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California Association Distance Learning Program
Notification of Distance Learning Deadline This is a reminder that all the continuing education units required to renew your license must be earned no later than the expiration date printed on your license. If some of your units are made up of Distance Learning courses, please allow yourself enough time to retake the test in the event you do not pass on the first attempt. CAMLT urges you to earn your CE units early! |
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If you pass, your certificate will be mailed to you from
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A Plague On U.S.
Completion of this course
requires downloading the Acrobat Version (link above).
You may then print a copy or view the downloaded file on your computer
to see the course material.
CASE STUDY (1):
A middle aged couple was vacationing in New York City from their ranch in New
Mexico. After several days of enjoying the luxury of their hotel and seeing
the sights, they both began feeling ill. Their symptoms were similar, fever,
fatigue, myalgia and one-sided inguinal swelling. Two days later, on Nov. 5,
they went to an emergency room (ER) in a New York City hospital after consulting
with their physician in New Mexico and the doctor at the hotel.
On admission the 55 year-old man appeared sickest with chills, diaphoresis (sweating), and lower extremity cyanosis. He had tender left inguinal adenopathy with overlying edema. His temperature was 104º F., blood pressure - 78/50, WBC count - 24,000/µL (normal: 4,300 - 10,800/µL), Platelet count - 72,000/µL (normal: 130,000 - 400,000/µL). A blood culture was taken and after 24 hours a gram stain showed bipolar gram negative rods.
The 47 year-old wife had tender right inguinal and femoral adenopathy with overlying erythema and induration. Her temperature was 102.2º F, blood pressure - 120/72, WBC count - 9,500/µL, platelet count - 189,000/µL. Aspiration of the inguinal lymph nodes did not yield any material.
CASE STUDY QUESTIONS:
1. What is the most probable organism recovered from the blood culture?
2. Where did the couple most likely become infected?
3. What is the usual route of infection for this disease?
4. The causative organism is on the list of possible bioterrorist agents. Why
wasn't this episode considered to be a bioterrorist incident?