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Alvernia University *
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Course
107
Subject
Medicine
Date
Feb 20, 2024
Type
docx
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2
Uploaded by nova99
Nouf - Shuruq
Margaret Walters, a 59-year-old female has presented to the ER with a high-grade fever (104.4◦F), generalized myalgia, severe pleuritic chest pain, and bradycardia. The patient reports that the chest pain and myalgia began three days prior to today. The patient also reports intermittent diarrhea and a wet cough that also began three days prior to today. Radiologic assessment reveals that the patient has right and left lower lobe pulmonary consolidation. Consultation of the patient’s medical history indicates that she has been participating in whirlpool hydrotherapy for the past two weeks as part of physical rehabilitation for an L3 lumbar
disc herniation. The patient’s medical record also shows a history of chronic tobacco use. Based upon this clinical assessment, the resident ER physician has recommended initiation of broad-
spectrum antibiotics and requests immediate consultation with an infectious disease specialist.
1.)
What broad diagnosis describes the patient’s pulmonary symptoms? Lung infection
2.)
What bacteria is causing the patient’s symptoms and what is the specific name of the disease it causes? Streptococcus pneumoniae
(pneumoniae).
3.)
The bacteria causing Margaret’s infection has the unique ability of growing and reproducing in the presence or absence of a host cell. a.
What is the classification of an organism that can live in the presence or absence of a host cell? Unicellular b.
Name two other bacteria that are in this classification i.
E. coli
ii.
Streptococcus 4.)
The infectious disease specialist has requested that the bacteria be gram-stained for analysis. What color will this particular bacterium be when viewed under a microscope and what gram designation (+ or -) should it be given? Purple (+)
5.)
The infectious disease specialist requests that a bacterial sample obtained from the patient’s sputum be streaked across a plate of nutrient agar (NA), MacConkey agar, and mannitol salt agar (MSA). After incubation, no growth
is noted on any of the three plates.
a.
What are some reasons as to why the bacteria did not grow on any of the agar media? These media has high concentration of salt which inhibit the growth of Streptococci species b.
What media is predominantly used to grow this bacterium and why? Blood agar 6.)
Upon recommendation from the resident ER, the patient was administered the antibiotic cefixime intravenously. However, no improvement was noted. Cefixime was discontinued and the patient was instead administered the antibiotic cefotaxime. The patient’s status failed to improve following the antibiotic switch.
a.
What are some reasons as to why the infection failed to respond to cefixime and cefotaxime? cefixime is broad antibiotic and streptococci is resistant to it
b.
Name two antibiotics that can effectively treat the patient’s infection Penicillin or amoxicillin
Ceftriaxone
7.)
What is another diagnostic test that could be performed to verify the identity of Margaret’s infection and the bacteria causing it? sputum culture
8.)
Where did Margaret’s infection most likely originate from? Name two additional reservoirs (sources of infection) for this bacterium Other people “large crowed”
Community acquired pneumonia Tabaco use
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