Question: Faculty, students, and staff at Rayburn High School have been dealing with an epidemic of unsightly, painful boils and skin infections. Over 40 athletes have been too sore to play sports, and 13 students have been hospitalized.

1. Faculty, students, and staff at Rayburn High School have been dealing with an epidemic of unsightly, painful boils and skin infections. Over 40 athletes have been too sore to play sports, and 13 students have been hospitalized. Clinical samples are taken from the hospitalized students for testing. The bacterium is Gram-positive, mesophilic, facultatively halophilic, spherical and attached in clusters. (25)

• What bacterium caused this condition?
• How might the bacterium have been transmitted?
• What are some virulence factors used by this bacterium?
• What treatment is typically used? Are there any issues with this treatment?

2. Ernesto is volunteering at a medical clinic, and this month hundreds of children are coming in so sick that some do not survive, many less than one year old. One of Ernesto’s patients is Maria, a very sick 13-month-old girl with very forceful coughing. Each cough is shocking, louder than you would expect from even an adult, followed by a high-pitched gasp for breath. The coughing spasms go on and on, depriving Maria of air until her lips and body turn blue. Eventually, she coughs so hard that she vomits. (20)

• What illness does Maria have? What symptoms led you to this decision?
• What pathogenic microorganism causes this disease?
• What are Maria’s treatment options?

3. The Davises were excited about their newborn twin boys and couldn’t wait to take them to see Mr. Davis’s father. Grandfather Davis was excited to see his first grandsons as well and thought their visit might take his mind off the pain of his shingles, which had suddenly appeared only days before. (25)

• What pathogenic microorganism is responsible for Grandfather Davis’s shingles?
• What treatment can remove this microorganism from the body?
• How did Grandfather Davis get shingles? Are the twins at risk of getting shingles from him?
• If Mrs. Davis asked you about visiting her father-in-law with the twins, what is your advice?

4. The jet takes off from Johannesburg, South Africa, and Lance relaxes in his seat. The constant, deep coughing of a woman seated beside him interrupts his reverie. Her loud, incessant coughing continues for the entire flight, and often she rubs her chest as if it hurts. Four weeks later, Lance opens a letter from the state department of health and learns he was exposed to a potentially deadly bacterium. The letter advises Lance to have his physician administer a skin test to determine if he has been infected. (30)

• What disease does the state department likely suspect was on the flight?
• What pathogenic microorganism causes this disease?
• How was the bacterium likely transmitted on the flight?
• What is the name of the skin test Lance will receive?
• What other diagnostic tests can identify the microorganism?
• What treatment should be given if Lance is infected? What are some concerns with treatment?

Extra Credit (+10)

Fever, chills, nausea, weakness and general yuckiness. Carlos thought he was getting the flu. Further, he had pulled a cactus thorn from his arm the day before, and the tiny wound had swollen to a centimeter in diameter. It was red, extremely hot, and much more painful than such a puncture had a right to be.

He shivered in bed with fever the next two days and suffered more pain than he had ever experienced, certainly more than the time he broke his leg. Even more than passing a kidney stone. The red, purple, and black inflammation on his arm had grown to the size of a baseball. It was hard to the touch and excruciatingly painful. He decided it was time to call his brother to take him to the doctor.

Carlos’ blood pressure dropped severely, and he was unconscious by the time they arrived. The doctor immediately admitted him to the hospital.

• What illness does Carlos have? What symptoms led you to this decision?
• What pathogenic microorganism is likely to have caused this condition?
• How might the microorganism have been transmitted?
• What virulence factor caused the fever? The extreme inflammation?
• What are Carlos’ treatment options? Why is it important to begin immediate treatment?

Tim, a well-known local businessman, is often seen with his ever-present cigar and jokes about the ‘smoker’s cough’ that frequently punctuates his conversations. Recently, Tim has been coughing more than usual – as well as experiencing a scratchy throat and low-grade fever. When the cough starts keeping him up at night, Tim finally goes to the doctor. Because Tim’s cough is dry, the doctor suspects a respiratory infection and orders a routine sputum culture. The sputum has a normal appearance, and a Gram test doesn’t reveal any pathogenic bacteria. Tim goes home, but a week later he’s back. Now he’s coughing nonstop, and he is sweaty and shaking. He is terrified that he has lung cancer.

• What disease does Tim likely have? What specific microorganism caused Tim’s disease?
• Why did the Gram stain not detect bacteria? How else can the doctor confirm the diagnosis?
• What treatment should Tim be given? What are some concerns with treatment?
• What normally protects the respiratory tract from infection? How could smoking have exacerbated Tim’s illness?