Solved by a verified expert:BIO 351: IMMUNOLOGYCASE STUDY #1*************************************************************************************Christopher Drury is a 4-year-old boy who presents to the emergency department lethargic with a high feverand a diffuse petechial rash. The child’s illness began three days ago when he developed a low grade feverand a sore throat. The next day, he was seen by his pediatrician and was found to be slightly febrile withpharyngitis. His throat was cultured and he was sent home with supportive care. Today, he developed adiffuse petechial rash and a fever peaking at 104 oC. He complains of a headache, joint pain. Nausea,vomiting and has become more lethargic. Prior medical history includes an admission for pneumococcalpneumonia at the age of 1, which resolved without complications.Physical exam (PE): Temperature: 39.6oC, Heart rate (HR) 145, Blood pressure (BP) 80/50, Respiratory rate(RR) 24, SaO2, 95% on room air. He is toxic appearing, somnolent, but arousable. His exam is significant fornuchal rigidity with a positive Kernig’s and Brudzinski’s sign, diffuse petechial rash and bilateral kneeinflammation. He has no focal neurological deficits.Laboratory Results: WBC 36,000/ul, Hematocrit 40%, Platelets 110,000/ulHe is hemodynamically stabilized; 2 blood cultures are sent and IV ceftriaxone is initiated for presumedmeningitis. Head CT shows no evidence of a mass lesion. A lumbar puncture is performed, which revealsgrossly cloudy cerebral spinal (CF) fluid with an elevated opening pressure, and increased protein anddecreased glucose content. Microscopically, the CSF reveals elevated WBC with a neutrophil predominanceand gram-negative diplococcic. The patient is admitted. At day 2, blood and CSF cultures grow Neisseriameningitidis. IgM and IgG levels to meningococcus are elevated.*************************************************************************************Directions: Type you answers to the following questions on a separate sheet of paper. Place the number ofeach question before your answer. Leave a space between your answers. Please use a size 12 font andsingle-space your answers. Use complete sentences. Do NOT use quotes, but definitely use references.Make sure to put your name in the header.*************************************************************************************Questions:1. Define the following terms: (10 points)A. Diffuse petechial rashB. Toxic appearingC. SomnolentD. Nuchal rigidityE. Kernig’s signF. Brudzinski’s sign2. Indicate what the normal range is for each of the following, what they are measuring, and whetherChristopher’s results are normal or abnormal. If the result is abnormal, what does that suggest about whatis happening to Christopher? (10 points)A. TemperatureB. Heart rateC. Blood pressureD. Respiratory rateE. SaO2F. WBCG. HematocritH. Platelet3. Why did they take a sample of Christopher’s CSF and what is the significance of each of the followingfindings: (10 points)A. Grossly cloudy CSFB. Elevated opening pressureC. Increased proteinD. Decreased glucose presentE. Neutrophil predominanceF. Gram-negative intracellular diplococcicG. Elevated IgM and IgG levels to meningococci4. How were the levels of IgM and IgG against Neisseria meningitidis determined? (10 points)5. What branch of the immune system is important for clearing infections with Neisseria meningitidis andwhy? How does that branch of the immune system eliminate the pathogen? (10 points)****************************************************************************************
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