Case Studies are an integral part of most Microbiology textbooks and courses and are a means of applying some of the information about infectious agents and the disease processes they cause. Case studies may be short with a series of key facts that lead to a logical conclusion or they may be lengthly, data driven scenarios of the disease process over days or weeks.
In this assignment, two cases are presented for review and analysis. Please submit a typewritten Word Document with the Case number heading and question numbers to the left of each answer.
Case 2
The patient is a 14 year old boy living in California with his parents, and active in school activities. He and his classmates had recently taken a field trip to one of the state parks but there was no incident or evidence of animal contact reported. He was well until mid-October, when he complained to his parents of having spasms of lower back pain. His symptoms progressed and he was taken to the emergency room complaining of lower back, buttock, and penile pain. He did not have a fever, but his WBC count was 20,000 and a neurological exam was normal. He was discharged with medication for pain and muscle spasm. He returned to the ER the next day having abdominal pain and priapism. He was admitted to the hospital and found to have high blood pressure, elevated WBC count, low-grade fever, and elevated creatinine phosphokinase; differential diagnosis at this time was appendicitis or pyelonephritis. However, no abnormalities were found with exploratory surgery and these were ruled out.
About the fifth day after the onset of symptoms the patient became agitated and combative, complaining of blurred vision and not able to move his legs. Further testing included two CNS (spinal fluid) samples, CT scan of head, and EEG, all of which were normal. On day six, the patient experienced periods of lowered body temperature, lower rate of respiration, slow heart action, abnormally low blood pressure and increased oral secretions. He was next transferred to another hospital with a discharge diagnosis of metabolic encephalopathy.
After transfer, another CNS sample was taken and was abnormal, corneal reflexes were absent, but MRI and CAT scans of the head were not definitive. The patient died about 18 days after the onset of symptoms. An autopsy was to be performed to determine cause of death. Upon autopsy, cellular inclusions were found in brain tissue.
- What infectious agent killed this young boy?
- Was it bacterial, viral, or fungal?
- What test especially needs to be performed on autopsy?
- Considering the number of health care professionals that were exposed, what course of action should be taken?
Case 3
Joe and Mike have been hunting and fishing buddies for several years. As soon as deer season opened in Connecticut, they loaded their equipment and one dog into the camper truck and headed out to a deer lease for a weekend of hunting. After two days of hiking, tracking, and sitting in the deer blind, they did not bag a deer. About a week after their trip, Mike became ill with a fever, dizziness, and a rash showing a bulls-eye (target) pattern in the skin. Mike decided to see his family physician, who, upon examining Mike, asked him if he had been hunting and commented he could make a probable diagnosis. He also said Mike was lucky.
1. Identify Mike’s illness.
2. Name the Genus and species of the causative agent. Is it viral, bacterial, or fungal?
3. On what basis did the physician make a probable diagnosis? Why was Mike lucky?
4. Name two antibiotics that can treat this illness.
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