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Pathogenic Microbiology Case study #2“A Homeless Hazard”By age37, Roxanne hadbeen living on the streets for more than twodecades.She is aware of people looking down at her because she is“homeless”. But, shenever understood their reactions. She said thebest day of her life was leaving home.She left home due to badtreatment from hermother since she was a girl.She learned to takecare of her own needs since no one is going to do it.Her mother hadcared more about her next drinkor fix than about Roxanne.Her motherhad different boyfriends, and there was a lot of fighting. One day,she found her mother’s money,took it then she went to the Greyhoundstation, and rode the bus as far as It her stolen money can takeher. She was scared, but loved her new freedom. To her, home was aprison so she vowed never to return. Roxannelearned that freedomcame with a price. She had a hard time finding a job. It wasnoteasy staying warm and fed. For money, she was able to do “oddjobs” for some people. She never had a problem finding food becauseshe can find a local church-run pantries, shelters, leftover in thetrash cans, or by fast dash through the market wearing a bulkycoat. She often stay at the shelter overnight, especially duringwinter. Roxanne’s only complaint about her lifestyle was a littleembarrassing. She hated to admitthat she was rarely clean andfresh. She had become too thin and her dental hygiene was notsomething she is proud of. She lost half a dozen of her teeth overthe years.Consequently, she found a friend, Hannah, who ran asecondhand store. She help Hannahsort the clothes in return she getan item to wear. One morning, Roxanne was wearing a mini-skirt.Hannah noticed the rashes and lumps on her thighs. She asked her tosee a doctor, but Roxanne refused. Two days later, Roxanne wasbecoming more uncomfortable andmiserable. She had even more lumpson her thighs. The old ones were larger and filled with pus. One ofthe lumps was the size of a golf ball and several others on theinside of her left leg appeared to be clustered together andextending down deep into her thighs.
1. Given Roxanne’s symptoms and living conditions, what do yoususpect is her skin problem?2. What is theusual causative agent forthis infection? Where this microbe is usually found?
3. What factors put a person at risk for this infection? Whichrisk factors does Roxannedemonstrate?4. What is the name applied toRoxanne’s cluster of deep lumps. Other than the clustering, how dothese lumps differ from other ones?When Roxanne arrived at theshelter that evening for dinner andcot, she immediately askedWilma, the shelter director, for Band-Aids. Wilma was shocked tosee her infection, and tied her best to convince Roxanne to seekprofession al help. When she flatly refused, Wilma gave her someclean towels and wash cloth, antibacterial soap, Q-tips, tripleantibiotic ointment, and a pair of sweat pants. She also gave herTylenol because she was feverish. Roxanne was instructed to gentlywash her legs with soap and water, pat dry, use the Q-tips to applythe ointment.5.WasWilma’s hometreatment protocol appropriate?Explain.6. What signs did Wilma recognize that prompted her torecommend professional medical care for Roxanne?After Wilma cameback to check on her. She asked Roxanne what she had done. She said“I popped ‘em and they don’t hurt near as much. They’re kinda likebig zits”.7. Whywas Roxanne’s action the wrong treatmentchoice?That night Roxanne tossed and turned on her narrow sheltercot. The pain in her leg was terrible and was drenched in sweat.When she did not come out for breakfast, Wilma went to check onher. She found Roxanne barely conscious. The infection had spreadup and down her legs with red striations extending even farther.Her forehead was hot to the touch. Wilma immediately called 911.8.What is the medical termdescribing these red striations? What doesthis sign suggest?
At the hospital, Roxanne had a temperature of 102.50F, pulse of160, rapid shallow breathing (30 breaths/minute), and confusion.Dr. Harris cultured her wounds and ordered blood cultures drawn.Antibiotics was initiated immediately, fever reducer was alsogiven. Dr. Harris began the tedious task of lancing and drainingthe infection, treating with antibiotic ointment, and packinglesions with gauze to promote draining.9. Why Dr. Harris orderedblood cultures and if infection is on Roxanne’s legs?Twelve hourslater, the lab contacted the nurse’s station, reporting growth ofGram positive cocci in clusters in two of the four blood culturebottles drawn. At 10 AM the next morning, the lab called again withculture results. Roxanne’s sore were positive for Staphylococcusaureus, which was sensitive to methicillin but resistant topenicillin.10. Is this MRSA? Explain.11. Is themethicillin-sensitive Staphylococcus aureus serious?12. Whatmechanism is responsible for the penicillin resistance? Whymethicillin is still effective?Although Roxanne was alreadyreceiving antibiotic therapy, shortly after the lab called with theculture results, she went into shock and died. Later thatafternoon, the laboratory sent Dr. Harris a follow up reportindicating growth of Staphylococcus aureus in the remaining twoblood culture vials.13. What term describes an active bacterialinfection in the blood? Why is the condition dangerous?14. Whatbasic prevention steps should you take to discourage developing aninfection such as Roxanne? When should professional care besought?At the hospital, Roxanne had a temperature of 102.50F, pulseof 160, rapid shallow breathing (30 breaths/minute), and confusion.Dr. Harris cultured her wounds and ordered blood cultures drawn.Antibiotics was initiated immediately, fever reducer was alsogiven. Dr. Harris began the tedious task of lancing and drainingthe infection, treating with antibiotic ointment, and packinglesions with gauze to promote draining.9. Why Dr. Harris orderedblood cultures and if infection is on Roxanne’s legs?Twelve hourslater, the lab contacted the nurse’s station, reporting growth ofGram positive cocci in clusters in two of the four blood culturebottles drawn. At 10 AM the next morning, the lab called again withculture results. Roxanne’s sore were positive for Staphylococcusaureus, which was sensitive to methicillin but resistant topenicillin.10. Is this MRSA? Explain.11. Is themethicillin-sensitive Staphylococcus aureus serious?12. Whatmechanism is responsible for the penicillin resistance? Whymethicillin is still effective?Although Roxanne was alreadyreceiving antibiotic therapy, shortly after the lab called with theculture results, she went into shock and died. Later thatafternoon, the laboratory sent Dr. Harris a follow up reportindicating growth of Staphylococcus aureus in the remaining twoblood culture vials.13. What term describes an active bacterialinfection in the blood? Why is the condition dangerous?14. Whatbasic prevention steps should you take to discourage developing aninfection such as Roxanne? When should professional care besought?
