Need help 1-13 thanks :) An Infectious Vacation It was late June 1988 as Jenny p

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Need help 1-13 thanks :)

An Infectious Vacation It was late June 1988 as Jenny paged through her scrapbook, fondly seviewin the photos from her family's vacation earlier that month. They had the wonderful time visiting relatives in Georgia. Jenny's favorite part of the vacation was their side trip to Tennessee. She and her cousin hiked Lookout Mountain and were amazed they could see four states simultancously from the summit. When her family returned home to Ohio a few days later, Jenay discovered two angry red bite marks-one on her left wrist and the other on her right thigh. Assuming they were infected mosquito bites, Jenny ignored them. Toward the end of summer, Jenny's mother noticed the bites were still there but had a dis. tinct appearance. The flat center was lighter in color than before, but a red rin like rash extended from it with a diameter of about five inches. by her dermatologist was unproductive as he admitted never before seeing An examination such a rash. He advised Jenny to continue taking tetracycline for her acne and to keep 1 This rash is diagnostic. What disease does Jenny have? What is the medical 2. What is the causative agent? Describe the characteristics of this microbe. 4. Clearly, Jenny's dermatologist missed a key diagnostic feature that wouldn't a watchful eye on the rash. Figure I. Target shaped rash term used to describe this characteristic rash? What is the common name for it? . What is the standard treatment for this condition? be overlooked today. Note the date of this case. Go online and do a quick review of the emergence of this disease in the United States. Compare the annual rates of reported cases in the 1980s, 1990s, and after 2000. s. Do you think the dramatic difference you observed with your Internet research represents an epidemic, better diagnosis and reporting, or both? Throughout the fall, Jenny's energy level declined. By Thanksgiving she com- plained of severe fatigue, muscle pain and weakness, sore, swollen knees, nausea, abdominal pain, and headache. Jenny was admitted to the hospital and diag nosed with abdominal pain of unknown etiology and carbohydrate intolerance hypoglycemia. 6. What standard laboratory tests were likely ordered when Jenny was ad- mitted? Why? Based on these two diagnoses, what results did these test results indicate? O7. Jenny never actually suffered from hypoglycemia or related carbohydrate metabolism disorders. Why might her blood glucose levels be abnormal, leading to this misdiagnosis? 8. Jenny's dermatologist had her on a daily tetracycline regimen for moderate infection? Would this treatment affect laboratory results/diagnosis? teenage acne. What effect would this prophylactic treatment have on her Jenny was hospitalized for three days. An NG tube for feeding was inserted, as she had lost 15 pounds in two months due to reduced appetite from the abdominal 38 Regionally Acquired Infections

Explanation / Answer

1. The disease which Jenny got is lyme disease or lyme borreliosis. The medical term used to describe the rash is erythema migrans. The common name for the rash is bulls eye rash.

2. The causative agent is Borrelia burgdorferi.

Characteristics : Borrelia are large, motile, refractile spirochetes with irregular , wide , open coils. They are usually 5-30 micrometer long and 0.3-0.7 micrometer wide. They are readily stained by ordinary methods and are weak gram negative by default.They have an outer membrane that contains an LPS- like substance, an inner membrane and a periplasmic space which contains a layer of peptidoglycan. They have endoflagella which contains within the periplasmic space.

3. Treatment : Tetracyclines, chloramphenicol, penicillin and erythromycin are effective.

4. In 1980s 2748 cases were reported to CDC, in 1990s 4882 cases and in 2000s 5473 cases were reported.

5. It clearly states epidemic of the disease.

6. The avaiable laboratory methods for the diagnosis of lyme disease fall into two catagories : direct methods to detect the spirochete and indirect methods that detect the immune response against it, mainly the detection of antibodies against the spirochete.

Direct methods include culture and PCR. Culture is gold standard method and media used are variations of the Barbour- Stoenner- Kelly (BSK) medium and modified Kelly- Pettenkofer ( MKP) medium. Cultures are examined using dark field microscopy or fluorescent microscopy after staining aliquots with acridine orange but sensitivity is improved by testing aliquots with PCR methods. They replicates slowly and cultures are kept for 8 to 12 weeks before being considered negative. PCR seems to be less sensitive particularly in case of plasma samples. New assay using broad range PCR and electrospray ionization mass spectrometry appears promising.In indirect test, sensitive enzyme immunoassay or indirect immunofluorescent assay are used. If the test is borderline or positive the sample is retested using separate IgG and IgM western blot.

7. In neuro lyme disease hypoglycemia is quite common. Lyme can contribute to adrenal fatigue, magnesium deficiency which can lead to hypoglycemia.

8. Tetracycline stops the multiplication of the bacteria and host immune response is given a leg up to iradicate the residual infection. The lab results will show protective antibodies against the antigen and blood culture may show decline in bacterimia.

9. The psychosmatic illness fits with the symptoms and this is the post lyme disease complications in neuro borreliosis.

10. Encephalopathy is in the third stage of the disease which is called as persistent infection.

11. Serological tests are ELISA or enzyme immunoassay and immunofluorescent assay or IF tests and immunoblotting. Antibodies take 1-2 months to appear, with initial IgM response followed by IgG. False positive syphilis serology may be seen, with FTA-ABS being positive and the VDRL test negative.

12. Inappropriate involuntary laughing and crying due to a nervous system disorder is the condition which occurs in pseudobulbar affect. It can happen in people with a brain injury and certain neurologic condition and is though to results from disruption of neural networks that control the generation and regulation of motor output of emotions.

13. Neurologic complications occur in the second stage of lyme disease with numbness, pain , weakness, bell's palsy, visual disturbance, meningitis, decreased concentration, irritability, memory and sleep disorder, nerve damage in arms and legs and few of the symptoms can be seen in Jenny's case. Pseudobulbar syndrome is more likely to happen due to the serious neurological disorder which she was suffering from.

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