Diagnosis Report for University Group

Background Information

There are 9 students at a university: Sue, Jill, Marco, Maria, Maggie, Alvin, Arnie, Anthony, and Wanda. The case first started when Sue Smith came into the university infirmary complaining of a large headache, extreme fatigue, and a fever. There were several other students with similar symptoms, bringing the need to explore further. This lab report will describe the process through which the different causes were found and how all the cases were interrelated. NOTE: All of the ELISA tests run were for neisseria meningitidis.

The Patients

Sue: Sue is an 18 ­year­ old biology major. She just recently moved into a dorm with her roommate, Jill. Sue is on the soccer team. She has been experiencing intense stress with multiple soccer games and a major calculus test. This is causing her to have little to no sleep. Sue also reported that she broke her ankle when she was eleven and that she has a mild case of asthma that she controls with an inhaler. Recently, Sue has been complaining of a headache as well as a slight fever. She has extreme lethargy and believes it’s due to stress. While visiting the college infirmary Sue informed medical personnel about stiffness in her neck. Sue also had a fever of 100 degrees. Sue agreed to further testing so we could better diagnose her infection.

Testing Results: Sue’s blood was collected to run a BLAST test on it. A DNA sequence was discovered to contain neisseria meningitidis, a form of meningitis. To confirm the suspected diagnosis, an ELISA test was run on her spinal fluid. Sue tested positive to the meningitis with an antigen level of 50 micrograms per milliliter.

Treatment: Sue was prescribed with antibiotics to fight the meningitis bacteria as well as corticosteroids for inflammation in her neck.

Jill: Jill is Sue’s roommate. She is also on the college’s soccer team with Sue. Lately, Jill has been feeling tired, saying her body feels “tight”. She played the entire soccer game for the last 2 days and has been completing multiple sessions with the trainer. She stretches to help with the light feeling all over her body, but she still feels sore. She says that she mostly drinks water, and tries to stay away from highly caffeinated drinks. Jill does tend to have a cigarette every now and then, although she is trying to quit. Spinal fluid was collected from Jill and an ELISA test was run to test for meningitis. Her test came back positive for Meningitis with an antigen level of 12.5 micrograms per deciliter. We decided to treat Jill with Antibiotics and corticosteroids to fight the bacteria and decrease the inflammation-causing her symptoms.

Anthony: Anthony is a reporter for the school newspaper. He spends most of his time running around campus covering multiple games at a time. Anthony came into the infirmary with a dry cough, muscle aches, congested sinuses, and a temperature of 100 degrees Fahrenheit. Anthony reported that he has been feeling more tired than normal. He used over the counter medication but said it seemed to have no effect except that it relieved some of his sinus congestion. A BLAST was run on Anthony’s blood and identified the Influenza B Virus. Acetaminophen was recommended to decrease the fever and help with the muscle aches. Antiviral medication was also prescribed to fight the virus. An ELISA test was run on the patient to test for meningitis but returned negative.

Wanda: Wanda is in the same sorority as Sue and Jill. She has been waking up with a sore throat and swollen glands. She has also had a fever for the past few days. Ray, Wanda’s boyfriend, has the same symptoms as Wanda but refuses to go to the doctor. A BLAST test was run on her blood. The results showed the Human Herpesvirus 4 strain, also known as Mononucleosis. There is no known treatment for Mono except for lots of rest and plenty of fluids. To help with the sore throat a streptococcal was prescribed. Wanda’s spinal fluid was collected to run an ELISA test on meningitis. Her test results were negative. So we ran

Maggie: Maggie lives in the same dorm building as Sue and Jill. She came to the infirmary complaining of a scratchy her throat. She has been drinking tea and gargling salt water to help with the irritation. She has not been able to regulate her temperature, coming in with a fever of 103. She has been experiencing hot and cold flashes. A BLAST test was run, identifying strep throat in her system. An ELISA test was run for Maggie, but it was negative. She was prescribed antibiotics for up to 10 days to clear the bacteria out of her system.

Maria: Maria is a very close friend of Sue and Jill. She shares food and beverages with both of them. Maria has reported that she feels tired with no energy. She also reported that she feels like her head is on fire. Maria has a fever of 103. She has not gone to a doctor yet. An ELISA test was run on Maria’s spinal fluid, and it returned positive. Maria had an antigen concentration of 3.33 micrograms per milliliter. Maria was prescribed some antibiotics and corticosteroids.

Arnie: Arnie is a photography student at the college that loves to take pictures of the athletic events at school. Some of his pictures have been featured in the school newspaper. Anthony has been interacting with Arnie for help. Arnie has reported a cough and a runny nose. He has tried increasing his vitamins to decrease the spread of the infection, but the infection still got worse. Arnie came into the infirmary with a fever of 100.5 degrees. A BLAST was run on Arnie’s blood and identified the Influenza B Virus. Acetaminophen was recommended to decrease the fever and help with the muscle aches. Antiviral medication was also prescribed to fight the virus. An ELISA test was run on the patient to test for meningitis but returned negative.

