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ART II. Case studies (10 points) -Name the genus and species of each of these. 1....


ART II. Case studies (10 points) -Name the genus and species of each of these. 1. A 15-year-old high school student who had n
11 12 13 15 16 The microbe is: - 3. A 12-year-old girl became ill with chills, headache, and fever (104 F) that lasted three
CP Ulugs Saveu Duve Calibri - 11 - BIVA -- 13 E E - . !11 12 13 14 15 16 The microbe is: A housewife fixed lunch for herself
5. An 18-year-old male high school student was brought by ambulance to the hospital emergency room. The patient was acutely a
3 6PbP---- The microbe is: 7. A 24-year-old female was hospitalized with a three week history of fever, chills, night sweats
UC Cicese. The microbe is: 8. A 24-year-old female was hospitalized with a 10 day history of increasing fever, one or two sev
ART II. Case studies (10 points) -Name the genus and species of each of these. 1. A 15-year-old high school student who had no prior known renal disease developed a sore throat and 103 Ffever. The fever and sore throat lasted for three days. Ten days later, he developed hematuria, puffy eyelids, and swollen ankles. He went to a physician, who noted an inflamed pharynx, enlarged and reddened tonsils, and palpable cervical lymph nodes. The patient had pitting edema of his feet and pretibial areas and a blood pressure of 165/105 mm Hg: the urine contained 4+ protein, 20 to 30 erythrocytes and 20 to 30 leukocytes per high field, some hyaline and granular casts, and one erythrocyte cast. The patient was admitted to the hospital where laboratory investigations included throat culture, serum for antistreptolysin O titer and beta 1C globulin (C3 component of complement system), and renal function evaluation. The patient was given bed rest and 1,200,000 units of procaine penicillin intramuscularly. The throat culture was positive, the antistreptolysin Otiter was 166 units per ml, C3 was 53 mg per 100 ml (normal, 110 to 160 mg per 100 ml), and the serum creatinine was 2.5 mg per 100 ml (normal, less than 1.5 mg per 100 ml). he microbe is: 2. A 25-year-old female was hospitalized because of increasing shortness of breath and development of a cough with blood-tinged sputum. Except for asthmatic attacks precipitated by various environmental allergies, she had always been in good health. One week before hospitalization, this patient had developed what she called "a cold" characterized by a mild sore throat and nonproductive cough. malaise, and a generalized dull headache. Three days prior to hospitalization the patient experienced a 15 minute severe shaking chill. After this episode the cough became worse and more productive of sputum (bloody looking). A physical examination revealed an oral temperature of 104 F, pulse 124 per minute, and blood pressure 112/70. Respirations were 36 per minute; each expiration was accompanied by a "grunt". The chest was hyper-resonant to percussion and filled with inspiratory and expiratory wheezes. Fine crackling rales were heard on inspiration over the lower anterior chest just to the right of the sternum. The patient had a total leukocyte count of 12,500 per cubic millimeter, with 7196 segmented neutrophils, 17% band cells, 1196 lymphocytes and 1% eosinophils. Urine was found to have a pH of 5.5 and gave a 1 + reaction for protein. A freshly collected sputum was gram stained and revealed numerous gram positive cocci and rods. Chest xray revealed a distinct infiltrate involving the right middle lobe. The Quellung reaction was positive. The patient's physician ordered procaine penicillin, 600,000 units via the intramuscular route every 6 hours and intermittent positive pressure breathing treatments to relieve the bronchospasm and allow the patient to rest more comfortably. le microbe is:
11 12 13 15 16 The microbe is: - 3. A 12-year-old girl became ill with chills, headache, and fever (104 F) that lasted three days. After the fever subsided, the girl felt completely well, but twelve days later, she had a febrile episode of two days' duration. Seven days later, she consulted a local physician: physical examination was normal, and no therapy was instituted. The next day her temperature rose briefly to 104 F. She had another episode seven days later and returned to her physician. Loosely coiled spirochetes were noted on a peripheral blood smear taken while she was febrile, and she was placed on tetracycline therapy. The patient and her parents had visited several western National Parks. They had stayed in an old wooden cabin on the North Rim of the Grand Canyon. The girl and her father carried firewood into the cabin but they noticed no ticks and gave no history of tick bites. The microbe is: 4. A housewife fixed lunch for herself and two others. The lunch consisted of home-canned gefilte fish (served cold with horseradish on toast) soft drinks and milk. She ate two portions of gefilte fish, her employee ate one portion and her daughter-in-law ate half a portion. Four hours later, she complained of headache, epigastric distress, hoarseness and slight dyspnea. The epigastric distress continued. She vomited repeatedly and experienced dryness of the mouth, weakness, constipation, and urinary retention. Examination by a physician revealed an anxious woman with labored respiration's (26 per minute): a blood pressure of 80/58 mm Hg, and a pulse rate of 110 beats per minute. The pupils were equal in size but somewhat dilated; they were reactive to light. Extraocular eye movements were normal, and no facial weakness was noted. Her throat and mouth were dry, and her voice was hoarse. The chest was normal to auscultation and to percussion. The abdomen was soft and nontender, with decreased bowel sounds. Deep tendon reflexes were normal. Because of a history of mild hypertension, the findings of tachycardia and hypotension and the history of substernal distress
CP Ulugs Saveu Duve Calibri - 11 - BIVA -- 13 E E - . !11 12 13 14 15 16 The microbe is: A housewife fixed lunch for herself and two others. The lunch consisted of home-canned gefilte fish (served cold with horseradish on toast) soft drinks and milk. She ate two portions of gefilte fish, her employee ate one portion and her daughter-in-law ate half a portion. Four hours later, she complained of headache, epigastric distress, hoarseness and slight dyspnea. The epigastric distress continued. She vomited repeatedly and experienced dryness of the mouth, weakness, constipation, and urinary retention. Examination by a physician revealed an anxious wom minute); a blood pressure of 80/58 mm Hg, and a pulse rate of 110 beats per minute. The pupils were equal in size but somewhat dilated; they were reactive to light. Extraocular eye movements were normal, and no facial weakness was noted. Her throat and mouth were dry, and her voice was hoarse. The chest was normal to auscultation and to percussion. The abdomen was soft and nontender, with decreased bowel sounds. Deep tendon reflexes were normal. Because of a history of mild hypertension, the findings of tachycardia and hypotension and the history of substernal distress suggested the possibility of a myocardial infarction. The patient was hospitalized. Lab findings included normal results for a complete blood cell count and urinalysis. Values of serum electrolytes, bilirubin, amylase, and protein determined on serum from blood drawn the morning after admission were all within normal limits. Chest and abdominal X-ray films were interpreted as normal. An EKG was unchanged from previous tracings. The patient was treated symptomatically with antacids, nasogastric Suction, and intravenous administration of fluids. Three days later the patient had a cardiopulmonary arrest and was resuscitated. Spontaneous respiration did not occur, and breathing was maintained on a mechanical respirator. No apparent benefit resulted from 80,000 units of bivalent (types A & B) and 10,000 units of type E antitoxin, which were administered intravenously. The next day the patient died. Autopsy showed generalized ischemic changes in the central nervous system and moderate arteriosclerosis of the coronary arteries with slight hypertrophy of the left ventricle. The liver and the spleen were enlarged and hyperemic. The lungs showed pulmonary edema with focal acute bronchopneumonia. The other two patients survived the infection. The microbe is:
