CASE STUDY PT.3

Sophie, a pregnant woman in her second trimester, finds out her 4-year-old son has chickenpox. Sophie cannot remember if she had chickenpox as a child or if she was vaccinated.

Why is Sophie concerned about her son's chickenpox?

Chickenpox can be severe for pregnant women and may harm the fetus.

Background: Lucy was treating a mild skin rash with a topical steroid, but the rash spread aggressively. 

Symptoms:

• Widespread rash.

• Less defined borders.

• Mild itching.

• Diffuse scaling.

• Irregular patches. 

Why does the rash spread in Tinea Incognita?

• The body's immune response is compromised.

• The steroids boost fungal growth.

• Steroids suppress the local inflammatory response.

• The original fungal infection becomes resistant.

Background: Elena developed a persistent cough and shortness of breath after working on a project clearing wooded areas. Symptoms: The pulmonary form of sporotrichosis is primarily acquired through:

Symptoms:

• Chronic cough.

• Shortness of breath.

• Chest pain.

• Night sweats.

• Weight loss.

The pulmonary form of sporotrichosis is primarily acquired through:

 

Inhalation of fungal spores.

Case Study 4: Luka, a 40-year-old archaeologist

Background: Luka was part of an expedition that discovered and explored ancient burial grounds. He started feeling ill several days after returning to his home city. 

Symptoms:

• High fever and chills.

• Fatigue.

• Rash which later turned to fluid-filled pustules.

• Prostration (extreme physical exhaustion).

• Cough and difficulty breathing.

How long can the variola virus survive outside the human body, particularly in cool environments?

Several years.

A 29-year-old pet store employee presents with a high fever, headache, muscle aches, and a dry cough that has persisted for a week. The patient also reports shortness of breath and has a history of exposure to various birds, including parrots, at work.

What is the most appropriate diagnostic test?

Serology for Chlamydia psittaci

A 35-year-old woman comes to your clinic with a persistent cough that has lasted for over a month. She reports that the cough is severe and comes in bouts, especially at night. She remembers receiving her vaccinations as a child but has had no booster shots in adulthood.

What is the most appropriate diagnostic test to confirm your suspicion of whooping cough?

 

Polymerase Chain Reaction (PCR) test.

Harold, a 75-year-old man with a history of poorly controlled diabetes, presents with a painful, red swollen area on his right lower leg. He mentions that he recently scraped his leg on the edge of a public hot tub. Despite cleaning the wound, it has become more swollen and painful over the past week.

Which is a significant risk factor for Harold's skin infection?

Poorly controlled diabetes

In a rural clinic, 2-year-old Eli, whose parents are hesitant about vaccinations, presents with a 3-day history of fever, croupy cough, and a noticeable foul-smelling nasal discharge. Upon examination, the physician notes a thick, grayish membrane covering his tonsils and uvula.

What is the expected finding on a gram stain of a sample taken from Eli's membrane?

Gram-positive rods

A 34-year-old woman recently adopted a rescue parrot. Two weeks after bringing the parrot home, she develops malaise, fever, and a headache. She also experiences a non-productive cough and mild dyspnea.

What is the most important initial action to take for this patient?

Prescription of a broad-spectrum antibiotic

Trevor, a 31-year-old art historian, notices a painless ulcer on his genitalia. He recalls having unprotected sexual encounters a few weeks prior during a conference trip. Recognizing the potential seriousness of his symptoms, he immediately seeks medical attention. His doctor orders a serological test for syphilis, which comes back positive for Treponema pallidum.

Question: What is the most likely cause of Trevor's genital ulcer?

Recent unprotected sexual encounters

Carlos, studying public health, notes wart-like growths on his genitalia. He knows that these are caused by a DNA virus with an icosahedral capsid and lacks an envelope, which can lead to cancer in persistent infections.

 

Genital warts (HPV)

An experienced cell biologist, 35-year-old Raj, experiences dysuria and a white discharge. He knows the responsible pathogen is an obligate intracellular gram-negative bacterium that can be identified by cytoplasmic inclusions seen in McCoy cells.

Chlamydia

Angela, a 23-year-old aspiring actress, visited her gynecologist for a routine check-up. During the examination, the doctor noticed several small, cauliflower-like growths on Angela's vulva and suspected genital warts. Angela was not aware of them and reported having multiple sexual partners over the past year. The gynecologist performed a biopsy, and the diagnosis confirmed an HPV infection.

Question: What finding during Angela’s examination led to the diagnosis of an HPV infection

Small, cauliflower-like growths

James, a 30-year-old volunteer at a medical mission in a developing country, notes a high incidence of dehydration among children presenting with diarrhea.

He considers a virus that is stable in the environment and known for its segmented, double-stranded RNA genome, often causing seasonal outbreaks.

