CF-endterm-group-4

Republic of the Philippines
STATE UNIVERSITY OF NORTHERN NEGROS

College of Nursing and Allied Health Sciences
Brgy. Rizal, Sagay City, Negros Occidental
(034)722-4120, www.nonescost.edu.ph
A Compilation of Comprehensive Reviews on Clinical Focus
In partial fulfilment of the requirements in Microbiology and Parasitology
Submitted by:
Joshua Q. Quilar
Submitted to:
Mr. Kenneth Benignos
TABLE OF CONTENTS
ABSTRACT………...………………………………………………………..………1
Clinical Focus 6
 OLIVIA’S CASE ……………………………………………………………2
Chemical Focus 7
 ANGELA’S CASE…………..….………………………………………...….3
Clinical Focus 8
 MICHAEL’S CASE……………………..…………………………………...4
Clinical Focus 9
 KERRY’S CASE …………………..……….………………………………..5

Clinical Focus 10
 ROBERTA’S CASE…………..………..………………………….……………6
References ……………………………………………………….………...………..7
In the field of medical care, there is a complex link between signs, tests, and ways to
treat people. By carefully looking at how people feel, ordering the right tests, and using
targeted treatments, doctors try to figure out complex medical issues and help patients get
better. This balance of checking, finding out what's wrong, and treating is the art and science
of medicine. Each choice doctors make can shape a patient's path to getting well.
Olivia, a one-year-old infant, is brought to the emergency room by her concerned
parents, who report a concerning set of symptoms. The young child is experiencing excessive
crying, irritability, sensitivity to light, unusual lethargy, and vomiting. Upon physical
examination, the physician also notes swollen lymph nodes in Olivia's throat and armpits, as
well as a swollen and tender area over her abdomen, specifically the spleen.
Additionally, Olivia appears reluctant to turn her head, suggesting severe neck pain.
These symptoms and physical findings suggest a strong immune response to a systemic
infection, potentially affecting Olivia's central nervous system. Prompt medical evaluation
and intervention are crucial to determine the underlying cause and provide appropriate
treatment to ensure Olivia's recovery.
In the medical journey of Angela, a 25-year-old female patient experiencing airway
constriction and labored breathing, a series of diagnostic tests and treatments have unveiled a
perplexing puzzle. Despite a lack of asthma or allergy history, her symptoms persist, leading
healthcare professionals to delve deeper into the intricate interplay of her immune system,
genetic predispositions, and environmental triggers. Angela's case highlights the intricate
nature of medical investigations and the importance of thorough evaluation in uncovering the
root cause of her airway distress.
Michael, a 10-year-old boy in generally good health, went to a birthday party on
Sunday with his family. He ate many different foods, but was the only one in the family to
consume the undercooked hot dogs served by the hosts. The following Monday, Michael
began experiencing concerning symptoms, including fever, muscle aches, nausea, and
diarrhea. Initially, his parents assumed he had caught the flu and kept him home from school.
However, after four days, Michael's condition worsened, with the development of
severe headaches and a spike in his fever. Worried about his deteriorating health, Michael's
parents finally decided to take him to a nearby clinic, where further testing confirmed the
presence of a gram-positive rod bacterium in his blood, leading the physician to suspect a
case of listeriosis.
Kerry's a 40-year-old airline pilot, case presents a complex medical puzzle involving a
recurring rash triggered by sun exposure, abnormal test results indicating hemolytic anemia
and proteinuria, and a sudden seizure, prompting a referral to a rheumatologist for suspected
autoimmune involvement.
Roberta, a 46-year-old real estate agent, recently underwent a laparoscopic
cholecystectomy (gallbladder removal) surgery, which was performed with the aid of a
duodenoscope, a specialized endoscope. After returning home from the hospital, Roberta
developed concerning symptoms, including abdominal pain, high fever, a burning sensation
during urination, and blood in her urine.
Clinical Focus 6: OLIVIA’S CASE

