The patient was a 21 -year-old migrant farmworker who was 27 weeks pregnant. She
ID: 79617 • Letter: T
Question
The patient was a 21 -year-old migrant farmworker who was 27 weeks pregnant. She presented with complaints of fever, headache, chills, frequency and urgency of urination, decreased appetite, and a 1-day history of diarrhea and decreased fetal movement. On physical examination, she had a temperature of 38.3 degree C, abdominal tenderness, and tachycardia. Her chest was clear on auscultation, and no cervical discharge or tenderness was seen on pelvic examination. Her laboratory studies were significant for a white blood cell count of 21,300/mu l. A cervical specimen assayed for Cblamydia tracbomatis using the ligase chain reaction was negative. Cervical culture for Neisseria gonorrboeae was not done. Two blood cultures were drawn, and the patient was begun on ampicillin-sulbactam and gentamicin. The next morning the patient complained of right costovertebral tenderness and abdominal pain. On ultrasound, there was no fetal movement, and intrauterine fetal demise was suspected. Labor was induced, and a stillborn infant was delivered vaginally. Cultures of blood, placenta, and umbilical cord all grew the organism seen in Fig. 1 and 2. What organisms do you think arc likely infecting this patient? If you learned mat the organism was catalase positive, how would that help you decide what organism was infecting this patient? What is the significance of headache in this patient's history? What is the natural history of this disease in pregnancy? What other patient populations are at risk for infection with this organism? How is this organism spread? What special characteristic of this organism may be important in its spread? This organism is classified as a facultative intracellular organism. Briefly describe how this organism is able to evade the host's immune system and survive intracellularly?Explanation / Answer
The pathogen might be Listeria monocytogenes. It is catalase positive. It produces acid but not gas in a variety of carbohydrates. Catalase is common enzyme found in all living organisms exposed to oxygen. it's catalyzes the decomposition of hydrogen peroxide to water and oxygen. If the bacteria is catalase positive when small amount of bacterial isolate is added to hydrogen peroxide bubbles of oxygen are observed.
It causes meningitis or encephalitis in the people with weekend immune systems. So headache is common symptom as the immunity is weakened in 3 rd trimester.
Adults 65 years and older and people with weak immune system most commonly develop severel instructions. The diseas primarily effects pregnant women newborns also.
This Bacteria is found widely in the environment in soil including decayinh vegetation and water and also include fecal Flora of large number of mammals. Ingestion of the organisms through unpasteurized milk contaminated vegetables is an important source. The organism may be transmitted from mother to foetus during pregnancy.
It reduces hemolysin which contributes for its virulence. It is non enzymatic cytolytic cholesterol dependent performing toxic protein which is activated by reducing agents and inherited by oxidizing agents. It life is the phagosomes and the bacteria escapes into cytosol where it grows intracellularly and are protected from extracellular immune system factors like complement system and antibodies.
Being facultative intracellular bacteria it in bed host cells which gives them selective advantage as they can survive within Eukaryotic cells and they are protected from the immune responses. It quickly escapes the phagosome Into The cytoplasm before phagosome lysosome fusion.
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