Rotavirus

Samantha, a 24-year-old hiking enthusiast, developed nausea and diarrhea after a hiking trip where she drank stream water.

She remembers reading about a protozoan with a life cycle that can complete in a single host and is often spread through water contaminated with its hardy oocysts.

Cryptosporidiosis

Kevin, a 19-year-old college freshman, comes down with rapid onset gastrointestinal upset after eating a fast-food chicken sandwich that sat out for several hours. Remembering his microbiology class, he suspects a toxin-mediated reaction caused by a bacterium that can withstand high salt levels.

Staphylococcal food poisoning

Emily, a 22-year-old medical student volunteering at a rural clinic, encounters a 6-year-old patient with abdominal pain, diarrhea, and traces of blood in the stool.

Knowing the area is endemic for soil-transmitted helminths, she considers a parasite that has a whip-like shape and is known for being transmitted through contaminated soil.

Whipworm

Maria, a 27-year-old biologist, develops stomach cramping and a flask-shaped ulcer in her colon after a research trip to the Amazon. \

She had studied protozoan parasites capable of encysting and knows the infection could be due to a protozoan that invades the intestinal lining.

Amebiasis

History: A 40-year-old living in a rural, tick-infested area develops recurring fever, nausea, and vomiting.

Symptoms: High fever, rigors, and severe headache, with symptom-free intervals.

Microbiological Clues: Spirochetes found in blood smear during febrile periods.

Differential Diagnosis:

Relapsing fever (Borrelia spp.)

History: A 42-year-old hiker presents with fever, fatigue, and muscle pains, followed by severe shortness of breath, after hiking in a forested area.

Symptoms: Flu-like symptoms initially, rapidly progressing to severe respiratory distress.

Differential Diagnosis:

Hantavirus pulmonary syndrome

History: A 30-year-old living in a Lyme disease-endemic area develops nonspecific flu-like symptoms and jaundice.

Symptoms: Fever, fatigue, and jaundice; mild splenomegaly on examination.

Differential Diagnosis:

Babesiosis

History: A 45-year-old individual living in a densely populated urban area develops a sudden onset of fever, headache, weakness, and cough with bloody sputum.

Symptoms: Rapidly developing pneumonia, difficulty breathing.

Microbiological Clues: Presence of bipolar-staining, Gram-negative rods in sputum samples, non-motile bacteria.

Differential Diagnosis:

Plague pneumonia

History: A 22-year-old woman, 2 days after a vaginal delivery, complains of severe pelvic pain and fever.

Symptoms: Uterine tenderness, tachycardia, hypotension.

Microbiological Clues: Blood and urine cultures showing Gram-negative rods.

Differential Diagnosis:

Puerperal sepsis

History: A patient presents with a rapidly progressive neurological disorder, starting with memory loss and quickly evolving to include muscle stiffness and difficulty speaking.

Microbiological Characteristics: Caused by abnormal isoforms of the prion protein, leads to rapid neurodegeneration, often fatal within a year of onset.

Diagnosis Options:

Creutzfeldt-jakob disease

History: A 55-year-old patient presents with fever, nausea, diarrhea, and signs of septicemia. They have a history of liver disease and recently consumed raw vegetables from a salad bar.

Microbiological Characteristics: Resistant to low pH, can grow in refrigerated conditions, facultative intracellular organism, flagellar motility

Diagnosis Options:

Listeria monocytogenes

Anna, a 19-year-old college student, shares drinks with her friends often. She recently developed painful sores inside her mouth and on her lips.

Which factor most likely contributed to Anna's condition?

Sharing drinks and possibly contracting HSV-1

Maria, a 26-year-old woman, is pregnant with her first child. She hears about a measles outbreak in her neighborhood and is worried about the risk to her unborn child.

Why is Maria concerned about contracting measles during pregnancy?

Measles in pregnancy can lead to miscarriage, premature birth, or a low-birth-weight baby.

Which footwear choice can exacerbate Tinea Pedis?

a highly contagious, superficial fungal infection of the feet.

Tight, non-breathable shoes.

Best choice: breathability and a wide toe box to keep feet dry and cool

Background: Emma spent a year in a remote village in Cameroon. After returning, she felt occasional muscle pains and noticed episodic swellings on her legs and arms. 

Symptoms:

• Migratory swellings.

• Muscle pains.

• Visual disturbances.

• Enlarged lymph nodes.

• Abdominal pain.

Which diagnostic procedure might confirm Emma's suspicion of loiasis?

Microscopic examination of blood.

A 40-year-old male prisoner complains of progressive fatigue, chest pain, and a productive cough with hemoptysis. He has lost significant weight over the past month and has a known history of untreated latent TB infection.

What is the most urgent action to take for this prisoner?

immediate isolation and airborne precautions