Question

Part I—Trouble in the Nursery

“Flesh eating bacteria? You’re kidding, right?” Dr. Matthew Mitchell winced as he tried to understand the alarmed nurse at the other end of the phone. “Slow down and tell me again what’s happening.” Matt knew that he needed to stay calm and try to buy time to understand the problem. It was the first time he had been left as the sole physician in charge of the struggling White Rock Clinic. Dr. Jennifer Eckenrode, the seasoned senior physician in their partnership, had left for Nepal two weeks earlier on a three-week expedition to climb Mount Everest.

The nurse, Joan Benjamin, continued, “All I know is that I have three really sick babies down here. The Wandell twins started to go bad yesterday. They have a strange rash on their thighs and they’re running a fever. I thought it was just ordinary diaper rash, but this evening when I was rubbing some ointment on it, the skin started coming off in sheets! Now the LaComb baby looks like she has the same thing under her arms.”

“You haven’t started using some new lotion or soap on them, have you?” asked Matt, hoping that he wasn’t going to have to resurrect his knowledge of infectious disease. “Perhaps you’re using something that’s too harsh for the skin of neonates.”

“No, no,” Joan answered impatiently. “I’ve been working in neonatal nurseries for 25 years. I think I know a thing or two about washing babies. Can you reach Dr. Eckenrode? She knows how to handle these sorts of things.”

Matt resisted the urge to snap back at her. If he had to call Jen in Nepal he’d never live it down. “No need to call her. She left me in charge. I just need to take a look at the little guys. I’ll be right up.”

Matt took the stairs up to the nursery two steps at a time. Turning down the hallway he could see a small cluster of visitors cooing and waving at a small red-faced infant being displayed through the nursery’s large plate glass window. Behind them Nurse Benjamin was hovering over an isolette. Matt hurriedly washed his hands and walked over to the isolette to examine the baby.

Joan didn’t look up when he arrived but simply murmured “Dr. Mitchell” under her breath as if his name were something distasteful. The Lacomb baby was wearing a tiny knit cap and was wrapped tightly in a hospital blanket. Matt gently unwrapped the blanket and lifted up the baby’s white undershirt to examine her skin. He could see some small vesicular lesions on the inside of her upper arm. Farther up, in the axillary area, there was a moist red area about the size of a quarter. The baby girl seemed warm to the touch, and she began to fuss and wave her fists in response to his probing. He replaced the blanket and walked over to the isolette that held the first of the Wandell twins.

“Baby Boy A is worse than his brother,” Joan called from across the nursery. Matt undressed Baby Boy A and removed his diaper to look at the affected area. The entire area of the tiny baby’s groin appeared to be involved, demonstrating the same strange skin infection. Maybe Joan was right—perhaps this was the beginning of necrotizing fasciitis, the famed “flesh eating bacteria” of tabloid lore. No matter what it was, he needed to act quickly to avoid any kind of negative publicity.

Matt looked up in time to see Ben Albin, the clinic administrator, enter the nursery wearing a grey pinstripe suit that seemed oddly out of place in the antiseptic and starched white surroundings of the nursery. “Dr. Mitchell,” Ben said curtly. “Nurse Benjamin has notified me that we have a potential situation here in the nursery. It looks as though we need to give Dr. Eckenrode a call.” Matt shot Joan a withering glance, but she studiously ignored it. “No, no,” he replied. “I’m sure I can handle this. Besides, Jen has probably already started up the mountain. She’s undoubtedly out of contact with everyone, except perhaps her Sherpa guides.”

“For your sake, I hope you’re right about being able to handle this,” Ben countered. “We can’t afford to have an epidemic in the news. You know that Whittaker Memorial Hospital has been looking for an excuse to shut us down. I’m sorry, but I can’t risk losing this clinic just so that you can pursue some idea of being a hero. I’ll give you 24 hours—after that I’m quarantining the nursery and calling in the county health department. If there is any negative publicity about delaying even a day, I’m holding you personally responsible.” With that, Ben turned abruptly and headed out of the nursery.

Matt looked down at the mewling infant and soberly rewrapped him in his powder blue blanket. “Well, Dr. Mitchell?” Joan inquired, her voice tinged with sarcasm. “What are your instructions?”

“I’ll have them written out for you as soon as I check on a few details,” Matt responded. He was going to have to read up on infectious agents that could cause this kind of a skin disorder—and fast. Matt wished he had been a better student of infectious diseases. He hated to admit it but he had just barely passed that part of his education. The reference collection in the clinic library was a bit sparse and somewhat outdated, but at least it was a place to start.

Question 1 (10 points)

What are some possible causes of skin infections? List at least 5 DIFFERENT organisms (include genus and species, if applicable). Briefly describe the problem each can cause.

Answer 1

Ans: causes of skin infection: 2) parasites and other different kinds of germs 0 vires : They cause warts, herpes simplex, shingles. genus - virus Species - Caken from type of disease] * Bacteria : causes impetigo , cellulitis , Staphylococcal infections egenus - vibro Species - Campelo bac tos, infectioris * Fungi : causes yeast, athlelis foot Genus - Tuber (truffle) Species - - Family - Tuberaceae @ parasites : cause body lice , head lice , Scabies.