The causative organism for tetanus is Clostridium tetani and can be found in manure containing garden soil. On infecting a wound it can live anaerobically, is a Gram-positive, endospore-forming, non-capsule forming pathogenic bacterium. The fact that it is found in soil and can infect a wound is a matter of concern in Mary's case. Because she suffered a 4cm deep cut on her leg while working in the garden, she may have exposed herself to C. tetani endospores. It is also not clear whether she has received a tetanus vaccine recently (Immunise.health.gov.au, 2017).
According to the guidelines in the “The Australian Immunisation Handbook” (Dept. of health, 2017) on administering a tetanus booster, discuss the rationale for giving Mary the tetanus booster
The rationale for giving Mary a tetanus booster is that she is 50 years of age and all Australians above this age are recommended for a tetanus toxoid booster, particularly if they have not received one during the previous 10 years. Besides, there have been cases where a booster has not protected people with minor wounds from getting tetanus, so a booster soon after the injury is usually given. Also, her exposure to garden soil puts Mary at a risk of Clostridium tetani infection.For each of the three wound observations indicate, and provide a rationale, as to whether it is a sign or a symptom.As soon as injury occurs, an acute inflammatory response sets in. The process of homeostasis begins in order to prepare for repair of the injured tissue.
Discuss the physiological basis of the first observation.
The wound edges are hot to touch and red. There is an instant release of chemicals that cause inflammation. These include histamines, complement components, prostaglandins and kinins among others. Under the impact of these the arterioles dilate and the permeability of their walls increases. This increases blood flow to the area so it appears red. Chemotactic movement of lymphocytes, monocytes and neutrophils to the area increases. An increase in the local temperature increases the metabolic rate of cells in the vicinity of the injury, so the area is hot to touch. Cells with phagocytic action, such as macrophages identify and kill the pathogens at the site of the injury (Marieb & Hoehn, 2014).`
Discuss the physiological basis of the second observation.
The surrounding tissue is swollen because of the leakage of fluid from the capillaries. This leads to the formation of exudate. The spaces between tissues are filled with the protein-rich fluid and this causes swelling of the tissue. It is also referred to as edema. Often the swollen tissue is painful and restricts activity in the affected area, thus forcing the patient to rest. This allows the process of repair to occur faster (Marieb & Hoehn, 2014).
Discuss the physiological basis of the third observation.
A purulent and odorous discharge is a sign that the wound is infected. Mary has also complained of fever and may have to take systemic antibiotics in order to treat the infection. In Mary's case the exposure of the wound to garden soil could be the reason why her wound became infected with microorganisms. The warm, moist and nutrition rich environment of the subcutaneous tissue promotes the growth of pathogenic organisms. The immune system responds by increasing exudate formation, inflammation and swelling and pain (Bowler, Duerden, & Armstrong, 2001). The wound can be sampled for a culture test to determine the pathogen and a sensitivity test can help to find the antibiotic that the infectious pathogen/s is sensitive to (Bowler, Duerden, & Armstrong, 2001). Once the antibiotic is administered it can kill the pathogen and help in the recovery from the injury.
Development and benefits of fever (Total: 5 marks).
How did Mary’s fever develop?
Mary developed fever as a consequence of the inflammatory response to the infection of her wound. Release of exogenous pyrogens in the form of endotoxins released by the pathogenic organism can stimulate the release of endogenous pyrogens or cytokines, such as tumor necrosis factor-α, interleukin-1, interleukin-6 and interferons. Prostaglandin E2 and endothelin I along with corticotrophin-releasing factor are released in response to the pyrogens. These act upon the preoptic area, a region of the anterior hypothalamus and trigger a febrile response. The temperature balance point is then raised to a higher level than it normally is. Heat production in the body follows accompanied by conservation of the heat and the body temperature begins to rise, resulting in fever (Craft, 2015).
Discuss two ways in which fever is beneficial.
Fever is beneficial in reducing infection because it can kill pathogens because they cannot multiply at higher body temperature. It reduces serum concentrations of copper, iron and zinc, these minerals are vital for replication of bacteria. Fever helps in faster diffrentiation of lymphocytes into B cells and T cells so the immune response becomes stronger and in response to fever the phagocytosis gets enhanced for faster killing of pathogens (Marieb & Hoehn, 2014; Craft, 2015).
Name one endogenous source of contamination and discuss the mode of transmission from the source to the new host.
Endogenous sources of contamination with Staphylococcus aureus is the skin and the mucosal surfaces. The organism is a commensal and lives on these surfaces without causing any harm to the human body. But in the inner reaches of a wound, the environment is favourable for it to multiply and offers more moisture, an optimal temperature and ample nutrition. But once it enters the wound, it becomes pathogenic and delays the tissue repair and causes fever. The Stapylococci can be transferred to the wound site through the patient's hand that may have been contaminated due to nasal mucosa or the oropharyngeal mucosa (Lee, 2016). In a study on patients with leg ulcers it was found that some patients who harboured Staphyloccoccal strains as nasal carriage had the same strains in the leg ulcers. This points to the risk of endogenous transmission of bacteria in patients (Gjødsbøl, Skindersoe, Skov, & Krogfelt, 2013). Removal of infection is difficult when a reservoir is present in the patient's body.
