A 25-year-old New Mexico rancher was admitted to an El Paso Hospital on February

Question

A 25-year-old New Mexico rancher was admitted to an El Paso Hospital on February 12th because of a two-day history of headache, chills, and fever (104°F). The day of admission, a golf-ball-sized swelling in the left axilla was noted. A lymph-node aspirate and a smear of peripheral blood were reported to contain gram-positive cocci, often in pairs. Under the assumption that a gram-positive organism had caused the patient's illness, he was given amoxicillin. The man’s condition worsened. Within a few hours of admission, he had a cardiopulmonary arrest. During resuscitation efforts, he vomited and aspirated his vomit. The patient died the next day. Family members later revealed that in the 2 weeks prior to becoming ill, the patient had trapped, killed, and skinned 3 kit foxes, 4 coyotes, and 1 bobcat. The patient had cut his left hand shortly before skinning the bobcat on February 7th. After his death, blood cultures revealed the presence of gram-negative rod bacteria.

1. What disease do you think this patient had? Explain how you came to this conclusion.

2. What microorganism was responsible for causing this disease?

3. How could a complete patient history have helped to save this patient?

4. What medical tests are required to diagnose this disease?

5. If the correct diagnosis had been determined soon enough, what would be your prescribed treatment regimen?

Explanation / Answer

1. The disease is plague

2. Caused by Yersinia pestis. It is primarily a rodent pathogen with human being an accidental host. Most of the organisms phagocytosed and killed by the polymorphonuclear leukocytes in the human host. A few bacilli are taken by tissue macrophages which are not able to kill it and provide protected environment to synthesise virulence factors. The organisms kill the macrophages and release into extracellular environment where the richest phagocytosis by the polymorphs. It quickly spread to the draining lymph nodes which swell. Within hoursa was the patient develop bacterial pneumonia. It is difficult to control which has hundred percent mortality

People with the plague need immediate treatment if treatment not received within 24 hour when the first symptoms occur death may occur.

Antibiotics such as streptomycin gentamycin doxycycline ciprofloxacin are used. Oxygen intravenous fluids and the respiratory support are also needed.

Diagnosis is made by taking samples from the blood part of a swollen lymph gland. Once the disease has been identified as possible cause of illness appropriate treatment should be started immediately.

Blood smears taken from suspected bubonic plague patients early in the course of illness ar usually negative for bacteria by microscopic examination but may be positive by culture. Specimens from Lymph node aspirate, blood culture, sputum culture, bronchial washing are cultured. Serological testing is possible to confirm the diagnosis.

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