Assessment:
The symptoms presented by Olivia, a one-year-old infant, including excessive crying,
irritability, sensitivity to light, unusual lethargy, vomiting, swollen lymph nodes in the throat
and armpits, and a swollen and tender abdomen over the spleen, suggest a strong immune
response to a systemic infection. The reluctance to turn her head and severe neck pain further
indicate a potential central nervous system involvement.
Diagnosis:
1. Symptoms Suggest: Olivia's symptoms, along with the physical examination findings,
suggest a strong immune response to a systemic infection, potentially affecting her
central nervous system due to neck pain and CSF abnormalities.
2. Tests Ordered:
To diagnose the problem, the physician ordered
 Complete blood count (CBC)
 Blood culture
 Lumbar puncture
The elevated white blood cell count in Olivia's bloodstream, along with the cloudy
cerebrospinal fluid (CSF) obtained during the lumbar puncture, indicates an infection.
The low glucose levels in the CSF and the high white blood cell count in the CSF
(1,163/mm3, normal range: 5-20/mm3) further support the presence of an infection
affecting the central nervous system.
3. Preliminary Diagnosis:
 Preliminary diagnosis: Meningitis, likely bacterial, due to cloudy CSF, elevated
white blood cell count, and low glucose levels in the CSF.
4. Reasoning:
 The elevated white blood cell count in Olivia's bloodstream (28.5 K/µL) and in the
CSF (1,163/mm3) indicates an active immune response to infection.
 The low glucose levels in the CSF (30 mg/100 mL) suggest bacterial consumption of
glucose, common in bacterial meningitis.
5. Recommended Treatment:
 Immediate hospitalization and initiation of intravenous antibiotics targeting common
bacterial pathogens causing meningitis.
 Supportive care to manage her symptoms, such as pain relief for her severe neck
pain, and close monitoring of her condition would be essential.
Implementation:
 Olivia should be admitted to the hospital for immediate treatment.
 Intravenous antibiotics, such as a combination of a third-generation cephalosporin (e.g.,
ceftriaxone) and vancomycin, should be started promptly to target the suspected bacterial
pathogen.
 Supportive care should include management of fever, pain, and hydration, as well as
close monitoring of Olivia's neurological status and vital signs.
 Repeat lumbar puncture may be necessary to monitor the response to treatment and
ensure the clearance of the infection from the cerebrospinal fluid.
Evaluation:
 Olivia's response to the antibiotic treatment should be closely monitored, with regular
assessments of her clinical symptoms, vital signs, and laboratory results.
 If Olivia's condition improves with the antibiotic therapy, the treatment plan can be
continued until the infection is fully resolved.
CONCLUSION
In conclusion, Olivia's presentation of symptoms, physical findings, and laboratory
results strongly indicate a bacterial meningitis infection, necessitating immediate
hospitalization and initiation of targeted antibiotic therapy. Close monitoring of Olivia's
response to treatment and ongoing supportive care will be essential in managing her
condition effectively and ensuring a favorable outcome for this young patient.
Clinical Focus 7: ANGELA’S CASE
Assessment:
Angela, a 25-year-old female patient in the emergency department, presents with shortness of breath,
airway constriction, and labored breathing. Despite no history of asthma or allergies, she experiences fear
due to a similar respiratory event that led to her father's sudden death at a young age.
Diagnosis:
1. Possible Causes of Airway Constriction:
 Airway constriction and swelling can be caused by an inflammatory response in the airways like
allergic reactions, infections, genetic predispositions, or environmental triggers could contribute to
airway constriction and swelling.
2. Swelling of Body Tissues:
 Swelling of body tissues in general is typically caused by inflammation, which leads to increased
blood flow and fluid accumulation in the affected area. Inflammation can be triggered by the body's
immune response to various stimuli, such as allergens, pathogens, or autoimmune reactions.
3. Innate Immune System Contribution:
 The aspects of the innate immune system that could be contributing to Angela's airway constriction
include mast cells and the complement system. Mast cells can release inflammatory mediators like
histamine upon activation, leading to airway swelling and constriction.
 The low level of complement protein C4 suggests a potential issue with the complement system,
which is part of the innate immune response and can contribute to inflammation..
4. Treatment with Antihistamines:
 Angela was treated with antihistamines to counteract the effects of histamine released during an
allergic response, aiming to reduce airway inflammation and constriction. Antihistamines help block
the effects of histamine and can provide relief.
5. Interest in Cytokine Levels:
 Monitoring cytokine levels in Angela's blood helps assess the inflammatory response and immune
activation, providing insights into the underlying cause of her airway constriction.
Implementation:
