85-year-old man in Brazil develops multi-drug resistant infection

Many conditions and diseases throughout the world are under-reported and worsen until the patient is forced to address the problem. Severe complications are often easily prevented if detected early. Diabetes is a disease many people live with for prolonged periods of time before proper diagnosis. For those who don’t know, Diabetes Mellitus affects the hormone insulin which influences how sugar is absorbed and transported in the body. Since sugar is the major source of fuel for all cells in the body, defects its regulation can cause major health complications, even organ failure.

A case study written by the Diabetic Foot and Ankle Journal investigated an incident of an 85-year-old man in Brazil admitted to the Emergency Room because of  “an ankle injury and a foot non-healing ulcer sustained from a drill accident 2 months prior to his visit in our hospital”. Lab results showed the ulcer colonized by several species of multi-drug resistant bacteria contributing to irreversible damage to the man’s foot. The man eventually had to undergo a lower-limb amputation. The hospital also did several blood tests, which diagnosed the man with Diabetes Mellitus—information unknown to him before the hospital visit. This case study shows the importance of education of diseases like Diabetes Mellitus as well as the dangers and virulence of multi-drug resistant bacteria.

This man had been living with Diabetes for 13 years prior to this hospital visit and had no knowledge he possessed the disease and had no means to manage and treat the complications associated with Diabetes Mellitus. His blood-work taken at the hospital showed deficiency in almost every respect—hematocrit, white blood cell, granulocyte, counts were well out of their normal ranges. Because of this, his immune system must have been greatly suppressed at the time of diagnosis as well as years prior. If his condition was detected and properly managed, health complications, like this serious infection, could have been prevented or at least mitigated. This shows the importance of education and awareness of inhibiting and life-threatening diseases.

Many aspects of the serious infection this man incurred could have been prevented by wound care as well as means to treat Diabetes. Since Diabetes Mellitus is known to be immunosuppressive, it was very hard for this man’s body to fight off the serious infection in his foot ulcer. The case study cited the man’s “denial and lack of knowledge regarding his disease and the importance of proper foot care”. The absence of education and knowledge led to a very serious, but perhaps preventable health complication.

In addition to an emphasis on health education and knowledge, this case study also demonstrated the virulence and robustness of multi-drug resistant bacteria. Many species of bacteria in biofilm—structures containing bacteria connected to a surface and to each other as well as polymeric extracellular substances. Bacteria in biofilms are known to increase the bacteria’s rate of survival in a certain environment. This makes them more resistant to treatment and contributes to the antibiotic resistance problem; many bacteria found in biofilm are resistant to different types of antibiotics. The bacteria in the man’s foot ulcer was resistant to a wide array of antibiotics and made wound healing virtually impossible—amputation was recommended in order to prevent the infection from spreading. The case study stresses the importance of antibiotic surveillance in order to mitigate the antibiotic resistance problem in order to make proper and effective treatment decisions easier for healthcare workers.

This case study is an example of two important things. Knowledge and educations in regards to health is of absolute importance especially in developing countries. Furthermore, multi-drug resistant bacteria make it incredibly difficult for healthcare workers to treat infection. Many of the complications incurred by this man could have been prevented or at lease mitigated; however, these complications also led to a significantly reduced quality of life. While not explored explicitly in this case study, a suppressed immune system over 13 years most likely led to prolonged sickness and additional health complications. In addition, the amputation doctors had to perform will inhibit the man’s way of life for the remainder of his years. Hopefully increased awareness through case studies like these in conjunction with further analysis, research and development will lead to not only more effective ways in educating and diagnosing people, but also means to treat cases like these.

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384988/

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