Discussion
A patient of acute lymphocytic leukemia with fever and neutropenia develops diarrhea after administration of amoxicillin therapy, which of the following organism is most likely to be the causative agent?
Answer: B
Correct answer: Clostridium difficile
Diarrhoea beginning after antibiotic therapy, in a hospitalised and immunosuppressed patient, is C. difficile until proved otherwise. The antibiotic suppresses the normal colonic flora, allowing the organism to overgrow and produce toxins A and B. Neutropenia and prior hospital exposure add to the risk. Salmonella and Shigella are community-acquired food and water-borne infections with no such antibiotic association, and C. perfringens causes a brief food poisoning unrelated to antibiotics.
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