Microbiology Case Studies

Professor Patricia Sidelsky Microbiology 11330 Rowan University Summer Session II

Case Study Problems

1 Read t!e case study Underline t!e significant facts " Researc! t!e case by using te#t reference $ Prescott% &arley% and 'lein(and Internet resources t!at are included wit! case studies )dditional medical resources s!ould also be documented 3 *rite out t!e answers in com+lete sentences ,!e answers s!ould eit!er be !and written on notebook +a+er$ lined( or com+leted on a word +rocessor - ,!e answers s!ould reflect scientific and medical accuracy )nswers s!ould be t!oug!tful and reflect com+re!ension of t!e ty+e of bacterial infection . /ames of bacteria s!ould be correctly written 0#am+le 1 in italics wit! 2enus ca+itali3ed and s+ecies in lower case Sta+!ylococcus aureus 4r Sta+!ylococcus aureus 5 2rades will be based u+on t!e criteria stated

Case Study 4ne Con6unctivitis in t!e Classroom

Mrs )llen% a teac!er at C!erokee &ig! Sc!ool% noticed t!at one of t!e girls in t!e front row of !er first +eriod 7iology class seemed to !ave red and teary eyes Initially w!en !e a++roac!ed t!e student% 8ennie% s!e believed !er to be crying and u+set *!en !e 9uestioned 8ennie% s!e found t!at !er eyes were red and a++eared to be very irritated S!e referred !er to t!e nurse U+on closer e#amination% t!e nurse% Mrs :ivingston% found t!e student;s rig!t eye to be blood s!ot ,!e lower lid was swollen and brig!t red ) t!ick disc!arge was found in t!e corner of t!e eye 8ennie com+lained t!at !er eye t!robbed Mrs :ivingston told 8ennie not to touc! !er eye S!e called t!e +arents and suggested t!at 8ennie see a +!ysician immediately for t!e correct diagnosis and treatment 8ennie remained in t!e nurse;s office until !er +arents came to take !er to t!e doctor

Case Study <uestions 1 *!at is t!e most likely diagnosis for t!is condition= *!at is t!e etiology of t!is infection= " *!at sign$s( lead one to sus+ect t!at t!e infection is bacterial in origin= 3 *!at is t!e treatment for t!is condition $ S+ecific antibiotics% +lease( Is t!e condition communicable= Please e#+lain= . *!at are some natural defenses of t!e eyes t!at assist in t!e +revention of
infections=

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'id;s &ealt! >!tt+?@@www kids!ealt! org@+arent@infections@eye@con6unctivitis !tml Mayo Clinic > !tt+?@@www mayoclinic com@!ealt!@+ink>eye@AS00".B )merican Camily P!ysician 1 !tt+?@@www aaf+ org@af+@DB0"1.a+@morrow !tml eMedicine > !tt+?@@www emedicine com@0M0R2@to+ic110 !tm

Case Study ,wo ,!e Case of t!e 2ra3ed 2ardener

) 5" year old botanist and !orticulturist was admiring !er garden of lilies w!en s!e s+otted a weed in t!e midst of !er flowers S!e !ad left !er gloves in t!e !ouse Unfortunately w!en s!e went to remove t!e offensive weed% t!e tiny t!orny base gas!ed !er !and S!e immediately went into t!e !ouse and was!ed t!e wound and added some to+ical antibiotic 6ust in case &owever% wit!in a day s!e noticed a +uffy red swelling around t!e gas! 7y t!e second day s!e became concerned w!en s!e awoke to find t!at w!en s!e tried to get u+ out of bed s!e found walking difficult S!e immediately called !er son w!o came to take !er to t!e 0R of t!e local Eirtua &os+ital immediately 7y t!e time s!e reac!ed t!e !os+ital s!e began to e#+erience difficulty wit! s+eec! and muscle s+asms ,!e doctor ins+ected t!e wound site and noted t!e now severe swelling &e was more concerned by !is +atient;s growing res+iratory distress and acute muscle s+asms ,!e +!ysician contacted t!e woman;s +rimary care give &e found t!at s!e !ad not received a ,etanus booster in more t!an ten years ,roubled by t!is information% !e immediately intubated !is +atient and administered counter measures Case Study <uestions 1 *!at is t!e immuni3ation t!e +atient s!ould !ave received= *!at is t!e recommended +eriod for booster s!ots " ,!e causative agent for t!is disease is FFFFFFFFFFFFFFFFFFFFFFFFFFF 3 *!at are t!e identifying c!aracteristics of t!is organism= - &ow did t!e organisms enter t!e !and of t!e gardener= . *!at causes t!e +aralysis=

