Case Studies: Respiratory System

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1. Jennifer had been experiencing the symptoms of a sore throat for a couple of days that had become progressively worse. This morning when she woke up, it was extremely difficult and painful to swallow. When she went to the doctor, he could see how red & swollen her tonsils were. He could also see some white areas in her throat. The nurse swabbed Jennifer’s throat and the rapid antigen test came up positive.
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Disease:
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Pharyngitis
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Causative Agent & Type:
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Streptococcus pyogenes bacteria gram-positive cocci chains
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Transmission:
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respiratory droplets and/or direct contact
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Culture & Diagnosis:
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throat swabs and rapid antibody test; culture on agar rules out any false negatives from the rapid antibody test
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Prevention:
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good hygiene
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Treatment:
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antibiotics;
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2. Bobby felt like he was coming down with something when he came home from the Thanksgiving holiday with his family. He first started sneezing and feeling like his throat was really itchy. Then he started running a fever and going through a lot of tissues.
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Disease:
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Rhinitis
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Causative Agent & Type:
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over 200 different viruses most often rhinovirus
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Transmission:
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respiratory droplets;
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Culture & Diagnosis:
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clinical presentation
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Prevention:
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good hygiene
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Treatment:
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supportive
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3. (Continued from above…) After a few days of experiencing sneezing, runny nose, scratchy throat & fever, Bobby started feeling pain & localized pressure in the middle of his forehead and alongside his nose under his eyes.
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Disease:
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Sinusitis
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Causative Agent & Type:
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various bacteria or fungi
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Transmission:
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normal flora (opportunistic); trauma
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Culture & Diagnosis:
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clinical presentation; imaging techniques
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Prevention:
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none
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Treatment:
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antibiotics (bacteria) or anti-fungal
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4. Jacob’s mother brought him to the pediatrician since he had been very irritable, pulling at his left ear and running a fever over 102°F for 3 days .
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Disease:
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Acute Otitis Media
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Causative Agent & Type:
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streptococcus pneumoniae, haemophilus influenzae bacteria
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Transmission:
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Endogenous (from previous infection)
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Culture & Diagnosis:
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clinical presentation; failure to resolve in 72 hours
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Prevention:
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conjugate vaccines (contains bacterial capsular material)
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Treatment:
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antibiotics; tympanic tubes
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5. Patsy’s symptoms began with a cough and sore throat which progressed to include a fever of 100°F. When it became painful to swallow and she had difficulty breathing, she sought medical attention. Upon examination, the doctor noted a greyish-white accumulation of material at the back of the throat that was partially covering the posterior aspect of the pharynx.
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Disease:
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Diptheria
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Causative Agent & Type:
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corynebacterium diptheriae bacteria gram-positive rods
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Transmission:
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respiratory droplets; direct contact; fomites
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Culture & Diagnosis:
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Tellurite medium (gray/black colonies)
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Prevention:
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diptheria toxoid vaccine
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Treatment:
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antitoxin plus antibiotics
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6. An otherwise healthy college student in his early 20’s goes to bed early one night because he’s feeling exhausted. The next morning, he can’t even bring himself to get up out of bed because he is feeling so bad. He has a severe headache, chills, all over body-aches and is running a fever. The next day he isn’t feeling much better, but he drags himself to the on-campus clinic. He is disappointed to learn that medication most likely will not improve his condition.
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Disease:
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Influenza
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Causative Agent & Type:
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Influenza A, B, anc C viruses
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Transmission:
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respiratory droplets, indirect contact (fomites)
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Culture & Diagnosis:
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clinical presentation
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Prevention:
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vaccines: inactivated seasonal vaccines (prediction for flu season); attenuated seasonal (flumist)
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Treatment:
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supportive; antiviral (needed to be started by 2nd day of infection)
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7. About 2 weeks after a visit to her grandparent’s house, 3 month old Caroline began coughing. The coughing increased in frequency and intensity to the point of her turning blue due to the inability to catch a breath. When arriving at the emergency room, the attending physician asked if anyone in the family had been coughing recently. Caroline’s grandmother had a dry cough, but she had been very careful to wash her hands before holding Caroline. The infant ended up being admitted and spent more than a month in the hospital, a week of that being in the ICU. The coughing was so intense at some points that several of her tiny ribs were fractured.
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Disease:
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Pertussis (whooping cough)
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Causative Agent & Type:
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Bordetella pertussis bacteria Gram negative coccobacillus
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Transmission:
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droplet contact
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Culture & Diagnosis:
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clinical presentation; bacteria cultured on agar
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Prevention:
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acellular vaccine (DtaP); prophylactic antibiotics;
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Treatment:
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supportive measures; antibiotics
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8. A 5 month old baby is rushed to the ER in respiratory distress. The mother explains that his symptoms started off with a runny nose the day prior which progressed to coughing, sneezing & wheezing and he wouldn’t nurse. Today at 1:00pm when the mother checked on him, she could see that he was retracting (his chest was pulling in) as he was fighting to breath. She rushed to the pediatricians office where they administered a breathing treatment, but it didn’t work, so they were sent to the hospital. The infant was admitted and put on oxygen and regular breathing treatments over the next 6 days.
