Seniors conclude clinical practicum with presentations
Concluding their clinical practicum, 28 seniors from the UW-Stevens Point clinical laboratory science (CLS) program presented their case studies and research projects to hospital program directors and School of Health Care Professions faculty and staff at the annual Student Presentation Day on Monday, March 12, 2012.
During students’ fourth year in the CLS program, they complete a full-time clinical practicum. This highly beneficial hands-on learning opportunity allows students to work under the supervision of experienced laboratory scientists and apply their knowledge in a professional setting.
The CLS program at the UWSP, one of the largest in the state and one of the few with national accreditation, has a 95 percent pass rate on the required national exam compared to 70 percent nationally.
Complete listing of presentations and location of clinical practicum:
Jamie Hintz: Cystic Fibrosis: A Tiny Cellular Defect with Big Effects (Mayo Clinic, Rochester, MN)
Cystic Fibrosis (CF) is a recessive inherited disease that damages multiple organs, making physiological processes inefficient and defective particularly resulting in malnutrition and lung infections. It is caused by a mutation coding for a trans-membrane ion channel known as the Cystic Fibrosis Trans-membrane Conductance Regulator (CFTR). This protein is found in cells that produce mucus, sweat, and digestive juices located primarily in the lungs, pancreas, liver, and intestines. Whereas a normal CFTR maintains proper fluidity, preventing mucous from becoming too viscous, a mutant CFTR is unable to maintain this balance resulting in thick secretions that eventually obstruct and clog affected organs. It is not only a very common genetic disease, but also is the most common inherited fatal disease among children and young adults in the United States. Approximately, one out of 3,000 children is born with Cystic Fibrosis.
Phanat Chang: Myeloproliferative Neoplasms – Polycythemia Vera: Do you know JAK? (Monroe Clinic, Monroe, WI)
Myeloproliferative neoplasms, also known as myeloproliferative disorders, are a group of heterogeneous diseases that originate from the clonal expansion of the hematopoietic pluripotent stem cell in which there is an overproduction of one or more of the formed elements of the blood. In this presentation, there are three classic MPNs that will be discussed; polycythemia vera, essential thrombocythemia and myelofibrosis with a primary focus on polycythemia vera. Polycythemia vera is an uncontrolled proliferation of erythroid, granulocytic, and megakaryocytic cells due to a chronic abnormality of the hematopoietic stem cell. The majority of diagnosed polycythemia vera patients have a mutation in the JAK2 protein which is associated with certain receptors and cell proliferation. Essential thrombocythemia is characterized by marked thrombocytosis with abnormal platelet function and an increased risk of thrombosis and hemorrhage. Myelofibrosis is an increase in the amount and density of the discontinuous linear network of delicate reticulin fibers that provides the structural framework on which hematopoiesis normally occurs. Along with the presentation is a case study on a patient who was diagnosed with polycythemia vera and later MF.
Laura Wayne: Not Your Average Ear Infection (St. Mary’s Hospital, Madison, WI)
This case study will follow a patient treated for an ear infection that later developed into meningitis, caused by Streptococcus pneumoniae. The treatment protocol for this patient at St. Mary’s hospital will be described in this presentation. Information related to the patient’s recovery and side effects related to the illness and treatment will also be offered. S. pneumoniae, a leading cause of meningitis in adults, will be discussed in this presentation. Also discussed is the growing trend of antibiotic resistance of S. pneumoniae. Many strains of S. pneumoniae are resistant to penicillin, but in recent years there has been a trend of multi drug resistance developing in many strains of S. pneumoniae. See how this multi-drug resistance has changed treatment approaches for meningitis caused by S. pneumoniae.
