https://padlet.com/gmv002/jti66zc6unnei076 A Case of Mistaken Identity en-us 2021-09-16 12:53:47 UTC 2021-12-09 04:07:12 UTC hello@padlet.com gmv002 https://padlet.com/gmv002/jti66zc6unnei076/wish/1745864118 After the agar plate with the woman's stool sample was incubated they found pink, encapsulated colonies. The pink colonies indicate that the organism ferments lactose because the acidic byproducts that are produced by lactose fermentation lower the pH, making it pink. Low pH in the intestines can cause diarrhea. They took part of this sample and put it on a slide in order to make a gram stain and view it under the microscope. When under a microscope they observed that this was a pink bacteria in the shape of bacilli. When a bacteria shows up pink with a gram stain this means that it is gram-negative. This is how they found that the woman had K. oxytoca. K. oxytoca is a pink (gram-negative), bacilli-shaped bacteria. ]]> 2021-09-16 12:58:07 UTC https://padlet.com/gmv002/jti66zc6unnei076/wish/1745864118 gmv002 https://padlet.com/gmv002/jti66zc6unnei076/wish/1745865643 A 39-year-old Amish woman had burns covering 56% of her body, most of those burns being third degree. Before obtaining these burns, she was healthy. She was admitted to the burn unit for treatment. Days after the treatment was started she began to have abdominal pain on her right side and watery diarrhea. The next day her abdominal pain began to heighten and her diarrhea became bloody. She also spiked a fever of 103.6 degrees Fahrenheit. Being febrile is a very common sign of infection. ]]> 2021-09-16 12:58:38 UTC https://padlet.com/gmv002/jti66zc6unnei076/wish/1745865643 gmv002 https://padlet.com/gmv002/jti66zc6unnei076/wish/1745866536 After the woman's diarrhea became bloody and the presence of infection was made clear from a blood test and temperature check they ran a few tests. 
A C. difficile toxin test was run on her stool. There were no signs of C difficile on any of the three samples. They incubated samples of her stool on selective media plates to check for any other bacterial pathogens. None of the plates showed any growth of common bacterial pathogens that cause diarrhea. Abdominal and pelvic CT scans were done. These showed thickening of the colon. Two sets of blood cultures and a superficial culture from the right thigh were done. These showed growth of K. oxytoca. K. oxytoca is a common healthcare-acquired infection and often causes bronchopneumonia, urinary tract infection, sepsis, and commonly leads to shock. It is not common for it to infect the colon. K. oxytoca is a natural bacteria in the intestinal tract, mouth, and nose. When levels of it in the body are above normal it is considered an infection. Antibiotics, like the one this woman was taking, can cause an unbalance in the body's natural bacteria. This is most likely what caused her infection. Her infection also could have been caused by her immune system being weakened by the burns and antibiotics and her burns making many great entryways for the bacteria.  ]]> 2021-09-16 12:58:57 UTC https://padlet.com/gmv002/jti66zc6unnei076/wish/1745866536 gmv002 https://padlet.com/gmv002/jti66zc6unnei076/wish/1745867197 The abdominal and pelvic CT showed that she had colitis. The tricky part was figuring out the cause of her colitis. K. oxytoca is not a common cause of her symptoms, therefore, it took longer for the healthcare team to find that it was the cause. They gave her penicillin for the infection caused by the burdock leaves but K. oxytoca is penicillin-resistant. Since K. oxytoca is penicillin-resistant and it took them longer to find the cause it was able to worsen. Because C. difficile is the most common cause of antibiotic associate colitis and infectious diarrhea, they originally assumed that it was this. ]]> 2021-09-16 12:59:11 UTC https://padlet.com/gmv002/jti66zc6unnei076/wish/1745867197 gmv002 https://padlet.com/gmv002/jti66zc6unnei076/wish/1745867940 When she originally came in the only thing wrong was the burn wounds. They started her with silver sulfadiazine cream. They ended up surgically removing the dead skin off the upper extremities. It was found that the patient needed another procedure but she decided to use burdock leaves and B & W ointment instead. After starting the burdock leave treatment her white blood cell count was 12,300/µL, with 43% bands. A normal level for white blood cells is 4,500-11,000/µL and a normal band percentage is less than 10%. White blood cells are the cells that fight infection in the body so when the number of these is above normal it is almost always an indication of infection. Band cells are immature neutrophils and a high percentage of these is also a very strong indicator for infection. ]]> 2021-09-16 12:59:24 UTC https://padlet.com/gmv002/jti66zc6unnei076/wish/1745867940 gmv002 https://padlet.com/gmv002/jti66zc6unnei076/wish/1745868545 When they found that the cause of her colitis was a penicillin resistant bacteria they stopped piperacillin/tazobactam therapy. They began to treat her with meropenem and levofloxacin. Following the days after they started a new treatment her diarrhea and abdominal pain stopped. Her white blood cell count also returned to normal. New stool cultures were done and no growth of K oxytoca was found. ]]> 2021-09-16 12:59:37 UTC https://padlet.com/gmv002/jti66zc6unnei076/wish/1745868545 gmv002 https://padlet.com/gmv002/jti66zc6unnei076/wish/1749696476 I am looking forward to learning more about the bacteria and viruses that cause infection. I think it is cool that this class interacts with our other class pathophysiology. I love learning about infection and disease causes. (I am not going to edit this as the class is over.)]]> 2021-09-17 22:26:08 UTC https://padlet.com/gmv002/jti66zc6unnei076/wish/1749696476 gmv002 https://padlet.com/gmv002/jti66zc6unnei076/wish/1749701708 https://www.patientcareonline.com/view/bloody-diarrhea-caused-infection-klebsiella-oxytoca-burn-patient
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192185/
https://www.frontiersin.org/articles/10.3389/fimmu.2021.586195/full
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657522/#:~:text=Infectious%20Causes%20Associated%20With%20Antibiotics,that%20also%20disrupt%20the%20microbiota.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657522/
https://www.webmd.com/digestive-disorders/what-is-hypochlorhydria
https://microbewiki.kenyon.edu/index.php/Klebsiella_oxytoca
https://www.pathologyoutlines.com/topic/microbiologyklebsiellaoxytoca.html
https://www.practicalpainmanagement.com/patient/conditions/gastrointestinal-pain/inflammatory-bowel-disease-overview]]> 2021-09-17 22:33:05 UTC https://padlet.com/gmv002/jti66zc6unnei076/wish/1749701708