Question

A 21-year-old woman presents to the physician's office for the evaluation of a swollen knee. She states that for the past 1-2 week she has had some achiness in several of her joints and a low-grade fever, but it seemed to localize to her left knee approximately 3 days ago. It has been red, hot, and swollen. She has had no injury to the area and has never had anything like this before. Her past medical history is significant for having been treated for Chlamydia at the age of 15. She takes oral contraceptive pills regularly. She is sexually active, has been with her most recent boyfriend for about a month, and admits to at least 10 sex partners in her lifetime. On examination, her vital signs are normal, but you notice that she walks with a limp. Her general examination is normal, and her skin is without rash. Her left knee is erythematous and warm to the touch. There is a visible effusion. Movement is limited because of pain and stiffness from the swelling. She refuses a pelvic examination because she doesn't see what that has to do with her sore knee. However, she does allow you to perform a joint aspiration. Lab results of the joint aspiration showed an unusually high number of polymorphonuclear leukocytes with intracellular Gram negative diplococci in the sample. Based on the information presented in the case study, answer the following questions:

1. What microorganism or virus do you believe is to blame for her illness?

2. What information from the patient’s symptoms contributed to your decision?

3. What information from the patient’s history contributed to your decision?

4. Based on what you know about this microorganism or virus, what steps can be taken to treat the illness?

Answer 1

1.Neisseria Gonorrheae is the bacteria causes her illness

2. Usually arthritis in general is differ from septic arthritis.

General arthritis affects both the joints equally, and all the joints are affected.

In this patient only one joint is more affected with arthritis, and it is with suppuration. So it is the complication of the neisseria gonorrheae infection.

3. History of multiple sexual partners helps to suspect N.gonorrheae.

Neisseria gonorrheae transmits from one person to another through sesuai contact.

4 . As the N.gonorrheae is bacteria, she need to be treated with anti bacterial drugs.

Penicillin is the drug of choice. If the patient is resistant for penicillin, ceftriaxone or quanalones are drug of choice.