Sarah Rudstrom: Hereditary Coproporphyria: Disease Process, Treatment and Prognosis (Mayo Clinic, Rochester, MN)
Hereditary Coproporphyria (HCP) is caused by an autosomal dominant trait inheritance resulting from the deficiency of Coproporphyrinogen oxidase (CPGO) in the Heme biosynthesis pathway. Its prevalence is unknown due to the difficulties in diagnosing and the unreliability of testing. Usually an excess of coproporphyrin specifically coproporphyrin type III in the urine and stool is diagnostic. A high urine coproporphyrin is nonspecific; due to many factors. One is liver disease. Therefore high coproporphyrins does not mean the patient has HCP. Those with HCP present with various clinical symptoms including abdominal pain, vomiting, constipation, neuropathies, psychiatric manifestations, cutaneous photosensitivity in 20% of cases, and even tetraplegia and paralysis. At the Mayo Clinic a 19-year-old women presented with episodic abdominal pain, having a history of family members diagnosed with porphyria. She was diagnosed with Hereditary Coproporphyria along with withdrawal from analgesics taken to help control her pain.
Ashley Sankey: Childbearing with Cancer and Chemo? (Aspirus Wausau Hospital, Wausau, WI)
A pregnant 20-year-old Mennonite was admitted to the Emergency Department in September 2011. She entered with symptoms of drowsiness, lymph-node enlargement, and severe pallor. She did not know that her nonspecific symptoms would soon be diagnosed as cancer. Later, a bone marrow aspiration with cytogenetic analysis showed that the patient had Acute Lymphoblastic Leukemia with Philadelphia Chromosome positivity. At initial admission, the patient was 28 weeks pregnant. The patient began treatment with chemotherapy during her third trimester and a viable female infant was delivered via cesarean section at 32 weeks gestation. The purpose of this case study is to observe the course of treatment and the patient’s response to treatment, give background information about ALL with Philadelphia chromosome, identify the prevalence of ALL during pregnancy, and examine the effects of ALL and chemotherapy on pregnancy.
Kirsten LaMarche: “HELLP” Me Rhonda! HELLP Syndrome – A Case Study (Langlade Hospital, Antigo, WI)
HELLP syndrome (hemolytic anemia, elevated liver enzymes and low platelet count) is a severe obstetric complication considered by many to be a severe form of pre-eclampsia. Both HELLP and Pre-Eclampsia occur during the later stages of pregnancy, and sometimes after childbirth. Early diagnosis is critical to prevent further complications such as DIC and liver rupture. The patient was a 40-year-old post-partum woman, who had evidence of pre-eclampsia in the weeks leading up to delivery. Within 24 hours of delivery the patient’s blood pressure was rising significantly, she experienced severe upper epigastric pain and vomiting, her platelet count was dropping rapidly and blood tests revealed that her liver enzymes were becoming increasingly abnormal. All of these symptoms combined led to the rapid diagnosis of HELLP Syndrome. HELLP Syndrome is an acute and critical obstetric syndrome which can have multiple presentations and variable prognosis. This case is of interest because if the diagnosis had been delayed, there could have been a significant risk of liver rupture or DIC, and patent survival could have been compromised.
Abby Vanden Wyngaard: The Yeast that’s a Beast! Cryptococcus neoformans (ThedaCare Laboratories, Neenah, WI)
When you think of yeast you probably think of bread rising in the oven. This particular yeast is vastly different than its bread-rising cousin. Cryptococcus neoformans is a formidable enemy, especially to those who are immunocompromised or immunosuppressed. Found in nature and bird droppings, this encapsulated yeast is able to protect itself from the environment. Cryptococcus neoformans is a cause of meningitis and is commonly found in patients suffering from AIDS. Meningitis is defined as inflammation of the meninges in the brain and spinal cord. The most useful specimen for detecting meningitis is a cerebral spinal fluid obtained from a spinal tap. My patient is an 81-year-old woman who was diagnosed with Cryptococcal meningitis after coming to the ER with symptoms of confusion and fatigue. This type of meningitis is often difficult to treat, and can be fatal. The treatment regimen can be extremely damaging to the body and great care is taken when prescribing medications for Cryptococcal meningitis. This is one yeast you do not want to mess with!
