401006 Bioscience 2: Describe the Physiological Basis| Case of Mary
Case study
– Painful and swollen,
– Red and warm when touched. – Purulent discharge.A wound swab was taken for culture and sensitivity. A stat dose of ceftriaxone 1g was administered IVI immediately (she did not require a booster tetanus injection as she had already received one three months ago).
She was then commenced on oral cephalexin 500mg to be taken every 6 hours before being sent home.
1. Describe the physiological basis for the appearance of Mary’s wound.
2. Explain TWO (one endogenous and one exogenous) likely sources for the contamination of the wound and the mode of transmission of the microorganism from each source.
Culture and sensitivity test confirmed the microorganism infecting the wound to be Staphylococcus aureus. The drug cephalexin was discontinued and replaced with oral dicloxacillin 500 mg every 6 hours.
3. Explain the rationale for the initial choice of antibiotics, and the subsequent change in antibiotic therapy to dicloxacillin. Discuss the mode of action of this antibiotic, and state any TWO of its common adverse reactions.
4. Describe the process by which Mary’s wound will heal
Answer:
Physiological basis of the wound observations:
The first line of defense in a wound that is, the normal skin lining is broken. The peril of injury contamination elevates as local situations promote bacterial development instead of host defense. With time, wounds become seized by microorganisms from the victim's microbial flora or other surrounding or person (Tshikantwa, Ullah, He & Yang, 2018). Microbes have various development needs although nutrients are available in wounds. Furthermore, they produce enzymes and toxins which degrade tissue to acquire nutrients, deactivate host defense mechanism to make sure of proliferation and survival in the tissue together with enabling fast distribution in the tissue (Laver & Specht, 2016). Consequently, mere bacteria enumeration in an injury is not the same as to developed injury contamination and proceeding phase for bacteria to inaugurate contamination is adhesion along with underlying structures.
The main aim in the management of wound is to redress the host bacteria balance and is most effective through certifying that the injury is cleaned of weary tissue and foreign bodies, the bacteria load, and swelling are managed and that sufficient tissue perfusion is retained (Laver & Specht, 2016). Topical antimicrobic agents continue to be utilized broadly for averting wound diseases, and present interests are concentrated on options to antibiotics like honey, cationic peptides, and antimicrobic moisture retentive dressings along with essential oils. To manage wound microflora, unregulated tenderness caused by underlying abnormal pathophysiological conditions along with micro-organisms is a significant factor related to the poor healing of wounds.
Extracellular matrix proteins such as collagens, fibronectin, laminin along with vitronectin in all wounds are susceptible together with glycosaminoglycans such as heparin sulfate and dermatan sulfate (Kaushal, Elbein & Carver, 2018). Microorganisms can adhere to these extracellular matrix elements through hydrophobic and charge interactions and via receptor-like particular binding. However, binding to these proteoglycans along with proteins has been recommended as the initial phase of tissue colonization, and the microbial agents articulate some surface tissues which intervene the procedure. Through binding to these extracellular matrix elements, the pathogens occur to be more secured from host defense mechanisms and can multiply and employ local structure harm with analytic signs of disease (Kaushal, Elbein & Carver, 2018).
Possible sources of contamination and modes of transmission
Endogenous source of infection is the victim’s flora. Typically, the cuticle is densely inhabited with bacteria, and on average each square centimeter of epidermis hoists up to 3 million microbes although the bacteria density varies with anatomical location (Krismer, Weidenmaier, Zipperer & Peschel, 2017). When there is a lowering of general, local resistance or an opening these microorganisms invade the tissue, and such opportunistic infections are difficult to prevent and manage in vulnerable people. For instance, the genera of staphylococci along with streptococci are typically found in the body but can become pathogenic in particular situations (Krismer, Weidenmaier, Zipperer & Peschel, 2017).
The mode of transmission is direct contact as the microorganisms gain access to the underlying blood tissue or bloodstream and cause infection (Truyens, Weyens, Cuypers & Vangronsveld, 2015). The bacteria being residing in the body it is directly transferred to the laceration hence causing infection.
- Name one exogenous source of contamination and discuss the mode of transmission from the source to the new host
An exogenous source of infection is as a result of contact with the surrounding and involves the microorganisms in the air or those introduced by traumatic injury (Verwilghen, 2015). The source in the case study is from a sharp object. The mode of transmission is a direct contact which happens when microorganisms are transferred by direct physical contact with an object such as a broken glass (Truyens, Weyens, Cuypers & Vangronsveld, 2015). In the case study Mary trod on broken glass, and because of the contact, the pathogens on the broken glass are directly transferred to the host.
Rationale for choices of antibiotics
-
- Rationale for the stat dose of ceftriaxone administered IVI immediately.
The stat dose of ceftriaxone is intended to stop the development of bacteria that may result in infection after an operation (Fernández, Tandon, Mensa & Garcia?Tsao, 2016). Its choice was developed by the wound’s condition and also before a surgery. The withdrawal of the drug was deemed because it only stops the bacteria from reproducing but not to kill the bacteria cell walls (Fernández, Tandon, Mensa & Garcia?Tsao, 2016).
