The Tired Swimmer Case Study Answer Key.zip
Ludmila Hargett
Annie is on a college swimming scholarship. Recently she has been feeling tired and her times have been getting slower. She has also noticed that her vision is often blurred. Concerned, she goes to see her doctor over the mid-term break and is referred to a neurologist, who finds that Annie is suffering from something more than just fatigue. This interrupted case study takes students through a series of stages that describe Annie's problems and symptoms. Students use their knowledge of nerve and muscle physiology to fit the pieces together and determine what is wrong with Annie. The case was developed for use in a one-semester animal physiology course that is taken by sophomore and junior science majors. It could also be used in an anatomy and physiology course.
Teaching notes are intended to help teachers select and adopt a case. They typically include a summary of the case, teaching objectives, information about the intended audience, details about how the case may be taught, and a list of references and resources.
A startling outbreak has been reported in Chicago and Milwaukee. Within the past 2 days, 15 people have visited emergency rooms complaining of high fever, fatigue, coughing, chest pain, and difficulty breathing. Several people have died, and others are near death!
Zeke said that he started coughing and feeling very tired shortly after he led a music workshop for 50 students at a Chicago concert hall. He thought he might have picked something up from one of the students in the class, or perhaps he caught it 2 days ago on a flight home from vacation in Africa.
You learn that Zeke and several of his friends took a trip to Mali last week. While they were there, Zeke took a side trip to meet a drum maker who taught him how to make djembes (African drums made of animal skins and wood). Zeke brought home 4 of the djembes he helped make.
Zeke and his friends returned home on the same 20-hour flight. After talking with Zeke's friends, you learn that he is the only one with a high fever, fatigue, cough, chest pain, and difficulty breathing.
It's too early to know for sure, but Zeke remembered coughing and feeling very tired immediately after the class. Most colds, flus, and other viral infections take at least 1 day before symptoms are easily noticed.
Lab results show patients are infected with a bacterium that doctors suspect might be anthrax. You immediately send the samples to public health laboratories for testing, but that will take a couple of days.
In the meantime, you need to talk with everyone who is sick - and their families - to find out which activities they participated in before becoming sick. When you look at the responses to your questions, it seems that many of the sick people participated in the same activities recently - like working in a government building or attending a music event.
You already have gotten information directly from sick patients or family members of those who died. You interview 85 people who are not sick, but participated in similar activities as those who are sick or died. In outbreak investigations we call these people the "population at risk of getting sick."
Hint: To find a possible source of the outbreak, look for both a high attack rate for those who participated in an activity and a low attack rate among those who did not participate.
Anthrax can be found naturally in the soil and can infect domestic and wild animals like cattle, sheep, and goats. The animals become sick when they eat spores (germs) in contaminated soil or vegetation.
It looks like all of the sick people attended a music event in Chicago. You may be on to something! But what about the high number of sick people who work in or near a government building? Is that something to worry about too?
No. You've already interviewed well and sick people in the Chicago building where people got sick. Interviewing workers in every government building in these 2 cities would not be as helpful as knowing what activity or exposure these people have in common. Knowing this can help you find out where this outbreak may have started.
With the large number of government workers who are sick, you decide to look into it more. Police reports show that there was a bioterrorism threat 3 days before Zeke and the others got sick - a former government employee threatened to mail anthrax to his old office building in downtown Chicago.
A bioterrorism attack is a deliberate release of viruses, bacteria, or other germs (agents) used to cause sickness or death in people, animals, or plants. Anthrax can be released quietly and without anyone knowing. Bioterrorists may send packages or envelopes that contain harmful germs, like in 2001, when anthrax was added to a powder and deliberately spread through the mail.
No. You interviewed the 2 sick people from Milwaukee and found out they had not been in or near any government buildings in Chicago for the 2 weeks before getting sick. Besides, you haven't determined that anthrax was ever actually mailed to the building in the first place.
That's correct. We need more evidence and lab tests before we can determine if this bioterrorism threat is real or a hoax. There are sick people 100 miles away near Milwaukee, Wisconsin. And remember, these sick people told you they had not been in or near the government buildings in Chicago.
Meanwhile, the results of the blood tests you sent to the public health labs indicate a need for further testing, so you send them away to special labs at the Centers for Disease Control and Prevention (CDC). The results from CDC labs show Bacillus anthracis, the bacteria that causes anthrax!
Based on this finding and the patients' symptoms, the doctors diagnose each patient with inhalation anthrax. You tell all the patients to begin treatment immediately. But if it's anthrax after all, does that mean the police missed something?
Since you've ruled out the government building as the place where all of the sick people came in contact with anthrax, you review the attack rates and interviews again. You find that everyone who's tested positive for anthrax also attended a music event at the same Chicago concert hall where Zeke held his music workshop.
Treatment of anthrax
Someone with symptoms of anthrax should get medical treatment as quickly as possible to have the best chances for a full recovery. Doctors will use several antibiotics that work best for treating anthrax. They will also consider which antibiotics are best for a patient based on his or her medical history.
Prevention of anthrax
Antibiotics can also be used to prevent anthrax from developing in people who have been exposed but have not yet developed symptoms. Anthrax spores in a person's body typically take 1 to 6 days to be "activated" - to start releasing their toxins - but some spores can take more than a month before they do so. That's why people who have been exposed to anthrax must take antibiotics for 60 days - to ensure anthrax is no longer in their bodies.
Inhalation anthrax
If a person breathes in anthrax, they can get inhalation anthrax. When anthrax germs are inside your body, they start to grow and multiply. This could happen quickly or it could take a long time. After the anthrax starts to grow, it releases toxins - or poisons - that will attack your body and make you sicker and sicker.
While you try to figure that out, there's something else you need to do. The 35 workshop participants who are healthy must be given antibiotics to prevent them from becoming sick (this is called post-exposure prophylaxis), since they may have been exposed to anthrax.
You talk to Zeke again. He remembers the drum maker in Mali was coughing and having trouble taking deep breaths, similar to the symptoms of all the sick people from the music workshop. You investigate further, contacting health authorities in Mali. They tell you that the drum maker passed away shortly after Zeke returned to Chicago.
You decide to go back to the other participants at the workshop to ask about it. Interestingly, most of the sick people report that while Zeke was showing them how to make the drum, they noticed a large amount of dust and particles floating in the air.
People can get anthrax through contact with infected animals or their products, such as hides or hair. In fact, anthrax used to be called "wool sorters' disease" and was considered a common risk for workers in wool mills, slaughterhouses, and factories that processed animal hides, hair, and bone.
Anthrax is rare in the United States, but outbreaks do occur in wild and domestic animals. Yearly vaccination of animals is recommended in areas that have had anthrax in the past. The disease is most common in parts of Central and South America, sub-Saharan Africa, central and southwestern Asia, southern and Eastern Europe, and the Caribbean.
You conduct tests of the drums Zeke played and the goat skins he used to make drums at the workshop. They're contaminated with anthrax spores! When the drums and skins were shown to Zeke's workshop, spores were released into the air. People who came closest to the drums and skins breathed the spores, making them sick.
The drums and the goat hides he brought back from Mali were not treated effectively with chemicals to kill anthrax spores. Zeke also did not report the goat skins he brought back from Africa to Customs and Border Protection. Because of this, when he returned to the US, it wasn't verified that they had been properly treated to kill anthrax spores.
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