Wait, huh?

Answer to Mystery Diagnosis #4:

Urinary Tract Infection

Urinary System 

A Urinary Tract Infection (UTI) is an infection that starts in your urinary system.  The urinary system is composed of the kidneys, ureters, bladder, and urethra.  Most UTIs involve the infection of the lower urinary tract – the bladder and the urethra.  A UTI is caused by a pathogenic organism (bacteria, fungi, or parasite).  The most common cause of UTI infections is the Escherichia coli bacterial strains that usually inhabit the colon.  Other bacteria that cause UTI infections include; Pseudomonas, Staphylococcus, Mycoplasma, Chlamydia, and Neisseria.  Fungi that can cause UTIs consist of Candida (yeast) and parasites such as Trichomonas. 

There are many risk factors of UTIs.  In general, any interruption or impedance of the normal flow of urine is a risk factor.  Women are more susceptible than men to UTIs because a woman’s urethra is shorter than a man’s.  Also, a woman’s urethra’s exit is close to the colon, which allows easier entry for pathogens.   

Signs and Symptoms (young individuals):

·        Frequent urge to urinate

·        Pain or burning during urination

·        Cloudy urine

·        Blood in urine can be present

·        Abdominal discomfort

·        Fever

Signs and Symptoms (in the elderly):

·        Mild or NO symptoms of UTI as seen in younger individuals)

·        Weakness

·        Lethargic

·        Sudden onset of confusion

·        Agitation

Detection of UTI:

·        Urine sample – a urinalysis will detect a high number of white blood cells (leukocytes), + bacteria, and + nitrite. 

Treatment of UTI

·        Antibiotics such as Ciproflaxacin (Cipro)

·        Home remedies include; cranberry juice, yogurt, and vitamin C.

Most UTIs cause no complications if they are treated quickly.  However, if left untreated UTIs can lead to dehydration, kidney failure, and sepsis. 

In Norma’s case, she displays the typical signs of an UTI that occurs in the elderly – a sudden onset of confusion and agitation. 

References:

Davis, Charles P., and Jerry R. Balentine. "Urinary Tract Infection (UTI In Adults) Symptoms, Causes, Treatment - What Causes a UTI on MedicineNet." MedicineNet.com. Web. 31 Oct. 2011. <http://www.medicinenet.com/urine_infection/page2.htm>.

Wait, huh?

Nora is a very active and lively 81 year-old grandmother.  Nora has been living in her daughter’s house for about the past five years and helps out with cooking, cleaning, laundry, and her grandchildren’s homework.  One day, Nora’s daughter noticed that Nora has been displaying a sudden onset of confusion and agitation.  Throughout the day, Nora’s mood changed dramatically and drastically.  So much, that Nora had no idea who her daughter or her grandchildren were.  Nora was also unable to perform her daily tasks that she was able to do the day before. 

Nora’s daughter took Nora immediately to her PCP (primary care physician) to figure out what was going on.  At the PCP, Nora did not complain of any pain or discomfort and she did not have a fever.  She was alert and oriented x 2 (she was oriented to time and place but not to person). 

Signs and Symptoms:

Sudden onset of –

1)    Confusion

2)    Agitation

What do you think Nora has?

Wisdom Teeth

Answer to Mystery Diagnosis #3:

Toxic Shock Syndrome

Toxic Shock Syndrome (TSS) is a toxin-mediated acute life-threatening illness that is caused by the bacterium Staphylococcus aureus or Streptococcus pyogenes.  

TSS was first discovered in 1978 and was originally liked to the use of tampons.  However, 50% of TSS cases are not associated with tampon use.  Other cases of TSS can include the bacterium invading areas of injured skin (such as cuts and scrapes), burns, and surgical sites.   

