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The first branch point is to determine the extent of penetration of the infection is it localized to the dermal layer or does the infection extend into the subcutaneous tissue The former leads one to an erysipelas diagnosis while the latter is indicative of a cellulitis infection On inspection it is difficult to assess the depth of infection so classic signs are looked for Erysipelas is indicated as a well demarcated erythematous painful lesion with high fevers and chills commonly present Usually erysipelas results as a consequence of lymphatic obstruction local trauma or abscess or fungal infections Ms V had signs that were dissimilar to this presentation and as such an alternate to erysipelas was considered Cellulitis is an acute inflammatory skin condition characterized by localized pain erythema swelling and heat with or without signs of fever It is important to distinguish a purulent infection from a non purulent one as that is key to identifying the most common pathogens Staphylococcus aureus purulent and Streptococcus pyogenes non purulent Ms V s presentation was non purulent and the blood cultures came back positive for S pyogenes Cellulitis usually presents unilaterally so a bilateral involvement should raise flags for other possible etiologies namely necrotizing fasciitis toxic shock syndrome and gas gangrene 3 The absence of any major systemic symptoms along with the clinical presentation of a subacute progression led to a low clinical suspicion of these alternate diagnoses despite Ms V having bilateral leg swelling S pyogenes are a catalase negative coagulase negative Lancefield Group A bacteria that are non spore forming cocci Histology frequently shows them in pairs or chains S pyogenes has a variety of virulence factors that makes it pathogenesis so widespread
Primary Source Analysis Document’s Document’s Author Unspecified followed principles outlined by Textbook chapter or chapters to which the document is relevant as a historical document The Northwest Ordinance of 1787 is relevant to Chapter 7 because it successfully demonstrates the Revolutionaries vision of Government It was designed to create an orderly world of middle class farmers who obeyed the law paid their debts worshipped as they pleased and were protected from despotic government and the unruly poor Oakes et al 2015 p 207 It also serves as a response to conflict between the national government and states trying to claim lands given from the British after the Revolution It is also relevant to Chapter 8 because it influenced conflict with controlling borders were Indians resided Lastly it is relevant to the chapters which remark about abolishment of slavery Chapter 13 The Politics of Slavery and Chapter 7 Analysis The Northwest Ordinance of 1787 established a procedure allowing new western regions to become fully equal states Settlers in the new territory were obligated to appoint governors and judges Furthermore adopt and publish in the district laws of the original states and report them to Congress Settlers had to elect a territorial legislature when their population was composed of five thousand free male inhabitants of full age district Any white man who owned fifty acres of property in the