5. An 18-year-old male high school student was brought by ambulance to the hospital emergency room. The patient was acutely agitated and incoherent. According to the patient's parents, he had complained that morning at breakfast of diffuse muscular aching, malaise, and anorexia. He had vomited his breakfast soon after eating and declined to go to school. Because of a very severe headache that was unresponsive to as afternoon a physician was consulted and examined the patient in his home. During the next several hours, the patient became extremely agitated, began to mutter in an incoherent fashion, and was totally disoriented. There was no history of previous sinus or middle ear disease or surgery. Brief physical examination in the emergency room revealed a temperature of 100.8 F (estimate axillary recording) and a blood pressure of 150/60-mm Hg. The patient was flailing about in a violent manner The neck was stiff. A few 1-3 mm petechial skin lesions were observed over the thighs and in each antecubital fossa. The lungs appeared clear; the heart seemed to be of normal size, and no murmurs were heard. Immediate lumbar puncture was performed, with the patient securely restrained. The cerebrospinal fluid appeared moderately cloudy and contained 15,000 leukocytes per cubic mm, of which 94% were segmented neutrophils. The CSF glucose was less than 5 mg per 100 ml, and simultaneous blood glucose was 194 mg per 100-ml. Direct gram stain on the centrifuged CSF revealed gram-negative diplococci. The microbe is: 6. A 23-year-old school teacher saw her physician because of a persistent sore throat and a low grade fever of approximately three days' duration. When her symptoms first began she had taken an oral tetracycline preparation which a neighbor had given her. Physical examination revealed several discrete white to yellow-gray patches of exudate over both tonsillar areas. Marked point tenderness at the angle of the right jaw coincided with palpably enlarged submandibular cervical lymph nodes. After a throat culture was obtained, the patient was given a prescription for an oral penicillin preparation. She was told that she had gram-positive cocci in chains and she started penicillin therapy. She was urged to take a full 10 day course of penicillin, at the end of which time she should report for a follo up throat culture. The patient followed these instructions to the letter; her follow up throat culture, taken 10 days after starting therapy revealed no gram-positive cocci. The microbe is: 7. A 24-year-old female was hospitalized with a three week history of fever, chills, night sweats and generalized abdominal and low back pain. One week prior to admission, she had had bitemporal -fana tho had hoon avaminad in the
3 6PbP---- The microbe is: 7. A 24-year-old female was hospitalized with a three week history of fever, chills, night sweats and generalized abdominal and low back pain. One week prior to admission, she had had bitemporal headache, dark urine and watery diarrhea. Three days before, she had been examined in the emergency room of the hospital; her hematocrit was 32, and her WBC count was 4900 with atypical lymphocytes. On admission, she had tachycardia and a rectal temperature of 40.9 C, other physical findings included a soft systolic murmur at the cardiac base, mild lower quadrant abdominal tenderness, hepatosplenomegaly, and bilateral costovertebral angle tenderness. Her hematocrit was 28 and hemoglobin was 8.4 g per 100 ml, and she had evidence of disseminated intravascular coagulation without bleeding. Liver function tests and electrolytes were normal; her white blood cell count was 2700. A month later the sister of this patient was admitted to the same hospital and gave a two week history of head cold and fever. The week prior to admission, she had experienced a dry, nonproductive cough, bitemporal headache, nausea, vomiting, and mild generalized arthralgia; she had also occasional night sweats, fever, and chills. On admission, her temperature was 38.6 C orally, and her pulse rate was 120 per minute. Epidemiological investigation revealed that the mother-in-law of the second patient had purchases goat cheese at a market in Juarez, Mexico, and that this cheese had subsequently been eaten by several members of the family. Both sisters gave a history of eating the cheese. The microbe is:
UC Cicese. The microbe is: 8. A 24-year-old female was hospitalized with a 10 day history of increasing fever, one or two severe shaking chills daily, and progressive weakness. A chronic, nonproductive cough, which the patient attributed to moderately heavy smoking, probably had become more prominent during the two or three weeks preceding hospitalization. A diagnosis of primary thrombocytopenia had been established approximately one year previously, based on the presence of splenomegaly. Initial physical findings included a temperature of 102 Forally, a pulse of 110 per minute, cesnication's 24 per minute, and a blood pressure of 110/70 mm Hg. The patient appeared acutely ill, dyspneic, and extremely apprehensive. Conversation was difficult because of intermittent paroxysms of coughing, which produced no sputum. Several nontender lymph nodes, up to 1 cm in diameter, were readily palpable in each axilla. The spleen was enlarged, with a firm, nontender edge descending at least 6 cm below the left costal margin on deep inspiration. Initial lab data include a total leukocyte count of 20,800 per cubic mm, a differential of 42% neutrophils, 25% band forms, and 1996 lymphocytes, and a hematocrit of 42; the platelet count was 2,120,000 per cubic mm. Chest X.ro pulmonary infiltrate extending out from the right hilum into the right lower lobe. One of the two blood cultures obtained at the time of admission to the hospital and before any antimicrobial agents were administered yielded a slow growing gram-negative bacillary rod. It was identified as Pseudomonas aeruginosa. The attending physician elected to initiate antimicrobial therapy with penicillin G administered intravenously, 2.5 million units every six hours. Because of the febrile course, with spiking fever ranging as high as 105,6 F, evidence of an increase in the right lower lobe infiltrate on a subsequent X-ray, and the report of a gram-negative bacilli in one of the two blood cultures, penicillin therapy was discontinued and cephalothin therapy was initiated. A lung biopsy of the right lower lobe was performed and the specimen revealed many focal granulomas consisting largely of histiocytes and epitheloid cells, with some areas of necrosis and caseation. Innumerable acid-fast bacilli were present The microbe is: 9. On chocolate agar, colonies are small raised, glistening, and gray-white. The bacterial cells are gram-negative and spherical, tending to occur in pairs with adjacent sides flattened. In gram stain preparations made from smears of purulent material, the cells tend to be located intracellularly. Biochemical results are oxidase positive, catalase positive, glucose positive, maltose positive, sucrose negative, lactose negative and beta lactamase positive. The microbe is:
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Answer #1