Logan Rastedt: Check for Ticks…Babesiosis is on the Rise (Sacred Heart Hospital, Eau Claire, WI)
The frequency of Babesiosis is increasing, most notably due to Babesia microti in the Northeast and upper-Midwest United States. Humans are infected by the vector, Ixodes scapularis (deer tick), which is also responsible for Lyme disease and Ehrlichiosis. Transmittal from human to human can also occur through infusion with infected blood products. Babesiosis is the most common disease transmitted through blood transfusions. Symptoms are minimal in healthy individuals, but can consist of fever, chills, and weakness or severe complications such as hemolytic anemia. However, increased disease severity including death is seen in immunodeficient patients of advanced age, on chemotherapy, or with previous splenectomy. Diagnosis and differentiation is made by microscopic viewing of the peripheral blood smear to identify the intraerythrocytic protozoal parasite. Treatments include antibiotic and antimalarial drugs such as oral quinine with intravenous clindamycin. Babesiosis is especially important to understand in Wisconsin, as it is one of the most highly affected areas in the United States. Prevention tips include protective clothing, insect repellent containing DEET, and checking the body for ticks after outdoor activity.
Chimmee Yang: Factor V Leiden: A Family Tree (Richland Hospital, Richland Center, WI)
Under normal conditions, factor V and factor VIII must be inactivated to prevent continual thrombin formation. This is accomplished by two important proteins, protein C and its cofactor, protein S. Protein C is found circulating in the blood as a zymogen that becomes activated by thrombin. The activated protein C is responsible for inactivation of factor V and factor VIII. Factor V Leiden is a genetic defect (single point mutation) that is a transition of guanine to adenine at nucleotide 1691 of the factor V gene. This changes the output of the specific amino acid sequence which substitutes arginine (normal) with glutamine (abnormal) at the 506 amino acid. This specific change is one of the cleavage sites where protein C binds to factor V. This leads into continued thrombin generation and promotion of thrombosis. After giving birth, a middle age woman developed a pulmonary embolism in her right lung. After removal of the embolism and a history of venous thrombosis, factor V Leiden was suspected. Detection of the defect was accomplished by genomic DNA and activated protein C resistance analysis. A family history and genetic testing of relatives was traced back five generations to where the first incidence of the factor mutation was recognized. All positive family members with the mutation had a recollection of clot disorders that could be suspected of Factor V Leiden.
Tricia Schaufenbuel: Emerging Ehrlichioses: A New Disease in the Badger State (Ministry St. Michael’s Hospital, Stevens Point, WI)
In the last 25 years, scientists have gone from believing Ehrlichial organisms are uncommon animal pathogens to actively researching every aspect of these organisms and their effect on man. As awareness increases it is becoming apparent that human ehrlichioses are more prevalent than previously known and affect individuals in broad portions of the United States and the world. Although some cases may be so mild as to go undiagnosed, other patients have more severe complications. Infection with any of these organisms can be fatal. The discovery of a new species of Ehrlichia in Wisconsin and Minnesota shows that there is much room for research, given the lack of specific, sensitive testing for this and other potential, new species. As the full scope of human ehrlichioses is slowly resolved, it is important that research continue to focus on more rapid and reliable testing to detect and diagnose all of these infections as early as possible.
Marcus Arneson Blood Doping: A Threat to Athletics (Mayo Clinic, Rochester, MN)
With sports there is competition. All athletes are making an effort to outperform their opponents. Some seek to do this through unethical measures known as performance enhancing drugs (PEDs). Different forms of PEDs have plagued many sports and jeopardized their integrity. One is blood doping. Blood doping is sought by endurance athletes. Athletes work to raise their red blood cell count to make them able to carry more oxygen and last longer in events. Blood doping consists of injections of blood units and taking erythropoietin drugs. As with most PEDs on the market, sports authorities have made strong attempts to test for these drugs and punish abusing athletes since the 1980s. Testing methods include the indirect and direct testing of rHuEPO as well as Continuous Erythropoietin Receptor Activator (CERA). Blood donations are tested through the use of flow cytometry and the Athletic Biological Passport (ABP). The positive benefit that these athletes seek does not come without negative side effects.
