Question

Case Study #14: Awoman with confusion and leg pain. History of Present lliness A woman in her fifties from Korea presented with confusion and severe pain in both legs, of one day's duration. Past Medical History There was a history of chronic hepatitis B virus (HBV) infection and cinhosis. She was status post resection of breast cancer more than a decade ear status post hemicolectomy for colon cancer 6 months before admission. Epivir HBV (lamivudine) had been started 3 months earlier Epidemiological History She had immigrated to United States more than a decade earlier and lived alone in suburban New York. She drank alcohol socially and did not smo intravenous drugs. There was no history of recent travel. She had had lunch in a Chinese restaurant one day before admission and had no history ot trauma The patient appeared drowsy, disoriented, and uncomfortable. The temperature was 104℉ (era blood pressure 9050 mm Hg, pulse 120 beats p respirations 22 breaths per minute. Sclera and skin were icteric. She was confused, but the neurological examination was otherwise non-focal. Phys the legs are shown i Studies and platelet eor, 30,000mm, The level of blubin was 4 B ; The white blood cell count (WBC) was 4,200mr㎡(band forms 39%): hematot 2 2.7 mg/dL); aspartate aminotransferase (AST) 29 UL, alanine aminotransferase (ALT) 60 UIL, creatine kinase (CPK) 94 UIL, prothrombin time (PT NR 1.9, partial thromboplastin time (PTT) 47 seconds and fibrin split products (FSP) were greater than 40 Diagnostic Procedure(s) and Resultis) The patient underwent surgical debridement Cultures from the tissue obtained during debridement grew an axidase positive, curved, gram negativ cultures were negative. Laboratory Results The oxidase and spot indole tests were positive for this organism The following biochemical reactions were obtained via the automated identification system esed in this laboratory (the Microscan Walkaway) positive and O esults) sUC ARG ORN LAC LYS ox IND Colony on TCBS 06 Naa 6%Nad ORNornithine LYS bysine NaC sodium chloride (salt) X. oxidase lND =indole ARG. arginine C lactose ferm. BS thiosulfate citrate bile salts sucrose agar SUC sucrose

Answer 1

1.This patient have chronic Hepatitis B virus infection and cirrhosis.Due to this chronic HBV infection only she developed cirrhosis of liver.Chronic form of this disease extend its infection to the liver.,Treatment for this viral infection is Epivir HBV (Lamivudine).It can't be stopped immediately after the symptoms have relieved.It is necessary to take for several months.Hence this client is taking this medication.

2.Normal band count percentage is 10% or less than to that.Here the patient has 39% it indicates she have infection.To fight against it her body is developing more WBC .It confirms that her blood stream is infected by the infectious organism.

3.From the biochemical results the organism is Vibrio cholerae.It is positive in both oxiadase and  indole test.And some of its strains show colorless. and all other biochemical results indicate V.cholerae.

4.E.coli and Pseudomonas aeruginosa are the other species of organism that can cause infection and disease in humans.