Essay: Malaria / Staphylococcus / Left Ventricular Contractile Dysfunction / Allostasis

Multiple choice questions
1) A 5-year-old boy from Guatemala is brought to the United States for correction of a congenital limb deficiency (missing a portion of a limb). The little boy has been unable to learn to walk, and physicians are hopeful that through surgical intervention, they will be able to improve the child’s quality of life. Upon arrival to the hospital, the child is noted to have a history of malaria. Malaria is caused by:
1. An opportunistic infection
2. A biologic vector
3. Human-to-human contact
4. Direct contact
Malaria is not an opportunistic infection. Opportunistic infections occur when organisms (bacteria, virus, etc.) takes over, overwhelm or take advantage of a host organism’s weakened or compromised immunity to cause a disease or alteration in homeostasis.
Human to human contact is a type of transmission where disease are spread or transmitted by the various ways one gets in close, physical contact or interactions with humans. The infecting organism can be spread through various forms of human interactions and contacts such as through cough or sneeze (airborne), semen (sexual), blood, body fluids, etc.
Direct contact is one route of transmission of diseases where actual physical contact is required for the disease to be transmitted. Getting an infection or disease by direct contact is not necessarily exclusively a human to human contact or interaction as humans can get the disease by direct contact by touching an animal or inanimate object that has a bacteria or virus.
Malaria is caused by an infection transmitted through a biologic vector. A biologic vector is a carrier that transmits an organism that causes sickness from one host to another. The protozoan is transmitted to humans through the biologic vector, the female Anopheles mosquito. According to Suresh et al. (2015), of all the four species, Plasmodium vivax and Plasmodium falciparum are most pervasive with Plasmodium falciparum causing the more severe presentation of the disease. A biologic vector causes malaria. This is the correct answer.
2) The child undergoes surgery and requires a partial amputation of the affected limb. Throughout his recovery, he has been plagued with intermittent fevers. Fever is the hallmark of most infectious diseases, and physicians determine he suffers from Staphylococcus aureus. This infection may be characterized as being:
1. Dimorphic
2. Nectrotizing
3. Prodromal
4. Commensal
According to McCance and Huether (2014), dimorphism is a characteristic of a fungus where it can take two forms or structures depending on the set of circumstances and environment factors. Dimorphic fungi take the form of yeast in body temperature and take the form of mold in cultures or room temperature. Since the source of the infection was a bacteria, this does not directly apply in the case of the child.
Necrotizing is another term for death. Necrosis of cells occurs as a result of the damages caused by the bacteria in the form of toxins and byproducts released over the course of the disease process. In a tissue level, necrosis occurs when blood flow is restricted or eliminated causing deprivation of oxygen and other vital nutrients.
Prodromal is a stage in clinical determination of the progression of a microorganism infection. This is the 2nd stage where the person infected is starting to feel the mild, initial signs and symptoms of the infection (McCance and Huether, 2014). I initially thought this was the correct answer because of the fevers, but after further reading and considering all the details and items discussed in the readings, I do not think this is the answer.
Commensal is a type of a relationship where one organism benefits without negatively affecting the other organism. According to Martin et al. (2013), one example of a commensal relationship is the gram-negative anaerobes in the GI system. The bacteria provides the host essential nutrients and help defend the host from infections, on the other hand, the host provides a stable living environment and necessary nutrients. Another commensal relationship in the body is between Staphylococcus aureus and the skin. Some has viewed Staph. aureus in the skin as a pathogen while some has views them as beneficial as it produces toxins that can inhibit growth of new organisms or different strains of Staph (Cogen et al., 2008). Infections from a commensal relationship can occur when the host has a weakened immunity. In the case study, the patient has a history of malaria and had surgery. I believe that the infection is caused by the commensal Staph. aureus organism that has taken opportunity of the host. This the correct answer.
