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Microbiology case:fever and pain in the left hand


Microbiology case:fever and pain in the left hand


حالة سريرية

الوصف الكامل Background
A 24-year old female automotive technician presents herself at the doctor’s office. She complains of fever and of pain in her left hand.
On physical examination, the patient had a deep wound on her left palm that was oozing pus. She had purplish, red streaks running up her left arm. She had enlarged lymph nodes at the elbow and under her arm. The patient’s skin was warm and dry.
In her history, the patient had punctured her left palm with sharp metal from the undercarriage of a "real cherry" 1977 Malibu about a week earlier. She said the wound had bled for a few minutes and she thought that she had washed it "real good" with soap and water. She had covered the wound with a large "band-aid" and gone back to work. She developed a fever about three days later. For the past couple of days, she "did not feel so good" and had vomiting and diarrhea.

1. What type of infection do you believe she has in this hand?
a. Streptococcus pyogenes
b. Staphylococcus aureus
c. Clostridium
d. Pseudomonas
e. Pasteurella multocida

2. From complaint and physical examination, which of the symptoms lead you to your choice of agent?
a. the fever and pain in the hand
b. the fever, wound with oozing pus and enlarged lymph nodes
c. the lymph nodes and red streaks
d. the warm dry skin
e. the pain, red streaks and enlarged lymph nodes

3. From the history, which of the information confirmed your choice?
a. The wound had bled for a while.
b. The wound was cleaned with soap and water.
c. The wound had been covered and had perhaps become anaerobic.
d. She had diarrhea and vomiting.
e. The cut was from a rusting car frame.

4. Which of the following is most likely to follow this infection?
a. gangrene and amputation
b. toxic shock syndrome
c. muscle spasms
d. neurological disfunction of the hand
e. arthritis

mbs2380's picture
by
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I think
1 is c,what do u think??Question
mbs2380's picture
mbs2380
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Quote:
1 is c,what do u think??

i do not know .....it is not clear
but i think it is c
because a and b are impossible....
and e is almost found where there is a wound caused by a cat or a dog.....
and the symptoms of d are different from these mentioned above........
and d is also wrong.....
i am not sure.....

Vince Carter


ya it is c,but what about other questions

mbs2380's picture
mbs2380
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number 2 is b (i am not sure about this)

number 3 is c

number 4 is a

Vince Carter


1-c
2-b !
3-c
4-c !!!!!
Embarrased

qusei

Quote:
4-c !!!!!

well....if the infection is caused by Clostridium...then i beleive that it is Clostridium Perfringens which cause gangrene (and so it is called gas gangrene)

Vince Carter


is that right?????

Vince Carter


والله ما بعرف ليش راح عقلي للكزاز!!!!

qusei

1-What type of infection do you believe she has in this hand?
c- Clostridium perfringens...

2-. From complaint and physical examination, which of the symptoms lead you to your choice of agent?

e- the pain, red streaks and enlarged lymph nodes

3- From the history, which of the information confirmed your choice?
c. The wound had been covered and had perhaps become anaerobic

4-Which of the following is most likely to follow this infection?
gangrene and amputation

first of all the diagnosis is cellulitis...

why is it cellulitis? ,read this :
the wound in the skin was infected and infection in the skin triggers the immune system to respond with neutrophils and other inflammatory mediators. These mediators are responsible for the 4 cardinal signs of infection: erythema, pain, swelling, and warmth. Because the infection occurs underneath the epidermis in the dermis and subcutaneous tissue, the margins of infection are not precise and are difficult to observe. Areas of edema and erythema often gradually blend into the surrounding skin. Systemic symptoms (eg, fever, malaise) may occur.

Red lines streaking away from a cellulitic area represent progression of the infection into the lymphatic system. Localized adenopathy is commonly observed with lymphangitis.
Crepitus is a sign of infection most commonly observed with anaerobic organisms.

from the history of our patient :
1-red streaks running up her left arm:red streak
2- enlarged lymph nodes :adenopathy of lymph nodes.
3- her hand was worm
4-She had covered the wound with a large "band-aid" and gone back to work:althogh cellulitis ight be caused by staphylococcus and streptococcus ,but the covering make us think of the anaerobic organism....
5-fever
6- she didn't feel so good:malaise

mbs2380's picture
mbs2380
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Quote:
is that right?????

yes u r totally right ,uncle KhaledEye-wink

Quote:
والله ما بعرف ليش راح عقلي للكزاز!!!!

so did I at first

I hope u get benefit from it

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mbs2380
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A 58 years old man presented with cellulitis of the left leg for last 3 days. He had started ciprofloxicin prior to his admission. The cellulitis initially limited to a small area of redness around his left ankle. This was associated with chills and rigor, and swelling of his left inguinal lymph node. He couldn't recall of any trauma or insect bite over his leg, nor did he have any past medical history of any chronic diseases. Over a period of 3 to 5 days the whole of the lower leg was involved, which was red and brawny to start with but later developed dark bluish-black hemorrhagic patches with blisters, over almost three quarters of his left lower leg. He was initially started on intravenous benzylpennicillin and flucloxacillin, but later changed to clindamycin.

The swabs and blood culture send on admission, and subsequently during his stay in the hospital, failed to grow any organisms. CRP was raised, but no other blood abnormality noted. The working diagnosis of necrotising fascitis was made, and a thorough debridment was done.

Biopsy revealed oedema and haemorrhage in papillary dermis, with vascular ectasia and inflammatory cell, appearances not suggestive of necrotising fascitis. The inflammation was limited to dermis, with no evidence of extension to the fascial planes.

The patient made steady progress and was sent home on oral clindamycin. Follow –up showed complete recovery.

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mbs2380
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-Vibrio vulnificus may infect skin that is injured in brackish water by scraping against rocks or stepping on organisms with hard shells. Patients infected with this organism, especially those with chronic liver disease, develop rapidly progressing cellulitis with systemic symptoms of illness.

-Skin injuries or exposure of damaged skin in fresh or brackish water may be infected by gram-negative bacilli such as Aeromonas species.

-Cellulitis that complicates bite wounds from cats and dogs may be the result of P multocida infection.

-Cellulitis in infants is usually caused by hematogenous spread of group B Streptococcus. These patients often have additional sites of infection such as the blood, joints, bone, kidneys, or central nervous system.

-Individuals who are immunocompromised may have gram-negative or fungal cellulitis.

-Cellulitis occurring around surgical wounds less than 24 hours postoperatively may result from GABHS or Clostridium perfringens. C perfringens produces gas, which is appreciated on examination as crepitus.

-Puncture wounds, especially through the bottom of sneakers, may cause Pseudomonas osteomyelitis and/or cellulitis, particularly in young people

-----

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mbs2380
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-Facial cellulitis is more common in adults older than 50 years.

-Perianal cellulitis, usually with GABHS, occurs in children younger than 3 years.

-Group B Streptococcus cellulitis occurs in infants younger than 6 months. Physicians must exclude underlying osteomyelitis or septic arthritis in these infants.
-Elderly patients with cellulitis are predisposed to thrombophlebitis.

reference: E-medicine

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mbs2380
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على راسي يا كبييييييييررررر........ Laughing out loud Laughing out loud Laughing out loud
الله يعطيك ألف عافية على هذه الجهود عظيمة.....
شكرا عمي بسام..........Embarrased Embarrased Embarrased

Vince Carter

Quote:
عظيمة.....

العظيمة

Vince Carter

Quote:
I hope u get benefit from it

thanx 4 u

qusei


ما شاء الله!!! شو هاد؟؟!!Shocked
شغلة بدها قعدة.
مشكور.

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