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Revolt on the Tuberculosis Ward


Joyce A. Shaw
School of Arts and Sciences
Endicott College


Monique is a 30-year-old Haitian woman with advanced pulmonary tuberculosis who has been transferred from a tuberculosis sanatorium to a large general hospital in Port au Prince after developing a secondary infection with Bacteroides fragilis at the site of her chest tube insertion. The patients on the hospital ward were disgusted by the foul smell of her wound drainage and wanted her removed from the unit. In this directed case, students investigate the characteristics of Mycobacterium tuberculosis and Bacteroides fragilis and review the anatomy and physiology of the respiratory system to help determine whether to keep the chest tube in place or remove it. Using statistics from websites of the World Health Organization, students also must balance the different social, cultural, and medical conditions that exist in Haiti while they formulate a recommendation as to how to end the patient revolt on the tuberculosis unit.  Originally designed for use in a general microbiology course, the case could also be suitable for an upper-level pathophysiology or clinical microbiology course.

  • Explain the epidemiology of tuberculosis.
  • Define the terms incidence, prevalence, and mortality.
  • Compare tuberculosis in Haiti and the United States.
  • Describe the causative microorganism, symptoms, and pathology associated with tuberculosis.
  • Identify anatomy of the thoracic cavity and specifically the pleural space.
  • Summarize phenotypic and growth characteristics of Mycobacterium tuberculosis.
  • Compile a list of risk factors for TB in developing countries.
  • Explain the precautions that must be observed when dealing with active tuberculosis.
  • Evaluate the effect of a secondary infection with Bacteroides fragilis in a patient with tuberculosis.
  • Compare primary versus secondary infections.
  • Identify routes of entry of pathogens into humans.
  • Compare local versus systemic infections.
  • Summarize phenotypic and growth characteristics of Bacteroides fragilis.
Keywords: Respiratory system; respiratory disease; infectious disease; bacteria; tuberculosis; secondary infection; Mycobacterium tuberculosis; Bacteroides fragilis; Haiti
Topical Area: Social issues, Social justice issues
Educational Level: Undergraduate lower division, Undergraduate upper division
Formats: PDF
Type/Method: Dilemma/Decision, Directed, Discussion
Language: English
Subject Headings: Microbiology   Medicine (General)   Nursing   Public Health  
Date Posted: 10/25/2012
Date Modified: N/A
Copyright: Copyright held by the National Center for Case Study Teaching in Science, University at Buffalo, State University of New York. Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work.

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