3) A 58-year-old male executive has been referred to a psychiatrist for depression after losing his job. The psychiatrist extensively interviews the client about his medical background and lifestyle. The man explains his previous job, which entailed long hours and stress from employees and his employer. Additionally, within the past year, his oldest son was diagnosed with cancer and has since passed away. According to psychiatrist, the man suffers from both acute and chronic stress.
Important effects of acute emotional stress, such as the death of a loved one, can cause:
1. Frailty
2. Posttraumatic stress disorder (PSTD)
3. Left ventricular contractile dysfunction
4. Gluconeogenesis
Frailty is a condition where vulnerability to disease and injuries are greatly amplified; it results from a decrease or exhaustion of a person’s reserves and defenses in both physiological and psychological aspects, resulting in the compromise and lowering of one’s ability to bounce back, deal with and manage stressors (Xue, 2011). I feel that frailty can result from both acute and chronic stress, but this is not my final answer as this is not necessarily life threatening.
PTSD is a mental disorder that is experienced by people who has went through a severe traumatic life threatening events in their past. PTSD also has some physiologic effects in the body. Even though the patient in this case has experienced stress in his life, I don’t think he has PTSD. This is not the correct answer.
Gluconeogenesis is the body’s synthesis of glucose from non-carbohydrate sources such as fat and proteins. In stressful situations, cortisol stimulates gluconeogenesis in order to provide abundance in glucose for the body to utilize. I don’t think gluconeogenesis is ultimately the correct answer because it occurs in stressful situations of any kind or time frame duration, the only difference and situation where gluconeogenesis occurs is where there is limited amount or absence of available carbohydrate source in the body.
Left ventricular contractile dysfunction is a condition where the left ventricle of the heart has a compromise in its ability to pump blood adequately to meet the body’s demand in order to function properly. Causes of Left ventricular contractile dysfunction ranges from heart attack, ventricular remodeling in response to hypertension, stress, etc. In this specific case, the patient’s acute and chronic stress has activated and sustained the stress response and feedback systems. Stress can be beneficial for a short period, but long term stress can be detrimental to health as it alters the body’s normal function through activation and sustained utilization of processes and feedback systems. According to McCance and Huether (2014), stress can be an etiology of cardiac diseases and stress can exacerbate an existing cardiac illness. Some alterations include the continuous release and presence of increased amounts of catecholamines and stress hormones. Other cardiac specific changes include hypertension and cardiac remodeling as a result of long-term demands on the heart. This is my answer.
4) Long-term or chronic exaggerated responses to stress can lead to disease. The adaptive physiologic response to stressful events is called:
1. Allostasis
2. Hypercortisolism
3. Immunomodulation
4. Cytotoxicity
Allostasis is the physiological adaptation the body undergoes in response to long term stressful events (McCance and Huether, 2014). It is the process of attaining homeostasis in spite of constantly changing physiologic responses to chronic stressors. People who experience constant stress have an overworked sympathetic nervous system that can cause wear and tear to body systems, organs and cells. This is the correct answer.
Hypercortisolism is the state of chronic or long-term exposure to increased amounts of cortisol in the body. It can be caused by various etiologies such use of steroid containing drugs, excess production of cortisol in the adrenal gland by carcinoma, increased ACTH production and stressful situations. This is an aspect of the physiologic response to prolonged stress, but is only a part of the whole picture. This is not the correct answer.
Immunomodulation is the manipulation of the immune system to achieve as specific goal that is beneficial to the patient as a whole. This can be achieved use of hormones, drugs and even aspects or components of the immune response. Stress affects a person’s immune system. Acute stress can be beneficial and can improve the immune system. Chronic stress can be detrimental as prolonged presence of catecholamine’s and stress hormones can alter the body’s normal processes. This is not the correct answer.
According to Cytotoxicity (2015), “cytotoxicity is the quality of being toxic to cell”. Cytotoxic substance can come from toxins from bacteria or byproducts released over the course of the disease process. This is related more to infection and not necessarily a stress response. This is not the correct answer.