1).GAS ( Group A Streptococcus) :- Pharyngitis strain 1,12..

Species - S. pyogenes

2). Streptococcus pneumonia.... Because Quellung reaction is positive...

3). Lyme disease due to Borrelia burgdorferi..

4). Clostridium botulinum.. Types of antitoxin given suggest the disease..

5). Neisseria meningitides ( meningococcus) :- neck stiffness suggest meningitis and gram staining reveals gram negative diplococci..

6). Group A beta hemolytic streptococcus..

7). Brucella melitensis :- Brucellosis..

Classic lriad: lliough die manifestations vary, die classic triad of fever with profuse night sweats, arthralgia/ arthritis and hepatosplenomegaly .

Undulating fever: Fever has a typical reminent course,
i.e. in between febrile period~ (which last for weeks),
there will be afebrile periods. ll is also called Malta
fever or Mediterranean fever.
• Musculoskelelal symptoms are present in about
one-half of all patients, which may mimic skeletal
tuberculosi~.
Vertebral osteomyelitis involves lumbar and low
dioracic vertebrae commonly.
• Septic ardiritis: Most commonly affected joints are
knee, hip, sacroiliac and shoulder joints.
• Other nonspecific symptoms: lliese include
abdominal pain. headache, diarrhea, rash, weakness/
fatigue, weight loss, vomiting, cough, pharyngitis.

8). Non tuberculous mycobacteria:- nonprodctive cough no sputum,

9). Neisseria meningitides.. Flattened adjacent sides gram negative diplococci. And biochemical result..

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