Question

Prologue: Alice Kaninchenbau was a 20-year-old junior at Boise St. University, where she majored in Political Science and played as an open-side flanker on the women's rugby team. In the last game of the season (against Weber St.) she suffered a broken nose (and the team suffered a 0-36 loss). Always an optimist, Alice considered her broken nose to be the perfect reason to have a rhinoplasty (and get the nose she had always wanted). The case: The antibiotic erythromycin was administered 24 hour before the surgery, and the procedure was uneventful. Twelve hours post-operatively, however, she experienced sudden nausea. Alice called for the nurse. As the nurse arrived, Alice vomited. While the nurse helped her to the bathroom Alice experienced dizziness, and complained of muscle aches in her legs and shoulders, and then experienced syncope. The nurse got her back to the bed, elevated her legs, and called for a physician from the ER. When the ER physician arrived two minutes later, Alice was conscious but listless. On examination, her temperature was 40.2°C, with elevated heart and respiration rates (165 beats per minute and 26 breaths per minute). Her blood pressure was depressed (88/50). One liter of physiological saline was administered intravenously, and her blood pressure was briefly restored to 110/70. Physical examination revealed marked hyperemia of the conjunctivae and oral mucosa, bilateral nasal packing (to control postsurgical bleeding), supple neck, diffuse pulmonary rales, edema of the hands and feet, a red rash on her trunk and extremities with petechiae evident, but no generalized lymphadenopathy or hepatosplenomegaly, nor any signs of local infection. At this point she was moved into intensive care, with intravenous nafcillin begun. Her blood pressure fell to 90/40, at which time she received 500 ml of 5% albumin intravenously and was intubated, with 100% oxygen provided. Pulmonary edema fluid bubbled freely from the intubation tube. A dopamine drip was used to increase cardiac additional fluids were given to maintain a systolic pressure of 90. An electrocardiogram was performed and showed relatively normal heart function. Extensive laboratory tests were performed. Her white blood cell count was elevated (20,500 cells pr'), with a predominance of neut neutrophils-indicating rapid mobilization of new neutrophils from the bone marrow). Serum electrolyte levels were in the normal range, SGOT and alkaline phosphatase levels were at the high end of normal, however, her CPK levels were elevated at 1,600 UL". Her urine was positive for blood glucose, and ketones. Blood coagulation time was prolonged; but the hematocrit (40%) and platelet count (245,400 cells pr') were normal. Cerebrospinal fluid (CSF) was normal, and upon microscopic examination showed no evidence of infection. Cultures of blood, urine, CSF, and vaginal fluid (she was not menstruating) were made. The nasal packing was removed from her nose and found to contain pus. The pus was Gram-stained, revealing the presence of PMNs in sheets, with both intracellular and extracellular Gram-positive cocci in clusters. She was immediately given intravenous oxacillin, clindamycin, and cefotaxime, along with intravenous immunoglobulin (IVIG).

Answer 1

1.)a.The epilogue determines that the patient had Toxic Shock Syndrome. Here the patient experience a severe rise in body temperature, with severe hypotension, rash and vomiting. This is possible after a surgery.The other symptoms shown by patient are dizziness,muscle aches,hyperopia of conjunctiva and oral mucosa

b.The toxin produced by the organism enters the blood and travels to the circulatory system ,there due to lack of appropriate and adequate antitoxin antibody, it infects the area leading to functional abnormality and decreasing the blood pressure.In addition to this vomiting leads to loss of fluid and further contribute to low blood pressure. When cardiac output is low the blood received by the lungs will be decreased and the toxins present in it leads to functional impairment and thus contributing to the fluid collection in the lungs causing pulmonary edema.This leads to hypoxemia ,breathing difficulty and needs ventilation artificially.

c.CPK are rekeased when there is an injury occurring to either skeletal or skeletal muscle.Here the toxin has reached the muscles and injured it leading to the release of CPK and this elevated levels in the blood.

2.)In this the  toxins reaches to all vital organs via blood .When it reaches the circulatory system it affects it by decreasing blood pressure, from their the toxin reach lungs to cause decrease in oxygen received and fluid accumulation happens.When there is hypotension the renal function is affected leading to decreased urine output, the injury to muscles lead to skin rash externally usually at palms and soles,the sensory system are affected by redness of the conjunctiva.In GIT it increases tte gastric mo init causing either vomiting or diarrhea. In order to fight the toxins ,the brain elevates the core body temperature, when this exceeds the tolerance the function of CNS itself is altered causing confusion and others problems.