Microbiology and Parasitology

Case Study No. 3

Student’s Name: _Agas, Maxine Rose A. _______________ Score: ________________

Student Number: _2020017491_______________________ Date: _07/09/21_______

CASE STUDY No. 1: Severe Acute Respiratory Syndrome Case Study

SCENARIO: Severe acute respiratory syndrome (SARS) is a newly identified respiratory infection caused by a
novel coronavirus. The SARS pandemic is believed to have originated in the Guangdong Province of China
during the fall of 2002. A SARS patient from this region traveled to Hong Kong on February 15, 2003, and may
have infected several guests at a hotel where he resided. One of the hotel guests was a resident of Hong Kong.
By February 24, the hotel resident came down with a fever, chills, dry cough, runny nose, and malaise. Over
the next several days, his symptoms worsened to pneumonia, leading to his hospitalization at the Prince of
Wales Hospital in Hong Kong.

The Prince of Wales Hospital is a large medical teaching hospital of the Chinese University of Hong Kong. By
March 12, a large-scale outbreak of SARS occurred inside of the hospital. During the initial outbreak, March 15
through 25, 2003, 44% of the SARS cases (68 of 156) admitted to the Prince of Wales Hospital were hospital
workers. SARS is a contagious disease that spreads from person to person primarily through contact with
respiratory droplets containing the SARS virus. Chinese University researchers and the Hong Kong Hospital
Authority conducted studies to determine why hospital workers were so vulnerable to SARS at this hospital.

Question:
1. Can you think of what factors contributed to the high rates of SARS transmission seen among
hospital workers?

The significant factor contributing to the high rates of SARS transmission seen among the hospital
workers is the mode of transmission itself. It spreads through respiratory droplets such as saliva and direct
and indirect contact between people (W.H.O, n.d.). As hospital workers are more prone to close contact with
the patients, droplet transmission by someone who manifests respiratory symptoms of coughing or sneezing
may put them at risk by transmitting droplets to their most exposed body parts: mouth, nose, and nose or
eyes (CDC, 2004). The transmission to the infected person's environment or objects, such as stethoscopes,
thermometers, and hospital room facilities, may also contribute. In addition, although there are no proven
studies that SARS can be transmitted airborne (CIDRAP, 2003), there are medical interventions that generate
aerosols in which can make the health care workers prone to infection as these procedures usually involve
respiratory droplets such as endotracheal intubation, open suctioning, manual ventilation before intubation,
tracheostomy, and cardiopulmonary resuscitation. These procedures are prevalent to SARS patients as they
can aid respiratory problems (WHO, 2020).

Centers for Disease Control and Prevention. (2004, April 26). Severe acute respiratory syndrome (SARS).
https://www.cdc.gov/sars/about/faq.html
Center for Infectious Disease Research and Policy. (2003, October 20). WHO finds no evidence of airborne
spread of SARS. https://www.cidrap.umn.edu/news-perspective/2003/10/who-finds-no-evidence-
airborne-spread-sars
World Health Organization. (2020, March 29). Modes of transmission of virus causing COVID-19: implications
for IPC precaution recommendations. https://www.who.int/news-room/commentaries/detail/modes-of-
transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations
World Health Organization. (n.d.). Severe acute respiratory syndrome (SARS). https://www.who.int/health-
topics/severe-acute-respiratory-syndrome#tab=tab_2
 2. What precautions would you take in caring for SARS patients?

When taking care of SARS patients, the first precaution that must be performed is hand hygiene.
Different hand hygiene techniques such as handwashing, antiseptic handwash, antiseptic hand rub, and
surgical hand antisepsis have shown effectiveness in preventing and controlling the transmission of pathogens
both in the community and in the healthcare setting (Akyol et al., 2006). Next, sanitizing the area is also one of
the precautions as pathogens can also be transmitted to the environment or objects exposed to the SARS
patients. Another thing is to wear recommended protective masks such as surgical masks and N95. These will
serve as a primary barrier that assists in preventing one’s respiratory droplets from reaching others. Health care
workers are required to wear one of these to protect their nose and mouth from exposure and decrease the
transmission to others (CDC, 2021). Also, wearing PPE (Personal Protective Equipment), such as gloves,
aprons, long-sleeved gowns, goggles, fluid-repellant surgical masks, face visors, and respirator masks, have
lessened the risk of transmission to the healthcare workers as well as to others (NIRIPCM, n.d.). Lastly, doing
social distancing for at least one meter, even though protected by PPE’s and masks, is essential as this provides
physical distance between one another that helps lessen the chances of being infected by close-distanced
patients (2020, WHO).

