Question

A 7 year-old female patient is admitted to a local hospital for a greenstick radius break.  The break is repaired, the patient is sent home and receives a cast a few days later.  The patient arrives back at the hospital 20 days afterwards complaining of pain, swelling under the cast.  Upon removal of the cast, there is notable swelling, pus and a furuncle.

a.       What type of specimen should you collect?

b.      What type of instant test would you perform?

c.       If your clinic ran out of the instant tests, what lower cost method would you use to identify the species.

d.      What would be the typical course of treatment?

e.      Due to some cases of antibiotic resistant infections at the same hospital, the doctors want to use a specimen and test for antibiotic resistance. What test would you perform, and which antibiotics should the doctor avoid prescribing?

A 37 year-old male comes to a free clinic in the middle of a metropolitan city. He said he does not like to use free services, but he has a skin condition that won’t heal. The patient takes off his right shoe and the doctor believes it is necrotizing fasciitis. The patient said he had a bad case of froze bite over the winter, and it just will not heal.  

a.       What type of specimen should you collect?

b.      Why type of precautions should be made immediately?

c.       What is the species of bacteria that most likely caused this condition? What group is it in?

d.      Now that you know the species, how would you discern the strain?

e.      List one rapid test and one more traditional testing method?

Answer 1

Given clinical conditions are :

7 year old female patient with gteenstick radius break, it is repaired and after 20 days complains of pain and swelling under the cast and the swelling contains pus and furuncle.

A. Even if an infection appears , Blood tests may be used to help diagnose the infection by the taking the blood sample . These may include:

WBC (white blood cell count)

ESR (sedimentation rate)

CRP (C-reactive protein)

B. The instant test that we would perform is by drawing the fluid from the swelling by the needle and analyzed to determine bacteria if present. Inexpensive biosensor is a diagnostic tool that provides instant diagnosis of bacterial infection.

C.other low cost test that can be used to identify the species of bacteria is culture of bacteria in laboratory. Gram staining followed by specify bacterial tests.

D. Course of treatment :

First clean the wound and remove as much contamination as possible from the skin, soft tissues, and bone. This procedure is called debridement and irrigation and is typically performed in an operating room. Depending on the severity of the injury, it may require several debridement and irrigation procedures.

Then treating it with antibiotics alone, but it will likely need additional surgery to clean out the infection. During surgery, the doctor will either swab or take samples of the infected tissue to find out what type of bacteria is causing the infection. This stage of treatment may require more than one surgery. Special drains may be placed in the wound to help rid it of pus. Antibiotic delivery systems, like "antibiotic beads," may also be used to provide higher concentrations of antibiotics.

Once the bacteria is identified the effective antibiotic treatment is started.