Question

A 70-year old diabetic woman came into the ER with a fever of 104°F, chills, and labored breathing. She produced thick sputum flecked with blood. The woman reported a recent history of a mild cold to the examining physician. A chest X-ray revealed extensive infiltration in the lower lobes of both lungs. The sputum was collected for microscopy and culture on blood agar. The gram-stain revealed gram-positive diplococcic and muccoid colonies with no hemolysis on the blood agar.

7. From the information given how can the causative bacterium be identified?

8. What virulence factor allows this bacterium to be more invasive?

A 20-year old college student who lives on campus was recently back home visiting his parents. His mother, who had attempted to awaken him the next morning, but had found him listless and difficult to rouse, brought him to the emergency room. Upon questioning by the attending physician, the mother reported that he had complained of a headache, stiff neck, and fever the day he arrived home. An examination of the patient revealed purpuric skin lesions on his chest and abdomen, a fever of 103°F, and low blood pressure (hypotension).

13. What would be your presumptive diagnosis for this patient?

14. What is the causative organism?

15.What diagnostic test & result would indicate a positive (confirmatory) diagnosis?

16.What populations are most at risk for contracting this disease

A few days following a severe sore throat, a young child developed a red, papular rash with a sandpaper texture on the chest, which spread across most of her body. Although her cheeks were red, the area around her mouth appeared white. Her tongue developed a white coating, which desquamated (skin peeled off), producing a “strawberry tongue” appearance.

17. What is the name of the disease?

18.  What is the name of the causative bacterium

19. What virulence factor led to the development of this disease?

20. What is the mechanism of action of this virulence factor? (how does it work)

A 4-year-old child was taken to the doctor with high fever, runny nose, watery eyes, and a cough. Upon examination the doctor noted tiny white spots on the inside of the child’s cheek and a raised red rash along the child’s hairline, neck, and trunk. A throat swab tested negative on a rapid strep test and was negative for culturable bacteria. Upon speaking with the mother the doctor found out the child had not received the MMR vaccine.

22. What is the likely diagnosis?

23. Which symptom(s) of the child is characteristic of this disease? What is the proper name of this symptom?

24. How can this disease be treated?

Mary is a healthy 3-year-old child living in Central Texas. She spends 4 days a week at daycare while her parents work. The daycare calls and she has developed a low-grade fever of 101-102. The fever persists for the next 4 days. She also is drowsy and complains that her head and tummy hurt and she does not want to eat. The parents call the doctor and he recommends Tylenol and fluids, keep the fever down and her body hydrated. By the fifth day her parents noticed that Mary has developed a rash on her head and chest that is spreading to her back. The lesions are red and raised and some even contain fluid. Mary’s parents become concerned and bring her to their primary care physician for a diagnosis.

25. Based on the information given, what is your initial diagnosis?

26. Will the organism be cleared from Mary's body

27. What disease is Mary at risk for developing later in life as a result of this infection?

28. What is the best way to prevent this disease

An infant born at 36 weeks' gestation and weighing 4.2 lbs was noted at birth to have congenital heart defects, hyperpigmented skin lesions, cataracts, swelling of the brain, and fluid around the heart. Hearing impairment was suspected after the infant failed a hearing screening test before hospital discharge. The mother, in her late 20s, was from urban Tanzania. She reported having received all of her childhood vaccinations in Tanzania, but rubella-containing vaccine had not been part of the routine vaccination schedule. She had no prenatal care in Tanzania. She reported having a rash around the time of her first missed menstrual period while in Tanzania. After the mother arrived in the United States approximately 46 days later she developed a varicella-like rash. She visited several clinics but no molecular tests were done to confirm the cause of her rash.

33. What is your diagnosis for the child?

34.. What is your diagnosis of the mother?

35. What is the best treatment for this child?

36.What is the best way to prevent this disease in unborn children?

Answer 1

7. Streptococcus pneumococcus

it is identified by gram positive diplodocus, mucous colonies by polysaccarides around it.

8. Virulence factor is

polysacHaridwar capsule prevents from phagocytosis

pneumolysin helps in antibody synthesis.

13. Meningococcal meningitis

14. Neiseria meningococcus

15. Cerebrospinal fluid - low sugar increased WBC’s and culture of csf positive for meningococcal.

16. Neisseria meningococcal infraction is more common in infants less than 1year of age, then adolescence.

17. Scarlet fever

18. Streptococcus Yogendra

19. Pryogenic toxin

20. Pryogenic toxin acts as a superantigens

it induces the inflammation by nonspecific activating T cells and stimulating production of inflammatory cytokines.

22. Measles

23. Spots in the cheeks of baby

name is Koplik spots

24.treatment is measles vaccine within 72hrs of exposure and immunogloblins

25. Erythema infectiosum

26. Yes

27. No infection in adults

28.isolation

33. Congenital rubella syndrome

34. Rubella infection

35. Surgical intervention for cardiac defects

Icu care

36 . Rubella vaccination