401006 Bioscience-Introduction to Bacterial or Viral Infection

Tetanus, also called lockjaw, is a rare, non-contagious disease caused by spores of the bacterium Clostridium tetani. The bacteria exist worldwide with no specific region of occurrence, and are primarily found in soil and animal intestinal tracts. It is a rare disease but if untreated it can prove to be fatal. The bacteria acts by releasing neurotoxin, tetanospasmin and a hemolysin called tetanolysin under anaerobic condition at the wound site (Simpson, 2012), which affects the nervous and muscular system causing severe muscle spasms. As Mary sustained the 4cm cut while digging manure she has a high risk of getting infected by the bacteria, hence it is a situation of concern.

he tetanus administering guidelines in the “the Australian Immunisation Handbook” states that adults above the age of 50 years not having received a booster dose of dT in the previous 10years should receive a booster dose to enhance the production of tetanus antibodies in the body. Further, deep-penetrating wounds are referred to as tetanus-prone and favours growth of t

Although signs and symptoms are two terms often used synonymously in medical science, yet there is a distinct difference between them in clinical terms. Symptoms can only be described by the person suffering from the same that is the patient’s experiences of a disease for example dizziness, numbness, light-headedness, fatigues, visions disturbances etc. On the other hand, signs are physical manifestation of the effects of the disease and are observed by other especially the physician for example bleeding, bruising, swelling, fever etc. (Kraft & Keeley, 2015). Signs are objective in nature while symptoms are subjective in nature. Hence, in the given case study all the three observations, wound edges red and hot to touch, surrounding tissue swollen and purulent and odorous discharge respectively are all signs of a clinical condition.

The natural bodily response to tissue injury is inflammation of the injured part, which includes both vascular and cellular responses. The first observation in Mary is wound edges are red and hot to touch. Tissue injury activates several chemical mediators like histamine, serotonin and complement system which cause substantial dilatation of the blood vessels to increase blood flow and leakage of serous fluid into the adjacent areas (Kalodiki et al., 2012). The increased blood supply makes the region red and transports immune cells such as leukocytes and antibodies to fight foreign particles. Due to increased blood supply the inflamed part acquires the core temperature of the body and feels warm to touch.

As the blood vessels dilate during inflammation, it becomes more permeable to white blood cells, nutrients and hormones which move into the interstitial space between cells. Thus fluid carrying the inflammatory cells diffuses into the injured area and cause swelling.

Purulent and odorous discharge is a sign of unhealthy wound and requires immediate treatment. Although some amount of exudate is normal in early inflammation, heavy and odorous discharge indicates the presence of growing bacterial contamination, as the body attempts to fight the same by maintaining a moist environment containing serum derivatives, proteins and inflammatory cells.

Mary’s wound swab culture found the presence of Staphylococcus aureus. Staphylococcus infection can be life threatening by causing sepsis. It is obvious that she incurred the bacterial infection through her wound and her rise in body temperature is the body’s response to fight the infection (Bennett, Dolin & Blaser, 2014).

Fever is the most common sign of a bacterial or viral infection. As it is a natural response to infection it has certain beneficial role in the body’s defence system. Firstly, elevated temperature enhances the body’s immune response against the infectious bacteria or virus. It stimulates the release of pyrogens altering the neurologic, endocrinologic and metabolic systems, T- and B-lymphocytes, interferon and other inflammatory mediators. Further high temperature deduces free iron levels, increasing ferritin which inhibits growth of various viruses and bacteria. Secondly, most microorganisms are temperature sensitive and cannot survive beyond an optimum range (Ray & Schulman, 2015). Temperatures 38-40 degree Celsius are unfavourable for bacterial growth and reproduction and thus can prevent spreading of the same.

Sources of contamination depend on various factors including the type of infection, microbiota of the patient and so on. Endogenous contamination occurs when the normal microbial flora of the patient acts against the body under certain favourable condition, which otherwise are harmless to the body (Williams, Hartley, Björkman & Trees, 2009). They are most common in immune compromised patients and the bacterial genus most commonly involved are Staphylococcus. Staphylococcus is a commensal organism of the skin and the upper respiratory tract and may cause endogenous infection through contact transmission.

