Bio Science Assignment

09.08.2021 in Case Study

Mary’s Case

The current case is about Mary’s infection. The problem started when she sustained a deep 4 cm cut to her right calf. After that, she immediately sought medical help. In the medical center, she was given a tetanus booster injection and received a wound cleaning. Her state was getting worse at home: she suffered from pain and fever. In the medical center, healthcare providers took the tissue around Mary’s wound for culture and sensitivity. The result of the analysis showed the Staphylococcus aureus that was sensitive to Amoxicillin. The first highly important issue of this case was tetanus prevention, especially after contact with the ground as it was in Mary’s case. Tetanus is an acute bacterial infection that causes extremely serious involvement of the nervous system that leads to the tonic tension of the skeletal muscle and generalized convulsions. Clostridium tetani is the etiological cause of this disease, which can survive over the years. This bacterium survives only in anaerobic conditions such as ground. That is why Mary required the application of the necessary methods of prophylaxis (Immunise Australia Program, 2017).

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Tetanus boost injection was the first medical procedure in the center that was given to Mary. This revaccination was an essential procedure in Mary’s case because tetanus usually resulted from cuts. The primary cause of giving tetanus boost was the place where Mary got her wound, the garden. The spores of tetanus usually exist in the ground that is why Mary had a high risk of getting a tetanus infection. Emergency tetanus prophylaxis begins with primary surgical treatment of the wound and simultaneous specific revaccination. Tetanus revaccination should be carried out as early as possible, but no later than in 20 days from the time of injury because of the duration of the incubation period (Immunise Australia Program, 2017). Usually, emergency prophylaxis of tetanus is carried out in such cases as frostbite and burns from the second to the fourth degree, trauma, with skin injuries and mucous membranes, abortions carried out outside hospital facilities, penetrating damage of the gastrointestinal tract, gangrene or necrosis of any type of tissue, long-term carbuncles, abscesses, childbirth outside medical institutions (for example, at home), or bites by animals. Overall, the preparations for emergency tetanus immunoprophylaxis consist of adsorbed diphtheria-tetanus toxoid with a reduced content of antigens (ADT-M), tetanus toxoid adsorbed, and anti-tetanus serum.

In the absence of reliable information about vaccinations, the state of anti-tetanus immunity is assessed directly at the time of the patient’s treatment of the injury. The scheme for choosing an emergency prophylaxis method is based on the results of determining the level of a specific antitoxin in the blood serum of a patient or on the indirect criteria that confirm the fact of vaccination against tetanus (age, sex, the absence of contraindications and so on) (Rodrigo, Fernando, & Rajapakse, 2014).

The three stages of wound observation are an irreplaceable part of the primary medical care after getting wound with the risk of the tetanus infection. This method is related to the visual observation of the wound in order to investigate the pathological changes. The first stage is a study of the wound edges. If they are red and hot to touch, it means that there is a pathological agent in the wound that causes inflammation. It is caused by the increase of the vessel’s diameter as a reaction to inflammation. The second stage is a study of the surrounding tissues (Marieb & Hoen, 2016). The presence of the swollen tissue is the second approval of the inflammation. It is caused by the increase of the pressure in the vessels around the wound and as result water with electrolytes comes to the surrounding tissue. The third stage is the analysis of the presence of purulent and odorous discharge. This is the sign of serious pathological changes, which is the third approval of the inflammation that may result in the grave illness. In Mary’s case, these three stages were accomplished and the results have shown the presence of the Staphylococcus aureus in the surrounding tissue of the wound (Craft & Gordon, 2015).

High fever was developed by the toxins produced by S. aureus. The inflammation caused by this bacterium is a process that can result in an increase in body temperature as a result of the immune reaction to the etiologic agent. The presence of the fever in Mary’s condition has a number of benefits. First, fever is a good reaction of the organism in a prognostic sense, because it is the result of the activation of the immune system, which informs about the presence of the infection in the organism (Craft & Gordon, 2015).

Staphylococcus aureus is a kind of globular gram-positive bacteria from the genus Staphylococci (Lee & Bishop, 2016). Approximately 25-40% of the population are permanent carriers of this bacterium, which can persist on the skin and mucous membranes of the upper respiratory tract. S. aureus can cause a wide range of diseases, from mild skin infections such as acne, impetigo (can also be caused by Streptococcus metabolites), furuncle, carbuncle, staphylococcal burn-like skin syndrome and abscess, to deadly diseases, such as infectious-toxic shock, pneumonia, meningitis, endocarditis, osteomyelitis, and sepsis (Lee & Bishop, 2016). The range of diseases extends from the skin, soft tissues, respiratory, bone, articular and endovascular to wound infections. It is still one of the four most common causes of nosocomial infections, often causing postoperative wound infections (Craft & Gordon, 2015). The exogenous possible source of contamination by S. aureus is the ground that can be presented in the wound because Mary was injured in the garden. It could come to the surrounding tissue of the wound and began to proliferate and destroyed the cells that caused inflammation (Craft & Gordon, 2015). The endogenous possible source of S. aureus could be the instances of bacterial strains that physicians usually found in the nose (Lee & Bishop, 2016).

Augmentin that was prescribed to Mary is a semisynthetic broad-spectrum antibiotic that was active used against many Gram-positive and Gram-negative microorganisms. This drug destroyed the action of microbial enzymes (?-lactamases) and did not affect the microorganisms that produced these enzymes (Bullock & Manias, 2017). Staphylococcus aureus does not produce ?-lactamases; that is why it is sensitive to Augmentin. Clavulanic acid is a ?-lactam, structurally related to penicillin group, which has the ability to inactivate ?-lactamases. The clavulanic acid in the Augmentin preparation protects amoxicillin from the destructive effect of ?-lactamases and expands its activity spectrum, including bacteria usually resistant to amoxicillin, as well as to other penicillin and cephalosporin groups. That is why the main reason of the prescription of this drug to Mary is high efficiency against Staphylococcus aureus and the most reliable option in this case (Bullock & Manias, 2017).

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