A hospitalized patient recovering from surgery develops an infection

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Part A: A hospitalized patient recovering from surgery develops an infection that has blue-green pus and a grapelike odor. What is the probable etiology? How might the patient have acquired this infection?

Part B: A 31-year-old man became feverish 4 days after arriving at a vacation resort in Idaho. During his stay, he ate at two restaurants that were not associated with the resort. At the resort, he drank soft drinks with ice, used the hot tub, and went fishing. The resort is supplied by a well that was dug 3 years ago. He went to the hospital when he developed vomiting and bloody diarrhea. Gram-negative, lactose-negative bacteria were cultured from his stool. The patient recovered after receiving intravenous fluids.

What microorganism most likely caused his symptoms?
How is this disease transmitted?
What is the most likely source of his infection, and how would you verify the source?

 

Sample Solution

Part A: Blue-Green Pus and Grapelike Odor

Probable Etiology:

Based on the description of blue-green pus and a grapelike odor, the most likely pathogen is Pseudomonas aeruginosa. This bacterium is known for producing pigments that can cause a blue-green discoloration in wounds or infections. It also has a characteristic fruity or grapelike odor.

Possible Modes of Acquisition:

The patient could have acquired the infection through:

  • Healthcare-associated infection (HAI): If the patient was hospitalized, they may have acquired the infection from contaminated medical equipment or healthcare workers.
  • Community-acquired infection: The patient could have acquired the infection outside of the hospital, possibly through contact with contaminated surfaces or other individuals.

Part B: Fever, Vomiting, and Bloody Diarrhea

Likely Microorganism:

Given the symptoms of fever, vomiting, and bloody diarrhea, the most likely cause is Escherichia coli (E. coli), particularly a strain that produces Shiga toxin.

Transmission:

  1. coli is typically transmitted through the fecal-oral route, meaning it is spread through contaminated food or water.

Most Likely Source of Infection:

Given the patient’s travel history and symptoms, the most likely source of infection is contaminated water. The well water at the resort may have been contaminated with E. coli.

Verifying the Source:

To verify the source of infection, the following steps could be taken:

  1. Water Testing: Collect samples of water from the resort’s well and have them tested for E. coli and other pathogens.
  2. Food Testing: If the patient can recall specific foods they consumed at the resort, samples of those foods could be tested for contamination.
  3. Epidemiological Investigation: Conduct an epidemiological investigation to identify other individuals who may have been affected by the same outbreak.

By investigating these potential sources, it would be possible to determine the specific cause of the patient’s illness and take steps to prevent further outbreaks.

 

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