1.

 (This case study

was modified from Strohl WA, et al. Lippincott’s Illustrated Reviews:
Microbiology.  Philadelphia, PA: Lippincott Williams and Wilkins, 2001. An
internet search may be required to locate answers to some of the questions).

A 25-year-old man was admitted to the

hospital in mild-June for malaise and shortness of breath of 1-day duration.
Three days prior to admission, he had developed sneezing and a runny nose. Two
days prior to admission, he developed a nonproductive cough, a headache behind
his eyes, a fever and red blotches on his face. One day prior to admission, the
rash covered most of his face and had spread to his arms and trunk. Physical
examination revealed a temperature of 100oF, a relatively low total
white blood cell count, labored breathing, a red face and an erythematous
maculopapular rash on his trunk, palms, and extremities. Examination of his
mouth revealed several salt-grain-sized, raised, white spots on his buccal
mucosa (the lining of his cheeks). Upon questioning, he stated that he had no
known tick exposure, that his mother had told him that he thought he might have
had measles as an infant, and that he had never received the measles vaccine.

A.       Why do you think the patient was asked about the tick exposure?’

The patient's rash might have been Rocky Mountain spotted fever, especially because it happened in
June, when ticks are abundant in many regions, both rural and urban.

B.       What disease is suggested by the combination of fever, rash and white spots on the patient’s
buccal mucosa?

Rocky Mountain spotted fever, a tick-borne illness, and Measles are the answers. Measles symptoms
include fever, cough, coryza, and conjunctivitis, as well as Koplik's spots, which are thin, white punctate
lesions on the buccal mucosa.

C.       What pathogens causes this disease.

Measles is caused by the Rubeola virus, a member of the Paramyxovirus family. Measles is a highly
contagious viral infection that causes fever, respiratory illness and symptoms, and a rash.

D.       What are the white spots called?

Koplik's spots are microscopic dots within the mouth that occur often in the early stages of measles
(rubeola). The spots resemble little granules of white sand and are frequently surrounded by a crimson
ring. They are most commonly seen within the cheeks (the buccal mucosa), opposite the first and second
upper molars.

E.        What laboratory tests would confirm the diagnosis?  

Using acute and convalescent phase sera for a retrospective immunologic prognosis, a fourfold increase
in these antibodies is considered definitive evidence that the disease, which is medically consistent with
measles, was, in fact, measles and not one of its early summer season mimics, such as Rocky Mountain
spotted fever, an enterovirus disease, or meningococcemia.

Case 2.  A 16-year-old girl is admitted to the

hospital with severe abdominal cramps and bloody diarrhea. She has a fever of
120oF. She has been experiencing the symptoms for the pat 3 days, since several
hours after eating at a fast-food restaurant with a group of her friends, she
recalls that the hamburger she ate was not very well cooked. (It is later
learned that the meat being used in that restaurant to prepare hamburgers has
been recalled because of bacterial contamination.)

Salmonella is the bacterium that caused the patient's illness. Salmonella may be found in a wide range
of foods, including cattle, chicken, eggs, fruits, pigs, sprouts, vegetables, and even packaged goods such
as nut butters, frozen pot pies, chicken nuggets, and filled chicken dinners. You might become sick if you
eat Salmonella-contaminated food. Salmonella infections may be severe, and they are extremely deadly
for certain people. Symptoms of infection often appear 6 hours to 6 days after ingesting contaminated
food. Symptoms include diarrhea, fever, and stomach pains. The sickness usually lasts 4–7 days and
people recover without the need of antibiotics.

Case 3.  An 80-year-old woman is transferred from a

nursing home to hospital because she is suspected of having pneumonia. She is
expecting chest pain, chills, fever, and shortness of breath. She has a
productive cough (meaning that she is coughing up sputum). A gram stain report
of the sputum reveals numerous WBCs and numerous Gram positive diplococci.

Streptococcus pneumoniae is a kind of bacteria. Streptococcus pneumoniae, often known as

pneumococcus, is a Gram-positive, spherical bacterium that is alpha-hemolytic (in aerobic settings) or
beta-hemolytic (in anaerobic settings) and belongs to the Streptococcus genus. They live in pairs
(diplococci), do not form spores, and are immobile.

Case 4.  A 40-year-old, male, AIDS patient, who spends

a great deal of his time exploring caves, presents with malaise, fever, chills,
headache, myalgia, chest pains, and a nonproductive cough.

 A.   Based on this limited information,

which of the following fungal diseases does this patient most likely have?

1.         coccidioidomycosis
2.        histoplasmosis
3.        cryptococcosis
4.       sporotrichosis
5.        zygomycosis

B.   if your preliminary diagnosis is correct, what would most likely be observed in a sputum specimen
from the
patient?

1.         broad, aseptate hyphae

2.        encapsulated, budding yeasts
3.        non encapsulated, budding yeasts
4.       pseudohyphae
5.        thin, septate hyphae

A. Histoplasmosis
B. Non encapsulated, budding yeasts

Case 5.  A 24-year-old man visits the clinic

complaining of persistent diarrhea, crampy abdominal pain, and foul-smelling
flatulence. He has not had any fever or chills, but often feels nauseous after
a meal. He states that the diarrhea has lasted for more than 2 weeks, and
started about a week to 10 days after he returned from a backpacking trip high
in the Colorado Rockies. When asked whether he drank any stream or lake water
on the trip, he replies, “Sure, all the time! That water sure is pure!” Perhaps
the water is not pure as he thinks! The laboratory reports the presence of
trophozoites and cysts of a flagellated protozoan in his stool specimens. What
parasite do you suspect?

Giardiasis is a parasitic infection caused by the Giardia parasite. It is the source of the diarrhea. Bloating,
nausea, discomfort, gas, tiredness, and a lack of appetite are among symptoms, as are explosive, watery,
greasy, foul-smelling feces.