can anyone help me with this? A 47-year-old diabetic male comes into his doctor\

Question

can anyone help me with this? A 47-year-old diabetic male comes into his doctor's office with fever, pain, and swelling in his right leg. He says his symptoms started about a week ago. He noticed some redness and swelling in his right leg which was followed by a brownish discoloration of the skin and the appearance of bloody blisters. A physical exam revealed extensive cutaneous gangrene over his right leg and many ruptured blisters. In addition, he has a dark, necrotic scab surrounded by very red skin which resembles a third-degree bum. A swab of the infected tissue of the leg reveals chains of gram-positive cocci under the microscope. A biopsy of the infected tissue reveals areas of necrosis in the dermal and subcutaneous layers along with infiltration of PMNs. In addition, the blood vessels within the subcutaneous layer are inflamed and contain blood clots. The patient was sent to the hospital where rapid removal of the necrotic tissue was required. The patient was also prescribed antibiotics. He eventually recovered and was released after an extended stay in the hospital. What disease does this patient have? What is the causative organism? Why was rapid removal of the necrotic tissue necessary? What may have predisposed this patient to this disease? Which antibiotics was the most likely prescribed and why?

Explanation / Answer

1). Gangrene is the localized tissue death and decomposition due to the obstruction of blood flow or bacterial infection. Diabetic patients often suffer from diabetic foot gangrene due to the obstruction of blood flow. In the given case, the patient is suffering from diabetic foot gangrene. The affected area looks dark, wit necrotic scab surrounded by red coloured skin.

2). Diabetic patients suffer from dry gangrene, which generally do not suffer from infection, dry gangrene may lead to wet gangrene, which is always associated with bacterial infection. Streptococcal species (gram positive cocci) causes gangrene, which is characteried by chains of streptococci. In this case, the causative organism is streptococcal species.

3). Rapid removal f necrotic tissue is necessary because it spreads to the other healthy tissues.

4). In diabeteis patients a small injury generally causes infection, which leads to gangrene. In this case, the might encountered an injury, which led to gangrene.

5). The preferred anti-biotics are penicillins, because they are more affective towards gram-positive bacteria.

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