Patient Overview

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Nolan came into the ER He is a 3 year old boy His mother brought him
today with complaints of who just came back from to the ER after she saw
bloody diarrhea over the visiting his grandmother blood in his stool and said
last 2 days in England he seemed cranky

Name, Course, Lab Section, Bench

 Signs and Symptoms

SIGNS: FEVER OF 101.5, SYMPTOMS: DESCRIBES PAIN IN

CLUTCHING HIS STOMACH HIS ABDOMEN, HIS MOTHER
SAYS HE HAS HAD FRESH BLOOD
IN HIS STOOL FOR 2 DAYS
 Think about
what you know
What body system is
affected?
It appears that his GI tract is likely
being affected
What normal flora is expected
in this site?
Escherichia coli, lactobacillus,
enterococcus, bifidobacteria, and
much more
If this is an infectious process,
what kind of pathogen is
responsible? (Bacteria, Virus,
fungus, protozoan, helminth,
prion)
Based on the blood in the stool, I
think bacteria are likely the pathogen
responsible for his infection

Name, Course, Lab Section, Bench

 Identify Differential
Diagnosis
Escherichia coli infection
Shigellosis
Salmonella
Campylobacteriosis
—> All share symptom of
bloody diarrhea

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 What questions would a HCP ask while
taking patient history:
How long ago did you return from
England and have you traveled
Patient anywhere else within the last month?
Have you started any new medications
History recently or made any major changes in
your diet?
Has anyone else you’ve been around
experienced similar symptoms (eg.
mom, family in England)?

Name, Course, Lab Section, Bench

 Patient Testing
Decide on tests to order
Even though the presence of fresh blood in Nolan’s stool is enough of an indication
of what potential pathogens may be causing his symptoms, a stool sample can be
taken in a large container
Nolan and his mother should ensure none of the stool touches the toilet
His sample may me rejected if there is too much urine contamination
If it takes more than 24 hours to process the sample, it should be refrigerated;
otherwise, can be kept at room temperature
Using the stool sample, a fecal smear can be performed
To confirm, a stool culture can also be done on MacConkey plates
Narrow your focus:
Presumptive
Diagnosis
The fecal smear showed an increased number of
neutrophils, and the stool culture came back
positive for shigella sonneii, indicating that
Nolan is suffering from Shigellosis caused by
Shigella Sonneii
Name, Course, Lab Section, Bench
 Describe the Treatment and
Prognosis

BECAUSE NOLAN DOESN’T BASED ON NOLAN’S THIS IS A HIGHLY CONTAGIOUS

HAVE ANY SEVERE SYMPTOMS, CONDITION AND AGE, I EXPECT DISEASE, SO NOLAN’S FAMILY
WE WILL GIVE HIM HIM TO MAKE A FULL SHOULD BE NOTIFIED AND HE
SUPPORTIVE CARE AND RECOVERY IN ABOUT A WEEK SHOULD USE A DIFFERENT
INSTRUCT HIS MOTHER TO TOILET THAN THE REST OF HIS
GIVE HIM LOTS OF FLUIDS HOUSEHOLD IF POSSIBLE. HE
SHOULD ALSO STAY AT HOME
WHILE HE HAS SYMPTOMS
AND ENSURE THAT HIM AND
HIS FAMILY USE PROPER HAND
HYGIENE

Name, Course, Lab Section, Bench

 Resolution
Nolan felt much better after 3 days, and his
symptoms were fully gone after 5 days
None of his family contracted Shigellosis

Gabriella Starets, MMG 1650, A04 Bench

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