Question

72 year old man, complaining of flu like symptoms, but without a fever.He also has a rash on the right side of his body. The rash consists of fluid filled blisters is very painful. Worst pain he has every had.Checking with our medical intern, he asks if during the patient history, if we asked our patient if he had the chicken pox as a child and if he has been vaccinated against shingles.Why would a childhood disease be important now?…. And what does a vaccine have to do with this?please don't answer this question unless you know the complete answers to the case study form below.This case study is for nursing class.

Below is the Case Study Form:

Patient History:

Patient #:_______________________

Age:___________________________

Sex:___________________________

Occupation:______________________

Family History/Preconditions:

Relevant Recent History:

Signs and Symptoms:

Signs:

Symptoms:

Microbiology:

Causative Organism(s):_________________

Modes of Transmission:_________________

____________________________________

Prevention:___________________________

Virulence Factor:

Mechanism of Virulence Factor:

Treatment:

Drug Name:__________________________

Class of Drug:________________________

____________________________________

Type of Admission:____________________

Potential Side Effects of Drug Treatment:

Mechanism of Treatment:

Lab Work:

Type of Sample Received:_______________

____________________________________

Test(s) To Determine Causative Organism:

Positive Results of Test(s):

Answer 1

Patient is suffering from the shingles, which causes the fluid filed red coloured blisters on the body.

• The shingles usually affect those who has suffered from chicken pox in their life, the virus (herpes zoster) is believed to remain in dormant stage for a very long time, virus particles in a single sensory ganglion switch from their latent lysogenic cycles to their active lytic cycles, which causes blisters and pain. So knowing the childhood disease (chickenpox) is important to properly diagnose the causative organism and nature of the disease.
• The vaccines against shingles are very effective in the prevention of the viral disease caused by the herpes zoster virus, if the patient has received the vaccine and still getting the disease it shows that patient might be suffering from some other similar disease or is immunocompromised, and if not then he should be vaccinated against the shingles, especially those who have suffered from chickenpox in the past.

1. Age – 72
2. Sex – male
3. Occupation - ?
4. Family history - ?
5. Sign and symptoms – flu like, no fever, and very painful red colored fluid filled blisters and rash.
6. Causative organism - varicella zoster virus (VZV)
7. Mode of transmission – reactivation of VZV from within the body, probably from previous chicken pox infection.
8. Prevention – vaccination
9. Virulence – chickenpox and shingles
10. Mechanism - single sensory ganglion switching from their latent lysogenic cycles to their active lytic cycles, causes blisters filled with lymph which breaks open.
11. Drug name and class of drug – antivirals (acyclovir, valaciclovir and famciclovir), analgesics for pain and corticosteroids for long term pain (postherpetic neuralgia).
12. Type of admission – oral and topical
13. Mechanism of drug - inhibits and inactivates HSV-specified DNA polymerases which prevents further viral DNA synthesis.
14. Type of sample received – tissue scraping, lymph from blisters, blood, saliva and CSF in some cases
15. Tests to determine causative agent - presence of VZV antibodies in the sample, tell tale blisters with lymph and pain with rashes.