Running head: I HUMAN CASE 1

I Human Case: Left Facial Paralysis

Student’s Name

Institutional Affiliation

Instructor

Date
I HUMAN CASE 2

I Human Case: Left Facial Paralysis

A 41-year-old male patient presents with a 2-week history of complaints of left facial

paralysis, acute on the onset. The patient also reports a history of persistent cough, fever, chills,

and different new lesions on the skin that also started about a fortnight ago (Papadakis, McPhee,

& Rabow, 2014). In coming up with an accurate diagnosis to inform the management of the

underlying condition for better outcomes, I collected a detailed history and a thorough physical

examination notified by the pathophysiology and etiological factors that relate to left facial

paralysis. As such, this provision helped me in coming up with a list of differential diagnoses

comprising of the pathological findings related to the results derived from the physical

examination and the history (Jameson et al., 2017). However, to rule out the differential

diagnoses and come up with a definitive diagnosis, I would employ objective diagnostic testing.

The pathophysiology of the patient’s underlying condition, endocarditis bacterial,

implicates at least three crucial elements, including cardiac valve preparation for bacterial

adherence, bacterial adhesion to the vulvar surface that had been prepared, and propagation of

the vegetation of infection (Kestler et al., 2017). Preparation of the valves follows trauma to

produce endothelial cell alteration hence disrupting the surface to allow for deposition of fibrin

and platelets to render the surface adherent to the bacteria that freely circulate in the blood. The

virulent bacterial factors that promote complex adherence include dextran (Ross et al., 2017).

The bacteria that adhere to the surface of the vegetation requires resistance in situ to avoid

complement bactericidal activities and phagocytosis by leucocytes. As such, the recommended

management plan would employ vancomycin 1 g IV BID for four weeks and gentamycin 80 mg

BID for five days (Jameson et al., 2017).

I HUMAN CASE 3

References

Jameson, J. L., Fauci, A. S., Kasper, D. L., Hauser, S. L., Longo, D. L., & Loscalzo, J. (2017).

Harrison's Principles of Internal Medicine 19th Edition and Harrison's Manual of

Medicine 19th Edition (EBook) VAL PAK. McGraw Hill Professional.

Kestler, M., Munoz, P., Marin, M., Goenaga, M. A., Viedma, P. I., de Alarcón, A., ... & Costas,

C. (2017). Endocarditis caused by anaerobic bacteria. Anaerobe, 47, 33-38.

Liesenborghs, L., Meyers, S., Lox, M., Criel, M., Claes, J., Peetermans, M., ... & Missiakas, D.

(2019). Staphylococcus aureus endocarditis: distinct mechanisms of bacterial adhesion to

damaged and inflamed heart valves. European heart journal, 40(39), 3248-3259.

Papadakis, M.A., McPhee, S.J., & Rabow, M.W. (2014). Current medical diagnosis &

treatment: Geriatric (2nd ed.). New York, NY: Routledge.

Ross, K. M., Mehr, J. S., Greeley, R. D., Montoya, L. A., Kulkarni, P. A., Frontin, S., ... &

Montana, B. E. (2018). Outbreak of bacterial endocarditis associated with an oral surgery

practice: New Jersey public health surveillance, 2013 to 2014. The Journal of the

American Dental Association, 149(3), 191-201.