5 *!at ot!er organisms belong to t!is 2enus t!at are medically significant= Aescribe at least t!ree

LINKS Med info > !tt+?@@medinfo ufl edu@year"@mmid@bms.300@bugs@clostet !tml eMedicine > !tt+?@@www emedicine com@med@to+ic"".- !tm Aoc'aiser;s Microbiology Page> !tt+?@@student ccbcmd edu@courses@bio1-1@lecguide@unit1@+rostruct@diseases@ctetani@ctet ani !tml CAC 1 ,etanus immuni3ation > !tt+?@@www cdc gov@ncidod@diseases@submenus@subFtetanus !tm CAC> 2eneral Information > !tt+?@@www cdc gov@ncidod@diseases@submenus@subFtetanus !tm CAC> 7otulism > !tt+?@@www cdc gov@ncidod@dbmd@diseaseinfo@botulismFg !tm Mayo Clinic > !tt+?@@www mayoclinic com@!ealt!@gangrene@&<00G3G &ealt! link > !tt+?@@!ealt!link mcw edu@article@D.-DD""D" !tml

Case Study ,!ree Ra+id Stre+

)t C!ildrens &os+ital$ C&4P( t!e 0R and Clinics are always busy ) .>year old w!ite male c!ild in good general !ealt! and +!ysical condition was +resented at t!e Saturday walk>in clinic by !is mot!er &e was broug!t in because !e !ad a fever% was cranky and !ad com+lained of a sore t!roat for about "- !ours 4n +!ysical e#amination by t!e attending resident% t!e +atient !ad a fever of 3D o C &e !ad considerable swelling and drainage of t!e +!aryn# and in t!e con6unctivae &is tonsils were enlarged and coated wit! a w!ite +atc!y e#udate &e !ad a red t!roat and swollen anterior cervical lym+! nodes &is ears were clear &is c!est sounded clear and !e !ad no additional remarkable findings on routine e#amination ) ra+id Stre+ test run )S)P by t!e lab was +ositive 7acteria grown from a t!roat swab taken at t!e time of e#amination indicated gram +ositive 7eta !emolytic bacteria 1 " 3 . *!at would be your +resum+tive diagnosis for t!is c!ild= *!y= *!at diagnostic testing would be indicated to follow t!is e#am= *!at is t!e most likely treatment for t!is illness= *!y is it im+ortant= *!at factors of t!is case allowed you to make a +resum+tive diagnosis= *!at serious conse9uences can result if treatment for t!is infectious agent !ad not occurred in a timely manner=

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Sore t!roat reference > !tt+?@@www c!es!ire>med com@services@bugs@stre+t !tml Stre+tococcus > grou+ ) > !tt+?@@www cdc gov@ncidod@dbmd@diseaseinfo@grou+astre+tococcalFg !tm Stre+tococcus > grou+ 7 !tt+?@@www cdc gov@ncidod@dbmd@diseaseinfo@grou+bstre+Fg !tm

More :inks !tt+?@@www kids!ealt! org@+arent@infections@lung@stre+Ft!roat !tml !tt+?@@www mayoclinic com@!ealt!@stre+>t!roat@AS00"50 !tt+?@@www emedicine!ealt! com@stre+Ft!roat@articleFem !tm !tt+?@@te#tbookofbacteriology net@stre+tococcus !tml !tt+?@@www abbottdiagnostics com@HourF&ealt!@Res+iratoryFInfections@Stre+ cfm !tt+?@@www cdc gov@ncidod@dbmd@diseaseinfo@grou+astre+tococcalFg !tm !tt+?@@www webmd com@a>to>3>guides@Ra+id>stre+>test>for>stre+>t!roat

Case Study Cour Sta+!ylococcus and a Sim+le Scratc!

