05/09/1990: The patient, a 16 year old female was well until 2 | Questions 47

05/09/1990: The patient, a 16 year old female was well until 2 days prior to admission when she had a fever to (39.9C) and vomiting. On the morning of admission, she had loose stools, continued fever, and vomiting. She was seen by her local pediatrician who noted that she was hypotensive (BP 76/48 mmHg) with a heart rate of 120 beats/min and a temperature of 38C. She had an erythematous rash, which was most prominent on her trunk. Cultures were obtained. The patient was given intravenous fluids and IV antibiotics and transported to the hospital, where she was admitted into the Pediatric Intensive Care Unit.

Laboratory studies indicated elevated liver enzymes, increased creatinine and blood urea nitrogen, and WBC count of 14,100 mm3 with 78% neutrophils and 18% band forms. The patient had begun her menstrual period 4 days before she became ill.

Qs:
1- what is the possible diagnosis of this case? How can confirm it? What is the possible sites for taking the sample?
2- what is the cause of the previous clinical signs the girl cames with? And what is the nature of it?
3- What is the most possible route this Microorganism get in?