Question

Read the case study below and answer the following questions in your response (do not look at anyone else's response). This is your first post that is due by 11/5 at 11:59 p.m. Your second post is to reply to one of your classmate's post and either agree or disagree with their diagnosis: A 35-year-old immunocompromised woman has come to the ER complaining of chest pains, a high fever, and a nasty cough that contains blood. As you finish up your initial diagnosis based on her symptoms, you suddenly notice a crusty lesion on her hand. After inquiring about the lesion, the woman mentions that she has been applying a topical ointment that contains bacitracin on her hand, but the lesion has not gone away. Out of curiosity, you ask the woman if she participated in any extended outdoor activities during the past six months. She says that about three months ago, she took a hike with some friends along the Mississippi River in Louisiana for a few days and then visited New Orleans. 1. What is your diagnosis? What disease could you have mistaken for because of the symptoms? 2. What is the causative agent? 3. How did this woman become infected? 4. How does the disease progress? 5. Why is this disease a big concern for immunocompromised patients? 6. How can you treat this disease?

Answer 1

1. Diagnosis - Blastomycosis. The symptoms can be mistaken for Lung Cancer.

2. Causative agent - Blastomyces dermatitidis

3. Blastomyces dermatitidis is seen in wet soil and in the decomposing wooded areas of the Mississippi River and Oreland. This woman, when she visited these places, might have breathed in, the tiny fungal spores of Blastomyces from the atmosphere.

4. The fungus when breathed in parasite spores, it is transformed into yeasts and attacks the lungs. It moves everywhere in the body by the blood. In immunocompromised individuals, it brings out the persistent skin disease with subcutaneous sores on the face and hands. These sores finally become crusty and stained leading to disfiguring scars.

5. It is fatal

6. Treatment

• Amphotericin B
• Ketoconazole
• Fluconazole and itraconazole, for mild and moderate disease
• Symptomatic and supportive treatment.