Microbio Skin and Eye Infection Case Studies

Are there steps the teacher should take to prevent the spread of this infection in the classroom? If so, discuss.

Hand washing for her and her students, disinfect the classroom, send a note to parents to notify them of the situation and to monitor their children to hopefully stop spreading, and encourage students not to touch their faces.

Is this a life-threatening condition?

Yes, it is life threatening and quick spreading

Are serious sequelae associated with this infection? If so, what are they?

Yes, the disease has potential to be fatal and can also lead to pneumonia.

Why was amputation the best solution for the infection in this case?

Once this disease begins, it can be fatal if not stopped abruptly. In most cases amputation is the only way to assure all the bacteria is removed and can no longer spread.

A 62-year old diabetic man presents in the emergency room with a swollen left leg with areas of blanching and blue mottling. A "foul odor" is coming from a dressed wound. The physicians remove the dressing and a brownish fluid is seeping from a wounded area. The fluid contains what appear to be small bits of the tissue. No pus appears to be present. The wound has a strong "rotten" odor. Five days earlier, while at his work as a farmer, he caught the leg in his manure spreader, sustaining a deep, crushing, grossly dirty injury. His wife cleaned the wound as well as she could with soap and water, dressed it with clean gauze, and wrapped it tightly with an elastic bandage to stop the bleeding. The second day they redressed the wound and applied triple antibiotic ointment. The patient treated his pain with ibuprofen (Advil). He reported the pain was not very bad for the first 72 hours. In the past 24 hours, the leg swelled and the mottling began to appear. A foul odor and severe pain accompanied the swelling. His wife convinced him to come to the emergency room even though they did not have medical insurance.

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A 24-year old female automotive technician presents herself at the doctor's office. She complains of fever and of pain in her left hand. On physical examination, the patient had a deep wound on her left palm that was oozing pus. She had purplish, red streaks running up her left arm. She had enlarged lymph nodes at the elbow and under her arm. The patient's skin was warm and dry. In her history, the patient had punctured her left palm with sharp metal from the undercarriage of a "real cherry" 1977 Malibu about a week earlier. She said the wound had bled for a few minutes and she thought that she had washed it "real good" with soap and water. She had covered the wound with a large "band-aid" and gone back to work. She developed a fever about three days later. For the past couple of days, she "did not feel so good" and had vomiting and diarrhea.

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In the late winter of 1988, pediatricians in big cities around the country started reporting large increases in the numbers of patients they saw with diffuse red rashes and high fevers (greater than 101 °F). The rash, usually extending downward from the hairline to the rest of the body, began after a two-week incubation period. The spots were often so close together that the entire involved area appeared red. Sometimes the skin in such an area peeled after a few days. The rash lasted five to six days. Many of the children also suffered from diarrhea. The age group most affected was preschoolers. This was a change in epidemiology (the branch of medicine that deals with the study of the causes, distribution, and control of disease in populations) for this infection, as previously the disease most often struck school-age children. A vaccine had been introduced for this disease in 1963, and since then only 5000-6000 cases a year had been reported in the United States. In 1989, 18,193 cases were reported. In 1990 the epidemic (an outbreak of a contagious disease that spreads rapidly and widely; incidence of disease above normal levels) peaked with almost 28,000 cases reported in the United States. Since then the incidence in this country has fallen rapidly and is again in the range of 5000-6000 cases a year.

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A 58-year old lawyer presents in the emergency room with headache, irritability, generalized muscle pain and uncontrollable back spasms. He has become very restless and worried because he has had the back spasms all through his court case that afternoon and they became extremely painful. In his history, the lawyer states that he has a very busy practice. He is on medication for high blood pressure (beta blocker) and has mild asthma. He injured himself about 10 days earlier, puncturing his left arm with a nail from an old barn he is tearing. The wound has produced moderate quantities of pus, but he has been keeping it clean. When asked, he did not remember having a tetanus shot since he was a kid. The wound was sampled for microscopic examination and culture. The back appears to have very tight contractions and spasms. The patient is in obvious agonizing pain.

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A woman brings her 6-month-old son to the pediatrician. You are following the doctor as part of your physician's assistant training. Before you enter the examining room the physician pulls the chart off the door and hands it to you. The nurse has written on the chart that the chief complaint is a group of lesions on the child's back. You enter the room and greet the mother. A toddler girl is leaning over to play with the baby in his carrier on the floor. The baby is giggling and appears healthy. You notice on the chart that the baby was breast-fed from birth through his fourth month. Mom explains that the spots on the baby's back just popped up two days ago and that the baby hasn't had a fever and seems well. She lifts the baby up and you examine the lesions - a group of about seven to eight blisterlike lesions localized to the left of the baby's spine. They have clear fluid in them. The physician says the lesions are diagnostic

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A woman is brought to the emergency department where you are working triage. She has an extremely swollen right lower leg. You see what appears to be an old surgical wound in the mid-calf, with rough scar tissue surrounded by purplish-red skin. She is in a lot of pain and her husband speaks for her. He tells you that three weeks ago she had a group of moles removed from that area. It had appeared to heal initially, but three days ago the incision area started looking bigger rather than smaller. She did not return to the physician, hoping the condition would resolve itself. In the past three days the area has begun to swell and become very hot. You call the attending physician immediately because you know that this is a serious condition. The patient is sent straight to surgery where the wound is debrided. Gram-positive cocci growing in chains are recovered from the wound. She is transferred to intensive care and put on high-dose intravenous antibiotics for the next 18 hours, but the next evening her leg is amputated below the knee. She remains in the hospital for two months following surgery and requires long-term antibiotic therapy and multiple skin grafts on her upper leg.