)n eig!teen year old student in an automotive tec!nology class at t!e local !ig! sc!ool com+lained of a +ain in !is !and &is mot!er was concerned because !e was feveris! and let!argic% &e wanted to stay !ome from sc!ool ,!e young man reluctantly admitted to !is mot!er t!at !e !ad cut !is !and during !is automotive class w!ile working on a car engine &e !ad was!ed !is !and wit! soa+ and water immediately at t!e faucet in t!e classroom &e !ad also covered t!e gas! wit! a band aid )lt!oug! !is teac!er !ad given !im a +ass to t!e sc!ool nurse to a follow u+% t!e student conveniently forgot w!en t!e bell rang and !e !ad to get to !is ne#t class on time *!en 9uestioned by !is mot!er% t!e young man admitted to !aving diarr!ea and vomiting t!e +revious day &is mot!er immediately made an a++ointment wit! t!e doctor ,!e doctor noticed t!at t!e boyIs arm was sensitive to touc! *!en e#amined t!e boyIs !ad !ad an o+en sore wit! +us ,!e area around t!e in6ury was edematous ,!e +!ysician immediately noticed t!at !e also !ad +ur+lis!% red streaks running u+ !is arm from t!e site of t!e in6ury ,!e doctor confirmed !is sus+icions w!en !e also observed enlarged lym+! nodes under t!e arm wit! t!e o+en wound ,!e skin on t!e arm felt very warm and dry

Case Study <uestions

1 *!at errors in t!e initial treatment of t!e studentIs in6ury occurred= *!at would you do to avoid t!is ty+e of infection= &ow could it be avoided= " *!at are t!e likely infectious agents for t!is ty+e of infection=

3 *!at sym+toms are indicative of an infection caused by t!is organism= - *!at are treatments of t!is serious ty+e of infection= *!at tests s!ould be done in t!e clinical laboratory at t!e !os+ital to determine t!e antibiotic to be used= *!at treatment s!ould begin immediately . If untreated w!at additional measures would need to be administered to +revent a widely disseminated infection=

:I/'s
!tt+?@@te#tbookofbacteriology net@sta+! !tml > ,odar 4n :ine Microbiology !tt+?@@www cfsan fda gov@Jmow@c!a+3 !tml > 7ad 7ug 7ook !tt+?@@www kids!ealt! org@+arent@infections@bacterialFviral@sta+!ylococcus !tml > 'idIs &ealt! !tt+?@@www emedicine com@P0A@to+ic"G0- !tm > eMedicine !tt+?@@www cdc gov@/cidod@diseases@submenus@subFsta+!ylococcus !tm > CAC and Sta+!ylococcus !tt+?@@medic med ut! tmc edu@+at!@00001-.5 !tm > Sta+!ylococcus !tt+?@@www cdc gov@ncidod@d!9+@arFmrsa !tml > MRS)$ CAC( !tt+?@@www mayoclinic com@!ealt!@mrsa@AS00G3. > MRS)$ Mayo Clinic( !tt+?@@www nlm ni! gov@medline+lus@ency@article@00G"51 !tm > Med:ine

