Clinical cases of GIT

infections
Dr. Chitra Pai, MD.
1. A 28-year-old woman presents to the emergency room with a 2-day history of severe
diarrhea and vomiting. Her symptoms started shortly after returning from a church
mission trip to Sudan. After several episodes of diarrhea she felt very weak and
experienced a lot of muscle cramps. On examination, her temperature is 37.2C
(98.9F), pulse is 115 beats per minute, and blood pressure is 100/58 mm Hg.
Her mucous membranes are dry, and her eyes appear sunken. Her skin is dry and
tents when lightly pinched. Her abdomen has hyperactive bowel sounds but is soft
and non-tender. Her stool is watery and tests negative for blood.
A complete blood count shows an elevated white blood cell count and an elevated
hematocrit. A metabolic panel shows hypokalemia and a low serum bicarbonate.
What pathogen most likely caused this infection?

A. Staphylococcus
B. Bacillus cereus
C. EIEC
D. Vibrio cholerae
E. Vibrio parahemolyticus.
F. O157: H7 E.coli
2. In relation with the previous question, which other etiological
agent shares the same mechanism leading to diarrhea?

A. Enteropathogenic E.coli
B. Enterotoxigenic E.coli
C. Yersinia enterocolitica
D. Enterohemorrhagic E.coli
E. Shigella dysenteriae
F. Giardia lamblia
G.Entameba histolytica
3. A 22-year-old man presents with a 3- day history of
severe diarrhea and vomiting. He had just returned
from a trip to Dominica where he had attended a sea-
food festival. He is afebrile, has sunken eyes, dry
tongue and a mildly tender abdomen. His stool
microscopy shows a significant pathogen with active
motility. Which of the following best describes the
underlying mechanism of action of the likely pathogen?

A. Stimulation of the vagus nerve.

B. An increase in cyclic AMP
C. Inhibition of the EF-2
D. Polymerization of actin filaments.
E. Destruction of the intestinal epithelial cells.
4. A 26- year -old man presents to the ER with severe nausea and 4
episodes of vomiting and diarrhea. On questioning he reveals that 3
hours ago he reheated and ate some unrefrigerated rice that his wife
had cooked the night before. Which of the following most likely is
responsible for his symptoms?

A. Enterotoxin of Clostridium perfringens

B. Heat stable enterotoxin of Staphylococcus aureus
C. Heat stable enterotoxin of Bacillus cereus
D. Enterotoxin of Salmonella enteritidis
E. Enterotoxin of Vibrio parahemolyticus
5. A 5 year old child visiting her grandparents in a ranch
in Texas, is brought to the pediatrician with complaints
that she has been feeling weak since the past 36 hrs. In
addition she has been experiencing difficulty in talking,
double vision and dryness of mouth. She ate a can of
beans and drank some apple juice the previous day.
What, most likely, caused this condition?

A. A gram positive, filamentous bacillus.

B. A gram negative curved bacillus.
C. A gram negative, lactose fermenting bacterium.
D. A gram negative, anaerobic, sporulating bacterium.
E. A gram positive anaerobic, sporulating, bacterium.
6. A mother brings her infant to the emergency because
of difficulty in swallowing and choking on his formula
feed. On examination the baby appears generally weak
and is not able to hold his head well enough. On further
questioning, the babys mother says that she had
recently started sweetening the babys food with honey.
Which of the following most likely caused this infection?

A. S. aureus
B. Bacillus cereus
C. E. coli
D. Clostridium botulinum
E. Clostridium perfringens
7.In the previous case, which of the following diagnostic
tests should be ideally carried out?

A. Culturing the bacteria from honey

B. Toxin detection in stool
C. Antibody detection in serum
D. Elisa to detect the toxin in the honey
E. Antigen detection in honey
8. A previously healthy woman became nauseated and
vomits 12 hours after eating home-pickled vegetables in a
tightly closed jar. Within 24 hours, she developed a diffuse
flaccid paralysis and respiratory impairment, necessitating
hospitalization and mechanical ventilation. Other symptoms
included diplopia and dysarthria. Which of the following is a
characteristic of the organism most likely responsible for
this infants symptoms?

A. Production of IgA protease

B. Production of toxin which acts on the vagus
C. Production of lecithinase
D. Production of endotoxin
E. Production of heat resistant spores
9. The Alaska Division of Public Health was informed by a local physician of a village
that 14 people became ill after eating fermented beaver tails and paws on 17 Jan.
Approximately 15 hr. after the meal, 10 of the 14 had symptoms, including dry mouth,
blurry vision, and general weakness. Two patients developed respiratory failure and
required mechanical ventilation while two patients recovered. Clinical specimens from
the 14 infected patients were tested at the Centers for Disease Control and Prevention
(CDC) laboratory. Serum samples and stool samples were positive for a toxin. The
toxin was also detected in the beaver paws. Bacteria cultured from the fermentation
containers grew only under anaerobic conditions. Which of the following best
describes the toxin that was responsible for this outbreak?

A. Toxin that catalyzes hydrolysis of membrane phospholipids

B. Toxin that integrates into cell membranes, leading to pore formation with cell lysis
C. Toxin stimulating macrophages to release pro-inflammatory cytokines
D. Toxin that inhibits the release of the neurotransmitter acetylcholine
E. Toxin that interferes with the 60S ribosome
10. A 50-yr-oldman presented with severe vomiting and loose motions. He
had no fever. His symptoms began three hours after eating lunch
consisting of green salad, cheese pies and cream cake that he had
purchased at the local store. On examination he had a tender abdomen
and vitals were normal. He recovered in a couple of days. Which of the
following measures would have prevented this infection?

A. Heating the food before serving

B. Screening the food handler regularly for the pathogen
C. Adding only certified eggs to the cake
D. Proper washing of vegetables used in the salad
E. Consuming items directly from the refrigerator