CASE 4:
A 60 year old male who is 4 months post orthotopic heart transplant for ischemic cardiomyopathy present with a 2 week history of increasing pain, swelling and tenderness in his right thigh. The patient also has a history of fever to 101° over the last 2 days. Meds: Cyclosporin, prednisone and azathioprine.
Physical examination: T. 38.0°C, BP 140/80, R-14, HR 80, No acute distress. Lungs: Clear, CV - S. and S2 NL no S3/ S4 Abd: soft, non-tender, no organomegaly. Ext: (R) thigh swollen red tender fluctuant 3cm x 3cm mass, some surrounding cellulitis Neuro: WNL
Laboratory: CXR: 2cm nodules in (R) upper lung, WBC 6.1, 88p, 8 bands, 2 L, 2 mono Aspirate of the lesion shows acute inflammation and gram-positive irregularly stained or beaded, branching filamentous organisms, modified Ziehl-Nielsen stain of the aspirate disclose acid fast organisms seen with the same morphology.
QUESTIONS:
1. Create a problem list from the history.
2. Identify and explain the significance of each pertinent physical finding.
3.Review the lab data and explain the findings.
4. What is diagnosis based on History, physical and lab data.
5. Describe succinctly, the disease each case represents
6. Describe the offending organism, its morphological, cultural characteristics and their normal habitat.7. How do these organisms gain access to humans?
8. Who are susceptible hosts?
9. How do they invade and spread in humans?
10. What defenses humans have against these organisms?11. How do these organisms able to overcome human defenses?
12. What is the end result of this battle between organisms and humans?
13. How do you diagnose this infection?
14. What are other clinical infections with these organisms?
15. What will be your therapeutic strategy?
16. How can you prevent it from spreading to others? Prevent its occurrence?