The patient is a 22 year-old female from southern India whoattends a small liberal arts college in the eastern United States.Two weeks after returning from spring break, she presented to alocal emergency room department complaining of a painlessulcerative skin lesion with impressive surrounding edema on herleft hand. Except for axillary lymphadenopathy on her left side,she was afebrile (no fever) and had no other remarkable symptoms.She remarked to the physicians that she had originally thought thelesion to be an insect bite, because it started as a raised andvery itchy bump before developing into a vesicle and then apainless ulcer, which then formed a black scab. Because she hadreturned home to India during the break, an infectious diseaseconsult was ordered. On further questioning, she revealed that shehad brought several untanned sheep and goat skins from home becauseshe designs and sews coin purses for her friends at school. She hasbeen working with the skins intensely (soaking, stretching,cutting, stitching, and staining) in a studio in the college artdepartment since returning to school.
a. Give all of the possible organisms (that we’ve studies) andwhy those organisms are possibilities for causing the patient’ssymptoms.
b. For the possible organisms that you gave for your answer inpart a, based on the symptoms only, which of the organisms can yourule out and why?
c. What laboratory tests can you use to rule out even more ofthe organisms? What results would you expect for each organism thatyou have not ruled out in part b.
d. Pick ONE of the organisms that you have left, give rationalwhy this could be the suspected cause of the illness, and givetreatment options.
