Case study..syphlis?

[KungFuFtr]

Hello

I appreciate anyone willing to take the opportunity to help me with this. I'm still reading and searching.

"During your first week on the job at the city's free clinic...You meet dwight a 53 year old overweight white man with several obvious problems. Dwight's feet are cracked and blstered and he has 3 infected toenails. (he tells you he's been homeless for the past 10 years for various periods). There are seeping sores in the folds of his wrists and under his arms. His gums are bleeding. He is here because he has greatly confused over the past 8 months and it seems to be getting worse. he has episodes of ranting and raving. he reports feeling crazy and being really scared. his friends brought him to the clinic and are waiting outside.

The supervising physician quickly joins you in the examining room. Together you examine dwight thouroughly and make a plan addressing his pressing needs for wound care. The DR. starts asking him about his health history. Dwight reveals very little, saying his memory is very bad. But he talks a lot about his past sexual exploits.

1. the dr. speaks with you in the hallway. he tells you mental illness is very common among the homeless population. dwight needs a thorough pcyc evaluation. The Dr. is fairly sure that some of dwight's neural symptoms are caused by an STD infection. which one? caused by which org?

2. If the blood comes back +, does it mean that dwight can transmit the disease to thers? Explain

3. Should dwight be treated w/antibiotics to remeady his neural symptoms?why or why not?

4. The patients blood came back +. For what other infectios disease should he now be tested?

5. the dr. tells you to expect to see more of these cases in the future. but a coworker, who graduated from nursing school 10 years ago, tells you that this disease (especially in later forms is rather rare and is decreasing in incidence.who is right ? explain.

Ok...i've been searching, and i believe it's neral syphlis. i'm uncertain about the bleeding gums and wrists tho...schankers? Maybe signs of crack cocaine use? Crack users supposedly are more suseptible. As far as being treated w/antibiotics...I thought damaged nural tissue is unrepairable? Does anyone know which other infectious diseases he should be treated for?

I'm not asking anyone to write the paper for me..Just perhaps throw me a bone or two

thanks

[Daytonite, BSN, RN]

well, here's what i can contribute to help you out, little that it is.

here are a couple of links to get you started. 30 years ago we saw a lot of syphilis in little old ladies in the nursing homes who had gotten it from their unfaithful husbands and never known it. we were taught that after the immediate acute infection syphilis goes into the nervous system and is forever incurable at that point. if this patient does have this type of syphilis, he's stuck with it. i'm not sure about re-infection or if he is able to infect others, however. i know there was a brief increase in the incidence of syphilis around the time that hiv came into the public eye and with the relaxing of sexual mores.

http://www.fpnotebook.com/id198.htm - a listing of stds

http://www.fpnotebook.com/id202.htm - an outline of diagnosis and treatement of various kinds of syphilis

http://labtestsonline.org/understanding/analytes/syphilis/sample.html - here is some information about the testing for syphilis - you can also link into more lab information about testing for syphilis on this web site. they don't specifically address the vdrl, however, which is a lab test for syphilis that was done routinely on just about everyone 30 years ago.

i think you need to consider hiv in this patient as well. although your scenario doesn't specifically mention thrush, yeast infection in the mouth is common in hiv positive individuals. however, gingivitis and pyorrhea are also common in people who do not take care of their teeth. bleeding gums goes along with gingivitis, but bleeding disorders also accompany diseases like liver failure as well which makes me wonder if he has a history of alcohol or drug abuse.

i don't think the man's sores on his feet are related to his syphilis. he was, after all, brought in by others, which makes me think he isn't taking care of himself so it is possible he has many hygienic problems. ulcers on the feet automatically make me think of circulation problems or diabetes. his overweight puts him in the perfect spot to be a type ii diabetic. this brings me back to thinking about alcohol or drug abuse causing liver problems--with liver problems usually come pancreatic problems. oh, i could go on. the sores in the folds of his wrists and under his arms are a puzzle to me, unless he has compromised immunity (hiv?) then, i'm also thinking that it is not likely that a alcohol and drug abuser is going to be overweight, sporadically homeless and confused, to boot.

i suspect this case study was designed just for this. i think that no matter what you come up with it is not going to be wrong. everything is so generalized that you could suggest 10 things wrong with this guy and they could all be correct. have fun!

[LydiaNN]

It's been a while, but if memory serves, the potential for infecting others is greatest in the earlier stages of syphilis. Everything else I was going to say was covered very well by Daytonite.

[KungFuFtr]

Thanks for the help!

I've been reading and taking notes like a madman.

[tonimoss14]

Hey know this might be a shot in the dark and from the looks of the date I'll be glad if you remember.... but my microbiology professor just gave me the exact same case study. I'm 99% sure it is Syphilis but this particular instructor gets tricky. If you could recall what the results were that would be great!!!