Case Study: Tetanus Booster, Wound Observations, Fever and Antibiotics

This case study presents a detailed analysis of a patient's condition, focusing on a tetanus infection and subsequent treatment. It begins with the rationale for administering a tetanus booster, discussing the Clostridium tetani organism and the importance of timely vaccination. The study then explores wound observations, differentiating between signs and symptoms and providing physiological explanations for inflammation, swelling, and purulent discharges. The development and benefits of fever are examined, along with potential sources and modes of bacterial contamination. Finally, the case study evaluates the appropriateness of Augmentin as an antibacterial agent, considering the colonizing organism Staphylococcus aureus and the added benefits of the drug's components. The assignment adheres to APA 6th edition referencing style and is supported by relevant literature, ensuring correct sentence structure, grammar, and presentation.

This template must be used to answer the case study.
(Please type your answers within the box underneath each question)
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1. Rationale for giving Mary a tetanus booster(Total: 5 marks)
1.1 What is the organism that causes tetanus and why is it of concern in this
situation?
The organism that causes tetanus is the spore of bacterium Clostridium tetani. The
bacteria primarily grow on dead tissues such as those surrounding tissue injuries. It
releases certain potent neurotoxins during its growth and affects the neuromuscular
system of the body often causing severe muscle spasms. The neurotoxin and
hemolysin involved are tetanospasmin and tetanolysin respectively (“Tetanus - the
disease.” WHO, 2017). Tetanus can cause severe complications if untreated.
Fractures of the bone may occur due to muscle spasm and convolutions, other
secondary infection may develop and even the patient may suffer from coma in
extreme cases. Hence the situation Mary is going through is concern.
1.2 According to the guidelines in the “The Australian Immunisation Handbook” (Dept.
of health, 2017) on administering a tetanus booster, discuss the rationale for
giving Mary the tetanus booster
Tetanus vaccination contains a toxoid that stimulates the production of antitoxins
against the neurotoxins rather the prevent growth of the bacteria. Even if complete
immunization dose is taken during childhood by middle age the levels of toxoids in

blood reduces considerably. Hence, the Australian Immunisation Handbook suggests
adults above 50 years of age who did not receive any dose in the previous 10years
should receive a tetanus booster dTpa, to prevent pertussis as well (“4.19
Tetanus.” Immunise, 2017).
2. Physiological basis of the three wound observations (Total: 10 marks)
2.1 For each of the three wound observations indicate, and provide a rationale, as to
whether it is a sign or a symptom.
Signs and symptoms are two medical terms extensively used in the field of clinical
science for the purpose of diagnosis and treatment of patients. These are two terms
often mistakenly used synonymously but have distinct meanings. Symptoms are the
feelings experienced by a person due to his/her diseased condition for example
feelings of nausea, dizziness, light-headedness. These parameters cannot be easily
measured from outside the patient’s body. On the other hand signs can be observed
by people other than the patient to get an overall idea of the patient’s clinical and
medical condition. Signs are often evaluated by doctors of concerned medical
practitioners. Signs of a disease include fever, swelling, bleeding, etc. As symptoms
and severity of the degree of symptoms can only be measured from a patient’s
description it is a subjective terms while symptoms while are easily observed from
outside of the body are objective in nature (Fenichel, 2009). Hence, it can be
concluded that all the three observations made in the given patient are physical
manifestations of the disease and can be referred to as Signs.
2.2 Discuss the physiological basis of the first observation.
Inflammation is the immediate bodily response to tissue injury, where the body aims
to repair the damaged area and fight against invading foreign organisms. It includes

both vascular and cellular response primarily mediated by chemicals such as
histamine, serotonin and complement system (Spitalnik, 2014). The considerable
increase in blood flow carrying immune cells makes the region red and hot to touch.
2.3 Discuss the physiological basis of the second observation.
With dilation of blood vessels in the surrounding regions of the tissue injury
permeability to different immune cells, chemical mediators and hormones increase
and fluid carrying such cells move into the interstitial space between the cells in order
to fight foreign organisms and repair the damaged tissues (Medzhitov, 2010). This
causes swelling of the surrounding tissues.
2.4 Discuss the physiological basis of the third observation.
Bacterial contamination in injured tissues often causes purulent odorous discharges
due to unhealthy bacterial growth and metabolism. Further, tissue fluid carrying
immune cells and dead WBC are discharged from the injured area as the body
attempts to fight such invading microorganisms (Dodiuk-Gad et al., 2007). Thus,
growing bacterial contamination and early stages of inflammation are characterised
by purulent odorous discharges.

3. Development and benefits of fever (Total: 5 marks).
3.1 How did Mary’s fever develop?
The report of Mary’s swab culture confirms the presence of colonizing Staphylococcus
aureus. Staphylococcus infection can be caused directly by the invading bacteria or
by production of certain toxins and may lead to sepsis if remains untreated. Fever is a
normal response of the body to bacterial infections which helps the body fights the
concerned organism. It is possible that Mary incurred the infection from her wound
and it is the reason why fever is caused.
3.2 Discuss two ways in which fever is beneficial.
Studies have shown that fever has several beneficial effects on the body and the
positive and negative effects of fever have been debated widely over the years. In
response to foreign body invasion the immune system of the body is substantially
augmented and the core body temperature is increased. The increased body
temperature helps stimulated the immune cells of the body including T- and B-
lymphocytes, interferon and other inflammatory mediators. These cellular responses
help the body fight against the foreign organisms. Further, increased body
temperature restricts growth of bacteria to a certain extent. As most bacterial cells are
temperature sensitive they are unable to grow and reproduce outside their optimum
temperature range (Evans, Repasky & Fisher, 2015). Thus fever mostly has
beneficial effects on the body up to a certain level beyond which it may cause
disruption of other normal bodily functions.
4. Possible sources of contamination and modes of transmission (Total: 10 marks)
4.1 Name one endogenous source of contamination and discuss the mode of
transmission from the source to the new host.
Contamination of bacteria and virus can occur via different routes, sources and