Peril in t!e Pinelands Case Cive

) young undergraduate student at Rowan University s+eciali3ing in 0cology% c!ecked in at !er college medical care center% re+orting a wide s+ectrum of !ealt! concerns S!e !ad recently com+leted a deer +o+ulation study as a +art of a researc! +ro6ect in t!e Pinelands of Sout! 8ersey ) week after !er field work was com+leted% t!e student began to feel fatigued and listless S!e e#+erienced an inability to concentrate and a general feeling of malaise S!e re+orted ac!es in !er legs w!ic! s!e attributed to walking miles t!roug! t!e +ineland forests ,!e +!ysician noted a circular K ras!K about . inc!es in diameter% wit! a brig!t red edge and a dim red center wit! t!e a++earance of a K bullIs eyeK 4n +!ysical e#am% t!e +atient !ad a fever of 3B . o C and an irregular !eart beat &er w!ite blood count reflected an elevation of w!ite blood cells% greater t!an 1.%000 cells@cm3 ,!e +!ysician ordered a test for :ymeIs Aisease to confirm !is sus+icions

1. *!at is t!e evidence suggests t!at t!e young graduate student !as contracted 2. 3. 4.
.

6. 7. 8.

:ymeIs Aisease= *!at is t!e environmental +at!way for t!is vector borne infection= &ow did t!e student come into contact wit! t!is vector= *!at is t!e basis of t!e blood test t!at confirms t!e +resence of t!is organism= *!at are t!e c!aracteristics of t!is +at!ogen= $Mor+!ology% bioc!emistry% and +at!ogenicity( *!at +recautions s!ould t!e graduate student !ave used to avoid t!is disease= ,!e sym+toms suggest w!at ty+e of antibiotic t!era+y= &ow s!ould t!e treatment be followed to eliminate t!e +ossibility of serious and continuing !ealt! +roblems=

:I/'S !tt+?@@www cdc gov@ncidod@dvbid@lyme@ > CAC :yme Aisease !tt+?@@www nlm ni! gov@medline+lus@lymedisease !tml > Med:ine !tt+?@@www lymenet org@ > :yme Aisease /etwork !tt+?@@www medicinenet com@lymeFdisease@article !tm > Medicine net !tt+?@@te#tbookofbacteriology net@:yme !tml > ,odars ,e#tbook of Microbiology !tt+?@@www wadswort! org@databank@borreli !tm > *adswort! Center

Case Study Si# ,!e ,em+erature ,ells t!e ,ale

7ased U+on Microbiology> Aiseases of t!e Aigestive System > ,ortora

Many of t!e ".00 students and em+loyees of a +ublic sc!ool system develo+ed diarr!eal illness on May "% "00G ,!e cafeteria served c!icken on t!at day 4n May 1% +art of t!e c!icken was +laced in water>filled +ans and cooked in an oven for " !ours at a dial setting of 1GGo C ,!e oven was turned off and t!e c!icken was left overnig!t in t!e warm oven ,!e remainder of t!e c!icken was cooked for " !ours for a steam cooker and t!en left in t!e device overnig!t at t!e lowest +ossible setting% -3oC ,wo seroty+es of a gram> negative% cytoc!rome o#idase negative% lactose>negative rods were isolated from 3" +atients <uestions

1. *!at is t!e +at!ogen= 2. &ow could t!is outbreak !ave been +revented=
3 :ist tests t!at could be done to identify t!is ty+e of +at!ogen in t!e laboratory= - *!at microbiological tests were done to test for t!is organism= *!at is mean by cytoc!rome o#idase negative and lactose negative=

:inks to solve t!is +roblem

!tt+?@@www u!mc sunysb edu@microbiology@2R)ML"0/02),IE0 !tm > 2ram negative enteric +at!ogens !tt+?@@www buddycom com@bacteria@gnr !tml > Clinical bacteria !tt+?@@vm cfsan fda gov@Jmow@c!a+1 !tml > 7ad 7ug 7ook !tt+?@@www cdc gov@ncidod@dbmd@diseaseinfo@salmonellosisFg !tm > CAC reference for Salmonella !tt+?@@www cdc gov@ncidod@dbmd@diseaseinfo@salmentFg !tm > Salmonella reference +age !tt+?@@www salmonella org@ > ,!e latest u+dates on Salmonella !tt+?@@www microbes info@resources@2eneralFMicrobiology@Microorganisms@0ubacteria@Sal monella@ > Salmonella links