Signs and Symptoms:

·         High fever

·         Rash that resembles a sun burn

·         Desquamation (skin peeling)

·         Hypotension

·         Multi-organ failure (involving 3 or more organ systems)

·         Myalgia (muscle pain)

·         Vomiting

·         Diarrhea

·         Headache

To detect TSS:

·         Blood cultures may be positive for Staphylococcus aureus or Streptococcus pyogenes growth

·         Usually diagnosed based on signs and symptoms

Treatment

·         Antibiotics

·         Dialysis (if kidney problems occur)

·         Fluids intravenously

·         Blood pressure medications

·         Removal of foreign materials (such as tampons or nasal packing)

·         Site of infection will be drained

TSS is a rare; however, it can fatal in up to 50% of cases.  In order to prevent TSS; wash your hands often, use a clean bandage for skin wounds, avoid tampons or change tampons frequently.   

My cousin obtained TSS by the bacteria Streptococcus pyogenes.  Streptococcus pyogenes is the strain of bacteria that causes strep throat.  My cousin was not aware that she was sick with strep throat when she had her wisdom teeth removed.  During her surgery, the S.pyogenes bacteria traveled into her surgical sites in her mouth and then infected her blood stream.  And that is how she became infected with TSS. 

References:

Larissa, Hirsch. "Toxic Shock Syndrome." KidsHealth - the Web's Most Visited Site about Children's Health. Jan. 2011. Web.17 Oct. 2011.  <http://kidshealth.org/parent/infections/skin/toxic_shock.html>.

"Toxic Shock Syndrome - PubMed Health." PubMed Health. 11 Sept. 2010. Web.17 Oct. 2011.                 <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001676/>.

Venkataraman, Ramesh, and Michael R. Pinsky. "Toxic Shock Syndrome." Medscape. 16 July 2010. Web. 17 Oct. 2011. <http://emedicine.medscape.com/article/169177- overview>.

Wisdom Teeth

My cousin was 18 years old when she had her wisdom teeth removed.  Her surgery went smoothly and there were no complications.  About four days after her surgery, she was feeling pretty sick.  She had a very high fever, muscle aches, headaches, hypotensive (low blood pressure), and a rash.  Her rash was widespread, red, and looked like a sunburn.  My cousin went into the emergency room and tests showed that her kidneys and liver were going into organ failure.   She was also experiencing signs of heart failure.   Her skin was peeling due to the rash and her hair was falling out.   She was immediately admitted into the hospital.  This was a very serious condition that she almost died from. 

Signs and Symptoms:

-malaise (a feeling of general discomfort)

-high fever

-muscle aches

-rash that resembled a sunburn

-hypotension (low blood pressure)

-kidney, liver, and heart failure

What do you think is going on?

Boy Scout

Answer to Mystery Diagnosis #2:

Rocky Mountain Spotted Fever

Rocky Mountain Spotted Fever is a disease that is caused by the bacteria, Rickettsia rickettsii, carried by ticks.  The bacterium is spread to humans by a tick bite.   

Most recent cases of Rocky Mountain Spotted Fever have been reported in Virginia, North Carolina, South Carolina, Maryland, Georgia, Tennessee, and Oklahoma. 

Most cases occur in the spring and summer months.  In 2006, approximately 2,300 cases were reported in the United States. 

Risk factors include hiking or camping in heavily wooded areas. 

Signs and Symptoms

-         Chills

-         Confusion

-         Fever

-         Headache

-         Muscle pain

-         Rash – rash usually first appears on wrists and ankles with spots that are 1 – 5 mm in diameter

Serious complications can occur such as; brain damage, heart failure, kidney failure, meningitis, pneumonitis, shock, and lung failure.  Paralysis, hearing loss, and nerve damage can also occur. 

Tests to detect RMSF:

-         Antibody titer

-         Complete blood count (CBC)

-         Kidney function tests

-         Partial thromboplastin time (PPT)

-         Prothrombin time (PT)

-         Urinalysis

-         Skin biopsy

If RMSF is left untreated it can become life-threatening and fatal.   About 3% of people who get this disease will die. 

Watch out for those tick bites! Make sure if you are out camping or hiking you take extra precautions because RMSF is known to occur in ticks located in Virginia.  Wear long pants, shirts, closed toed shoes, and tick repellent.  

“Rocky Mountain Spotted Fever – PubMed Health.”  Rocky Mountain Spotted Fever.  9 June 2011.  

 Oct. 2011. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH00001677/>