B. The patient was a 44- year old male with a past medical history significant h
ID: 99004 • Letter: B
Question
B. The patient was a 44- year old male with a past medical history significant hypertension, non-insulin-dependent diabetes, hypercholesterolemia, and a history of heavy smoking (two packs per day for 20 years). He presented to the emergency room with complaints of chest pain and was found to have suffered a myocardial infarction. A cardiac catheterization on hospital day 3 showed three-vessel coronary artery disease, and he underwent triple coronary artery bypass graft on hospital day 5. On hospital day 7, he developed septic shock and acute renal and respiratory failure requiring intubation. At that time, he had a fever of 102.6 oF, his arterial blood gas revealed a p02 of 89 mm Hg on 100% O2, and he had a white blood cell count of 27,000/uL. Two blood cultures were obtained. A chest radiograph showed a left lower lobe infiltrate with pleural effusion. A chest tube was placed to drain the effusion. On day 11, pus was noted to be seeping from his sternal wound. The wound was debrided and a rib biopsy was performed. Blood cultures, drainage from his chest tube, tracheal aspirates, pus from his sternal wound, and a rib biopsy all grew the bacterium below. The organism was catalase positive and coagulase positive. A Kirby-Bauer of the isolate is also shown.5. What is the most likely organism causing his infection? Briefly describe the evolution of his infection and discuss the four different types of infections he had with this organism.
6. How do you interpret the susceptibility results seen in the above image? What virulence factors does this bacterium possess which account for the susceptibility results?
7. The species of bacterium was found to have infected five other patients in the same hospital ACCU. All had undergone heart surgery over a recent 3-week period. What could be done to determine if these patients were infected with the same or different strains of this bacterium?
8. If it were determined that these patients were all infected with the same bacterium, what steps would you take to prevent further infections form occurring? In your discussion, explain how this bacterium can be spread. B. The patient was a 44- year old male with a past medical history significant hypertension, non-insulin-dependent diabetes, hypercholesterolemia, and a history of heavy smoking (two packs per day for 20 years). He presented to the emergency room with complaints of chest pain and was found to have suffered a myocardial infarction. A cardiac catheterization on hospital day 3 showed three-vessel coronary artery disease, and he underwent triple coronary artery bypass graft on hospital day 5. On hospital day 7, he developed septic shock and acute renal and respiratory failure requiring intubation. At that time, he had a fever of 102.6 oF, his arterial blood gas revealed a p02 of 89 mm Hg on 100% O2, and he had a white blood cell count of 27,000/uL. Two blood cultures were obtained. A chest radiograph showed a left lower lobe infiltrate with pleural effusion. A chest tube was placed to drain the effusion. On day 11, pus was noted to be seeping from his sternal wound. The wound was debrided and a rib biopsy was performed. Blood cultures, drainage from his chest tube, tracheal aspirates, pus from his sternal wound, and a rib biopsy all grew the bacterium below. The organism was catalase positive and coagulase positive. A Kirby-Bauer of the isolate is also shown.
5. What is the most likely organism causing his infection? Briefly describe the evolution of his infection and discuss the four different types of infections he had with this organism.
6. How do you interpret the susceptibility results seen in the above image? What virulence factors does this bacterium possess which account for the susceptibility results?
7. The species of bacterium was found to have infected five other patients in the same hospital ACCU. All had undergone heart surgery over a recent 3-week period. What could be done to determine if these patients were infected with the same or different strains of this bacterium?
8. If it were determined that these patients were all infected with the same bacterium, what steps would you take to prevent further infections form occurring? In your discussion, explain how this bacterium can be spread. B. The patient was a 44- year old male with a past medical history significant hypertension, non-insulin-dependent diabetes, hypercholesterolemia, and a history of heavy smoking (two packs per day for 20 years). He presented to the emergency room with complaints of chest pain and was found to have suffered a myocardial infarction. A cardiac catheterization on hospital day 3 showed three-vessel coronary artery disease, and he underwent triple coronary artery bypass graft on hospital day 5. On hospital day 7, he developed septic shock and acute renal and respiratory failure requiring intubation. At that time, he had a fever of 102.6 oF, his arterial blood gas revealed a p02 of 89 mm Hg on 100% O2, and he had a white blood cell count of 27,000/uL. Two blood cultures were obtained. A chest radiograph showed a left lower lobe infiltrate with pleural effusion. A chest tube was placed to drain the effusion. On day 11, pus was noted to be seeping from his sternal wound. The wound was debrided and a rib biopsy was performed. Blood cultures, drainage from his chest tube, tracheal aspirates, pus from his sternal wound, and a rib biopsy all grew the bacterium below. The organism was catalase positive and coagulase positive. A Kirby-Bauer of the isolate is also shown.
5. What is the most likely organism causing his infection? Briefly describe the evolution of his infection and discuss the four different types of infections he had with this organism.
6. How do you interpret the susceptibility results seen in the above image? What virulence factors does this bacterium possess which account for the susceptibility results?
7. The species of bacterium was found to have infected five other patients in the same hospital ACCU. All had undergone heart surgery over a recent 3-week period. What could be done to determine if these patients were infected with the same or different strains of this bacterium?
8. If it were determined that these patients were all infected with the same bacterium, what steps would you take to prevent further infections form occurring? In your discussion, explain how this bacterium can be spread.
Explanation / Answer
5. The patient has got Staphylococcal infection infected by methicillin-resistant Staphylococcus aureus(MRSA). The infection progressed by firstly having a triple coronary bypass surgery, then a septic shock that had renal as well as respiratory failure. Then there was pleural effusion with a sternal wound which had a pus seepage. The patient had pneumonia, septicemia, infection of the wound and tracheitis as the four infections with the bacterium.
6.The susceptibility of the Staphylococcus aureus is determined by the level of infection in a patient. The above case shows series of infections that occurred one by one in the patient which infected the cardiac system as well as the genitourinary tract of the patient. The MRSA strain is resistant to many of the present antibiotics which make them more susceptible. The virulence factors of the MRSA includes a number of surface proteins that help it to attach the host surface proteins for example fibronectin and laminin and invade the immune system of the patient. The factors also include antigens, enzymes, and toxins produced by the organism. this includes capsule, adhesins, enzymes like coagulase and lipase and several other factors.
7. The other infected patients are infected by the same strain or other strains of the bacterium can be by the culture test of the patient's blood and if the infection is nosocomial then the strain is MSRA only otherwise they may other strains of the bacterium.
8. If the patients are infected with the same strains, those patients should be isolated and strict aseptic conditions should be followed for prevention from further infection. The bacterium spreads by direct contact with an infected person, or by using a contaminated object, or by inhalation of the infected droplets of a sneeze of a cough. So to prevent the infection from spreading proper sanitization methods should be followed.
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