Case History:

An Epidemic

A pregnant 18-year-old woman came to the Ford County urgent-care clinic with a low-grade fever,malaise, and headache. She was sent home with a diagnosis of influenza. She again sought treatment 7 days later with a macular rash on her trunk, arms, hands, and feet. Further questioning of the patient when serology results were known revealed that I month previously, she had a painless ulcer on her vagina that healed spontaneously.

The same day, patient #2 sought medical treatment for a penile ulcer.

In a routine examination, patient #3, a pregnant female, had positive serologic tests for this disease but was asymptomatic.

Patient #4 was tested because of her sexual contact with patient #2. She had no symptoms and a positive serologic test.

Patient #5, a contact of patients #3 and #6, was also serologically positive. He frequently traveled to a neighboring county, which reported a 290% increase in this disease over the preceding year.

Patient #6, a female, had a rash and also tested positive. Patients 1 and 2 were in drug-abuse rehabilitation; these two were the only two who reported use of crack cocaine.

1. What bacterial diseases can cause rashes?

2. What serologic tests are used to diagnose these infections?

3. What is the disease? How did six residents of Ford County get this disease?

1. What are the consequences of not treating this infection?

The Solution

1. Rickettsia rickettsii (spotted fever), Salmonella typhi, Borrelia burgdorferi, Staphylococcus aureus (toxic shock syndrome), Streptococcus pyogenes (scarlet fever), and Treponema pallidum.

2. VDRL, rapid plasma reagin, and FTA-ABS for syphilis; agglutination tests for Lyme disease, S. pyogenes, and spotted fever. S. aureus is usually diagnosed from cultures (gram-positive, coagulase positive).

3. Syphilis. Patient #5 apparently brought the disease to Ford County and gave it to patients #3 and #6 during sexual intercourse; they could have given it to the others.

4. Tertiary syphilis may develop in the adults; the fetus can contract congenital syphilis.

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