 Despite negative allergy testing and sputum analysis, elevated inflammatory cytokines, mildly
elevated white blood cell count, and low complement protein C4 levels suggest a complex immune
response contributing to Angela's condition.
Evaluation:
 The new information, including the elevated inflammatory cytokines and low complement C4 levels,
suggests that Angela may have an underlying autoimmune or autoinflammatory condition affecting
her respiratory system. This could be a form of vasculitis or a condition like eosinophilic
granulomatosis with polyangiitis (EGPA), which can cause airway inflammation and
constriction.
 Low levels of complement proteins, such as C4, can be seen in certain autoimmune or
autoinflammatory conditions. This includes systemic lupus erythematosus (SLE),
antiphospholipid syndrome, and hereditary angioedema.
CONCLUSION
In summary, Angela's case presents a complex diagnostic challenge that requires a comprehensive and
multifaceted approach. The negative results for common allergens and pathogens, coupled with the elevated
inflammatory cytokines and low complement protein C4 levels, suggest an underlying immune-mediated
mechanism contributing to her persistent airway constriction. Further specialized testing and investigation
will be crucial in identifying the specific cause of Angela's condition, which may involve genetic
predispositions, autoimmune processes, or other (rare)disorders.
Clinical Focus 8: MICHAEL’S CASE
Assessment
 Signs and Symptoms:
 Fever: Michael's body temperature is elevated, indicating an infection.
 Nausea and Achiness: These symptoms suggest that Michael's body is responding to an infection,
possibly with a systemic effect.
 Severe Headaches: This symptom could be a sign of meningitis or encephalitis, which are common
complications of listeriosis.
 Stiff Neck: This symptom is consistent with meningitis, which is an inflammation of the protective
membranes (meninges) surrounding the brain and spinal cord.
 Hemiparesis (Weakness of One Side of the Body): This symptom could indicate that the infection
has spread to the nervous system, causing damage to the brain or spinal cord.
 Stage of Michael's Disease:
The progression of Michael's symptoms suggests that the infection has progressed beyond the initial
gastrointestinal stage. The development of severe headaches, stiff neck, and hemiparesis indicates that
the infection has spread to the central nervous system, which is a more severe stage of listeriosis.
Diagnosis
 Bacterium in Blood: No, the presence of a gram-positive rod in Michael's blood is not part of
normal microbiota. Blood is normally sterile, meaning it does not contain bacteria. The presence of
bacteria in Michael's blood indicates that he has an infection.
 Portal of Entry: The portal of entry for the bacteria is likely the gastrointestinal route. Michael ate
undercooked hot dogs at a birthday party, which is a common source of foodborne pathogens. The
bacteria then translocated from the gastrointestinal tract to the bloodstream, causing the infection..
Planning
 Pathogen and Virulence Factors:
 The pathogen causing listeriosis in Michael is Listeria monocytogenes. This bacterium is a
facultative intracellular pathogen, meaning it can grow both inside and outside host cells. The
virulence factors that contribute to the signs and symptoms Michael is experiencing include:
 Listeriolysin O (LLO): This toxin allows the bacterium to escape vacuoles upon entry into a host cell.
 Actin Assembly-Inducing Protein (ActA): This surface protein enables the bacterium to produce actin
tails, move around the cell's cytoplasm, and spread from cell to cell without exiting into the extracellular
compartment.
These virulence factors contribute to the signs and symptoms Michael is experiencing, including the
progression to severe neurological symptoms.
 Spread of Infection:
It is likely that the infection will spread from Michael's blood. The presence of bacteria in the blood
indicates that the infection has already spread from the gastrointestinal tract. The development of new
symptoms such as stiff neck and hemiparesis suggests that the infection has spread to the central
nervous system, which is a more severe stage of listeriosis. This could lead to further complications and
potentially life-threatening conditions if not treated promptly and effectively.
Implementation
 Treatment: Michael received a broad-spectrum antibiotic and is undergoing intravenous antibiotic
therapy and fluid replacement in the hospital to combat the systemic infection.
CONCLUSION
In conclusion, His symptoms progressed from gastrointestinal issues to severe neurological
symptoms like a stiff neck and hemiparesis. The Listeria monocytogenes infection, a facultative intracellular
pathogen, spread beyond the gastrointestinal tract and into the central nervous system, causing life-
threatening neurological complications. Prompt and aggressive intravenous antibiotic therapy and close
monitoring are crucial for managing this advanced stage of listeriosis and improving Michael's chances of
recovery.
Clinical Focus 9: KERRY’S CASE
Assessment
Kerry's symptoms of developing a rash after sun exposure, despite precautions, along with abnormal
