Question A: After dental work oral streptococci can enter the blood (bacteremia) and if not cleared by the immune system can cause an infection in the heart known as infectious endocarditis or develop into sepsis or septic shock. As your patient has had his spleen removed he has a compromised immune system and so is predisposed to these conditions. A dental procedure could therefore be dangerous unless he takes high doses of antibiotics beforehand and continues to take them for 6–12 hours afterwards.
Question B: Endocarditis, sepsis, and septic shock are serious conditions that can be fatal. Therefore, if he doesn’t follow the doctor’s orders he is putting his life at risk. Even if he’s not killed, he could end up in hospital for a prolonged period and his health will take a long time to return to normal.
Question A: Bubos are found in patients with bubonic plague, gonorrhea, tuberculosis, chancroid or syphilis. An STI is not likely unless there has been a serious sexual assault, which you should ask about sensitively. If there has been no assault, the position of the bubos would lead you to think that the unfortunate patient has bubonic plague.
Question B: Plague is one of the most virulent bacterial infections known and if untreated will most likely kill your patient. You must therefore tell a doctor immediately. If treated with promptly with streptomycin your patient has a 90% chance of survival. Your patient should also be isolated in case the infection has spread, or does spread, to the lungs, causing pneumonic plague which is very contagious.