Adam Rendmeister: Antibody Stew (Wild Rose Community Memorial Hospital, Wild Rose, WI)
Imagine yourself as a cook; you’ve just finished a stew from scratch! You take a sip and realize – OH NO, this doesn’t taste right! There’s something bad in it! Can you identify it? Can you get it out?! Can you save your stew?! Blood bankers face this same type of head scratching, frustrating, and complex problem from time to time. Transfusing blood products to patients requires complex lab tests to ensure compatibility. A major concern is whether a recipient has antibodies. The presence of auto-antibodies in a recipient can make pre-transfusion reactions very difficult to interpret. Failure to correctly identify a patient’s blood type or cross match compatibility can result in feverish reactions, difficulty breathing, poor circulation, and sometimes death. This case study describes a 45-year-old female patient in need of a blood transfusion. The pre-transfusion reactions show results that disagree. Forward and reverse ABO reactions do not match, the antibody screen is positive and she is cross-match incompatible with all units tested. Warming and cooling methods fail to resolve the discrepancies. Is there something wrong with this blood bankers’ method? Which antibodies does she have? Is it possible to achieve readable and reliable reactions? Join me to discover what the true interfering ingredient is in this ANTIBODY STEW!
Stephanie Cisewski: MALDI-TOF: The Future of Microbiology? (Aspirus Wausau Hospital, Wausau, WI)
The identification of microorganisms is a major obstacle in providing patients with appropriate antimicrobial treatment. A definitive identification can take days. A new method has emerged that can reduce identification time to a few minutes from isolated growth. MALDI-TOF MS (Matrix-Associated laser desorption/ionization time-of-flight mass spectrometry), developed for commercial use in 1988, was first used for bacterial identification in 1996. It is a technique to simultaneously screen many biomolecules to determine their identity, which can be used for rapid bacterial and fungal identification using whole cells or crude cell extracts from isolated colonies. The sample is ionized and particles are separated by mass-to-charge ratio, producing a spectrum. MALDI-TOF enables laboratories to identify organisms from overnight growth. Advantages of MALDI-TOF include high sensitivity, rapid detection time, and low cost of operation. MALDI-TOF MS use for microbiology is a leap forward from a diagnostic and patient-outcome perspective. Use of this technology in the laboratory will provide rapid results, so clinicians can provide effective treatment.
Kaitlyn Backhaus: Neonatal Hyperuricosuria: A Baby’s Day Out with the Rolling Stones (Riverview Hospital, Wisconsin Rapids, WI)
The implementation of consistent clinical OB/GYN practices has proven to be extremely beneficial for identifying abnormalities in fetal development. Many disease processes can be detected very early in fetal gestation, which assists the doctor in determining if the fetus will either face a relatively normal life, or if fetal demise will occur. Pyelectasis, or the enlargement of the renal pelvis, has been seen during prenatal ultrasound screens, and is thought to be caused by a blockage in the ureter, between the kidney and the bladder. The solute-to-solution ratio of the urinary filtrate is very important for proper renal function, and any fluctuation in this ratio can lead to serious health problems. Nephrolithiasis is defined as the development of urinary kidney stones. Kidney stones, or renal calculi, are formed by a variety of urinary crystals that are concentrated in the kidney during reabsorption, and harden into a solid aggregate. This particular case report discusses the possible causes, the mechanism of kidney stone development, and the prognosis of a newborn male who experienced the passing of a kidney stone a few days after birth.
Tina Lee: NMR Lipid Profile: Particle Number Matters! (Ministry St. Michael’s Hospital, Stevens Point, WI)
It is well known that heart disease is the number one cause of death among men and women in the United States. A study found that 50 percent of patients hospitalized following a heart attack had a cholesterol level within the normal range, so simply knowing your cholesterol level is not enough. The NMR Lipoprofile Test directly measures the particle size and particle number of low density lipoproteins (LDL); the “bad” cholesterol. The higher the number of LDL particles blocking the blood vessel, the higher the risk of heart attack. Lipid profile testing can aid physicians in choosing more effective treatment options for their patients and help give patients a better understanding of their heart health. A literature review will provide an overview of the benefits of the NMR Lipoprofile Test.
