The patient was a 21-year old migrant Latina farm worker who was 27 weeks pregna

Question

The patient was a 21-year old migrant Latina farm worker who was 27 weeks pregnant. She presented with complaints of fever, headache, neck stiffness, chills, frequency and urgency on urination, anorexia, and a 1-day history of diarrhea. The patient stated that her symptoms began after she had consumed home-made white queso canasta made from unpasteurized goat’s milk. The patient was worried about her baby because she had not felt the baby move in a few days. A physical examination, the patient had a temperature of 101 oF, abdominal tenderness, and tachycardia. Her chest was clear on auscultation, and no cervical discharge or tenderness was noted on pelvic examination. Her laboratory findings were significant for white blood cell count of 21,300/uL. A cervical specimen assayed for Chlamydia trachomatis using ligase chain reaction was negative. Cervical C and S for Neisseria gonorrhoeae was unremarkable. Blood cultures and CSF cultures were initiated. The patient was started on empirical therapy of ampicillin-sulbactam and gentamcin. The next morning the patient complained of right costovertebral tenderness and abdominal pain. On ultrasound, there was no fetal movement, and intrauterine fetal demise was suspected. Labor was induced, and a still born infant was delivered vaginally. Cultures of blood, CSF, placenta, and umbilical cord grew the organism which was a gram positive rod that was subtly beta hemolytic. 9. What are the likely bacteria infecting the patient? If you learned that the bacterium is catalase positive, how would that help you decide what the bacterium is that would be infecting the patient?
10. What is the significance of headache and stiff neck in this patient’s history? What is the natural history of this disease in pregnancy?
11. What other patient populations are at the risk for infection with this bacterium?
12. How is this organism spread? What special characteristics of this bacterium ay be important in its spread?
The patient was a 21-year old migrant Latina farm worker who was 27 weeks pregnant. She presented with complaints of fever, headache, neck stiffness, chills, frequency and urgency on urination, anorexia, and a 1-day history of diarrhea. The patient stated that her symptoms began after she had consumed home-made white queso canasta made from unpasteurized goat’s milk. The patient was worried about her baby because she had not felt the baby move in a few days. A physical examination, the patient had a temperature of 101 oF, abdominal tenderness, and tachycardia. Her chest was clear on auscultation, and no cervical discharge or tenderness was noted on pelvic examination. Her laboratory findings were significant for white blood cell count of 21,300/uL. A cervical specimen assayed for Chlamydia trachomatis using ligase chain reaction was negative. Cervical C and S for Neisseria gonorrhoeae was unremarkable. Blood cultures and CSF cultures were initiated. The patient was started on empirical therapy of ampicillin-sulbactam and gentamcin. The next morning the patient complained of right costovertebral tenderness and abdominal pain. On ultrasound, there was no fetal movement, and intrauterine fetal demise was suspected. Labor was induced, and a still born infant was delivered vaginally. Cultures of blood, CSF, placenta, and umbilical cord grew the organism which was a gram positive rod that was subtly beta hemolytic. 9. What are the likely bacteria infecting the patient? If you learned that the bacterium is catalase positive, how would that help you decide what the bacterium is that would be infecting the patient?
10. What is the significance of headache and stiff neck in this patient’s history? What is the natural history of this disease in pregnancy?
11. What other patient populations are at the risk for infection with this bacterium?
12. How is this organism spread? What special characteristics of this bacterium ay be important in its spread?
The patient was a 21-year old migrant Latina farm worker who was 27 weeks pregnant. She presented with complaints of fever, headache, neck stiffness, chills, frequency and urgency on urination, anorexia, and a 1-day history of diarrhea. The patient stated that her symptoms began after she had consumed home-made white queso canasta made from unpasteurized goat’s milk. The patient was worried about her baby because she had not felt the baby move in a few days. A physical examination, the patient had a temperature of 101 oF, abdominal tenderness, and tachycardia. Her chest was clear on auscultation, and no cervical discharge or tenderness was noted on pelvic examination. Her laboratory findings were significant for white blood cell count of 21,300/uL. A cervical specimen assayed for Chlamydia trachomatis using ligase chain reaction was negative. Cervical C and S for Neisseria gonorrhoeae was unremarkable. Blood cultures and CSF cultures were initiated. The patient was started on empirical therapy of ampicillin-sulbactam and gentamcin. The next morning the patient complained of right costovertebral tenderness and abdominal pain. On ultrasound, there was no fetal movement, and intrauterine fetal demise was suspected. Labor was induced, and a still born infant was delivered vaginally. Cultures of blood, CSF, placenta, and umbilical cord grew the organism which was a gram positive rod that was subtly beta hemolytic. 9. What are the likely bacteria infecting the patient? If you learned that the bacterium is catalase positive, how would that help you decide what the bacterium is that would be infecting the patient?
10. What is the significance of headache and stiff neck in this patient’s history? What is the natural history of this disease in pregnancy?
11. What other patient populations are at the risk for infection with this bacterium?
12. How is this organism spread? What special characteristics of this bacterium ay be important in its spread?

Explanation / Answer

9. On the basis of the symptoms shown by the patient + the test result information that it is a rod shaped gram positive bacteria and the kind of food she consumed before the infection shows that the most likely bacteria infecting the patient can be- Staphylococci, Streptococci and Listeria.

      If it is learnt that the bacterium is catalase positive that means it can be either Staphylococci or Listeria because Streptococci being anaerobic gives negative result.

      Also it is given that it is beta hemolytic bacteria and infection was caused by raw milk +one day diarrhea history, so there are good chances of being this bacteria- Listeria

10. Headache and stiff neck are one of the symptoms shown by the Listeria infection patient when the infection has reached to the nervous system.

     The pregnant women are on the risk due to the mildly impaired immune system. It usually happens during the third trimester when the immunity is lowest. A single bacterium is sufficient to cause placental infection.

11. Other people who are at risk:

12. Listeria can spread through water, fecal contamination and even through soil through raw vegetables that have been contaminated from it .

It can also spread through contaminated food like animal meat, unpasteurized milk or food made of it.

Features of Listeria helping it in its spread:

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