel movements per day), remarkable sigmoidoscopy, and exposure to antibiotics. Detection of toxins in the diarrheal stool is the mainstay of delineation of the etiology.


TABLE 42-1 Differential Diagnosis and Rationale for Inclusion (consideration)






Antibiotic-associated diarrhea or colitis (Clostridium difficile)

Bacterial enteritis (dysentery)
Campylobacter

Salmonellosis

Inflammatory bowel disease (IBD)

Irritable bowel syndrome (IBS)

Viral gastroenteritis

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Aug 25, 2016 | Posted by in MICROBIOLOGY | Comments Off on 42

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