Case Study Analysis: Mary's Tetanus Booster, Infection, and Treatment

This case study examines the case of Mary, who received a tetanus booster after a deep cut and subsequently developed a wound infection. The assignment delves into the organism causing tetanus (Clostridium tetani) and the rationale for administering the booster. It analyzes wound observations, differentiating between signs and symptoms, and explores the physiological basis of each observation, including redness, heat, swelling, and purulent discharge. The study also addresses the development and benefits of fever, the sources and modes of contamination (endogenous and exogenous), and the appropriateness of Augmentin as an antibacterial agent for Staphylococcus aureus infection. The provided solution includes detailed explanations of the physiological processes involved, the benefits of the prescribed treatments, and the potential side effects. References from various books and journals are also included.

This template must be used to answer the case study.
(Please type your answers within the box underneath each question)
1. Rationale for giving Mary a tetanus booster (Total: 5 marks)
1.1 What is t he organism that causes tetanus and why is it of concern in this
situation?
Clostridium tetani is the organism responsible for causing Tetanus. These are often
found in dust, soil or in animal excreta. Tetanus is a very serious bacterial infection
that may be very painful as it can cause stiffness in the muscles and also can affect
the CNS of a human body. At the time of any deep cut or wound, these enter in the
flesh and causes the growth of microorganisms in the spores at the place of wound
which may also can generate tetanospasmin (Simpson, 2012). It is a very powerful
toxin that directly controls the nerves handling the muscles. Mary had a deep cut of
4cm which makes it obvious to have Tetanus. That time, it was very essential to give
her a Tetanus booster as it may have affected her central nervous system directly. It
may prove to be painful for her.
1.2 According to the guidelines in the “The Australian Immunization Handbook” (Dept.
of health, 2017) on administering a tetanus booster, discuss the rationale for
giving Mary the tetanus booster
As Mary had a deep cut of 4cm in her right arm, she must have diagnosed which
might have lead to the development of Clostridium tetani bacteria inside that cut
which can have direct impact on the nerves as well as muscles (Blum & et.al ,
2012). The central nervous system can also get effected by infection caused by
Clostridium tetani bacteria. It might cause a direct impact on CNS of Mary, due to
which she would experience various problems like severe headache, fever, infinite
sweating, spasms in the muscles, unable to swallow etc. Along with these factors, the
bacteria can also lead to death sometimes. It can prove as a very dangerous

bacteria. The effect of the tetanus vaccine lasts from 2 days to 4 weeks, and
sometimes till months too, but it can prevent Mary from such serious issues as getting
infected by such bacterium that can cause troubles to her nervous system as well as
her muscles.
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.
The three wound observations were; wound edges that were red and too hot to touch.
Secondly swollen tissues that were surrounding the wound and the lastly the odorous
and purulent discharge. All these three act as a sign for some abnormal behavior of
tetanus (Ronaghi & et.al, 2010. Or these may also would have happened because
of side effects of tetanus booster vaccine. When Mary went to hospital again, a swab
of her wound was taken for culture and Staphylococcus Aureus bacteria was present
in that wound swab. So, she was diagnosed withdose of Augmentin for a few days.
2.2 Discuss the physiological basis of the first observation.
The first observation was wound edges that were too red and hot to touch. It is done
to check whether the wound is healing or are there any signs of infection. 48 hours
after the tetanus injection, Mary realized severe joint pain and blood pressure, which
are symptoms of side effects of the tetanus booster.
2.3 Discuss the physiological basis of the second observation.
The second observation was swelling of tissues surrounding the wound. Pus draining
out from the wound is considered under this. Swelling of the wound is actually a
process in which white blood cells generate antibodies in a human body tries to
prevent the infected area from infections by various bacteria and viruses. When any

inflammation occurs in the body, different chemicals are extracted released from
WBC’s towards the wounded area. This makes the area red and warm.
2.4 Discuss the physiological basis of the third observation.
The last factor is odorous and purulent discharge from the wound. The purulent
discharge seems milky appearance drawn from the wound. Most of the times, it is a
sign of infection. Opaque secretion that is yellow, tan, brown or green is Purulent
(Simpson, 2012). It is never considered to be normal. Mary was also going through
the same problem as it indicates an infection or bacterias present in the wound. Odor
also signifies infection and it considerers all other factors as well like type of drainage
along with the amount.