It is most often transmitted by direct or indirect contact with a discharging wound. Transmission is possible via direct, indirect or with vehicular contact. Direct skin contact with an infected person can transmit the bacteria. Indirect contact involves contact with infected materials such as soil. Lastly, vehicular transmission involves a medium for transmission such as food, water, blood and sometimes air.

When bacterial contamination takes from outside the body of the patient it is called exogenous contamination. There are various sources of exogenous bacteria as aquatic as well as terrestrial environments contain billions of bacteria. It is most often transmitted by direct or indirect contact with a discharging wound. Transmission is possible via direct, indirect or with vehicular contact. Direct skin contact with an infected person can transmit the bacteria. Humans can cause infection either if they are infected with symptoms or infected without symptoms or even when they are just a carrier without the incidence of the disease. Indirect contact involves contact with infected materials such as soil (Williams, Hartley, Björkman & Trees, 2009). Lastly, vehicular transmission involves a medium for transmission such as food, water, blood and sometimes air. Lastly, vehicular transmission involves a medium for transmission such as food, water, blood and sometimes air.

Infections are treated based on antibiotic sensitivity of the infecting microorganism. As Staphylococcus has antibiotic resistivity to Penicillin by destroying the beta-lactam ring of the antibiotic by the action of the enzyme beta-lactamase. Thus the combination drug, Augmentin containing Amoxicillin and beta-lactamase inhibitor, clavulanate potassium is effectively used to treat Staphylococcus aureus infection (Cehajic-Kapetanovic & Kwartz, 2010). The primary component amoxicillin is effective for a broad spectrum of both gram-positive and gram-negative bacteria. Hence, Augmentin is the appropriate prescription for treating the concerned patient.

Amoxicillin is an upgraded version of the classic antibiotic penicillin. Compared to Penicillin it can resist damage from gastric acid and is more potent against anaerobic bacteria. It can be combined with other medications to augment its efficacy. It is most often used to treat infection from unknown bacteria and can treat infections of the bladder, respiratory tract, E. coli etc. However, amoxicillin is sensitive to Staphylococcus enzyme beta-lactamase. Augmentin additionally provides more strength to Amoxicillin with the presence of the second active ingredient beta-lactamase inhibitor, clavulanate. It is similar to the structure of penicillin and blocks a wide range of bet-lactamases by interrupting with their active site (Ball, 2007). It renders amoxicillin to act at its full potential against organisms including antibiotic sensitive ones.

References

Ball, P. (2007). Conclusions: the future of antimicrobial therapy–Augmentin® and beyond. International journal of antimicrobial agents, 30, 139-141.

Bennett, J. E., Dolin, R., & Blaser, M. J. (2014). Principles and practice of infectious diseases. Elsevier Health Sciences.

Cehajic-Kapetanovic, J., & Kwartz, J. (2010). Augmentin duo™ in the treatment of childhood blepharokeratoconjunctivitis. Journal of pediatric ophthalmology and strabismus, 47(6), 356-360.

Immunise - The Australian Immunisation Handbook 10th Edition. (2017). Immunise.health.gov.au. Retrieved 23 August 2017, from https://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home

Kalodiki, E., Stvrtinova, V., Allegra, C., Andreozzi, G., Antignani, P. L., Avram, R., ... & Gaspar, L. (2012). Superficial vein thrombosis: a consensus statement. Int Angiol, 31(3), 203-216.

Kraft, N. H., & Keeley, J. W. (2015). Sign versus symptom. The Encyclopedia of Clinical Psychology.

Ray, J. J., & Schulman, C. I. (2015). Fever: suppress or let it ride?. Journal of thoracic disease, 7(12), E633.

Simpson, L. (Ed.). (2012). Botulinum neurotoxin and tetanus toxin. Elsevier.

Williams, D. J. L., Hartley, C. S., Björkman, C., & Trees, A. J. (2009). Endogenous and exogenous transplacental transmission of Neospora caninum–how the route of transmission impacts on epidemiology and control of disease. Parasitology, 136(14), 1895-1900.