Marco: Marco is Sue’s lab partner and friend in biology. The pair spend many hours together, and they share food. Marco reported extreme fatigue and a large headache. An ELISA test was run on Marco’s spinal fluid and returned positive for meningitis. Marco had an antigen concentration of 1.67 micrograms per milliliter. Antibiotics and corticosteroids were prescribed.

Alvin: Alvin is dorm neighbors with Marco. He has reported a lack of sleep this past week due to a major chemistry test he is studying for. He has also reported a headache and sore throat. Alvin refused to give consent for a BLAST on his blood. However, an ELISA test was run for Alvin, but it returned negative. It was noticed that Alvin met Wanda with a cup of coffee, therefore it can be inferred that Alvin has mononucleosis. Wanda and Alvin may have shared the cup, spreading the disease.. Since there is no definite treatment, a recommendation has been given that he rest and drink plenty of fluids.

Conclusion

Using all the evidence, it can be assumed that patient zero is Sue, as she had the highest concentration of meningitis in her spinal fluid. A large concentration means the bacteria can spread easily.

How it Spread

To find patient zero, concentrations of meningitis in each of the patients of the ELISA test were taken. Patient zero is the index case or initial patient in the population of an epidemiological investigation, therefore a higher concentration meant the bacteria has cultivated longer in the patient. Using this information, it was determined that Sue is patient zero, as she had the highest concentration of meningitis at 50 micrograms/milliliter.

The four patients with meningitis were Sue, Jill, Maria, and Marco. Meningitis mainly spreads through droplets of respiratory or throat secretions from carriers and prolonged contact with a carrier. The relationships between the patients were explored to find the spread of the bacteria. Jill was roommates and teammates with Sue, meaning the meningitis could easily spread to her, through living in close quarters. Jill had the next highest concentration of meningitis at 12.5 micrograms/milliliter. The next highest is Maria, at 3.33 micrograms/milliliter. Maria reported that she always shares food with Sue and Jill, meaning meningitis could have easily spread to Maria through droplets of saliva. Marco had the lowest concentration of meningitis at 1.67 micrograms/milliliter. Marco continually shared food with Sue, therefore droplets of saliva could have transferred the meningitis. There was a possibility that Marco may have been patient zero since his antigen concentration was so low he might have been at the end of his illness, however, Marco said that he wanted to treat whatever he had as soon as possible before he got worse.

The Influenza B virus was also diagnosed for both Arnie and Anthony. Arnie reported that he had been dealing with the symptoms for the flu longer, and is therefore more likely to be patient zero for this virus. Arnie interacted with Anthony frequently for school pictures and spread the flu as a consequence through droplets of saliva or cough.

Mononucleosis was diagnosed for Wanda and Alvin. Wanda was diagnosed through a BLAST run on her blood sample. She also reported that her boyfriend had all the same symptoms and they both refused to go to the doctors for a little while. Alvin has mononucleosis as well, as Wanda met him with a cup of coffee after the first checkup. However, further testing could not proceed as Alvin refused to cooperate.

Maggie was diagnosed from strep throat, most likely given to her from Sue, Jill, or Maria. Meningitis has the same bacteria as strep throat, therefore the bacteria could have easily spread.

Treatments

Neisseria Meningitidis: For the patients that tested positive for neisseria meningitidis (Sue, Jill, Maria, and Marco), cefotaxime was prescribed and a corticosteroid for the inflammation that meningitis can bring on. Cefotaxime better fights the bacteria and it better crosses the blood-brain barrier when fighting the bacteria. To prevent the spread of the disease, the Meningococcal conjugate vaccine (MCV4 or Menactra) will be given out to all the patients that were tested and returned negative for meningitis from the ELISA test as well as all of the other students in the campus. If the students have not been vaccinated before and they are currently sick from another infection, it makes them highly susceptible to bacterial meningitis.

Influenza B Virus: Antiviral medication was prescribed to fight the virus. This medication block ion channels that reduce the virus’ ability to reproduce. To further prevent the virus from spreading, students on campus will be subject to the Haemophilus influenzae type b vaccine. This allows antibodies to be developed against the virus, should it enter the system.

Mononucleosis: There is no treatment for mono, however it is important to reduce contact with others, rest, and take a lot of fluids.

Strep Throat: Doctors typically prescribe penicillin or amoxicillin to treat strep throat. For individuals with a penicillin allergy, newer generations of antibiotics may be used. These include cephalexin, erythromycin and azithromycin. All of these antibiotics kill strep bacteria by attacking and weakening the cell wall, causing the bacterium to burst open.

References

• http://health.nytimes.com/health/guides/disease/the­flu/overview.html
• http://www.mayoclinic.com/health/mononucleosis/DS00352/DSECTION=treatments­
• http://www.cdc.gov/meningitis/bacterial.html
• http://en.wikipedia.org/w/index.php?title=Cefotaxime&oldid=568704104
• http://www.everydayhealth.com/meningitis/vaccination.aspx