test results indicating hemolytic anemia and proteinuria, are concerning. Her seizure further complicates the
situation, prompting a referral to a rheumatologist for suspected autoimmune involvement.
Diagnose
1. Concerns about Sun Exposure:
Kerry's concern about the rash and her cautious approach to sun exposure are valid. Despite
using sunscreen and limiting sun exposure, the persistence of the rash indicates an underlying issue
that needs medical attention. It is essential for Kerry to seek further evaluation to determine the cause
of the rash beyond typical sunburn symptoms.
2. Conditions Related to Sun Exposure:
Kerry's symptoms, including the rash, proteinuria, hemoglobinuria, and low hematocrit,
suggest a potential autoimmune condition triggered by sun exposure. Conditions like lupus, which
can be exacerbated by sunlight, should be considered. The presence of hemolytic anemia and the rash
pattern indicate the need for a thorough evaluation by a rheumatologist to investigate autoimmune
disorders associated with sun exposure.
3. Referral to Rheumatologist:
Despite not exhibiting classic musculoskeletal symptoms, Kerry's case presents with systemic
manifestations like the rash, proteinuria, and hemolytic anemia, which can be indicative of
autoimmune diseases like lupus. Rheumatologists are experts in diagnosing and managing
autoimmune conditions, including those affecting multiple organ systems beyond the joints. Given
the complexity of Kerry's symptoms and the suspected autoimmune nature of her condition, a
rheumatologist's expertise is crucial for accurate diagnosis and appropriate treatment.
Plan
1. Further Testing: Kerry should undergo the recommended blood tests for lupus, including the ANA
and anti-Smith (Sm) antibody tests, to confirm the suspected diagnosis and guide treatment.
2. Treatment and Management: Depending on the diagnosis, Kerry may require treatment for
hemolytic anemia, lupus, or any other underlying autoimmune condition identified. This may involve
medications, lifestyle modifications, and close monitoring.
3. Follow-Up Care: Kerry should prioritize follow-up appointments with the rheumatologist to
establish a definitive diagnosis and develop a comprehensive treatment plan tailored to her specific
condition.
Implement
1. Confirm Diagnosis: The rheumatologist should perform the ANA and anti-Sm antibody tests to
confirm the suspected diagnosis of lupus. These tests will help identify the presence of
autoantibodies associated with the condition.
2. Manage Symptoms: Kerry's treatment plan should also address the management of her specific
symptoms, such as the photosensitive rash and hemolytic anemia. This may involve sun protection
measures, medications to control the rash, and treatments to address the anemia.
CONCLUSION
In conclusion, Kerry's concerns are valid given her symptoms and test results. It is essential for her
healthcare team to thoroughly investigate the underlying cause of her symptoms, considering conditions
related to sun exposure and autoimmune disorders, to provide her with appropriate care and management.
Clinical Focus 10: ROBERTA’S CASE
Assessment
Possible Causes of Roberta's Symptoms:
Roberta's symptoms of sudden-onset high fever, abdominal pain, burning sensation during urination,
and blood in her urine are indicative of a urinary tract infection (UTI). UTIs are commonly caused by
bacteria, with E. coli being a frequent culprit. In Roberta's case, the symptoms likely arose due to the
introduction of bacteria into her urinary tract during her recent gallstone surgery, leading to a nosocomial
(hospital-acquired) infection
Based on the information provided, some possible causes of Roberta's symptoms include:
 Urinary tract infection (UTI): The presence of abdominal pain, high fever, burning sensation during
urination, and blood in the urine strongly suggest a UTI.
 Surgical site infection: The recent laparoscopic cholecystectomy (gallbladder removal) surgery could
have led to a surgical site infection, which can cause abdominal pain and fever.
 Sepsis: The combination of high fever, abdominal pain, and other symptoms could indicate the
development of sepsis, a potentially life-threatening condition caused by the body's overwhelming
response to an infection.
Diagnosis
The physician's suspected diagnosis of a urinary tract infection (UTI) is reasonable, given Roberta's
symptoms and her recent surgical procedure. The physician's plan to order a urine culture to confirm the
presence of bacteria and identify the specific pathogen is an appropriate next step.
Possible Ways Bacteria Could Have Been Introduced to Roberta's Urinary Tract During Surgery:
During Roberta's cholecystectomy (gallstone surgery), bacteria could have been introduced to her
urinary tract through various means. One possible route is the use of medical instruments like the
duodenoscope, which, if not properly sterilized, can carry bacteria into the urinary tract. Additionally,
improper hygiene practices during surgery or postoperative care could have facilitated the entry of bacteria
into her urinary system, leading to the infection
Planning
The physician's plan to prescribe a course of the antibiotic ciprofloxacin is a reasonable initial