Melissa Kozlovsky: A Case Study: Acute Myeloid Leukemia (ThedaCare Laboratories, Neenah, WI)
A non-Hispanic, 61-year-old female went to a primary care clinic complaining of back and pelvic pain in September, 2011. Upon the examination she had clear lungs and an increase in pain with lumbar flexion. Many different tests were ordered and her complete blood count (CBC) showed thrombocytopenia and anemia. A manual differential was also ordered but was not completed. Later that day she was admitted into AMC where her 100-cell differential was flagged with variant lymphocytes and 42 cells that were suspicious for blasts. Her white blood cells were also noted to have Auer rods. A smear for pathology review was made and later the peripheral blood was sent to the Tricore Reference Laboratory of the University of New Mexico. She was diagnosed with Acute Myeloid Leukemia (AML). AML occurs more often in adults than in children and is more common at around 60 years of age. AML usually starts within the bone marrow, commonly causing anemia and thrombocytopenia. Many patients will seek medical attention with symptoms pertaining to the flu, weakness and abnormal bleeding patterns.
Amy Rounsville: TRALI: “Won’t” you be my neighbor? (St. Mary’s Hospital, Green Bay, WI)
Transfusion-related, acute lung injury, also known as TRALI, is a complication following transfusion of blood products that can be life-threatening. TRALI has been reported from all types of blood components including whole blood, aphaeresis platelets, fresh frozen plasma, cryoprecipitate, granulocytes, and stem cell products. TRALI is categorized by the acute onset of respiratory distress in patients who have received a transfusion. Transfusion-related, acute lung injury is not yet fully understood, but there are two different theories. According to the Food and Drug Administration, TRALI was the leading cause of transfusion-related deaths in both sexes and averaged 24 fatalities annually from 2003-2005. We will examine a case study of a 44-year old woman with melanoma and pulmonary metastases who is given two units of packed red cells and developed the reaction of TRALI after the second unit. Currently there is no screening test for transfusion-related acute lung injury.
Julia Weber: Lions and Tigers and Toxoplasmosis…Oh My! (Ministry St. Mary’s Hospital, Rhinelander, WI)
Toxoplasmosis is an infection caused by the parasite Toxoplasma gondii. Toxoplasmosis is the “T” in the TORCH complex of perinatal infections. The parasite is transmitted via various routes including: ingesting undercooked, infected meat; ingesting the environmentally resistant form of the organism that can be passed through soil, litter boxes, or cat feces; or placental transfer of the infection to a newborn from an infected mother. Most infections are due to the ingestion of undercooked, infected meat. Yet, the placental transfer of the infection from the mother is very important to diagnose and understand. An infected mother with toxoplasmosis has severe congenital implications like mental retardation, blindness, epilepsy, hydrocephalus and retinochoroiditis. The prognosis of the infant depends on the severity of the infection and onset during gestation. Treatment options are available for congenital toxoplasmosis, but expectant mothers should be aware of the risk of infection and take preventative measures.
Cass Donegon: TB or Not TB; That Remains the Question (Divine Savior Hospital, Portage, WI)
Mycobacterium tuberculosis currently infects one-third of the world’s population. This is estimated to be about nine million people with a mortality rate of about two million annually. Tuberculosis (TB) is caused by members of the Mycobacterium genus and is a respiratory infection. While some people become infected actively others can develop a latent infection. This happens when there is a cell mediated response in the body and granulomas are formed encasing the bacteria, becoming dangerous if the granulomas would ever burst or rupture. Difficulties arise as the infection becomes active TB. Traditional TB testing methodology includes tuberculin skin test (TST), chest x-ray and sputum smears. New to the healthcare world is the QuantiFERON-TB Gold, which is a more specific blood test for TB. The QuantiFERON-TB Gold test can rule out many false positives, such as the BCG vaccines and localized skin reactions, which make it more specific. This presentation will explore the ins and outs of the Quan-tiFERON-TB Gold test and its ability to diagnose latent TB.
