How did this patient become infected with this organism?  What was the role of his gangrenous feet in the development of this infection?

Case studies

This 63-year old alcoholic was taken to the emergency room of a local hospital with obvious gangrene on both feet.  He was stuporous.  During that evening, he had a seizure and was treated with phenytoin and barbiturates.  That night he was transferred to a university hospital.  At that time,  he was noted to have opisthotonic posturing and to have developed increasing rigor, respiratory distress, and unresponsiveness.  On examination, he had a temperature of 41.7C rectally, a blood pressure of 70/30 mm Hg, a heart rate of 110- beats per minute, and a respiratory rate of 40/min.  Examination was notable for marked trismus.  The neck was stiff and hyperextended.  Necrotic, blackened areas were present over both feet, and several draining ulcers were noted on the heels and toes. Neurologically the patient responded to deep pain with a grimace.  On the basis of these findings, specific therapy, in addition to supportive care, was initiated, and the patient ultimately recovered.

In Addition to identifying this infectious disease and the infectious agent, ANSWER THE FOLLOWING QUESTIONS:

What virulence factor produced by the infectious agent was responsible for his trismus?

How did this patient become infected with this organism?  What was the role of his gangrenous feet in the development of this infection?

What is the therapy used to treat this infection?

How might this infection have been prevented?