3. Development and benefits of fever (Total: 5 marks).
3.1 How did Mary’s fever develop?
As Tetanus booster helps in preventing infection in human body, it has some side
effects as well (Ronaghi & et.al, 2010). The same way, Mary developed some of
these after being diagnosed through the tetanus injection. She had developed joint
pain, fever at 38.2C and also there was a rise in blood pressure of 120/80 mm Hg.
The actual recommended dose for a tetanus booster is 0.5 mL in every 10 years.
Mary’s fever was may be due to some immunosuppressive drugs that interacted with
the tetanus booster. These drugs can be alkylating agents, corticosteroids and
radiation also can interact with them.
3.2 Discuss two ways in which fever is beneficial.
Although fevers are painful, but they also help a human body in various ways. It is a
sort of response to the infection through the vertebrates. Fevers fight back with
certain infections with a type of immune cell, lymphocyte which is also called a C-D-8
plus cytotoxic T cell (Blum & et.al, 2012). This excretes out all the cells that are
infected with tumor cells and viruses. A higher body temperature maximizes the
amount of these cells, hence makes the body more efficient in fighting to the
infections. Fever helps in stimulating the body’s defenses by sending white blood cells
and generating antibodies so that they may be able to destroy the root of infection.
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.
Endogenous sources of contamination are those that have been generated within the
tissue, cell or the organism itself. These act like sequences of DNA that have been
developed from those viruses or bacteria which are already present in the genomes
of the germ cells. Some modes of transmission can be as following (Ronaghi &
et.al, 2010). In the inhalation of stomach, the constituents inside may lead to

pneumonia. In the bowel perforation, various Enterobacteriaceae like peritoneal cavity
causes septicemia and peritonitis. Free radicals, both the species of the reactive
oxygen, i.e. ROS and RNS (Reactive nitrogen species), both have been derived from
endogenous sources. These sources can be mitochondria, phagocytic cells etc.
4.2 Name one exogenous source of contamination and discuss the mode of
transmission from the source to the new host.
An exogenous source is something that is already present in a human body and is
active, but is being originated outside of the organism. Exogenous sources of
contamination are the bacteria that are evolved in closed biological systems from the
external world. Mostly, they are present in terrestrial and aquatic surroundings.
These microorganisms can be pathogenic or benign. These bacteria after entering a
closed environment can cause risky diseases like cholera. Various number of
diseases can be caused by the bacteria like tetanus, gonorrhea etc.
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?
When Mary inspected fever and high blood pressure, she went to hospital. There, a
swab of her wound was taken for culture. It was found that the colonizing organism
present was Staphylococcus Aureus. She was suggested Augmentin for five days
(Blum & et.al, 2012). It is an appropriate approach as it is an antibiotic that helps
in preventing the infection. It affects in curing the infectious bacteria in ear, skin,
nose or in urinary area. The drug belongs to a group of medications that is
categorized as beta lactam antibiotics. Although, it prevents the infection, it also has
some side effects like sometimes it may cause a feeling of nausea, vomiting or
urticaria, which means itchy and red spots in the urinary tract.
5.2 Describe the added benefits that Augmentin provides, with reference to the role of
the major ingredients in Augmentin.
Augmentin is available as a generic product. Augmentin as compared with the other
antibiotics, has less side effects. It is a very common way to treat bacterial infections
(Simpson, 2012). Some do not feel comfortable having the medications in tablet or
liquid form, so this antibiotic is available in liquid, tablet and in capsule types. The
drug helps in treating infections in ears, nose, urinary area and skin. It has various

side effects also like nausea and diarrhea but they are observed in very few cases.