Question

The patent was a 6-year-old female from North Carolina. She was in her usual state of good health until 10 days prior to admission, when she had a tick removed from her scalp. She developed a sore throat, malaise, and a low grade- fever 8 days after tick removal, she was seen by her pediatrician when she began developing a pink, .acular rash, which started on her palms and lower extremities and spread to cover her entire body. The pediatrician's diagnosis was viral exanthem. One day prior to admission she developed purpura, emesis, diarrhea, myalgias, and increased fever. On the day of admission, she was taken to her local hospital emergency room because of mental status changes and was admitted. Her physical examination significant for diffuse purpura, periorbital, and foot edema; cool extremities with weak pulses; and hepatosplenomegaly. Her laboratory studies showed a white blood cell count (WBC) OF 14,900/ul and greatly increased coagulation times. A presumptive diagnosis was made and ampicillin and chloramphenicol therapy was begun. She was intubated and transferred to one of the University of North Carolina Hospitals. She died soon after arrival. The diagnosis was confirmed by serological studies.

1. Which conditions do her physical findings on admission suggest? List three organisms that can cause these types of physical findings besides the one that is present here?

2. Was the observation that a tick had been removed from her scalp important to this case? which infectious agent are spread by ticks?

3. What parts of the country have the highest number of cases of this disease reported each year? could you get this disease in Massachusetts ( please explain)?

4. what measures can be taken to prevent this disease?

5. what are your interpretations of the relevant history and clinical / lab findings?

6. What is the infectious agent and the infection disease?

Answer 1

1.The physical findings of the patient suggests Toxix Shock syndrome due to tick bite

The organism which can cause theses types of symptoms are

• Rickettsia rickettsii
• Borrelia burgdorferi
• Ehrlichia chaffeensis

2.The observation strictly to be fine after tock removal is assess the site for any left over parts ,fluids of the tick at the site because the fluid usually contains the causative agent and can again cause infection. After removal the site has to be cleaned with soap and water thoroughly.

The infectious agents spread by ticks are

• Rickettsia conorri
• Powassan virus

3.They are common in

• South eastern parts
• Western US
• South central US
• Mexico
• South western Canada

The disease can occur is Masacchutes but the most common are lyme disease, Babesiosis and Anaplasmosis, rarely Rocky mountain Spotted fever

4.The measures which can be taken to prevent this disease are

• Staying away from the site of the infectious agents causing disease
• Wearing protective clothing and hats if visiting the site
• Antirepellants must be applied before reaching those places.
• If bit by a tick ,remove the tick removed by an expert the earliest and seek medical help