The patient is a 23-year-old male who works as a baker’s assistant. He presented to the emergency room with a low-grade fever, malaise, and headache. He was sent home with a diagnosis of influenza. He presented 7 days later with a 1 day history of worsened headache, photophobia, and stiff neck. On physical examination he appeared to be in mild distress with a temperature of 38.8oC. He had mild nuchal rigidity and a maculopapular rash on his trunk, arms, palms, and soles of his feet. There were no mucus membrane lesions. He had a white blood cell count of 11,200 / mm3 with an increased frequency of PMNs. A computed tomogram (CT scan) of the head was normal, and a lumbar puncture revealed 120 white blood cells / mm3 with 80% lymphocytes and 20% PMNs. The next day a serological test of the CSF revealed the diagnosis. After obtaining the diagnosis, further questioning of the patient revealed that 1 month previously he had a painless ulcer on his penis which healed spontaneously.
The following questions are to be addressed in your paper:
1. What is the diagnosis for this patient? What stage is being presented?
2. According to your textbook, what other possible diagnoses should you have considered? What other diseases might have similar symptoms?
3. Which of the signs, symptoms, history, clinical exam, and laboratory findings were most important for you to make your diagnosis? What symptoms brought this patient to the clinic in the first place? Is this a common symptom with this disease? How common is it?
4. Are any particular people especially at risk for this disease? How is it transmitted? How prevalent is this disease? Can there be carriers? What happened during the Tuskegee experiments?
5. What is the etiological agent (causative agent) of this disease? Give the major characteristics associated with this organism (shape, gram stain reaction, habitat, special properties of this organism). Does this organism cause other diseases? If so, what are they?
6. What properties (virulence factors) does this organism have that allow it to cause disease? How do they help the organism cause disease? What are the stages of disease?
7. Are there any special techniques required to grow this organism in the clinical lab? Can this organism be grown on nutrient agar plates? How is this organism usually identified in the lab? What methods are used?
8. Is there a vaccine available for this disease? If so, what does the vaccine consist of?
9. What is the appropriate treatment for this disease? If antibiotics are suggested to be used, which antibiotics are recommended? Is antibiotic resistance a major problem with this organism?
10. What is the appropriate nursing care for this patient?