Part I—Trouble in the Nursery “Flesh eating bacteria? You’re kidding, right?” Dr
ID: 213133 • Letter: P
Question
Part I—Trouble in the Nursery
“Flesh eating bacteria? You’re kidding, right?” Dr. Mark Maddison winced as he tried to understand the
alarmed nurse at the other end of the phone. “Slow down and tell me again what’s happening.” Mark
knew that he needed to stay calm and try to buy time to understand the problem. It was the fi rst time
he had been left as the sole physician in charge of the struggling Black Rock Clinic. Dr. Jullie Elridge,
the seasoned senior physician in their partnership, had left for Nepal two weeks earlier on a three-week
expedition to climb Mount Everest.
The nurse, Jill Benoit, continued, “All I know is that I have three really sick babies down here. The
Willis twins started to go bad yesterday. They have a strange rash on their thighs and they’re running a
fever. I thought it was just ordinary diaper rash, but this evening when I was rubbing some ointment on
it, the skin started coming off in sheets! Now the Levi baby looks like she has the same thing under her
arms.”
“You haven’t started using some new lotion or soap on them, have you?” asked Mark, hoping that he
wasn’t going to have to resurrect his knowledge of infectious diseases. “Perhaps you’re using something
that’s too harsh for the skin of neonates.”
“No, no,” Jill answered impatiently. “I’ve been working in neonatal nurseries for 25 years. I think I
know a thing or two about washing babies. Can you reach Dr. Elridge? She knows how to handle these
sorts of things.”
Mark resisted the urge to snap back at her. If he had to call Jullie in Nepal he’d never live it down. “No
need to call her. She left me in charge. I just need to take a look at the little guys. I’ll be right up.”
Mark took the stairs up to the nursery two steps at a time. Turning down the hallway he could see a
small cluster of visitors cooing and waving at a small red-faced infant being displayed through the nursery’s
large plate glass window. Behind them Nurse Benoit was hovering over an isolette. Mark hurriedly
washed his hands and walked over to the isolette to examine the baby.
Jill didn’t look up when he arrived but simply murmured “Dr. Maddison” under her breath as if his name
were something distasteful. The Levi baby was wearing a tiny knit cap and was wrapped tightly in a
hospital blanket. Mark gently unwrapped the blanket and lifted up the baby’s white undershirt to examine
her skin. He could see some small vesicular lesions on the inside of her upper arm. Farther up, in the
axillary area, there was a moist red area about the size of a quarter. The baby girl seemed warm to the
touch, and she began to fuss and wave her fi sts in response to his probing. He replaced the blanket and
walked over to the isolette that held the fi rst of the Willis twins.
“Baby Boy A is worse than his brother,” Jill called from across the nursery. Mark undressed Baby Boy A
and removed his diaper to look at the affected area. The entire area of the tiny baby’s groin appeared to
be involved, demonstrating the same strange skin infection. Maybe Jill was right—perhaps this was the
beginning of necrotizing fasciitis, the famed “fl esh eating bacteria” of tabloid lore. No Marker what it
was, he needed to act quickly to avoid any kind of negative publicity.
Mark looked up in time to see Bill Alkin, the clinic administrator, enter the nursery wearing a grey
pinstripe suit that seemed oddly out of place in the antiseptic and starched white surroundings of the
nursery. “Dr. Maddison,” Bill said curtly. “Nurse Benoit has notifi ed me that we have a potential situation
here in the nursery. It looks as though we need to give Dr. Elridge a call.” Mark shot Jill a withering
glance, but she studiously ignored it. “No, no,” he replied. “I’m sure I can handle this. Besides, Jullie
has probably already started up the mountain. She’s undoubtedly out of contact with everyone, except
perhaps her Sherpa guides.”
“For your sake, I hope you’re right about being able to handle this,” Bill countered. “We can’t afford to
have an epidemic in the news. You know that Whitley Memorial Hospital has been looking for an excuse
to shut us down. I’m sorry, but I can’t risk losing this clinic just so that you can pursue some idea of
being a hero. I’ll give you 24 hours—after that I’m quarantining the nursery and calling in the county
health department. If there is any negative publicity about delaying even a day, I’m holding you personally
responsible.” With that, Bill turned abruptly and headed out of the nursery.
Mark looked down at the mewling infant and soberly rewrapped him in his powder blue blanket. “Well,
Dr. Maddison?” Jill inquired, her voice tinged with sarcasm. “What are your instructions?”
“I’ll have them written out for you as soon as I check on a few details,” Mark responded. He was going
to have to read up on infectious agents that could cause this kind of a skin disorder—and fast. Mark
wished he had been a better student of infectious diseases. He hated to admit it but he had just barely
passed that part of his education. The reference collection in the clinic library was a bit sparse and somewhat
outdated, but at least it was a place to start.
Questions
1. What are the challenges Dr. Maddison is facing?
2. What information does he have so far about the infection?
3. What are some possible causes of skin infections? List at least fi ve different organisms.
4. What should Dr. Maddison’s next move be in determining the cause of the babies’ infection?
Explanation / Answer
1) Challenges Dr. Maddison facing is that It was the first time he had been left as the sole physician in charge of the struggling Black Rock Clinic.
2) Information he have far about the infection is:
The Levi baby wore a tiny knit cap and was wrapped tightly in a hospital blanket. He gently unwrapped the blanket and lifted up the baby’s white undershirt to examine her skin. He could see some small vesicular lesions on the inside of her upper arm. Farther up, in the axillary area, there was a moist red area about the size of a quarter. The baby girl seemed warm to thetouch, and she began to fuss and wave her fists in response to his probing. He replaced the blanket and walked over to the isolette that held the first of the Willis twins.
Baby Boy A is worse than his brother. Mark undressed Baby Boy A and removed his diaper to look at the affected area. The entire area of the tiny baby’s groin appeared to be involved, demonstrating the same strange skin infection. Maybe Jill was right he was thinking—perhaps this was the beginning of necrotizing fasciitis, the famed “flesh eating bacteria” of tabloid lore.
3) Possible cause of skin infections:
a) Bacterial skin infection: occurs when bacteria enter the body through a break in the skin, such as a cut or a scratch. organism- straptococcus.
b)Viral Skin Infection:organism- poxvirus
c) fungal infection: organism-candida yeast
d) parasitic skin infection: Tiny insects or organisms burrowing underneath your skin and laying eggs.
Answer 4) Dr. Maddison's next move be in determining the cause of the babies infection, he will firstly determine how infection spread, in which environment, what types of skin infection it will be before treating the babies.