[NP-Clinical] liver enzymes/diarrhea update

[Nicole Joslin]

Hi all,
    I also wanted to update on the young female patient that presented 
with nausea, diarrhea, and elevated liver enzymes. Her stool cultures 
came back positive for salmonella not typhi as well as c. diff! Her 
abdominal ultrasound showed gallbladder sludge. I called the patient and 
she insisted that she had not been on an antibiotic in any shape or form 
in 2 years. As a matter of fact she had not even sought any medical care 
in the past 2 years because she had remained healthy. I even reviewed 
the possibility of any topicals and she had not taken those either. Has 
anyone seen c. diff. in a healthy young person working in an office 
setting, no health issues/co-morbidities, and absolutely no antibiotic use?
    I consulted with a gastroenterologist and he was perplexed about the 
positive c. diff. and felt she must have been on antibiotics at some 
time. He had also reccomended the abd. u/s, which I then did order, as I 
stated above. Her labwork is now all back to normal and rechecked stool 
2 1/2 weeks later. C. diff now negative, but salmonella not typhi still 
present. How long does that remain? That is not supposed to be treated 
with antibiotics if not typhi.  She did take the flagyl course to treat 
the c. diff.
    So could this have been a simultaneous gallbladder sludge/c. 
diff/salmonella case? Which part would have elevated the liver enzymes? 
It couldn't be the gallbladder sludge, because I would have expected an 
elevation to remain at the 2 1/2 week mark instead of returning to 
normal. She is going to see a GI specialist anyways.
    And as far as the salmonella, she was one of 25 people that ate at a 
Canton, CT Margaritaville restaurant that week-end that was on the news 
for salmonella poisoning. 20 people got sick and 5 were actually 
hospitalized. Ick! They were on the news with people scrubbing walls and 
everything.
    Any ideas on the c. diff?

Thanks,
Nicole Joslin, MS, APRN, NP-C