Transcript Team Case Study 4 Chelsea Doyle Del Marie

Team Case Study 4
Chelsea Doyle
Del Marie Patton
Tiffany Kullijian
Background
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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:
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β-hemolosis
Gram stain: GPC in chains
Differential Diagnosis
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Streptococcus pyogenes
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Streptococcal pharyngitis
Streptococcus agalactiae
Important Factors
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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
Important Facts Cont.
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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
What’s Wrong?
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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
Organism
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Streptococcus pyogenes
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GPC in chains
β-hemolitic
Causes rheumatic fever which can cause
heart damage
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Streptococcus agalactiae
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Occurs mainly in the vagina
Causes neonatal bacteremia, pneumonia, and
meningitis
Not related to cellulitis
Treatment
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Rheumatic Fever
 Bed rest
 Penicillin (Strep. Pyogenes)
 Steroids (inflammation)
 Diuretic
 Aspirin
Cellulitis
 Soak in warm water
 Elevate of extremity
 Prevention of pressure
Problems With Treatment
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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
Mode of Transmission
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Airborne
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Coughing
Sneezing
Bad hygiene
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droplets
Not washing hands
Person to person contact
Portal of entry: Nose or mouth
Prognosis
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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