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Scenario 2: A 42-year-old man with Swelling of his Right Calf

Scenario 2: A 42-year-old man with Swelling of his Right Calf

Scenario 2: A 42-year-old man comes to clinic with chief complaint of pain, redness, and swelling of his right calf. He states that he had been working in his yard using a string trimmer when the trimmer slipped and cut his leg. He cleaned the wound with water from the garden hose and covered the wound with a large Band-Aid. Several days later, he developed fever to 100.6˚ F and chills and noticed that his leg was swollen and red. He comes to the emergency department for definitive care.

Scenario 3: A 34-year-old Hispanic-American male with end-stage renal disease received kidney transplant from a cadaver donor, as no one in his family was a good match. His post-operative course was uneventful, and he was discharged with the antirejection drugs Tacrolimus (Prograf), Cyclosporine (Neoral), and Imuran (Azathioprine). He did well for 3 months and had returned to his job as a policeman. Six months after his transplant, he began to gain weight, had decreased urine output, was very fatigued, and began to run temperatures up to 101˚F. He was evaluated by his nephrologist, who diagnosed acute kidney transplant rejection.

Scenario 4: A 65-year-old obese African American male patient presents to his HCP with crampy left lower quadrant pain, constipation, and fevers to 101˚ F. He has had multiple episodes like this one over the past 15 years and they always responded to bowel rest and oral antibiotics. He has refused to have the recommended colonoscopy even with his history of chronic inflammatory bowel disease (diverticulitis), sedentary lifestyle, and diet lacking in fiber. His paternal grandfather died of colon cancer back in the 1950s as well. He finally underwent colonoscopy after his acute diverticulitis resolved. Colonoscopy revealed multiple polyps that were retrieved, and the pathology was positive for adenocarcinoma of the colon.

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Why the Client Presented with the Symptoms

  Aspergillus fungus causes invasive Aspergillosis. The patient presented with the symptoms because of the environmental exposure to the Aspergillus spp that causes Aspergillosis. Aspergillus spp. is present in environments such as soil. The client might have been exposed to the patient in his work environment or predisposed due to immunosuppression (Fosses Vuong & Waymack, 2021). The patient experienced fever due to the immune response to the infection. Accordingly, Aspergillus infection on the respiratory system stimulates the release of alveolar macrophages and neutrophils as the defense response, hence, fever. The immune response is also characterized by the release of inflammatory mediators such as leukotriene that lead to symptoms such as fever. The patient experienced fatigue and some chest pains with coughing due to the disease process such as phagocytosis. The activation of the conidia causes the loss of the protective layer of the respiratory system, which impairs gaseous exchange leading to fatigue. The chest pain with coughing was experienced due to the invasion of the lyphae of the infective microorganism on the endothelial cells. The invasion of the endothelial cells leads to thrombosis and endothelial damage, hence chest pains and hemoptysis. The hypoxia, invasion of the extracellular matrix, and inflammatory responses also lead to the development of the symptoms that the client presented with to the hospital (Challa, 2018).

Scenario 2: A 42-year-old man with Swelling of his Right Calf

Genes Associated with the Development of the Disease

The risk of developing invasive Aspergillosis is mainly attributable to the influence of genes. Accordingly, the risk of developing the disease is significantly elevated in carriers of IRF412203592T/T genotypes. The risk of the development of the disease is low in carriers of C allele. The prevalence of the development of the disease is moderate in the carriers of IRF4GGTC and IRF4AATC halotypes. In addition, the risk of developing the disease is elevated in individuals with IRFrs12203592 genes. The effect of genes that include cRel, NFkB1, RelB, and NFkB2 on the development of the infection is however low (Lupiañez et al., 2016). Therefore, there is an increased risk of the disease development in patients with specific genes.

Process of Immunosuppression and Effects on the Body

Immunosuppression is the process in which the innate ability of the body to fight against infection and disease is lowered or suppressed. The suppression can be deliberate or due to a disease process. Deliberate immunosuppression is achievable with the administration of drugs such as rapamycin, azathioprine, cyclosporine and corticosteroids. The use of treatments such as irradiation in the cancer treatment may also lead to depression of the immune system. Irradiation may also be used in depressing the reactivity of the immune system in cases of bone marrow or organ allotransplant. Immunosuppression may also be due to the effect of a disease process. For example, patients affected by diseases that include acquired immune deficiency syndrome have suppressed immunity. The immunosuppression arises from the destruction of the CD4 cells by the HIV-1 virus. Immunologic tolerance may also lead to immunosuppression secondary to the role of antigen-induced reactions. The effects of immunosuppression on the body are the increased susceptibility to diseases and infections. The additional side effects of immunosuppression to the body include loss of appetite, fatigue, nausea, vomiting, and malignancy (Fattahi & Ward, 2017). Therefore, patients should be educated about the risk factors of immunosuppression, prevention and management to improve their lifestyle and behavioral decisions alongside use of medications.




Challa, S. (2018). Pathogenesis and Pathology of Invasive Aspergillosis. Current Fungal Infection Reports, 12(1), 23–32. https://doi.org/10.1007/s12281-018-0310-4

Fattahi, F., & Ward, P. A. (2017). Understanding Immunosuppression after Sepsis. Immunity, 47(1), 3–5. https://doi.org/10.1016/j.immuni.2017.07.007

Fosses Vuong, M., & Waymack, J. R. (2021). Aspergillosis. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK482241/

Lupiañez, C. B., Villaescusa, M. T., Carvalho, A., Springer, J., Lackner, M., Sánchez-Maldonado, J. M., Canet, L. M., Cunha, C., Segura-Catena, J., Alcazar-Fuoli, L., Solano, C., Fianchi, L., Pagano, L., Potenza, L., Aguado, J. M., Luppi, M., Cuenca-Estrella, M., Lass-Flörl, C., Einsele, H., … Sainz, J. (2016). Common Genetic Polymorphisms within NFκB-Related Genes and the Risk of Developing Invasive Aspergillosis. Frontiers in Microbiology, 7. https://doi.org/10.3389/fmicb.2016.01243


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