treatment approach for a suspected UTI. However, the physician should also consider the possibility of a
surgical site infection or sepsis, and plan for further evaluation and treatment if the UTI treatment is not
effective.
Implementation
The physician should ensure that Roberta understands the importance of completing the full course
of antibiotics, even if her symptoms start to improve. Roberta should also be advised to monitor her
symptoms closely and report any worsening or new symptoms to the physician.
Evaluation
The physician should follow up with Roberta to evaluate the effectiveness of the antibiotic treatment. If
the UTI symptoms do not improve or if new symptoms develop, the physician should consider alternative
diagnoses and adjust the treatment plan accordingly. As for how bacteria could have been introduced to
Roberta's urinary tract during her surgery, some possible ways include:
 Contamination of the surgical instruments or the surgical site with bacteria from the gastrointestinal
tract
 Improper sterilization or handling of the duodenoscope used during the surgery
 Spread of bacteria from the surgical site to the urinary tract during the procedure
 Poor hand hygiene or other lapses in infection control protocols by the surgical team
CONCLUSION
In conclusion, the physician should investigate these potential sources of infection and implement
appropriate measures to prevent similar nosocomial infections in the future. Careful follow-up and ongoing
communication will be essential to ensure a successful recovery and identify any underlying issues.
References
Bass, P. (2022, February 24). Is Squeezing Leading To Your Wheezing? Verywell Health.
https://www.verywellhealth.com/what-is-bronchoconstriction-200966
Barbhaiya, M., Hart, J. E., Malspeis, S., Tedeschi, S. K., VoPham, T., Sparks, J. A., Karlson, E. W., Laden,
F., & Costenbader, K. H. (2023). Association of Ultraviolet B Radiation and Risk of Systemic Lupus
Erythematosus Among Women in the Nurses’ Health Studies. Arthritis Care & Research.
https://doi.org/10.1002/acr.24974
Better Health Channel. (2018, July 19). Lymphatic System. Vic.gov.au.
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/lymphatic-system
CDC. (2017, June 29). Symptoms. Centers for Disease Control and Prevention.
https://www.cdc.gov/listeria/symptoms.html
CDC. (2018, December 3). Clinical Features/Signs and Symptoms | Outbreak of Listeriosis Linked to Blue
Bell Creameries Ice Cream Products | Listeria | CDC. Www.cdc.gov.
https://www.cdc.gov/listeria/outbreaks/ice-cream-03-15/signs-symptoms.html
Centers for Disease Control and Prevention. (2021, October 6). Urinary tract infection. Centers for Disease
Control and Prevention. https://www.cdc.gov/antibiotic-use/uti.html
Cleveland Clinic. (2023, April 6). Urinary Tract Infections. Cleveland Clinic.
https://my.clevelandclinic.org/health/diseases/9135-urinary-tract-infections
John Hopkins Medicine. (2019). Disorders of the Immune System. John Hopkins Medicine; The Johns
Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/disorders-of-the-immune-system
Kim, A., & Chong, B. F. (2020). Photosensitivity in cutaneous lupus erythematosus. Photodermatology,
Photoimmunology & Photomedicine, 29(1), 4–11. https://doi.org/10.1111/phpp.12018
Kivi, R. (2022, March 26). What Causes an Airway Obstruction, and How Is It Treated? Healthline;
Healthline Media. https://www.healthline.com/health/airway-obstruction
Kovacs, J. S. (2021, October 31). Urinary Tract Infection (UTI). WebMD.
https://www.webmd.com/women/your-guide-urinary-tract-infections
Lewis, S. M., Williams, A., & Eisenbarth, S. C. (2019). Structure and function of the immune system in the
spleen. Science Immunology, 4(33), eaau6085. https://doi.org/10.1126/sciimmunol.aau6085
Liao, S., & Padera, T. P. (2020). Lymphatic Function and Immune Regulation in Health and Disease.
Lymphatic Research and Biology, 11(3), 136–143. https://doi.org/10.1089/lrb.2013.0012Mayo
Clinic. (2022, February 11). Listeria infection (listeriosis) - Symptoms and causes. Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/listeria-infection/symptoms-causes/syc-20355269
Mayo Clinic . (2022, September 14). Urinary tract infection (UTI) - symptoms and causes. Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-
20353447
NHS Choices. (2020). Listeriosis. NHS. https://www.nhs.uk/conditions/listeriosis/
R.V.N.J. (2019, June 1). The Link Between Sun Sensitivity and Lupus: Rheumatology Center of New
Jersey: Rheumatologists. Www.rhcnj.com. https://www.rhcnj.com/blog/the-link-between-sun-
sensitivity-and-lupus
Vevers, S. (2023, January 11). Why does sun exposure trigger a lupus rash? Www.medicalnewstoday.com.
https://www.medicalnewstoday.com/articles/lupus-rash-from-sun

CF-endterm-group-4

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

CF-endterm-group-4

Uploaded by

Copyright:

Available Formats

Republic of the Philippines

STATE UNIVERSITY OF NORTHERN NEGROS

A Compilation of Comprehensive Reviews on Clinical Focus

In partial fulfilment of the requirements in Microbiology and Parasitology

 KERRY’S CASE …………………..……….………………………………..5

Clinical Focus 6: OLIVIA’S CASE

You might also like