The patient is a 55-year-old male that comes to a Veterans Hospital on an outpatient basis for his periodic examination. He has a history of homelessness and chronic substance abuse. He states that he is clean not been abusing any substance for the past year. He also has a medical history significant for COPD, diabetes, and tobacco use. He currently presents with a two week history of what he describes as eczema around his ears and the back of his neck. He describes that the itching has been so intense as of late that he has broken through the skin areas at the base of his hair line on the back of his head a few times in the last week. These areas are described as red, erythematous, with some pustules producing a white discharge indicating an infection secondary to the itching.
It was decided to culture the superficially infected areas with a Gram stain included. Within an hour the Gram stain result was reported as “Many Gram positive cocci in clusters and moderate amounts of white blood cells seen”. The preliminary concern was an infection with Staphylococcus aureus, possibly a methicillin resistant strain, and thus it was planned to treat the infection as if it were an MRSA infection out of concern. The patient was provided with a course of trimethoprim/sulfamethoxazole (TMP/SMX; Bactrim, Septra) and told to call the clinic back the next day for further instructions.
While obtaining the cultures the nurse had noticed white material that at first was misidentified as dandruff until further observations of the material made her more suspicious for another condition. She reported her concerns to the attending physician. Snips of hair were obtained after consulting with the physician, and sent to the Microbiology Laboratory for microscopic examination.
The snips of hair were carefully laid out under a microscope for observation. After several scans of the material the following was observed on several strands of hair:
A day later the patient was diagnosed as having a superficial secondary MRSA infection as suspected upon the initial evaluation and was initially treated appropriately for the infection. The secondary infection is directly related to the object identified in the hair snip and would require further treatment and notification of the patient.
ANSWER THE FOLLOWING QUESTIONS:
What is identified in the hair snip observation by the technologist?
What is the genus and species name for the organism identified?
What genus/species is closely similar morphologically to this organism?
What group of organisms is this organism a part of and what are other members in this group important for in terms of human disease.
What populations are prone to infestations with this organism?
What are the most common methods employed for the eradication of this infestation?
Name some common forms of transmission for this organism.
*Disclaimer: The information contained in this case study is to be used only as a case study example for teaching purposes. The information in the case study is both factual and fictional. Opinions formulated by the author are intended to stimulate discussion.