MICROBIOLOGY – MCB 2010C
Pathogens Case Study Assignment
Name _________________________________
Valencia College / Dr. Gessner / Summer 2013
Write the name of the disease causing the problem for each of the case study patients. (Each
correct answer is worth 2 points) Either common names or scientific names are ok. 
CASE STUDY
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TURN OVER 
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_____________/ 50 points
21. Baby Rose C. has been home from the hospital, since her delivery, for 4 months and has
been the picture of health. Rose is teething and was so irritable last week that her mom
decided to give Rose some baby Tylenol using her doctor’s recommendation. To make
the medicine go down “better,” Rose’s mom Laura, heard that a spoonful of honey will
make Rose not fuss so much when taking the baby Tylenol. In the last 3 days, Rose has
been constipated and has not produced any stools and Laura has begun to feel her own
breasts becoming engorged. After calling Rose’s pediatrician, Laura is instructed to give
Rose some apple juice to get Rose “back on track.” Two more days pass and Rose just
doesn’t seem right; her eyelids are droopy, her head seems somewhat “floppy,” she is
barely suckling, she drools more than usual, she cries with the faintest sound and she
doesn’t seem to be taking good, deep breaths. It is the weekend, so Laura brings Rose
to the emergency room at their local hospital. Upon physical exam, the emergency
room doctor notices that Rose has decreased muscle tone, has little to no gag reflex,
shows poor tendon reflexes and seems irritable. The doctor tells Laura that Rose needs
to be admitted for a full workup to determine the cause of Rose’s medical issues. In the
meantime, Rose is put in the intensive care unit and is put on a ventilator while she is
given intravenous fluids and nasogastric tube feeding. The results of Rose’s workup
reveal she has no fever, she is not septic, her blood profile and panel are unremarkable,
no abnormal findings are found with her serum ammonia levels, radiographs prove
normal and toxin tests are pending. A stool sample is obtained through colonic
irrigation and a spore forming bacillus is found, as is a potent toxin, in Rose’s stool; she
is administered an immunoglobulin, BIGIV. After being in the hospital for over one
month, Rose is able to breathe and feed normally again and recovers fully from her
ordeal.
What is causing baby Rose’s constipation and breathing problems?
Laura fed Rose honey. Why can this be a potential problem when fed to newborns less
than one year of age?
Could the problem have been caused by something other than feeding Rose honey; if
so, what?
What is BIGIV and how did it help Rose?
22. Glyniss H., a 45 year old professor of Cultural Studies, has been feeling sluggish recently
and has been polyphagic, polyuric and polydipsic. She has lost weight, she notices her
mouth is often dry and her skin feels dry and sometimes itches. Furthermore, Glyniss is
noticing creamy white patches developing in the back of her throat, on her inner cheeks
and on her tongue. When Glyniss goes to her doctor to find out what is going on, the
doctor learns about Glyniss’s medical history and suggests they initially run a blood
profile and a fasting blood glucose test. The blood glucose test returns with a level of
190 mg/dl. When scraped, to culture the patches, the areas are red and slightly bleed
when the creamy white substance is removed. A positive diagnosis returns for yeast.
After treatment with an antifungal medication, the creamy white patches resolve;
Glyniss though now must address her other medical issue, her elevated fasting blood
glucose levels.
What is etiology of the creamy white patches in Glyniss’ mouth?
How is a fasting blood glucose test performed and what are normal serum blood glucose
levels?
What diseases and drugs can predispose a person to the condition causing the oral
lesions in Glyniss’ mouth?
The yeast causing Glyniss’ oral problem, is common in the human oral flora. Why then
did Glyniss have this medical issue and why do babies commonly get the same problem?
23. Pauline G., a 4 year old female, presents to the pediatrician because she is itching and has
red pimple-like spots between her fingers, around her wrists and elbows, between her
buttocks and around her waist. Pauline, known as Polly, goes to a Long Island nursery
school and tells the doctor that some other kids at school have also been itching
recently. Polly says the itching has been getting worse over the last week, particularly at
night. The doctor notices what appear to be red tracks near the small spots on Polly’s
skin. After doing a CBC and blood panel, Polly’s doctor performs a skin scraping of
several of the pimples that Polly hasn’t scratched. Upon microscopic evaluation of the
scrapings, the lab technician discovers small round insect-like organisms that look like
balloons with 8 legs and a mouth. The legs can even be seen moving and Polly asks if
she can see. The doctor also performs an ink burrow test with a washable felt tip
marker and then alcohol, and notices burrows under the skin surface. Polly is shocked
that insects are burrowing in her skin. The doctor provides Polly’s mother with a skin
lotion containing permethrin and suggests that all the family members living with Polly
also apply the lotion to their entire bodies making sure not to get any in the eyes or
mouth; furthermore the nursery school is contacted and told of the problem causing the
other children to itch. Polly can return to nursery school when the treatment is
complete and the lotion has been washed off.
