1. Team Case Study 4 Chelsea Doyle Del Marie Patton Tiffany Kullijian

2. Background 40-year-old intravenous drug user 40-year-old intravenous drug user Fever and dizziness for several weeks Fever and dizziness for several weeks Cellulitis in his right arm (inflamed and oozing) Cellulitis in his right arm (inflamed and oozing) Abnormal EKG Abnormal EKG Systolic murmur Systolic murmur Blood agar revealed: Blood agar revealed: β- hemolosis β- hemolosis Gram stain: GPC in chains Gram stain: GPC in chains

3. Differential Diagnosis Streptococcus pyogenes Streptococcus pyogenes Streptococcal pharyngitis Streptococcal pharyngitis Streptococcus agalactiae Streptococcus agalactiae

4. Important Factors Drug user Drug user What drugs is he under the influence of What drugs is he under the influence of Doesn’t take care of himself Doesn’t take care of himself Immunosuppressed Immunosuppressed Whether a sore throat was present previous to dizziness, fever, and cellulitis Whether a sore throat was present previous to dizziness, fever, and cellulitis If he has been around anyone with a sore throat If he has been around anyone with a sore throat

5. Important Facts Cont. If he has had rheumatic fever as a child If he has had rheumatic fever as a child How long has the sore on arm been inflamed How long has the sore on arm been inflamed If there are sores anywhere else besides arm If there are sores anywhere else besides arm

6. What’s Wrong? Patient had strep throat Patient had strep throat He let sore throat go untreated He let sore throat go untreated Untreated Strep. throat caused rheumatic fever Untreated Strep. throat caused rheumatic fever Inflammation from body’s natural defense caused damage to the heart (systolic heart murmur) Inflammation from body’s natural defense caused damage to the heart (systolic heart murmur) Because of the damaged skin and streptococcal infection, cellulitis was present at the injection site Because of the damaged skin and streptococcal infection, cellulitis was present at the injection site

7. Organism Streptococcus pyogenes Streptococcus pyogenes GPC in chains GPC in chains β -hemolitic β -hemolitic Causes rheumatic fever which can cause heart damage Causes rheumatic fever which can cause heart damage Streptococcus agalactiae Streptococcus agalactiae Occurs mainly in the vagina Occurs mainly in the vagina Causes neonatal bacteremia, pneumonia, and meningitis Causes neonatal bacteremia, pneumonia, and meningitis Not related to cellulitis Not related to cellulitis

8. Treatment Rheumatic Fever Rheumatic Fever Bed rest Bed rest Penicillin (Strep. Pyogenes) Penicillin (Strep. Pyogenes) Steroids (inflammation) Steroids (inflammation) Diuretic Diuretic Aspirin Aspirin Cellulitis Cellulitis Soak in warm water Soak in warm water Elevate of extremity Elevate of extremity Prevention of pressure Prevention of pressure

9. Problems With Treatment Reaction to his street drugs with the prescribed medications Reaction to his street drugs with the prescribed medications Tissue destruction if antibiotics are not taken Tissue destruction if antibiotics are not taken Damage to heart muscles and valves if treatment is not followed Damage to heart muscles and valves if treatment is not followed

10. Mode of Transmission Airborne Airborne droplets droplets Coughing Coughing Sneezing Sneezing Bad hygiene Bad hygiene Not washing hands Not washing hands Person to person contact Person to person contact Portal of entry: Nose or mouth Portal of entry: Nose or mouth

11. Prognosis If patient complies with treatment: If patient complies with treatment: He will recover from infection within 3-4 weeks He will recover from infection within 3-4 weeks Carditis may last 2-3 months in severe cases Carditis may last 2-3 months in severe cases If the patient does not comply with treatment: If the patient does not comply with treatment: He will not recover from infection He will not recover from infection Heart complications and cellulitis will continue to get worse Heart complications and cellulitis will continue to get worse Patient will most likely continue his current life-style, therefore, the outcome will not be good Patient will most likely continue his current life-style, therefore, the outcome will not be good The Rheumatic Fever will never fully disappear The Rheumatic Fever will never fully disappear