The patient was a 32-year-old Haitian male referred to the hospital with a 3-wee

Question

The patient was a 32-year-old Haitian male referred to the hospital with a 3-week history of fever, nausea, vomiting, and diarrhea. Four days after returning from Haiti, where he had seen unembalmed bodies at a funeral, he developed a temper- ature to 39.5°C myalgias, constipation, and rectal pain. He was admitted to an outside hospital overnight and given intravenous (v) oefo taxime. He was discharged on oral cephalexin. His symptoms recurred 2 weeks later, 1 week prior to admission, and his therapy was changed to metronidazole. Five days prior to admission, the patient developed fever, diarrhea with six watery stools per day, nausea, vomiting, and dark urine. On the day of admis- sion, the patient passed out while walking to the bathroom. On admission, he had a temperature of 37.7%C, supine pulse rate of 104 beats/min, and blood pressure of 115/75 mm Hg. The rest of his physical and laboratory findings were unremarkable. On the second hospital day, the patient became acutely agitated, pulled out his iv lines, and tried to leave the hospital. He claimed that a voodoo curse had been placed on him and that he was "already dead." Hepatitis and HIV serologic tests were negative. Blood and stool cultures were diagnostic. A Gram stain and growth on MacConkey and blood agars and a triple sugar iron slant of the organism causing the patients illness are shown in Fig. 1,2 and 3. 1. What was the etiologic agent of this infection? 2. the significance of the patient's travel history in his develop- ing this infection. 3. Why did the patient have a syncopal episode on his way to the bath- room? Would his vital signs on admission explain why he passed out? Is his bizarre behavior consistent with his infection? 4. Organisms were found in both blood and stool. Briefly explain the pathogenesis of the bacteremia. Figure 1 Figure 2

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