On May 30, a 22-year-old man complained of right hand weakness. On June 1, he co

Question

On May 30, a 22-year-old man complained of right hand weakness. On June 1, he complained of right arm numbness. On June 2, he exhibited several episodes of staring and unresponsiveness lasting 10-15 seconds. He consulted a physician in Mexico, who prescribed an unknown medication. That evening he presented himself to a hospital emergency room in Texas complaining of right hand pain. He had been punctured by a catfish fin earlier in the week, so, based on this information, he was treated with cefriaxone and tetanus toxoid. On June 3, when he returned to the emergency room complaining of spasms, he was hyperventalating and had a white blood cell (WBC) count of 11,100 per mm^3. Although he was discharged after reporting some improvement, he began to have intermittent episodes of rigidity, breath holding, hallucinations, and difficulty in swallowing. Eventually he refused liquids. That evening he was admitted to the intensive-care unit of another hospital in Texas with a preliminary diagnosis of either encephalitis or tetanus. Manifiestations included frequent spasms of the face, mouth and neck; stuttering speech; hyperventilation; and temperature of 37.8 degrees C. The WBC count was 17,100 per mm^3 with a granulocytosis. He was sedated and observed. On the morning of June 4, th epatient was confused, disoriented, and areflexic (without reflexes.) Although his neck was supple, muscle tonus was increased in his upper extremities. Analysis of cerebrospinal fluid indicated slightly elevated protein; slightly elevated glucose and 1 WBC per 0.1 mL. An electroencephalogram showed abnormal activity. Because he had uncontrolled oral secretions, he was intubated. His temperature rose to 41.7 degrees C and he was sweating profusely. The man died on June 5. The patient had worked as a phlebotomist for a blood bank and had donated blood on May 22. His platelets had been transfused before he became ill, but the remainder of his blood products were destroyed. Questions: 1. What was the purpose of the cefriaxone? The tetanus toxoid? 2. What is granulocytosis? 3. What is the most likely cuase of the man's illness and death? 4. What other information do you need to be sure? 5. How could he have been treated? 6. How should the platelet-recipient be treated?

Explanation / Answer

1. Ceftriaxone is a broad spectrum cephalosporin, which is used to prevent many bacterial infections especially during pneumonia, urinary tract infections, etc. The patient is suspected to have been infected by clostredium tetani bacterium, which causes tetanus. As the patient is suffering from increased secretion, this may increase the risk of bacterial infections. To prevent the occurrence of bacterial infections, and also to kill the clostridium tetanus bacteria, the patient is administered with ceftriaxone.

Tetanus toxoid is to prevent the muscle spasm and convulsions and lockjaw (characteristic of tetanus), which is generally observed in tetanus patients.

2. Granulocytosis is the increased proliferation of granulocytes namely eosinophils, basophils and neutrophils in the body.

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