Please answers all Questions of this clinical scenario: A 23-year old female wal
ID: 128538 • Letter: P
Question
Please answers all Questions of this clinical scenario:
A 23-year old female walks into a small-town medical clinic complaining of recent malaise, fever and chills, dry cough and myalgia.
Upon examination, she has a temperature of 38.5 C, blood pressure of 100/62 mm Hg, pulse rate of 110 beats per minute, and a respiratory rate of 38/minute. She also reports chest and abdominal pain, but no overseas travel or exposure to birds or rodents.
1. Discuss what you believe are the most likely bacterial/viral diseases and why. (Give your differential diagnosis of 4 diseases that this case study might be based upon.)
The doctor orders a chest X-ray and cultures her throat/nasopharynx. He also does some rapid serological tests. No diagnosis is made at this time, so he sends her home and waits for test results to decide on appropriate treatment. When the results are called to the patient, she tells the nurse she's feeling worse, with higher fever, acute dyspnea, and cyanosis. The chest X-ray shows infiltrates and mediastinal widening. The culture shows large, box-car-like, Gram positive rods with "holes" in the center of them.
2- What are the "holes" in the microbes and how can they be better visualized?
3. Supportive therapy is recommended during her subsequent hospitalization, but not antibiotics.
4- Why are antibiotics ineffective at this time in the disease process?
5- What virulence factors are involved in this disease? Explain in detail what they are and how each one affects the body.
6- What makes this a good weapon for bioterrorism?
Explanation / Answer
1) Gram-positive bacteria are bacteria that give a positive result in the Gram stain test, which is used traditionally as a method to identify and classify the bacteria into two different categories according to their cell wall. These gram positive bacterias take up the crystal violet stain used in the test, and then appear to be purple-coloured when seen through a microscope.
Depending on the presentation of recent malaise, fever and chills, dry cough, chest pain, abdominal pain and myalgia it is suggestive of Anthrax (inhalation) and the condition could be Bacillus anthracis. This condition, resembles a common cold (fever, cough, malaise) which progresses to severe dyspnea, diaphoresis, stridor, cyanosis and shock and also the chest xray shows a mediastinal widening. If the cases are not treated it can lead to severe complications like Hemorrhagic mediastinitis, thoracic lymphadenitis, and/or meningitis.
Gram positive bacilli seen on blood smear and culture as box car like rods with a hole in the center which is a spore. Inhalation of such spores from contaminated animal products can lead to the illness.
Differential diagnosis:
- Clostridium perfringens is a spore-forming gram-positive bacterium that is found in many environmental sources as well as in the intestines of humans and animals.C. perfringens bacteria are the third most common cause of foodborne illness, with poorly prepared meat and poultry, or food which is kept for long standing which harbors the infection.
- Some Bacillus species can cause food poisoning, such as Bacillus cereus and Bacillus licheniformis. Bacillus cereus can result in two different kinds of intoxications. It can either cause nausea, vomiting, and abdominal cramps or diarrhea and malaise.
- Viral Hemorrhagic Fever : Manifestations of VHF often also include flushing of the face and chest, small red or purple spots (petechiae), bleeding, swelling caused by edema, low blood pressure (hypotension), and shock. Malaise, muscle pain, headache, vomiting, and diarrhea occur frequently. The severity of symptoms varies with the type of virus.
- Coxiella burnetii: is a small Gram-negative bacterium that is highly resistant to environmental stresses such as high temperature, osmotic pressure, and ultraviolet light. It also represents symptoms like fever, acute dyspnea, malaise, abdominal pain.
2) The holes in the center are the pores of the bacteria. These pore forms the pore forminf proteins which are toxic in nature to cause illness. These pores help in penetrating the cell wall of the host and starts multiplying and exhibits symptoms.
3) Antibiotics are just part of the treatment but cannot be considered as core. There are many supportive treatments than antibiotics which are;
- Strategies to control fever like Anti-pyretic drugs, nursing care includes tepid sponging, use of loose clothes, proper ventilation or use of coolant
- Change of positions and back care or body care to reduce malaise
- Anti emetics to control nausea
- Following strict standard precautions to control any spread of infections
- Vaccination if applicable to illness
- Fluid management to maintain hydration in the body by administration of Intravenous fluids or some parenteral fluids to manage the nutritional status
- Balanced diet including high protein and high carbohydrate to boost energy levels
- Electrolyte balancing by assessing the electrolytes levels and administration of electrolytes as per the requirements of the body
4) The antibiotic administration can work effectively when administered within the stipulated period of the onset of infection and if the patients arrives late it does not play an effective role in killing organisms and their toxicity. And if proper set of antibiotics are not used then the patient may land up with antibiotic resistance. On the other hand, during infections created by viral overload or viral infection, antibiotic therapies doesnot work because viral infections settles on its own within the period of infection.