A 25-year-old New Mexico rancher was admitted to an El Paso hospital on February

Question

A 25-year-old New Mexico rancher was admitted to an El Paso hospital on February 12th because of a 2-day history of headache, chills and 40 degree C fever. The day before admission he began vomiting; the day of admission, an orange-sized swelling in the left axilla was noted. A lymph-node aspirate and a smear of peripheral blood were reported to contain gram-positive cocci, often in pairs. Under the assumption that a gram-positive organism had caused the patient's illness, he was given cefoxitin. The man was acutely ill. Within a few hours of admission, he had a cardiopulmonary arrest. During resuscitation efforts, he vomited an aspirated his vomitus; a chest X-ray showed bilateral infiltrate. Additionally, the patient bled from several body sites. The patient died within 6 hours of admission. In the 2 weeks before becoming ill, the patient had trapped, killed, and skinned 3 kit foxes, 4 coyotes, and 1 bobcat. The patient had cut his left hand shortly before skinning the bobcat on February 7th. After his death, biochemical testing of a gram-negative rod isolated from blood cultures identified the etiology as Enterobacter agglomerans.

Questions:

1. Identify the following periods: Incubation, prodromal, illness, decline.

2. Identify the etiologic agent of the disease.

3. What microbiologic tests would you perform to verify the etiology?

4. How might have the patient been treated between February 7th and 12th?

5. What special precautions needed to be taken by the hospital and mortuary personnel?

Explanation / Answer

1. Incubation: 7th to 10th

Prodromal: 10th-12th

illness: 11th

Decline: Few hours after the admission

2. The clinical presentations caused by Enterobacter are lower respiratory tract infections include asymptomatic colonization, tracheobronchitis, pneumonia. As with other respiratory pathogens, chronic obstructive pulmonary disease.

3. It is difficult to differentiate Pantoea spp. from other members of this family, such as Enterobacter, Klebsiella, and Serratia species. In the laboratory, growth of Enterobacter isolates is expected to be detectable in 24 hours or less; Enterobacter species grow rapidly on selective (ie, MacConkey) and nonselective (ie, sheep blood) agars.

4. Because the patient had a cut on 7th Feb, he might have been given normal antiseptic cream and antibiotic to prevent any bacterial infection due to the exposure of the cut.

5. Use of gloves for all patient contact as part of universal precautions to reduce the cross contamination.

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