Name one exogenous source of contamination and discuss the mode of transmission from the source to the new host.
When transfer of an organism to the patient occurs through contact with other surfaces or persons, the source is said to be exogenous. An exogenous source of the Staphylococus aureus could be contamination of hands of healthcare staff. Since S. aureus contamination from soil is quite unlikely, exogenous contact through hands of people around Mary could be a likely source. Contamination through objects that been touched by other people is another possibility. In a study on healthcare workers, it was found that they contaminated non-sterile disposable gloves with pathogens and skin commensals (Hughes, Cornwall, Theis, & Brooks, 2013). Since the strains isolated from the gloves were virulent, it is alarming that hand washing regimen is not being followed by healthcare workers when retrieving gloves from a box. Gloves could therefore act as transmission vehicles and cause nosocomial infections in hospital settings. Another study focussed on spread of infectious organisms through the surfaces of stethescopes, keyboards and handsets. The difference in microbial counts before and after disinfection was compared. Disinfection was recommended in particular for the first aid units where contamination of surfaces was found to be rather high (Messina, et al., 2013).
Given the colonizing organism was Staphylococcus aureus, discuss why Augmentin is an appropriate prescription?
Staphylococcus aureus causes wound infections but most of the infections are caused by the antibiotic resistant strains. In Mary's case, her wound was infected and the only way to cure the infection was to administer a systemic antibiotic which would be effective against the causative organism. The wound swab that was taken for a culture sensitivity test confirmed that it was an S aureus infection that was sensitive to Amoxycillin and Augmentin also contains Amoxycillin, so it was an appropriate choice of antibiotic for treating her infection (Bullock & Manias, 2017).
Describe the added benefits that Augmentin provides, with reference to the role of the major ingredients in Augmentin.
Staphylococcus aureus is often resistant to the antibiotic Amoxycillin which is a penicillin derivative. Amoxycillin can inhibit bacterial growth because the beta lactam ring in its structure inhibits the formation of the peptidoglycan cell wall in bacteria. But the inappropriate use of antibiotics has led to the development of antibiotic resistance in bacteria. S. aureus can produce the enzyme beta lactamase which renders the beta lactam antibiotics incapable of blocking cell wall formation. Augmentin is a combination of amoxycillin and clavulenic acid. Clavulenic acid is a beta lactamase inhibitor and therefore in its presence amoxycillin can continue to inhibit the multiplication of S. aureus and cure the infection (Bullock & Manias, 2017).
Referencing in-text and in reference list conforms to APA 6th Ed. referencing style.
Critique supported by relevant literature as prescribed.
Correct sentence structure, paragraph, grammatical construction, spelling, punctuation and presentation.
Bowler, P. G., Duerden, B. I., & Armstrong, D. G. (2001). Wound Microbiology and Associated Approaches to Wound Management . Clinical Microbiology Reviews, 14(2), 244–269. https://doi.org/10.1128/CMR.14.2.244-269.2001.
Bullock, S., & Manias, E. (2017). Fundamentals of pharmacology (8th ed.). Frenchs Forest, Australia: Pearson Australia.
Craft, J. &. (2015). Understanding pathophysiology (2nd Australian and New Zealand ed.). . Chatswood, Australia: Elsevier.
Gjødsbøl, K., Skindersoe, M. E., Skov, R. L., & Krogfelt, K. A. (2013). Cross-contamination: Comparison of Nasal and Chronic Leg Ulcer Staphylococcus aureus Strains Isolated from the Same Patient. . The Open Microbiology Journal, 7, 6–8.
Hughes, K. A., Cornwall, J., Theis, J.-C., & Brooks, H. J. (2013). Bacterial contamination of unused, disposable non-sterile gloves on a hospital orthopaedic ward. The Australasian Medical Journal, 6(6), 331–338. https://doi.org/10.4066/AMJ.2013.1675.
Immunise.health.gov.au. (2017, August 1). /Aus-Imm-Handbook.pdf. Retrieved from https://immunise.health.gov.au: https://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/7B28E87511E08905CA257D4D001DB1F8/$File/Aus-Imm-Handbook.pdf
Lee, G. &. (2016). Microbiology and infection control for health professionals (6th ed.). . Melbourne, Victoria : Pearson Australia.
Marieb, E., & Hoehn, K. (2014). Human Anatomy & Physiology, Global Edition. Pearson Education Limited.
Messina, G., Ceriale, E., Lenzi, D., Burgassi, S., Azzolini, E., & Manzi, P. (2013). Environmental Contaminants in Hospital Settings and Progress in Disinfecting Techniques. BioMed Research International, 429780. https://doi.org/10.1155/2013/429780.