Besides treating bacterial pneumonia with antibiotics, it might also be necessary to: Perform a liver transplant Perform neurosurgery Administer cardioprotective agents Use a ventilator
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Step 1: Bacterial pneumonia is an infection of the lungs that can cause serious complications, including heart problems. Show more…
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Case 2 (Respiratory Tract Infections) The patient was a 64-year-old retired postal worker with a medical history of extensive facial reconstruction for squamous cell carcinoma of the head and neck. He had a 30-year history of smoking. The patient presented with progressive shortness of breath, a persistent, productive cough, purulent sputum, and fever to 39.0°C 2 days prior to admission. On physical examination he had a temperature of 37.3°C, respiratory rate of 18 per minute, pulse rate of 103 beats/min, blood pressure of 154/107 mm Hg, and pO2 of 92 mm Hg. Chest auscultation revealed coarse breath sounds at the left lower base with bibasilar fine crackles. He was found to have a left lower lobe infiltrate on chest radiograph. His admission white blood cell count was 10,600/ul with 70% neutrophils, and his hemoglobin was 9.4 g/dl. Sputum Gram stain at admission revealed >25 polymorphonuclear cells and >25 squamous epithelial cells per low-power field. Because of the high numbers of squamous epithelial cells, the specimen was not processed further. Two blood cultures obtained at admission were positive for the organism seen in Fig. 8.1. The Gram stain from the blood culture bottle is shown in Fig. 8.2. The patient was admitted to the hospital and treated with ceftriaxone intravenously. Upon defervescence, he was discharged on a regimen of oral azithromycin based on the organism's identification and antimicrobial susceptibility results. Of note: this was the patient's third episode of this illness in the past month. Isolates from all three episodes belonged to the same serotype, type 23. Figure 8.1 Figure 8.2 1. What disease process was ongoing in this patient? What clinical prediction rules could be applied to this patient in determining whether he should be hospitalized? Why do you think the decision was made to hospitalize him? 2. What organism was causing this individual's infection? 3. What other patient populations are at risk for infection with this organism? 4. Two different virulence factors produced by the organism infecting this patient are important in disease pathogenesis. What are they, and what role do they have in the pathogenicity of this organism? 5. What strategies are available to prevent infections with this organism? Why are preventive strategies becoming of greater importance with this organism? 6. How do you explain the patients having repeated episodes of infection with the same serotype of this organism? There are at least two and possibly more explanations.
Madhur L.
1. You work in the morgue in Havana as a forensic pathologist. Given Arjun's risk factors, possible exposures, and symptoms, what are the five most likely infectious agents (names, specific species) that killed him? Please explain your reasoning (multiple right answers if you can support why it's likely). (15 points) 2. You analyzed the blood work that the ship's doctor had performed. This helped to narrow down possible causes of Arjun's death. How did you know this? (10 points) * Platelets - 29 x 10^9/L * C3b/C4b - 2.4 g/L and 2.1 g/L respectively * Atypical lymphocytes - 21% * Neutrophils - 10.0 x 10^9/L * Lymphocytes - 5.8 x 10^9/L 3. You took samples from his lesions and lungs and conducted RT qPCR. The results are below. As a confirmation, you used an ELISA to show the tissue was positive for antibodies to gE. Describe these assays and interpret these results. You now know what killed him! (15 points, use the Chapter 28 video lecture to help here) 4. What are the basic properties of this pathogen? (5 pt) 5. What was this pathogen doing in Arjun's body to cause disease? (pathogenesis, virulence factor names, use Chapter 25 and google scholar) (20 points) 6. How did Arjun's innate immune system try to protect him from the infection? (make sure it is both general version from the 26/7 lecture and also via research, specific for this type of attack) (10 points) 7. Please describe the acquired immune reaction that occurred in response to this infection. (make sure it from the 26/7 lecture, as if he had been vaccinated, and also via research, specific for this type of attack, i.e. how it won and killed him) (20 points) 8. If he had been your patient from the first onset of symptoms, what would you have done to prevent his death? How does this treatment work at a molecular level? (5 pt, use internet resources)
Adi S.
Case 49 A 48-year-old man had a long history of alcoholism and was admitted to the intensive care unit with profound hypotension and gastrointestinal bleeding. He was intubated and given intravenous fluids and transfused with packed red blood cells. He remained intubated and ventilator dependent for several weeks. He developed fevers and was treated with broad-spectrum antibiotics. Culture of his tracheal aspirate showed polymorphonuclear leukocytes and gram-negative rods. His chest radiograph was not mentioned.
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