IntroductionCertain Staphylococcus aureus strains produce Panton-Valentine leukocidin, a toxin that lyses white blood cells causing extensive tissue necrosis and chronic, recurrent or severe infection. This report documents a confirmed case of methicillin-sensitive Staphylococcus aureus strain harboring Panton-Valentine leukocidin genes from Trinidad and Tobago. To the best of our knowledge, this is the first time that such a case has been identified and reported from this country.Case presentationA 13-year-old Trinidadian boy of African descent presented with upper respiratory symptoms and gastroenteritis-like syptoms. About two weeks later he was re-admitted to our hospital complaining of pain and weakness affecting his left leg, where he had received an intramuscular injection of an anti-emetic drug. He deteriorated and developed septic arthritis, necrotizing fasciitis and septic shock with acute respiratory distress syndrome, leading to death within 48 hours of admission despite intensive care treatment. The infection was caused by S. aureus. Bacterial isolates from specimens recovered from our patient before and after his death were analyzed using microarray DNA analysis and spa typing, and the results revealed that the S. aureus isolates belonged to clonal complex 8, were methicillin-susceptible and positive for Panton-Valentine leukocidin. An autopsy revealed multi-organ failure and histological tissue stains of several organs were also performed and showed involvement of his lungs, liver, kidneys and thymus, which showed Hassal's corpuscles.ConclusionRapid identification of Panton-Valentine leukocidin in methicillin-sensitive S. aureus isolates causing severe infections is necessary so as not to miss their potentially devastating consequences. Early feedback from the clinical laboratories is crucial.
In this paper, we explore the concept of a scenariobased serious game for healthcare solutions. The complexity of the interactions and the multitude of actors is captured in a scenario, which is then played with the help of an additional game platform, here called "scenario system". The platform allows high school students to play through a healthcare scenario, possibly including eHealth technology, thereby teaching them about interactions and technology used in modern healthcare. The mobile serious game is based on context and role-triggered tasks for the players so that the game is guided, but includes a certain dynamic and flexibility. The project contributes a method and a tool to use scenarios for user testing of eHealth systems and services as well as an alternative method for teaching the complex domain of eHealth systems to unfamiliar users (e.g. highschool students).
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