Case Study 1

2001 by D'Maris Allen

A 23-year old female walks into a small-town medical clinic complaining of recent malaise, fever and chills, dry cough and myalgia.

Upon examination, she has a temperature of 38.5 C, blood pressure of 100/62 mm Hg, pulse rate of 110 beats per minute, and a respiratory rate of 38/minute. She also reports chest and abdominal pain, but no overseas travel or exposure to birds or rodents.

1. Discuss what you believe are the most likely bacterial/viral diseases and why. (Give your differential diagnosis of 4 diseases that this case study might be based upon.)

2. The doctor orders a chest X-ray and cultures her throat/nasopharynx. He also does some rapid serological tests. No diagnosis is made at this time, so he sends her home and waits for test results to decide on appropriate treatment.

3. When the results are called to the patient, she tells the nurse she's feeling worse, with higher fever, acute dyspnea, and cyanosis. The chest X-ray shows infiltrates and mediastinal widening.  The culture shows large, box-car-like, Gram positive rods with "holes" in the center of them.

What disease do you now know this is?  What is the etiologic agent and how was it acquired?   

What are the "holes" in the microbes and how can they be better visualized? 

4. Supportive therapy is recommended during her subsequent hospitalization, but not antibiotics.

Why are antibiotics ineffective at this time in the disease process?

What virulence factors are involved in this disease? Explain in detail what they are and how each one affects the body.

5. What other ways does this microbe enter the body?  Be specific about the source of microbes (reservoirs) for each type.  Describe the disease symptoms of each type.

Fully describe how this disease can be prevented.

What makes this a good weapon for bioterrorism?

Discuss three other microbes that would make the most dangerous bioweapons and include why each would be effective.


Don't forget to properly submit your references (endnoting) with your answers!