- Rationale for the oral cephalexin.
The oral cephalexin is intended to interfere with the formation of the bacteria’s cell wall and to rupture the wall along with killing the bacteria. The choice of cephalexin is developed because the bacteria cell walls need to be damaged having the fact that ceftriaxone cannot kill the cell wall. This drug is withdrawn to dicloxacillin since it is ineffective against infections caused by Staphylococcus aureus (Reddy, Kumari & Sivajothi, 2016).
- Rationale for the change to oral dicloxacillin.
Dicloxacillin is intended to work against bacteria which are resistant to other penicillins like Staphylococcus and assist in clearing up the bacterial infection through inhibiting bacterial development (Hassett, 2018). The drug was realistic since it is effective against Staphylococcus aureus. The drug was chosen to cure staphylococcus aureus due to its lower risk of drug-induced liver injury, and it does not have the cautions on the peril of severe cholestatic hepatitis.
- State two adverse reactions to dicloxacillin.
The two adverse reactions of dicloxacillin are pain and inflammation at the injection site when it has been administered along with nausea (Stark, Ross, Kershner & Searing, 2015).
Process by which Mary’s wound will heal
Mary's wound will heal through three stages which involve inflammation, proliferation, and remodeling (Dreifke, Jayasuriya & Jayasuriya, 2015). Inflammation stage starts immediately after the accident when the damaged blood vessels leak transudate leading to tenderness. Swelling manages bleeding together with preventing infection, and the fluid engorgement permits curing and restore cells to proceed to the wound’s site. Bacteria, damaged cells along with bacteria are cleared from the injury site, and growth factors, nutrients, and enzymes together with white blood cells create the warmth, redness, pain, and swelling (Dreifke, Jayasuriya & Jayasuriya, 2015).
In the proliferation phase, the injury is restored with new tissues consisting of extracellular matrix together with collagen and hence it contracts. The collagen is laid down, and it is random, and the injury is thick, and the contraction is enabled by myofibroblasts which grips and pull the wound edges together using the same mechanism to that of smooth muscle cells (Dreifke, Jayasuriya & Jayasuriya, 2015). The epithelial cells resurface the injury finally, and epithelialization occurs rapidly when wounds are kept hydrated and moisty.
The last phase is the remodeling stage when collagen is remodeled from type III to type I and the injury completely closes. Apoptosis is used to clear the cells which were used to restore the injury and no longer required. Here, collagen is organized along tension lines and water is reabsorbed to allow collagen fibers to lie closer together and cross-link which minimizes scar gauge and makes the wound area strong (Dreifke, Jayasuriya & Jayasuriya, 2015).
References
Dreifke, M. B., Jayasuriya, A. A., & Jayasuriya, A. C. (2015). Current wound healing procedures and potential care. Materials Science and Engineering: C, 48, 651-662.
Fernández, J., Tandon, P., Mensa, J., & Garcia?Tsao, G. (2016). Antibiotic prophylaxis in cirrhosis: Good and bad. Hepatology, 63(6), 2019-2031.
Foong, K., Allen, F., Islam, I., Srivastava, N., & Seneviratne, C. J. (2017). Microbial Biofilms: An Introduction to Their Development, Properties and Clinical Implications. In Microbial Biofilms (pp. 1-32). CRC Press.
Hassett, D. J. (2018). U.S. Patent No. 9,925,206. Washington, DC: U.S. Patent and Trademark Office.
Kaushal, G. P., Elbein, A. D., & Carver, W. E. (2018). 19 The Extracellular Matrix. Medical Biochemistry E-Book, 243.
Krismer, B., Weidenmaier, C., Zipperer, A., & Peschel, A. (2017). The commensal lifestyle of Staphylococcus aureus and its interactions with the nasal microbiota. Nature Reviews Microbiology, 15(11), 675.
Laver, N. V., & Specht, C. S. (2016). Pathogenic Properties of Infectious Organisms and Tissue Reactions. In The Infected Eye (pp. 13-35). Springer, Cham.
Reddy, B. S., Kumari, K. N., & Sivajothi, S. (2016). Methicillin-Resistant Staphylococcus aureus (MRSA) Isolated from Dogs with Recurrent Pyoderma. J Dairy Vet Anim Res, 3(2), 00073.
Stark, M. A., Ross, M. F., Kershner, W., & Searing, K. (2015). Case Study of Intrapartum Antibiotic Prophylaxis and Subsequent Postpartum Beta?Lactam Anaphylaxis. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 44(5), 610-617.
Truyens, S., Weyens, N., Cuypers, A., & Vangronsveld, J. (2015). Bacterial seed endophytes: genera, vertical transmission, and interaction with plants. Environmental Microbiology Reports, 7(1), 40-50.
Tshikantwa, T. S., Ullah, M. W., He, F., & Yang, G. (2018). Current trends and potential applications of microbial interactions for human welfare. Frontiers in microbiology, 9, 1156.
Verwilghen, D. (2015). Surgical site infections: What do we know?. Equine veterinary journal, 47(6), 753-755.
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