A 70-year old diabetic woman came into the ER with a fever of104°F, chills, and labored breathing. She produced thick sputumflecked with blood. The woman reported a recent history of a mildcold to the examining physician. A chest X-ray revealed extensiveinfiltration in the lower lobes of both lungs. The sputum wascollected for microscopy and culture on blood agar. The gram-stainrevealed gram-positive diplococcic and muccoid colonies with nohemolysis on the blood agar.

7. From the information given how can the causative bacterium beidentified?

8. What virulence factor allows this bacterium to bemore invasive?

A 20-year old college student who lives on campus was recentlyback home visiting his parents. His mother, who had attempted toawaken him the next morning, but had found him listless anddifficult to rouse, brought him to the emergency room. Uponquestioning by the attending physician, the mother reported that hehad complained of a headache, stiff neck, and fever the day hearrived home. An examination of the patient revealed purpuric skinlesions on his chest and abdomen, a fever of 103°F, and low bloodpressure (hypotension).

13. What would be your presumptive diagnosis for thispatient?

14. What is the causative organism?

15.What diagnostic test & result would indicate apositive (confirmatory) diagnosis?

16.What populations are most at risk for contractingthis disease

A few days following a severe sore throat, a young childdeveloped a red, papular rash with a sandpaper texture on thechest, which spread across most of her body. Although her cheekswere red, the area around her mouth appeared white. Her tonguedeveloped a white coating, which desquamated (skin peeled off),producing a “strawberry tongue” appearance.

17. What is the name of the disease?

18.  What is the name of the causativebacterium

19. What virulence factor led to the development of thisdisease?

20. What is the mechanism of action of this virulencefactor? (how does it work)

A 4-year-old child was taken to the doctor with high fever,runny nose, watery eyes, and a cough. Upon examination the doctornoted tiny white spots on the inside of the child’s cheek and araised red rash along the child’s hairline, neck, and trunk. Athroat swab tested negative on a rapid strep test and was negativefor culturable bacteria. Upon speaking with the mother the doctorfound out the child had not received the MMR vaccine.

22. What is the likely diagnosis?

23. Which symptom(s) of the child is characteristic ofthis disease? What is the proper name of this symptom?

24. How can this disease be treated?

Mary is a healthy 3-year-old child living in Central Texas. Shespends 4 days a week at daycare while her parents work. The daycarecalls and she has developed a low-grade fever of 101-102. The feverpersists for the next 4 days. She also is drowsy and complains thather head and tummy hurt and she does not want to eat. The parentscall the doctor and he recommends Tylenol and fluids, keep thefever down and her body hydrated. By the fifth day her parentsnoticed that Mary has developed a rash on her head and chest thatis spreading to her back. The lesions are red and raised and someeven contain fluid. Mary’s parents become concerned and bring herto their primary care physician for a diagnosis.

25. Based on the information given, what is your initialdiagnosis?

26. Will the organism be cleared from Mary'sbody

27. What disease is Mary at risk for developing later inlife as a result of this infection?

28. What is the best way to prevent thisdisease

An infant born at 36 weeks' gestation and weighing 4.2 lbs wasnoted at birth to have congenital heart defects, hyperpigmentedskin lesions, cataracts, swelling of the brain, and fluid aroundthe heart. Hearing impairment was suspected after the infant faileda hearing screening test before hospital discharge. The mother, inher late 20s, was from urban Tanzania. She reported having receivedall of her childhood vaccinations in Tanzania, butrubella-containing vaccine had not been part of the routinevaccination schedule. She had no prenatal care in Tanzania. Shereported having a rash around the time of her first missedmenstrual period while in Tanzania. After the mother arrived in theUnited States approximately 46 days later she developed avaricella-like rash. She visited several clinics but no moleculartests were done to confirm the cause of her rash.

33. What is your diagnosis for the child?

34.. What is your diagnosis of the mother?

35. What is the best treatment for thischild?

36.What is the best way to prevent this disease inunborn children?