Case Studies: Bacterial Diseases
For each of these try to determine the disease and the underlying pathogenic mechanisms responsible
Clicking the "diagnosis" button will give you the answer to the case and key identifying symptoms
CASE 1
The patient, a 6-year-old boy, came home from school tired and cranky. By suppertime he was hot and flushed and complaining of a sore throat; he refused to eat and vomited once. His mother took him to a clinic, where his temperature was noted to be 39.4° C. The doctor found that the patient had a red throat with grayish-white exudate on both tonsils, and the cervical nodes were enlarged and tender. A throat swab was taken for a rapid enzyme immunoassay test to detect streptococcal group A antigen; it was positive. The doctor prescribed a shot of a long-acting penicillin preparation. Within 2 days, the patient felt fine.
CASE 2
The patient, a 52-year-old man with severe chronic alcoholism, was brought to an emergency room by a policeman who found him lying on a street. Physical examination revealed a lethargic, disheveled man with a temperature of 102° F and a respiratory rate of 36/minute. During respiration, the right side of the chest moved much less than the left side (splinting). On auscultation, there was evidence of consolidation of the upper lobe of the left lung. A sample of bloody sputum was obtained, and a Gram stain revealed many neutrophils and Gram-negative rods.
The patient was treated
with broad-spectrum antibiotics. The sputum culture was reported to have a
heavy culture of the causative organism. The patients hospital course was
stormy, and he required mechanical ventilation for 4 days. Eventually he recovered
and was discharged to a chronic care hospital after 3 weeks.
CASE 3
On April 6, a woman with severe watery diarrhea was admitted to a Dade county hospital on her return from Ecuador. Although stool cultures were negative for Vibrio cholerae, testing of acute and convalescent blood samples detected a 32-fold rise in vibrocidal antibody titers, indicating recent infection Vibrio cholerae O:1.
The patient had traveled
to Ecuador from March 27 through April 6. She reported eating raw oysters
in Salinas Beach, Ecuador on March 29. She also consumed ice during her stay.
On April 2, she developed watery diarrhea with 30 - 40 stools per day. On
return to the U.S. she was admitted to the hospital.
CASE 4
As the aircraft cruised at 35,000 feet, the cabin attendants passed out a lunch meal that included ham sandwiches. Two hours later, two-thirds of the passengers aboard the 747 jet developed nausea and vomiting. Diarrhea occurred in about one-third of those effected. The waiting lines for the facilities trailed down the aisle. As a result of such epidemics, rules for serving the cockpit crew different meals went into effect.
CASE 5
A 22-year-old female school teacher entered the emergency room with a 2-day history of headache and fever. On the day of admission she failed to come to school. When the patient's mother went to her apartment, she found her daughter in bed, confused, and highly agitated. When the patient arrived in the emergency room, she was comatose. Analysis of her spinal fluid demonstrated 380 cells/mm3 (93% polymorphonuclear leukocytes). Gram stain of CSF showed many gram-negative diplococci, and the same organism was isolated from blood. Despite prompt initiation of therapy with penicillin, the patient expired.
CASE 6
On December 19, a man aged 86 years with a history of hypertension and coronary artery disease (CAD) sustained a splinter in his right hand while gardening. On December 22, the patient saw a physician for wound care. At that time, he was not treated with either a vaccine or prophylactic immune globulin (TIG). His vaccination history was not documented in the medical record; he had no history of military service.
On December 26, the patient received treatment for pharyngitis from a local
physician. On December 29, he presented to an emergency department (ED) with
difficulty talking, swallowing, and breathing and with chest pain and disorientation
of 2 days' duration. He was admitted to a general medicine ward with a preliminary
diagnosis of stroke.
On January 2, the patient had neck rigidity and respiratory failure requiring
tracheotomy and mechanical ventilation and was transferred to the intensive
care unit (ICU) with the disease diagnosed. He was administered a dose of
toxoids (Td); TIG was ordered but was unavailable. On January 11, the patient
received nonspecific intravenous immune globulin (pooled plasma, 7.5 grams).
His hospital course was complicated by two myocardial infarctions, congestive
heart failure, a lacunar stroke, and pneumonia. He died on February 2.