Microbiology Case Study

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Microbiology case study
Spring 2009

Case Study

On July 14th, a 26 year-old man developed severe nausea and bloody emesis. At a local hospital emergency room, he was treated with IV fluids and antiemetic medication and admitted for further observation. That evening he became disoriented, combative, and had difficulty breathing. On July 16th, he became hypotensive and hypoxic and was transferred to a specialty care facility for ventilator support. Examination revealed a temperature of 104 F (40 C), unequal pupils, copious oral secretions, scattered bilateral pulmonary crackles, and a white blood cell count (WBC) of 46.6. Broad spectrum antibiotics were initiated. On July 20th, the patient developed a cardiac arrhythmia, respiratory and renal failure and died on July 21st. Three days earlier, a friend told the family that sometime around May 12th, the patient had been awakened by a bat on his right hand. He killed the bat and was bitten in the process. The patient did not seek medical attention. Investigation found in the patient’s house multiple portals of entry for bats, openings between the attic and living areas, and extensive deposits of guano in those areas.

1. What is the diagnosis?
2. What organism caused the disease?
3. Who can get the disease?
4. How is the disease transmitted?
5. What is the course of treatment for this illness?
6. How is a person affected by the disease?

1. Rabies
2. Rhabdovirus. An RNA virus that belongs to the order Mononegavirales, viruses with a nonsegmented, negative-stranded RNA genome. Has a distinct “bullet” shape.

3. All warm blooded hosts (species of mammals), including humans, and is almost always fatal.

4. Transmission of rabies virus usually begins when infected saliva of a rabid animal host is passed to an uninfected animal. Various routes of transmission have been documented and include contamination of mucous membranes (i.e., eyes, nose, mouth), aerosol...
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