Question

Forty-year-old Beatrice notices an ulcer on the distal aspect of her right third finger approximately 12 days prior to admission. She develops chills and fever and is treated with oral penicillin without success. Bea is then referred for admission to this hospital. On physical examination, Bea is an obese female in moderate distress. Her temperature is 40^o C, and her respiration 18/min. Remarkable physical findings include an excoriated, ulcerated lesion of the right third finger and associated epitrochlear and axillary lymphadenopathy. Cultures (including blood and wound surface) are negative. Retrospective questioning reveals that Bea had butchered a rabbit 1 week prior to the onset of her illness.

A. What pathogen is the most likely etiologic agent?

B. Give two reasons why the laboratory must be notified in advance when attempting to isolate this organism from tissues.

C. Serologic diagnosis is attempted in this patient. Her initial titer against this bacterium was 320, and a follow-up titer 2 weeks later is 2,560. How much of a rise in titer does this represent, and does such a rise indicate disease?

D.   Describe two other means of transmission that might occur with this pathogen

Answer 1