Question

MICROBIOLOGY CASE STUDY : PLEASE ANSWER TO THE BEST OF YOUR ABILITY! thank you!The patient is an 82 year old female, Jane, who lives alone except for three cats, drives, and has an active family, community, and social life. Lately, however, she complained to her oldest daughter, Sara, that she just felt tired and out of sorts. Sara remembered that her mother had a cold and cough about six weeks ago but had not seen the family physician and seemed mostly recovered. However, Sara noticed recently that she still had a dry (non-productive) cough and complained of a slightly sore throat. Sara suggested that her mom visit her physician and an appointment was made.

The physical assessment noted that heart and chest sounds were normal, blood pressure was slightly elevated, throat was red, and there was no fever. The physician ordered a rapid streptococcus assessment and a chest x-ray, and EKG; the streptococcus screen was negative and x-ray and EKG normal. CBC and routine chemistry panel were ordered and Jane was sent home with a prescription for amoxicillin and diagnosis of probable viral respiratory infection. Three days later laboratory results arrived and showed that the RBC was normal, the WBC total count was slightly elevated, and the differential count showed elevated segmented neutrophils. The chemistry panel was normal.

Ten days later Jane had completed the course of amoxicillin but was not feeling better and reported to Sara that she was light-headed and “short of breath” at times, without physical exertion. Sara was alarmed and alerted the physician who suggested they go to the hospital ER. In the ER, it was determined that the patient’s temperature was 99.8 ⁰C, blood oxygen level was low and a CT scan of the chest was ordered. The CT scan revealed a small amount of fluid in both lungs.

1. What illness has Jane had for possibly six weeks?
2. Is this a bacterial, viral, or fungal infection?
3. Why was amoxicillin not effective?
4. What is the next course of treatment?

Answer 1

In the preesnt case study, Jane , 82 year old women, who was staying with a number of pets, came for physicians consultation with the symptoms of,

• Tierdness
• H/O cough and cold six weeks ago and slightly recovered
• Dry cough
• Sore throat
• Physical examination reveled BP is elevated, Presence of redness in throat
• Lab findings were normal, except slight increse in WBC and neutrophils
• She was treated for respiratory infection with amoxycillin
• After 10 days (ccompleted the course of amoxycilin) she visisted hospital again with worseniing of symptoms like

-lightheadness

-shortness of breath

PE revealed Elevation of temperature, 99.8

-Decreased saturation level

Presence of fluid in lungs

The illness she had probably for six weeks

• Waling pneumoniae or Asymptomatic pneumonia may be the disese she had for six weeks, Which is probably tarnsmitted from her pets
• Earlier it can be asymptomatic and caused by an atypical bacteria called Mycoplasma pneumoniae, which can live and grow in the nose, throat, trachea and lungs
• They will be having features like ,

-Milder symptoms

• Sore throat (pharyngitis)
• Feeling tired (fatigue)
• Chest pain
• Mild chills
• Low-grade fever
• Persistent cough that can be dry or produce mucus
• Sneezing
• Headache

-Natural resistance to medicines that would normally treat bacterial infections

-Often mistaken for a virus because they lack the typical cell structure of other bacteria

-Symptoms of walking pneumonia may come on slowly, beginning one to four weeks after exposure.

- Later stages of the illness, symptoms may worsen, the fever may become higher

• Since the dises not diagnosed earlier symptoms got woesened

2. Bacterial /Viral

• It is caused by Mycoplasma pneumoniae a bacteria that commonly causes mild infections of the respiratory system.

3. Why amoxycilin not effective

• Mycoplasmas lack a cell wall and, therefore, they are inherently resistant to beta-lactam antibiotics
• Amoxicillin nor amoxicillin clavulanate cant cover the atypical organisms like , Mycoplasma pneumoniae, sice it lacks bacterial cell wall.
• Amoxycilin acts by destructing bacterial cell wall
• Overuse of amoxicillin can contribute to the development of antibiotic-resistant bacteria.

4.Course of treatment

ANTIBIOTICS

in Mycoplasma Pneumonia itreatment of choice could be,

• Doxycycline, macrolides
• Fluoroquinolone in Klebsiella Pneumonia
• 3rd generation cephalosporin with or without aminiglycoside,
• carbapenams Aztreonam, β lactam-β- lactamase inhibitor, fluoroquinolone
• Legionella Pneumonia
• Macrolide + rifampin, fluoroquinolone
• Doxycycline + rifampin
• Pneumocystis TMP-SMZ, pentamidine + prednisone.
• Dapsone + trimethoprim + Clindamycin + primaquine + Trimetrexate

other treatments

 Oxygen therapy

 Nutritional support

 Fluid and electrolyte management

 Bronchodilators medications: albuterol sulphate, metaproterenol or methylxanthines.

 Deep breathing exercises and spirometry

 Chest physiotherapy

 Percussion & Vibration

 Postural drainage

 Nasotracheal suctioning