NIU nurs308 Danielle’s Difficulty Case Study latest 2018

Danielle’s
Difficulty: Risks, Treatments, and Prevention of Clostridium difficile

Part I – A Difficult Disease

What an awful holiday season it had been for Danielle, an
11th grader at Ithaca High School. It all started right before Thanksgiving
when she had to have her wisdom teeth removed. Her mouth hurt so much she
couldn’t enjoy most of the Thanksgiving meal. That and the antibiotic she was
taking, clindamycin, gave her a metallic taste in her mouth, and so even the
mashed potatoes she could eat didn’t taste right. On Thanksgiving, her
83-year-old grandmother had fallen and broken her thumb and elbow. She had been
in the hospital for a few days and then in a rehab center for a week. When
Danielle had visited her grandmother in the rehab center, she had seemed to be
in good spirits and was looking forward to getting ready for the Christmas
holiday. Danielle had promised her grandmother she would come and help decorate
her Christmas tree.

Shortly before Christmas, Danielle’s grandmother developed
watery diarrhea. Her doctor told her to take Imodium® A-D, an anti-diarrhea
medicine that works by slowing down intestinal motility. The next day she had
terrible abdominal cramping and Danielle’s father took her grandmother to the
urgent care center. As soon as they took her vital signs and heard her history,
they sent her to the emergency room. From there Danielle’s grandmother was
admitted to the intensive care unit with a diagnosis of kidney failure due to
dehydration induced by diarrhea caused by infection with Clostridium difficile.
Within days, in spite of aggressive antibiotic therapy with metronidazole and
vancomycin as well as heroic medical care, Danielle’s grandmother’s condition
worsened and on December 30th she died of sepsis.

Now it was New Year’s Eve day and Danielle was starting to
experience severe abdominal pain. Danielle was hoping it was just stress and
not that she had “C. diff” like her grandmother.

Questions

1. What are
the risk factors for developing Clostridium difficile disease?

2. Which of
these risk factors did Danielle’s grandmother probably have?

3. What, if
any, risk factors did Danielle have for developing C. difficile disease?

4. What is
the role of spores in the development of C. difficile disease?

5. How do
the toxins of C. difficile contribute to the signs of disease?

NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE

Part II – Relapse

When Danielle mentioned her stomachache to her father, he
immediately took her to the emergency room. There they confirmed Danielle had
C. diff. Danielle was given a three-week course of metronidazole, by the end of
which she was feeling better. Once she went off the drugs, however, her
abdominal pain returned.

Questions

1. Does the
reappearance of Danielle’s symptoms suggest another bout of C. difficile
disease?

2. What
factors could cause a relapse in C. difficile disease?

3. If
Danielle’s symptoms are due to a relapse of C. difficile, what alternative
treatments might you suggest for her?

Image in title block is a micrograph depicting Gram-positive
C. difficile bacteria from a stool sample culture obtained using a .1?m filter.
Photo by Janice Carr, provided courtesy of CDC/ Lois S. Wiggs, public domain,
http://phil.cdc.gov/phil/details.asp.

Case copyright held by the National Center for Case Study
Teaching in Science, University at Buffalo, State University of New York.
Originally published October 17, 2013. Please see our usage guidelines, which
outline our policy concerning permissible reproduction of this work.

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