case Study

1) What was the purpose of the ceftriaxone? The tetanus toxoid?

2) What is granulocytosis?

3) What is the most likely cause of the man’s illness and death?

4) What other information do you need to be sure?
5) How could he have been treated?

6) How should the platelet-recipient be treated?
Encephalitis, Texas
Background
On May 30, a 22-year-old man complained of right hand weakness.
On June 1, he complained of right arm numbness.
On June 2, he exhibited several episodes of staring and unresponsiveness lasting 10 to 15 seconds.
He consulted a physician in Mexico, who prescribed an unknown medication. That evening, he presented himself to a hospital emergency room in Texas complaining of right hand pain. He had been punctured by a catfish fin earlier in the week, so, based on this information, he was treated with ceftriaxone and tetanus toxoid.
On June 3, when he returned to the emergency room complaining of spasms, he was hyperventilating and had a white blood cell (WBC) count of 11,100 per mm3. Although he was discharged after reporting some improvement, he began to have intermittent episodes of rigidity, breath holding, hallucinations, and difficulty swallowing. Eventually he refused liquids. That evening, he was admitted to the intensive-care unit of another hospital in Texas with a preliminary diagnosis of either encephalitis or tetanus. Manifestations included frequent spasms of the face, mouth, and neck; stuttering speech; hyperventilation; and a temperature of 37.8°C. His WBC count was 17,100 mm3 with granulocytosis. He was sedated and observed.
On the morning of June 4, the patient was confused, disoriented, and areflexic (without reflexes). Although his neck was supple, muscle tonus was increased in his upper extremities. Analysis of cerebrospinal fluid indicated slightly elevated protein, slightly elevated glucose, and 1 WBC per 0.1 ml. An electroencephalogram showed abnormal activity. Because he had uncontrolled oral secretions, he was intubated. His temperature rose to 41.7°C, and he was sweating profusely.
On June 5, the man died.
The patient had worked as a phlebotomist for a blood bank and had donated blood on May 22. His platelets had been transfused before he became ill, but the remainder of his blood products were destroyed.

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