What is Polly’s most probable diagnosis?
What environmental measures should Polly’s parents take in the home, in addition to
using the skin lotion, to prevent a recurrence of Polly’s infestation?
Two weeks after her treatment, Polly has no skin lesions yet still has some itchiness.
Even though the treatment worked, what is causing the continued itching AND what can
Polly do about it, with the doctor’s approval?
24. Travis K, a 1 year old male from Baker Lake, Nunavut, Canada, presents to the
village clinic, coughing and sneezing, with a runny nose and a temperature of
100 °F that has lasted a few days. The doctor presumes Travis has a cold and
sends him home, with his mother, to get the typical symptomatic relief for a
cold: plenty of fluids, rest, decongestants and increasing the humidity in the
igloo . One week later, Travis is not any better, and his condition has
deteriorated to the point where his dry, hacking coughs are followed by a sound
made by sucking in air, he has fits of coughing lasting about 30 seconds
sometimes followed by vomiting and one eye has conjunctival hemorrhaging.
The coughing fits are scaring his mother, since he almost seems to stop
breathing and turns red; between the fits, Travis doesn’t seem to be eating or
drinking like usual. The doctor is suspicious that Travis may become dehydrated
and upon auscultation, is fearful Travis may be developing pneumonia. Travis is
sent to the big hospital in Nunavut’s capital city, Iqaluit, where he can be better
cared for. At the Iqaluit hospital, the doctors perform a general physical, do
blood work (lymphocytosis) and blood cultures, nose and throat cultures, have
chest x-rays taken and learn, when taking the medical history, that Travis has
never had his childhood vaccines. The doctors inform Travis’ parents that he will
need to be admitted to the hospital and put in isolation. He is administered IV
fluids, is put in an oxygen tent and is given azithromycin until the test results
return. The PCR test comes back positive for the bacterium suspected to be
causing Travis’ signs and symptoms. Travis’ family members are also put on
preventative antibiotics and are suggested to get vaccinated for this disease.
What is the probable infectious cause of Travis’ coughing?
Give the names of the vaccines and the immunization schedule, during a person’s
life, that the vaccine for this disease should be given.
What are some of the signs of dehydration that the clinic doctor in Baker’s Lake
probably noticed to make her think Travis was dehydrated?
Why are antibiotics given to a person with this infection, even when at the coughing
stage of the disease, they don’t really do much to help the patient any more.
25. Lynda M. is a 36 year old stay at home mother of 7 children, 3 dogs a cat who lives in
southwest Florida. Lynda is on the Women’s Professional Bassmaster’s Fishing Tour
where she has had some success but recently she says her “game is off” and she has not
been feeling her usual self. Having recent sleeping difficulties, Lynda goes to her doctor
also complaining of a mildly pruritic vulva and itchiness around her anus. Upon physical
exam, the doctor notices Lynda is fine, with all blood work and urinalysis coming back as
within normal ranges. Lynda has no diarrhea, abdominal pain or fever and has a healthy
appetite. The doctor does notice that her anus is reddened and inflamed from the
constant scratching Lynda says is the reason she came to see the doctor. When the
doctor asks Lynda whether her children have been complaining of the same problem,
Lynda says sometimes they do but she makes sure they bathe well and hasn’t been
overly concerned. The doctor suspects several parasites could be causing the problem
but on stool check and using cellophane tape on a tongue depressor nothing is noted.
The doctor sends Lynda home with directions to perform the tongue
depressor/cellophane tape test to herself and her children and to bring back the sample
the following day. The following day, the samples are returned and Enterobius eggs are
noted under the microscope.
What is the cause of Lynda’s anal itching?
Should Lynda’s entire family, including her husband, be treated for this parasite?
Why or why not?
Was one of the pets the probably source of this infestation? Explain why or why
not.
Is this infestation an indication of a person’s hygiene or socio-economic background
or could this infestation occur in anyone? What was the probably source of Lynda’s
infestation?