Aaron Wroblewski: Hairy Cell Leukemia: If You Have Leukemia, Hope for This One (Mayo Clinic, Rochester, MN)
Each year physicians diagnose 2,000 new cases of patients with Hairy Cell Leukemia (HCL) in North America and Western Europe. This rare form of B-lymphocyte chronic leukemia was named for the prominent cells with cytoplasmic projections, called Hairy Cells. HCL commonly presents with pancytopenia, significant splenomegaly, and bone marrow involvement. Men are four to five times more likely to develop hairy cell leukemia than women, with higher frequency in older people. Constituting 2% of all leukemias, HCL must be determined by differential diagnosis to rule out variants, and other splenic B-cell lymphomas. Physicians must evaluate the clinical, cytological, histological, and immunophenotypic features for appropriate diagnosis. Treatment of HCL has changed over the past 50 years and now testing successful clinical trials. Patients will be evaluated in order to choose the correct treatment option whether it is chemotherapy, biologic therapy, splenectomy, or a clinical trial. More than 95% of new patients are treated with cladribine or pentostatin and most can expect about ten years of HCL remission. Although treatments today have great success, researchers stay vigilant to find a complete cure for HCL.
Michelle LaFever: Pretty in Pink: A Microorganism Causing a Severe Transfusion Reaction (Mayo Clinic, Rochester, MN)
Transfusion reactions are a severe, potentially life-threatening reaction to a blood transfusion. A reaction can occur in many different forms during a transfusion, which is why investigation into the exact cause is important. This case study presents a 42-year-old female who presented symptoms during a blood transfusion. The patient’s clinician began the work-up with a history of blood products given and patient vital signs. After initial observations, laboratory tests began to complete the reaction work-up. The laboratory performed tests in both transfusion medicine and microbiology to determine the cause of the reaction. After the microbiology cultures turned positive and the microorganism was identified, susceptibilities were performed on the isolated organism. Finally, research into the microorganism was done and treatment began on the patient. This case shows the importance of investigating the cause of the reaction so proper treatment can be given and the patient can maintain a healthy life.
Juliana Vang: Preeclampsia: the Good, the Bad, and the Ugly (Southwest Health Center, Platteville, WI)
Preeclampsia is a condition characterized by hypertension and proteinuria that presents around the 20th week of pregnancy. These characteristics are often accompanied by edema of the hands and face and sudden weight gain over the course of a few days. There is no known cause for preeclampsia but physicians and researchers have speculated that it could be a result of an autoimmune disorder, blood vessel complications, poor diet, or genetics. In most mild cases, bed rest and hydration are prescribed and managed at home. In severe cases, complications can range from severe headache and vision changes to the development of Eclampsia and HELLP Syndrome. A patient case study ofpreeclampsia with progression to HELLP syndrome is discussed.
Jena Trzebiatowski: Mosquitos Suck! The Plasmodium War (Black River Memorial Hospital, Black River Falls, WI)
Every 30 seconds a child dies from Malaria. This disease, which infected over 216 million people in 2010, is caused by the Plasmodium parasite. Five strains infect humans. Though Plasmodium spp. are only found in certain tropical locations, their vector, the female Anopheles mosquito is found world-wide, making the spread of Malaria in non-endemic areas via infected travelers easy. For this reason, it is important for Medical Technologists in the United States as well as other non-endemic areas to identify the Plasmodium parasite microscopically. The vast distribution of the Malaria vector and the high occurrence of the most deadly strain of Plasmodium, P. falciparum, make eradication of the disease difficult. Misuse of antimalarial medications, such as artemisinin, over the past decade has contributed to a rapidly increasing rate of drug-resistant strains of P. falciparum. Development of antimalarial vaccines are underway, with the RTS,S/AS01 vaccine currently in the third phase of its clinical trials and showing the most promising results. To date vector control has been the most effective means of preventing the spread of Malaria. The World Health Organization, working with the CDC and other organizations, has plans to eradicate Malaria in the next 10 years.
Kayleigh Guillaume: Rhabdomyolysis (Aspirus Wausau Hospital, Wausau, WI)
Rhabdomyolysis, a possible life threatening condition, is the destruction of striated muscle and subsequent release of cellular contents into the bloodstream. Its clinical history is rooted in ancient biblical literature. Today, it continues to affect nearly 26,000 individuals in the United States annually. The risk factors and causes of rhabdomyolysis are numerous and diverse. They range from traumatic injuries and physical exertion to viral and bacterial infections and metabolic disorders. Approximately 16% of patients suffer from acute renal failure. Fortunately, prompt diagnosis and treatment can improve the prognosis.
