4. Based on clinical presentation, you suspect your patient has contracted syphilis. You take the appropriate cultures and examine them using dark field microscopy. If you are correct, type of pathogenic bacteria should you be able to find in your patients specimen?
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A 20-year-old male student is brought by his girlfriend to the emergency department of a local hospital. Upon physical examination, the patient is found obtunded, has a temperature of 39°C, a blood pressure of 104/52 mmHg, and a heart rate of 148 bpm. He has a stiff neck and generalized petechial rash with two areas of purpura. CSF is collected. The opening pressure is 180 mmH2O. WBCs 4300/mm3 with 91% neutrophils, glucose is 10 mg/dL, and protein is 755 mg/dL. A gram stain and culture of CSF is performed, with Gram stain indicating Gram-negative cocci. Which organism is most likely responsible for this illness? Explain your answer and list the characteristics given above that drive you to your diagnosis. Which part of the microorganism is responsible for the clinical manifestations of this disease? Be very specific. Which group of bacteria possesses this structure?
Penny R.
A pregnant 18-year-old woman came to the Ford County urgent-care clinic with a low-grade fever, malaise, and headache. She was sent home with a diagnosis of influenza. She again sought treatment 7 days later with a macular rash on her trunk, arms, hands, and feet. Further questioning of the patient when serology results were known revealed that one month previously, she had a painless ulcer on her vagina that healed spontaneously. The same day, patient #2 sought medical treatment for a penile ulcer. In a routine examination, patient #3, a pregnant female, had positive serologic tests for this disease but was asymptomatic. Patient #4 was tested because of her sexual contact with patient #2. She had no symptoms and a positive serologic test. Patient #5, a contact of patients #3 and #6, was also serologically positive. He frequently traveled to a neighboring county, which reported a 290% increase in this disease over the preceding year. Patient #6, a female, had a rash and also tested positive. Patients 1 and 2 were in drug-abuse rehabilitation; these two were the only two who reported use of crack cocaine. Discussion Questions What is syphilis? What is its causative agent and how is it transmitted (spread) to its host(s)? What are the host(s) for the causative agent of syphilis? What virulence factors are associated with the microbe that cause this disease? What serologic tests are used to diagnose syphilis infections? In the above case study, what are the stages of the disease observed in Patients 1 and 2? What medical interventions (i.e. treatments) can be applied in this case for the above patients? What are the consequences of not treating this infection?
Adi S.
The patient is a 23-year-old male who works as a baker's assistant. He presented to the local emergency room with low-grade fever, malaise, and headache. He was sent home with a diagnosis of influenza. He presented 7 days later with a 1-day history of worsened headache, photophobia, and stiff neck. On physical examination he appeared to be in mild distress with a temperature of 102.2 oF. He had mild nuchal rigidity and a maculopapular rash on his trunk, arms, palms, and soles. Areas on his palms and soles had some papulosquamous lesions. There were no mucous membrane lesions. No focal deficits were seen on neurologic examination. He had a white blood cell count of 11,200/mm3 with an increased number of PMN. A computed tomogram (CT scan) of the head was normal, and a lumbar puncture revealed 120 white blood cells/mm3 with 80% lymphocytes and 20% PMN, a glucose level of 40 mg/dl (normal), and a protein level of 82 mg/dl (elevated). Blood cultures were obtained, and antimicrobial therapy was begun. The next day a serologic test of his CSF and blood revealed the diagnosis. Further questioning of the patient when the serology results were known revealed that 1 month previously, he had a painless ulcer on his penis which healed spontaneously. His condition improved greatly over the next 3 days and his rash cleared within 10 days. 1. Which bacterial infections can cause a maculopapular rash? What is the most likely agent of his infection?2. In what stage of this infection is this patient? What is the significance of his CSF findings? Describe the disease course as it occurs in infected patients who go untreated.3. How can the diagnosis of this infection be made? What is the difference between the screening test for the organism infecting this patient and the confirmatory test? How are these two tests used?4. If this patient had been found to have a T-helper cell count of <200 and was HIV seropositive, what adjustment to his antimicrobial therapy would be necessary to treat the infection causing his skin rash?
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