modes of transmission. Two primary sources of contamination are endogenous and
exogenous. Several factors come into play determining the source of contamination
and severity of the same. The microorganisms residing within the body of a healthy
patient often play a vital role maintaining a healthy lifestyle. However, under certain
condition the normal microbiome of the human body may act against the same and
cause severe infection. Such contamination that is caused by bacteria from within a
patient’s body is known as endogenous contamination (Collins, 2008). This occurs
primarily when the immune system of the patient is compromised and the body is
susceptible to foreign body invasion. AIDS is a very common example of endogenous
contamination where viral invasion causes immune suppression which leads to
various secondary infection. HIV that causes aids is transmitted from contact with
blood infected with virus and injured skin or mucus membranes. Once infected with
HIV the immune system is compromised and opportunistic microorganisms of the
body cause infection in different parts of the body. Some infections include
Candidiasis caused by otherwise harmless fungus residing in the mucous membrane
of the body; Pneumonia caused by Stretococcus pneumoniae, etc.
4.2 Name one exogenous source of contamination and discuss the mode of
transmission from the source to the new host.
Exogenous contamination on the other hand is caused by microorganisms
originating from outside the body. The surrounding is predominated by millions of
bacteria and viruses of both terrestrial and aquatic sources. This occurs via many
routes such as direct contact with the infected person mostly via skin contacts.
Indirectly exogenous contamination can occur via contact of unprotected body parts
with soil or other environmental materials. Further, certain media like air, water or
food may cause contamination by vehicular transmission (Collins, 2008).

5. Appropriateness of Augmentin as the antibacterial agent prescribed to Mary
(Total: 5 marks)
5.1 Given the colonizing organism was Staphylococcus aureus, discuss why
Augmentin is an appropriate prescription?
Augmentin is an antibiotic containing Amoxicillin and beta-lactamase inhibitor.
Certain infections that are resistant to Amoxicillin are treated with Augmentin as it
can prevent the resisting action of the bacteria through beta-lactamase activity (Ball,
2007). Amoxicillin further is a derivation of the antibiotic Penicillin. Staphylococcus
bacteria are sensitive to Amoxicillin which is also used to treat a wide range f gram
positive and gram negative bacteria. As Mary is diagnosed with Staphylococcus
aureus infection Augmentin is the appropriate prescribing drug for her.
5.2 Describe the added benefits that Augmentin provides, with reference to the role of
the major ingredients in Augmentin.
Apart from containing the traditional Amoxicillin antibiotic Augmentin contains a beta-
lactamase inhibitor. Certain bacteria have the ability to disrupt the beta lactam ring
found in many antibiotics including Amoxicillin, which is an upgraded derivative of
Penicillin. It is accomplished by production of an enzyme beta-lactamase. Beta-
lactamase inhibitors bind to beta-lactamase enzyme produced by the bacteria and
inactive the active site of the enzyme thus increasing the efficacy of the antibiotic
(Burns et al., 2010). As staphylococcus is resistant to Amoxicillin alone the beta-
lactamase inhibitor, clavulanate present in Augmentin provided the added benefit for
the antibiotic to perform its action without any disruption. Hence, it alloes amoxicillin
to act with its full potency.
6. Presentation (Total: 5 marks)
6.1 Referencing in-text and in reference list conforms to APA 6th Ed. referencing
style.
6.2 Critique supported by relevant literature as prescribed.

6.3 Correct sentence structure, paragraph, grammatical construction, spelling,
punctuation and presentation.

References
“4.19 Tetanus.” Immunise,
www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/
Handbook10-home~handbook10part4~handbook10-4-19. Accessed 27 Aug. 2017.
“Tetanus - the disease.” WHO | Tetanus, World Health Organization,
www.who.int/immunization/topics/tetanus/en/index1.html. Accessed 27 Aug. 2017.
Ball, P. (2007). Conclusions: the future of antimicrobial therapy–Augmentin® and
beyond. International journal of antimicrobial agents, 30, 139-141.
Burns, C. J., Goswami, R., Jackson, R. W., Lessen, T., Li, W., Pevear, D., ... & Xu, H.
(2010). U.S. Patent Application No. 12/776,745.
Collins, A. S. (2008). Preventing health care–associated infections.
Dodiuk-Gad, R., Dyachenko, P., Ziv, M., Shani-Adir, A., Oren, Y., Mendelovici, S., ... &
Rozenman, D. (2007). Nontuberculous mycobacterial infections of the skin: a
retrospective study of 25 cases. Journal of the American Academy of
Dermatology, 57(3), 413-420.
Evans, S. S., Repasky, E. A., & Fisher, D. T. (2015). Fever and the thermal regulation of
immunity: the immune system feels the heat. Nature reviews. Immunology, 15(6),
335.
Fenichel, G. M. (2009). Clinical pediatric neurology: a signs and symptoms approach.
Elsevier Health Sciences.
Medzhitov, R. (2010). Inflammation 2010: new adventures of an old flame. Cell, 140(6),
771-776.
Spitalnik, S. L. (2014). Stored red blood cell transfusions: iron, inflammation, immunity, and
infection. Transfusion, 54(10), 2365-2371.