Brittany Tenor: The Burgundy Cancer: Multiple Myeloma (Bellin Memorial Hospital, Green Bay, WI)
Multiple Myeloma, a plasma cell malignancy, accounts for 10% of all hematological malignancies and 2% of all cancers in the United States. Although the disease typically presents as an asymptomatic illness, the progression of malignancy can cause the disease to develop into a life threatening situation. Multiple Myeloma leads to the disruption of the body’s various organ systems by three primary processes: plasmacytoma in the bone marrow, overproduction of monoclonal immunoglobulin, and the deterioration of bone structure. Here we will discuss the pathophysiology behind common late stage symptoms by reviewing two case studies showing the effects of these processes on laboratory tests such as: complete blood count (CBC), creatinine, BUN, calcium, urine protein, serum electrophoresis, and urine electrophoresis. The case studies will focus on the common and uncommon symptoms seen as Multiple Myeloma progresses throughout the body, and the treatments taken in hopes to suppress the disease.
Jessica Henning: Bacillus Anthracis: The Lethal Killer (Sauk Prairie Memorial Hospital, Prairie du Sac, WI)
Bacillus anthracis has been wreaking havoc since ancient history. It is thought that biblical scriptures, which describe illness, may have been related to Bacillus anthracis. In 1877, scientist Robert Koch successfully related Anthrax signs and symptoms to the causative bacterial agent (B. anthracis). This correlation was the first time in history that a bacterium was said to cause a specific illness. Exposure to B. anthracis spores causes three forms of Anthrax disease: cutaneous, gastrointestinal, and pulmonary. Even-though B. Anthracis is sensitive to penicillin and other commonly used antibiotics, by the time the treatment is administered it is often too late. Production of a capsule and three virulent proteins contributes to the bacteria’s lethal capability. A case study from the New England Journal of Medicine describes gastrointestinal anthrax in a 24-year-old female from Massachusetts. The journal reviews the diagnosis, laboratory results, treatments administered, and patient prognosis. The journal concludes the report by identifying possible sources of Anthrax infection. In this unique patient case study, the source of the Anthrax infection ended up being very unusual.
Jessica Gustavson: POEMS: Piecing Together a Diagnosis (Mayo Clinic, Rochester, MN)
POEMS is a rare paraneoplastic syndrome standing for polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes. However, the components of this acronym are just a few of the effects of this syndrome. The diagnosis of this uncommon condition is often delayed due to a lack of understanding. The patient’s history and physical exam, symptoms, and laboratory findings are the pieces of the puzzle needed to correctly diagnose POEMS. There is a variety of treatment options for POEMS and its related conditions, necessitating a correct diagnosis to avoid adverse outcomes due to treatment error. POEMS is often confused with a variety of other hematologic and neurologic disorders, making it a complicated set of symptoms to recognize. There is much discussion on proper laboratory testing to reach a diagnosis and how to most effectively treat POEMS to prolong the longevity of the patient. Research on the syndrome and treatment options is in the early stages and there is still a lot to learn about POEMS.
Emery Smith: The Ixodes Confusion (Berkshire Medical Center Laboratory, Pittsfield, MA)
Lyme disease was first recognized as an epidemic in the United States in 1978. Now, in 2010, more than 30,000 cases have been diagnosed across the country. Given the fact that there is a diversity in symptoms are associated with Lyme, it can be tricky to diagnose and therefore often difficult to treat. In this case study, we will observe a 20-year-old patient as she battles through the many symptoms of Lyme disease as the symptoms progressively get worse. This patient was believed to be first infected at the age of 13 but was not diagnosed, and therefore not treated until the age of 17. Due to the long period of going untreated, the patient has exhibited many established symptoms of Lyme disease ranging all the way from memory loss to unexpected weight gain. Even though she was cure of this disease with appropriate antibiotics, she still faces lifelong ramifications of this disorder. With this study, we hope to make the public more aware of the various symptoms of this disease in order for earlier diagnosis.