Snake Hunter

 



At the town clinic in rural Arizona you receive a patient suffering from fever, chills, and a headache. He is a forty-year-old Caucasian male. He works as the local auto mechanic and says his symptoms began two days ago.

Question 1 - Single Best Answer

Many viruses can cause these symptoms, but which bacteria would be a likely cause of this trio of symptoms?   

A) Pneumococcus, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes
B) Neisseria gonorrhoea, Mycoplasma pneumonia, Clostridium tetani
C) Rickettsia, Aeromonas, Streptococci
D) Almost any bacteria could.
E) Francisella, Yersinia, Borrelia, Listeria, Leptospira

When the symptoms began, he figured it was a cold he had caught while on an overnight hunting trip for rattlesnakes and small game. But now he feels much worse than any cold or flu ever made him feel.

You ask him to tell you more about the trip in detail. He says he and a friend went together. They hunted primarily for snakes, but killed two jackrabbits, which he had skinned and cooked himself, for dinner.

Question 2 - Single Best Answer

Can any of your list of bacteria causing his symptoms be contracted from rabbits, and if so, which?   

A) Francisella
B) Yersinia
C) Brucella
D) Borrelia
E) Listeria

Most of the trip was spent hiking and searching for snake lairs in the foothills. He had consumed nothing found in the foothills besides the rabbit meat and some prickly pear cactus. All other food and water was carried in their backpacks. Neither he nor his partner had been injured in any way, and they had only the usual number of mosquito, flea, and tick bites. He had to remove a particularly tenacious tick from his forearm with a tweezer. They had also bathed in a shallow pool near a stream.

Question 3 - Single Best Answer

Which of the bacteria on your list can be contracted from insects? (For the purposes of this question, consider the tick an insect.)   

A) Pseudomonas, Streptococcus
B) Rickettsia, Streptococcus
C) Rickettsia, Borrelia, Francisella
D) Rickettsia, Borrelia, Bacillus anthracis
E) Rickettsia, Francisella, Streptococcus

Question 4 - Single Best Answer

Which of the following causes of zoonoses can be contracted from swimming or washing in natural bodies of water?   

A) Yersinia
B) Bacillus anthracis
C) Leptospira
D) Francisella
E) Borrelia

Question 5 - Single Best Answer

Should you consider plague as a valid part of your differential diagnosis for the patient under consideration?   

A) Yes
B) No

Question 6 - Single Best Answer

Plague is a bacterial disease endemic to the Southwest. What fungal disease is uniquely endemic in this part of the country?   

A) histoplasmosis
B) coccidioidomycosis
C) actinomycosis
D) candidiasis
E) cryptococcosis

Question 7 - Single Best Answer

Could this patient be suffering from coccidioidomycosis?   

A) yes
B) no

Upon physical examination the patient appears to be well developed and otherwise normal, though his pulse is elevated. You examine his extremities and locate an ulcerated lesion on his right hand. The axillary lymph nodes are swollen and hard. The patient reports pain when you palpate them.

Question 8 - Single Best Answer

The ulcer is   

A) probably unrelated to his fever
B) primary syphilis
C) possibly due to Francisella
D) definitely caused by S. aureus
E) definitely physical trauma

Besides these painful lymph nodes, he is experiencing myalgia in his upper arm and shoulder muscles. His fever is 102.5 F and he is perspiring. Upon auscultation his heart sounds fine with no rubs or murmurs. His prostate feels normal, and there is no purulent discharge from his penis, nor evidence of sores or warts upon his genitals. The infection seems to be limited to his upper right arm, so you take samples of the fluid in the ulcer on his hand for testing, as well as blood and urine samples. He is instructed to return home and rest. He is to stay warm and return to the clinic if his symptoms worsen. He is given oral Gentamycin and Cefoxitin as an initial treatment based on his symptoms. You send samples by courier to the nearest hospital, fifty miles away in a neighboring town.

Question 9 - Single Best Answer

What is your diagnosis now?   

A) tularemia or plague
B) definitely plague
C) definitely tularemia
D) Lyme disease
E) toxic shock syndrome

The patient returns and informs you that though he feels somewhat better, he is still feeling the symptoms of his infection. He tells you that he used ibuprofen as a pain reliever. You draw more blood and order specific serologic tests for the bacteria F. tularensis and Y. pestis, and begin intramuscular injections of 3000 mg of Erythromycin (at 39 micrograms/ kg body weight). You tell him to return once in the morning and once in the evening for additional shots. This regimen is to continue for the next six days. On the morning of his third day on the new antibiotics he reports that his fever and pain have disappeared. His lymph nodes are not as swollen. You caution him to continue with his therapy in order to completely eliminate the offending organism. The serological testing confirms the presence of antibodies to F. tularensis.

Question 10 - Single Best Answer

Where did the organism enter the body?   

A) lungs
B) hand
C) genitals
D) stomach (by eating the rabbit meat)
E) through an insect bite

Question 11 - Single Best Answer

What was the source of the disease?   

A) mosquito bite
B) contaminated cactus
C) rabbit blood
D) bad water
E) flea bite

Question 12 - Single Best Answer

What is a major virulence determinant of F. tularensis?   

A) exotoxin
B) antigenic variation
C) intracellular growth
D) complement resistance
E) adherence to respiratory mucosa