Kay Peterson, a 50-year-old woman began to suffer flu-like symptoms, including fever, aching joints, sore throat, and a headache. Feeling miserable but not terribly concerned, she took some ibuprofen and went to bed. By the following morning, she began to feel increasingly ill, and was unstable on her feet, confused, and complaining of light-headedness. Realizing this was more than just the flu, her husband rushed her immediately to the nearest emergency room. An initial examination showed that most of Kayâs vital signs were normal. Conditions that may provide some clues were rapid pulse and respiration, an inflamed throat, and a stiff neck. A chest X ray revealed no sign of pneumonia, and a blood test indicated an elevated white blood cell count. To rule out a possible brain infection, a puncture of the spinal canal was performed. As it turned out, the cerebrospinal fluid (CSF) the technician extracted appeared normal, microscopically and macroscopically. Within an hour, Kay began to drift in and out of consciousness and was extremely lethargic. At one point, the medical team could not find a pulse and noticed dark brown spots developing on her legs. When her condition appeared to be deteriorating rapidly, she was immediately taken to the intensive care unit and placed on intravenous antibiotics. One of the emergency room doctors later reported, "Her medical situation was so critical that our intervention was truly a matter of life or death." Because Kayâs symptoms pointed to a possible infection of the central nervous system, a second spinal puncture was performed. This time the spinal fluid looked cloudy. A Gram stain was performed right away, and cultures were started. Required:
a. What are signs and symptoms of disease? Give examples from the case that appear to be the most diagnostically significant.
b. What is the importance of a Gram stain in diagnosis of an infection like this?