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Team Case Study 4

Team Case Study 4. Chelsea Doyle Del Marie Patton Tiffany Kullijian. Background. 40-year-old intravenous drug user Fever and dizziness for several weeks Cellulitis in his right arm (inflamed and oozing) Abnormal EKG Systolic murmur Blood agar revealed: β - hemolosis

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Team Case Study 4

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  1. Team Case Study 4 Chelsea Doyle Del Marie Patton Tiffany Kullijian

  2. Background • 40-year-old intravenous drug user • Fever and dizziness for several weeks • Cellulitis in his right arm (inflamed and oozing) • Abnormal EKG • Systolic murmur • Blood agar revealed: • β-hemolosis • Gram stain: GPC in chains

  3. Differential Diagnosis • Streptococcus pyogenes • Streptococcal pharyngitis • Streptococcus agalactiae

  4. Important Factors • Drug user • What drugs is he under the influence of • Doesn’t take care of himself • Immunosuppressed • Whether a sore throat was present previous to dizziness, fever, and cellulitis • If he has been around anyone with a sore throat

  5. Important Facts Cont. • If he has had rheumatic fever as a child • How long has the sore on arm been inflamed • If there are sores anywhere else besides arm

  6. What’s Wrong? • Patient had strep throat • He let sore throat go untreated • Untreated Strep. throat caused rheumatic fever • Inflammation from body’s natural defense caused damage to the heart (systolic heart murmur) • Because of the damaged skin and streptococcal infection, cellulitis was present at the injection site

  7. Organism • Streptococcus pyogenes • GPC in chains • β-hemolitic • Causes rheumatic fever which can cause heart damage • Streptococcus agalactiae • Occurs mainly in the vagina • Causes neonatal bacteremia, pneumonia, and meningitis • Not related to cellulitis

  8. Treatment • Rheumatic Fever • Bed rest • Penicillin (Strep. Pyogenes) • Steroids (inflammation) • Diuretic • Aspirin • Cellulitis • Soak in warm water • Elevate of extremity • Prevention of pressure

  9. Problems With Treatment • Reaction to his street drugs with the prescribed medications • Tissue destruction if antibiotics are not taken • Damage to heart muscles and valves if treatment is not followed

  10. Mode of Transmission • Airborne • droplets • Coughing • Sneezing • Bad hygiene • Not washing hands • Person to person contact • Portal of entry: Nose or mouth

  11. Prognosis • If patient complies with treatment: • He will recover from infection within 3-4 weeks • Carditis may last 2-3 months in severe cases • If the patient does not comply with treatment: • He will not recover from infection • Heart complications and cellulitis will continue to get worse • Patient will most likely continue his current life-style, therefore, the outcome will not be good • The Rheumatic Fever will never fully disappear

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