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Disease:
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Respiratory Syncytial Virus (RSV)
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Causative Agent & Type:
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Respiratory syncytial virus (RSV)
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Transmission:
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droplet and indirect contact via fomites highly contagious
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Culture & Diagnosis:
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direct antigen testing
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Prevention:
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passive antibody for high-risk children
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Treatment:
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supportive (assistive ventilation); antiviral drugs in severe cases
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9. On the flight home from Philadelphia, Pennsylvania to San Francisco, California you notice a man in one of the seats across the aisle coughing quite a bit and you are rather annoyed that he isn’t trying to shield it in any way. You think about asking the stewardess to speak with the man or move you to another seat, but you don’t want to cause waves so you leave it alone. A couple of weeks go by before you develop a cough. You begin to feel pain in your chest as well but don’t think much about it. You go to see the doctor as a precaution. When asked about possible contact with any sick people, you mention the man on the plane. The doctor orders a skin test & chest X- ray. You develop a spot about 8mm across 48 hours after the skin test and when you go back to the doctor to see the results of the chest x-ray, he shows you a whitish area in the upper portion of your lungs.
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Disease:
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Tuberculosis (white plague)
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Causative Agent & Type:
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Mycobacterium tuberculosis bacteria; M.avium in AIDs patients; M.Bovis from unpasteurized milk.
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Transmission:
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respiratory droplets
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Culture & Diagnosis:
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tuberculin testing; chest X-rays; direct identification of acid-fast bacilli; cultural isolation, antimicrobial susceptibility testing
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Prevention:
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limit exposure to infectious airborne particles; patient isolation in negative-pressure rooms; other extensive precaution
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Treatment:
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antibiotics
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10. Andy and Peter (twins) were 3 years old, when they became sick with high fever, difficulty breathing and other flu-like symptoms. Andy also had a seizure. The boys were rushed to the hospital by ambulance. Culture of a nasal swab on blood agar showed colonies with alpha-hemolysis and a subsequent Gram stain of one of the colonies revealed Gram-positive cocci in chains.
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Disease:
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Pneumonia
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Causative Agent & Type:
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Streptococcus pneumoniae bacteria Gram + cocci
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Transmission:
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respiratory droplets or endogenous transfer
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Culture & Diagnosis:
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gram stain; alpha-hemolysis on blood agar
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Prevention:
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polysaccharide vaccine
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Treatment:
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antibiotics
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11. Several days after a convention of elderly veterans at a hotel, news spread about many of the individuals that had attended coming down with symptoms of pneumonia including cough, chest pain, muscle aches, headache & fever. In all, 221 people were sickened and 34 of those died. During an investigation by the CDC, it was determined that an infectious organism was being spread via the hotel’s faulty air-conditioning system.
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Disease:
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Pneumonia (Legionnaire’s Disease)
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Causative Agent & Type:
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Legionella pneumophilia bacteria: Gram – rods
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Transmission:
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vehicle (air and aerosols)
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Culture & Diagnosis:
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specialized selective agar
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Prevention:
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none
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Treatment:
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antibiotics
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12. Sheila worked at a local homeless shelter. The shelter was of course more crowded during the winter months so during that time Sheila worked 6 days a week. For several days in December, she had felt like she was dragging and without energy. Her joints hurt, muscles ached and she had a cough with mild sinus congestion but she continued working for about a week. When she started running a fever she finally went to the doctor.
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Disease:
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Pneumonia (Walking Pneumonia)
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Causative Agent & Type:
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Mycoplasma pneumoniae bacterial rods
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Transmission:
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droplet contact in close living quarters
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Culture & Diagnosis:
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tests to rule out any other etiologic agent
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Prevention:
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none
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Treatment:
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not recommended in most cases; antibiotics if necessary
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13. Several visitors to Yosemite National Park became ill with fatigue, muscle ache & fever that progressed to coughing and shortness of breath within 5 weeks of their visit to the park. In all, 10 people became sick and 3 of them died. An epidemiological study linked all of the sick visitors to a set of cabins that were infested with rodents.
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Disease:
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Pneumonia
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Causative Agent & Type:
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Hantavirus virus
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Transmission:
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vehicle (rodent urine, feces, saliva contaminated dust)
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Culture & Diagnosis:
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serology; PCR
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Prevention:
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avoid mouse habitats and droppings
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Treatment:
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supportive
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14. Tom was diagnosed with colon cancer and was in the midst of chemotherapy treatment. He began to develop symptoms including fever, chest pains, dry non-productive cough and joint pain. Blood was drawn over a period of several days and examined for any rise in antibody titer. A sputum sample was analyzed by immunofluorescence and revealed the presence of a pathogen that would only cause symptoms in an immunosuppressed individual.
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Disease:
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Pneumonia
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Causative Agent & Type:
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Histoplasma capsulatum fungi
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Transmission:
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vehicle (inhaled soil contaminated with bad/bird feces)
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Culture & Diagnosis:
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serology; rising antibody titer
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Prevention:
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avoid contaminated soil, bat/bird dropppings
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Treatment:
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anti-fungals
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15. A patient with severe alcohol-withdrawal symptoms was admitted to the hospital and administered very high doses of sedatives and anti-seizure medications. He was intubated and hooked up to a ventilator to help prevent any complications from the medications. While on the ventilator for two days, the patient’s condition seemed to worsen. He was given a chest X-ray which showed haziness in both lungs indicating infection.
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Disease:
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Noscomial Pneumonia
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Causative Agent & Type:
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polymicrobial infection of: streptococcus pneumoniae, Klebsiella pneumoniae, and coliform bacteria
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Transmission:
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endogenous bacteria; normal biota enter lower respiratory tract via abnormal breathing, aspiration, or ventilation
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Culture & Diagnosis:
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typically only reveals normal flora
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Prevention:
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reduce transfer
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Treatment:
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broad-spectrum antibiotics

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