The Northern Ireland Regional Infection Prevention and Control Manual. (n.d.). Personal Protective
Equipment. https://www.niinfectioncontrolmanual.net/personal-protective-equipment

Centers for Disease Control and Prevention. (2021, April 19). Guidance for Wearing Masks.
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html

Akyol, A., Ulusoy, H., & Ozen, I. (2006, February 14). Handwashing: a simple, economical, and effective
method for preventing nosocomial infections in intensive care units. The journal of hospital infection
62(4): 395-405. doi: 10.1016/j.jhin.2005.10.007.

World Health Organization. (2020, April 1). Coronavirus disease 2019 (COVID-19) Situation Report.
https://www.who.int/docs/default-source/coronaviruse/situation-reports/
20200401-sitrep-72-covid-19.pdf?sfvrsn=3dd8971b_2#:~:text=Social%20and%20
physical%20distancing
%20measures,within%20families%20and%20communities.

CASE STUDY No. 2: Animal Hides and Anthrax Disease Case Study

SCENARIO: A 35-year-old male presented to a London hospital complaining of difficulty breathing. His
symptoms progressed quickly, and he was transferred to the hospital’s intensive treatment unit suffering from
respiratory failure, which soon progressed to multiple organ failure. A blood culture revealed gram-positive,
encapsulated, nonmotile rods preliminarily identified as Bacillus anthracis. This is the bacterium that causes
the disease anthrax, and it has the ability to survive for long periods of time without water or nutrition. The
presence of B. anthracis was later confirmed by the Novel and Dangerous Pathogens Division of Britain’s Health
Protection
Agency.

Question:
1. What characteristic of B. anthracis allows the bacterium to survive without water or
nutrition?
 The characteristic of B. anthracis that allows the bacterium to survive without water or nutrition is
aided by its nature to produce spores, which resist hostile conditions where vegetative cells are intolerant
(Mahon et al., pp.365, 2014). They form endospores when deprived of nutrition. They can live in a metabolically
dormant state and dehydrate for years but can change into vegetive cells once activated by environmental
cues. These endospores mainly rely on their survival through conformational changes of their enzymes when
associated with adverse conditions of high temperature, desiccation, extreme freezing, and chemical
disinfectants. Their parts also contribute to their dormancy as its cortex, which is highly hydrated with a cross-
linked peptidoglycan matrix, protects its core that contains the genome and could keep it dehydrated.
Additionally, their outermost protective barrier, the coat, can provide chemical protection for the cortex against
hydrolytic enzymes (Sunde, et al., 2009).

Mahon, C.R., Lehman, D.C., & Manuselis, G. (2014). Textbook of Diagnostic Microbiology (5th ed, pp. 365).
Singapore: Elsevier Saunders

Sunde, E.P., Setlow, P., Hederstedt, L., & Halle, Bertil. (2009, November 17). The physical state of water in
bacterial spores. Proceedings of the National Academy of Sciences of the United States of America
106(46): 19334–19339. doi: 10.1073/pnas.0908712106

2. Where is B. anthracis found?

B. anthracis is usually found and distributed in the soil, where they remain inactive for years. Once
domestic and wild animals (primarily herbivores) are exposed to the environment, the bacteria can contract
the infection by ingesting spores on forage plants, infected through the soil, and by ingesting spores deposited
on leaves by flies after feeding on an anthrax-infected carcass. When the spores enter a lesion in the
gastrointestinal mucosa, they can germinate and flow into the bloodstream and lymphatics, making the animals
infected with anthrax. Therefore, as herbivorous animals are the primary hosts of this bacterium, humans may
contract the infection by directly contacting the infected herbivores or indirectly through their products such as
hides and wools (Turnbull, 1996, Anthrax section, para 1 & 4).

Turnbull, P.C.B. (1996). Bacillus. In: Baron S, editor. Medical Microbiology (4th ed). Texas: Galveston (TX).
https://www.ncbi.nlm.nih.gov/books/NBK7699/