29 Jul WHAT ARE THE CHANCES OF YOU BECOMING INFECTED WITH HIV FROM YOUR PATIENT’S TEARS?
Case Scenario I
A 7 year old girl is brought in to the doctor’s office by her mother. Upon
examination, the doctor notices that the girl has a fever, and a fine ‘sandpaper’-like rash.
The girl states that, ‘…it’s hard to swallow, and my throat hurts. My ears hurt too!” The
doctor is not surprised to find that the girl’s throat appears reddened, and her tongue is
spotted and strawberry-like. The doctor obtains a throat culture and sends the culture to
you.
1. When you receive the culture, you decide to gram stain this unknown organism.
Please list the 4 steps of gram staining.
2. After gram staining, you find that the organism is ‘gram-positive.’ You next prepare a
culture of the organism on blood agar. When you inspect the culture, you find that a
‘clear ring’ has begun to form around each of the colonies. What has caused this ring?
How does this help you to identify this organism? Please draw a picture depicting what
you can see on your Petri plate.
3. Based on the gram stain, and on the way the organism behaved on the culture media,
what organisms could this be? What is the basis for your conclusions?
4. Now let’s add the patient’s symptoms, and what the doctor observed. Based on the
little girl’s symptoms, what the doctor observed, the gram stain results, and the way the
organism behaved on the culture media, what do you think this organism is? How did
you come to your conclusion?
5. Now that you have reached your conclusion, you can go to the “Index” at the back of
your text and see everything that the author’s have included about this organism. After
reviewing this information, please tell me what this organism has in its cell wall. How
does this help the organism? Briefly describe how we gain immunity from this organism.
Case Scenario II
You are sitting in the lab, getting a head start on next week’s project. Suddenly,
the door opens and you see you professor racing toward you. As he passes you,
apparently on his way to the lab next door, he drops a baggie on your desk and says, “Do
me a favor and gram stain this for me. Oh, be careful and don’t forget to …….”
Unfortunately, the rest of his sentence is drowned-out by the whoosh of the door opening.
By the time you look up from the baggie, he’s gone.
You notice that the baggie contains a plastic tube. You can see that the tube
contains a swab, and you notice that on the outside of the bag is “E. Coli” written in
marker. You decide to follow your professor’s directions.
1. As you reach for the baggie, you remember your professor’s last words: “Be
careful…” Did he mean for you to be careful handling this specimen? Should you put
on gloves? Should you find a mask? How is E. Coli typically transmitted?
2. You remove the specimen from the bag. Please list the four steps of gram staining.
When you have finished gram staining this specimen, what color is the slide? Why is it
this color?
3. The lab is very quiet, so you decide to have a peek at the slide. The baggie was
correctly labeled, and you are indeed looking at E. Coli. Please draw what you see
through the microscope.
4. You decide that it’s time that you learned a bit more about E. Coli, so you grab your
beloved text. Where does the text say that E. Coli is normally found? Does it normally
cause us any trouble? You notice that there are a number of different types of E. Coli.
Please list all the types, and briefly mention the problems that each can cause, and who in
our society is most likely to be affected by these different types.
5. Finally, you notice that there is a particularly nasty strain of E. Coli 0157:H7. What
does this strain do? What steps can we take to protect ourselves and our loved ones from
this strain, and from other problematic strains of E. Coli?
Case Scenario III
A young girl comes into your clinic. She seems very upset as she shows you a
home pregnancy test which she has removed from her purse. The test shows “positive.”
Your patient asks you what exactly has made her test stick change colors, and how
certain she can be of this result.
You remember back to your thorough reading of chapters 18 and 19, and you
easily answer her questions.
1. Please tell me the answers that you gave her.
2. After having received her answers, your patient confides that her pregnancy resulted
from a regrettable one-night encounter with a man who has a reputation for ‘sleeping
around.’ She is concerned about her risk from HIV, and would like to be tested. How
soon after this encounter can she accurately be tested? What two tests were used
historically, and what is available now?
3. Your patient decides to be tested. Next she asks what happens if her test comes back
‘positive.’ Is there a vaccine for HIV? What therapies would you be able to tell her
about?
4. Finally, your patient shares her last concern with you. She tells you that her sister has
two daughters. Her sister’s first pregnancy was free of complication. However, your
patient tells you that her sister’s blood ‘attacked’ the second child. She is concerned that
this might happen to her as well. What is your patient talking about? How does the test
for this condition work? How might a ‘RhoGAM’ injection benefit this patient, and at
what point in her pregnancy should she receive it?
5. You say goodbye to your patient, and she thanks you for your help and for your
terrific answers to her troubling questions. As she leaves, your patient gives you a
relieved hug and you realize that your cheek is now wet from a few of her residual tears.
Do you call the ‘HAZMAT’ crew? What are the chances of you becoming infected with
HIV from your patient’s tears? Why?
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