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3.Why do the Mycoplasma bacteria shown have such unusual cell

shapes?

4.  Predict the effectiveness of treating a Mycoplasma infection with penicillin, an antibiotic that inhibits cell wall synthesis.

Janet collaborated with the university health center staff to test respiratory samples from the affected students and quickly confirmed M. pneumoniae as the causative agent. To curtail the outbreak, Janet and school administrators implemented an outreach campaign to alert the university community and educate them on healthy practices to minimize pathogen transmission in the college setting.

INVESTIGATE:

5.  Should Janet's prevention plan include administering a vaccine against walking pneumonia?

Using a survey to assess the effectiveness of their outreach campaign, Janet was pleased that 79% of the students who were aware of the outbreak reported following her recommendations to reduce infection spread. She was frustrated, however, to discover that 54% of the campus was completely unaware of the outbreak, putting them at high risk both for acquiring the infection and for serving as a pathogen reservoir that could extend the outbreak.

6.  What methods of communication do you think would be the most effective means of reaching college students with this vital information?



As a nursing student, Kelsey went to a clinic in Amarillo, Texas on a service trip with her school. Her work there with the refugees primarily from Central America broadened her view of nursing and her knowledge of diseases not commonly encountered in the United States.

Working alongside Anna, a nurse mentor, Kelsey noticed that many of the patients coming to the clinic suffered from the same symptoms: mild diarrhea, abdominal cramps, lethargy, and a rash on their feet (see the Figure).




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1.  Describe the appearance of the foot rash.

2.  What does the foot rash symptom suggest about this gastrointestinal infection? Why would refugees from Central America be more likely to experience this illness than individuals from the United States?

One day, Anna and Kelsey examined Isabel, a 17-year-old woman who, in addition to presenting with diarrhea, fatigue, and a rash on her feet, was 7 months' pregnant and appeared severely malnourished.

"Isabel, are you still taking your prenatal vitamins and eating all of the foods I recommended?" Anna asked her patient.

Isabel nodded yes and said, "I eat plenty. I'm hungry all the time. This baby gives me terrible cravings. Sometimes I'm not satisfied unless I eat mud, but today, I've been chewing on this stick," Isabel said, pulling a gnawed small branch from her pocket. Anna led Kelsey out of the exam room to consult.

"Isabel is experiencing the urge to eat nonfood items, or pica. Why would Isabel demonstrate this symptom that we didn't see in our other patients?" asked Anna.

Kelsey answered, "She looks very malnourished compared with the others, and pica usually manifests in people not receiving adequate nutrition. Like the others, I think Isabel has a gastrointestinal parasite. What were the results of her blood test and stool analysis? Does the infection cause additional symptoms when the patient is pregnant?"

3.  Why would malnutrition be more prominent in Isabel than in the other patients?

Anna replied, "When I checked Isabel's blood, I found her erythrocyte count was low and her eosinophil count was elevated. I also discovered some tiny ovoid structures in her stool specimen."

Kelsey said, "From her gastrointestinal symptoms and the results of her lab work, it sounds as though Isabel has a hookworm infection."

INVESTIGATE:

4.  

a.  What does an elevated eosinophil count suggest?

b.  Why might Isabel demonstrate anemia if she suffers from hookworms?

c.  What is the connection between anemia and pica?

d.  What are the ovoid structures found in the stool specimen?

REVIEW:

5.  What organism causes a hookworm infection? How does a hookworm infection cause gastrointestinal symptoms?

"Exactly," Anna replied. "Unsanitary conditions contaminate the soil with the parasite's eggs. Hookworm larvae living in the soil penetrate the skin to gain access to a human host and most of our patients are barefoot. A dose of mebendazole will cure Isabel's worm infection, but what would you recommend to help Isabel avoid reinfection?"

Kelsey replied, "Because sanitation is much better in the United States, Isabel's risk of reinfection is already reduced. She should be encouraged not to go barefoot and return to the clinic if her foot rash comes back."





As the semester came to a close, college freshman Marla Jenkins started feeling run down and developed a cough. She took an over-the-counter cold medication to relieve her symptoms. I hope I'll feel well enough to study for my last two finals after the drugs kick in, Marla thought.

Marla's medicine did little to alleviate her discomfort, and she felt progressively worse throughout the day. By bedtime she had a headache, chills, muscle aches, fatigue, and a noticeably worse cough with a temperature of 102.9°F (39.4°C). Marla took two ibuprofen tablets before lying down for the night.

Marla didn't make it to her remaining final examinations. Her alarm went off at 7 a.m., but Marla didn't stir despite the blaring noise. Tiffany, her roommate, called to Marla but received no response. When she failed to shake Marla awake, Tiffany phoned 911.

When Marla finally awoke, she found herself in the intensive-care unit (ICU) of a hospital with her worried parents by her bedside. They were talking to Dr. Sheldon, an infectious-diseases specialist, who told them her lab results were positive for the novel H1N1 influenza virus.




1.  How many types of peplomers are found on the surface of the novel H1N1 influenza virus?

"Marla is extremely ill," Dr. Sheldon explained to the Jenkins family. "Contrary to what most people think, the flu is not always a simple illness. Flu, like any pulmonary infection, may lead to life-threatening complications that require professional medical intervention."

"How long do I have to stay in the hospital?" Marla asked nervously. "I have two final exams to take today. Can't you just give me some medicine and send me back to school?"

INVESTIGATE:

2.  What is the novel H1N1 influenza virus?

3.  What do the H and the N stand for?

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