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You are the school nurse at Willowdale Elementary. This morning Ms. Matthew, one of the first-grade teachers, brings a little girl named Keisha to your office. Her right eye is swollen and bloodshot. The lining of her lower lid is bright red. There is a thick yellow discharge in the corner of the eye.

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Kate, your sister-in-law, is about to undergo fertility treatments. Her doctor insists that she receive the rubella vaccination, and then wait several weeks before beginning the actual fertility regimen. Kate calls you and wants to know why she has to do this. You ask her if she is able to produce evidence of vaccination for rubella (also known as German measles). She says no; her family had a house fire a few years ago and all those records were lost. "But I had German measles when I was in second grade!" she says. "I remember I was really sick and missed almost a month of school." You suggest that she follow her doctor's advice and get the immunization.

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What is the schedule for vaccination for this infection in this United States?

12-15 months booster 4-6 years

When do most children in the United States receive their rubella immunization?

12-15 months booster at 4-6 years

What is the treatment for this condition> Elaborate. Is the condition communicable?

Antibacterial eye drops if the infection was viral there would not be a treatment beyond TLC. Yes, it is extremely communicable.

How should this wound be treated?

Antibiotics, removal of effected tissue which could include amputation of infected limb.

How is the bacterium transmitted?

Can be person to person or transmitted through non-sterile medical equipment.

What is your diagnosis in this case?

Gangrene

What is herd immunity? Discuss it in relation to this outbreak.

Herd immunity is population acquired immunity. In relation to the measles epidemic mentioned above, such a large amount of the population was exposed to and infected by the virus, they acquired her immunity. Once measles is contracted, the body builds an immunity to the virus and the chances of getting it again are low.

What factors probably influenced the fact that the baby did not have symptomatic illness when the baby was 2 months old. Explain the link between the girl's illness and the baby's condition.

It is reasonable to assume the mother has immunity to the virus and was passing antibodies to the baby through breastmilk. This is known as naturally acquired passive immunity.

What are some of the eye's natural defenses that help to prevent infections?

Lysozyme in tears, outer lining of the eyeball.

What was this resurgent infection?

Measles Virus

What condition did this patient have? What features suggest that it is not Clostridium perfringens gangrene?

Necrotizing fasciitis (flesh eating bacteria). They are Gram-positive cocci.

Is this a dangerous condition? Why or why not?

No but can be contagious. TLC should be offered.

What is the most like diagnosis, and what is the etiology (the cause or origin of the disease)?

Pink eye (conjunctivitis). Encountering the bacteria through other people/objects.

Why would a fertility specialist recommend the rubella vaccine? Why does he suggest a waiting period after vaccination and before conceiving?

Rubella can be dangerous if contracted during pregnancy and can cause harm or miscarriage.

Kate suggests that she had rubella in second grade, but the disease she described doesn't sound like rubella to you. Why not?

Rubella does not typically last more than a week. Kate probably had regular measles.

What are the lesions diagnostic of? Explain how you decided.

Shingles. They produce a clear fluid and are typically localized to a single area. usually, no other symptoms are present when one has shingles.

What is your diagnosis here?

Teatanus

Although this particular condition is somewhat unusual in babies, the lesions indicate that the child must have experienced a common childhood illness earlier. Which one?

The Chickenpox

What factors probably influenced the fact that the baby did not have symptomatic illness when his sister was experiencing it? What factors led to the eruption of lesions now?

The baby was two months old when the 3 year old girl had the illness. it specifies the baby was breastfed until four months old. The baby was receiving passive immunity through the breastmilk of the mother, and now that the baby is not breastfed, the immunity may have weakened, causing the baby to contract the virus with symptoms.

What is the proper treatment of this problem?

The best course of treatment would be penicillin, respiratory aide, and muscle relaxants. It is highly likely for tetanus to be fatal once it reaches his stage.

The mother says that, to her knowledge, the baby has not had this common childhood illness, but that his 3 year old sister had it four months ago, when the baby was 2 months old. explain the link between the girl's illness and the baby's condition.

The child may have already had some type of passive immunity to chickenpox or contracted the virus with nonsymptoms.

What sign leads you to believe that the infection is bacterial in origin?

The yellow discharge being produced.

What are some possible reasons for the epidemic in 1989-1991?

There may have been a lack of vaccinated people, or the bacteria may have mutated to become resistant to the vaccine

How could this have been prevented?

Vaccination, proper would cleaning.

Is it likely that the patient's diabetes contributed to the problem as presented?

Yes, diabetes patients do not always have proper blood supply and this can inhibit the body from healing the wound by itself.

What type of infection do you believe she has in this hand? a. Streptococcus pyogenes b. staphylococcus aureus c. clostridium d. pseudomonas e. Pasteurella multocida

b. staphylococcus aureus

From complaint and physical examination, which of the symptoms lead you to your choice of agent? a. the fever and pain in the hand b. the fever, wound with oozing pus and enlarged lymph nodes c. the lymph nodes and red streaks d. the warm dry skin e. the pain, red streaks and enlarged lymph nodes

b. the fever, wound with oozing pus and enlarged lymph nodes.

Which of the following is most likely to follow this infection? a. gangrene and amputation b. toxic shock syndrome c. muscle spasms d. neurological disfunction of the hand e. arthritis

b. toxic shock syndrome

From the history, which of the information confirmed your choice? a. the wound had bled for a while b. the wound was cleaned with soap and water c. the wound had been covered and had perhaps become anaerobic d. she had diarrhea and vomiting e. the cut was from a rusting car frame

d. she had diarrhea and vomiting