Question 29 Match the infection type to the appropriate description Patient is a sex worker which a chronic hepatitis B infection who has recently become infected with hepatitis D virus from needle sharing due to heroin use Patient in ER presents with cough, myalgia, high fever, chillls, headache, malaise; explains that two weeks ago he intercepted a shipment of macaws and cockatiels in a suitcase at Logan Airport where he is a customs agent; serology indicated a bacterial infection HIV-positive patient has show severely depressed CD4 T-cell count for several months despite aggressive HAART treatment; she sees her internist with a complaint of painful white lesions on her tongue and inner cheeks which are diagnosed as thrush (oral candidiasis) Patient is a sexually active 16 year old; she has recently begun having sex with a steady boyfriend and reports douching several times a week to always feel "fresh"; her symptoms include vaginal discharge and a fishy odor; amine whiff test confirm bacterial vaginosis caused by Gardnerella vaginalis Patient is a 14 year old wrestler whose thigh rash has a distinctive red raise border; he is being withheld from competition until his skin condition is deemed non-infectious; his pediatrician confirms a diagnosis of ringworm which will require two weeks of topical Fluconazole as a treatment A. endogenous B. zoonotic C. opportunistic D. superinfection E. superficial
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Adi S.
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.
Consider the information and answer the questions that follow. This data was modified from Pi, X., Li, Z., Jin, L., Zhang, Y., Zhang, L., Wang, L., & Ren, A. (2018). Secondhand smoke during the periconceptional period increases the risk for orofacial clefts in offspring. Paediatric and Perinatal Epidemiology, 32(5), pp. 423-427. doi: 10.1111/ppe.12497 The following scenario was taken from a case-control study examining whether exposure to secondhand smoke during the prenatal period among infants with nonsmoking mothers is associated with an increased risk for orofacial clefts. In northern China, investigators recruited 101 infants with orofacial clefts and 561 healthy infants. Investigators interviewed each infant's mother and asked about her secondhand smoke exposure during pregnancy. 55 mothers of infants with orofacial clefts and 173 mothers with healthy infants reported exposure to secondhand smoke during the prenatal period. What is the null hypothesis for this study? There is no association between prenatal secondhand smoke exposure and orofacial clefts. The odds of prenatal smoke exposure among infants with orofacial clefts is greater than the odds of prenatal smoke exposure among healthy infants. The risk of orofacial clefts among infants with prenatal smoke exposure is greater than the risk of orofacial clefts among infants without prenatal smoke exposure. The odds of orofacial clefts among infants with prenatal smoke exposure is greater than the odds of orofacial clefts among infants without prenatal smoke exposure.
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