Virtual Escape Room

Hello! Welcome to this Microbiology Virtual Escape Room. Please read the following to determine if you would like to take part in this study. ''Participant Information Sheet for Microbiology Virtual Escape Room'' Name of department: Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS) Title of the study: The Use of Virtual Escape Rooms in Clinical Microbiology Education ''Introduction'' My name is Jacob Darroch, I am a 4th Year Undergraduate Student at SIPBS, currently writing my honours thesis on the use of Virtual Learning formats in Clinical Microbiology education. ''What is the purpose of this research?'' To determine the effectiveness of a virtual learning format in Clinical Microbiology education. ''Do you have to take part?'' No, and you may withdraw your participation at any time. ''What will you do in the project?'' You will play through the Escape Room and will be asked to fill out a brief survey afterwards. ''Why have you been invited to take part?'' You have been invited because you have shown interest in this study and clicked the link. ''What are the potential risks to you in taking part?'' There are no risks associated with this project. ''What information is being collected in the project? '' Opinion data about your experiences. No personally identifiable data will be collected. ''Who will have access to the information?'' Myself and my Supervisor, Dr. Morgan Feeney ''Where will the information be stored and how long will it be kept for?'' Information will be stored on my University OneDrive, and will be processed and deleted within a year. Thank you for reading this information – please ask any questions if you are unsure about what is written here. All personal data will be processed in accordance with data protection legislation. Please read our Privacy Notice for Research Participants for more information about your rights under the legislation. ''What happens next?'' If you wish to take part in this project, please click the continue button at the bottom of this page. If you do not wish to participate, feel free to close this window, and thank you for your attention. ''Researcher details:'' Jacob Darroch University of Strathclyde ''Chief Investigator details:'' Dr. Morgan Feeney University of Strathclyde This research was granted ethical approval by the SIPBS Departmental Ethics Committee. If you have any questions/concerns, during or after the research, or wish to contact an independent person to whom any questions may be directed or further information may be sought from, please contact the following email address: ethics@strath.ac.uk //By pressing continue, you agree to the following:// //* I confirm that I have read and understood the Participant Information Sheet for the above project and the researcher has answered any queries to my satisfaction.// //* I understand that my participation is voluntary and that I am free to withdraw from the project at any time, up to the point of completion, without having to give a reason and without any consequences.// //* I understand that anonymised data (i.e. data that do not identify me personally) cannot be withdrawn once they have been included in the study.// //* I understand that any information recorded in the research will remain confidential and no information that identifies me will be made publicly available.// //* I consent to being a participant in the project.// ''DO NOT USE YOUR BROWSER BACK OR REFRESH BUTTONS AS THIS WILL RESET YOUR PROGRESS'' ''THIS EXPERIENCE WORKS MUCH BETTER ON A COMPUTER OR LARGER DEVICE'' ''YOU MAY WISH TO USE A NOTEBOOK AND PEN TO NOTE YOUR FINDINGS'' [[Continue|Background]]

(font: "Courier New")[Monday, February 3rd 20XX Reports of a worrying disease outbreak in Japan have been brought to you, a Head Epidemiologist based in the CDC's East Asian and Pacific Office in Tokyo. According to these preliminary reports, at least $deaths1 people have died and a further $hospitalisations1 people have been hospitalised over the weekend in Hiroshima, the largest city in the Country's Chugoku Region. Our team have been tasked with investigating this outbreak, and have been given the following responsibilities: * Identifying the pathogen resposible for the outbreak * Investigating a potential source of the outbreak * Suggesting measures to control the outbreak //''Make sure to read all of the reports and records before proceeding to the next phase of your investigation.''// [[Symptomatic Report]] [[Demographic Report]] (link: "Interview Records")[ (if: $category is 1)[(goto: "Interviews1")] (else-if: $category is 2)[(goto: "Interviews2")] (else:)[(goto: "Interviews3")] ] //''Once you are ready, press "Continue" to further your investigation.''// (if: $visited1 and $visited2 and $visited3)[ [[Continue|Question1]] ] (else:)[ You need to read all three reports before you can continue... ]]

(font: "Courier New")[//''Primary report on Clinical Observations and Symptomatology of suspected patients of Hiroshima gastroenteritis outbreak''// We have received a preliminary report from a laboratory team, detailing the observed symptoms of patients that are suspected to be suffering from the pathogen of interest in the current outbreak. ''Centers for Disease Control and Prevention (CDC) Internal Report: Preliminary Symptom Profile of Unknown Disease Outbreak'' To: CDC East Asia and Pacific Office From: Outbreak Response Team – Hiroshima Date: November 25, 2024 Subject: Symptomatology of Current Outbreak in Coastal Regions This report provides a consolidated profile of the symptoms observed in patients affected by the ongoing outbreak in coastal areas. While the causative agent has not yet been identified, the symptom pattern is consistent among cases and suggests a potentially waterborne or seafood-associated origin. Symptom Analysis ----------------------------------------------------------------------------------------------- 1. Early Presentation (0–48 Hours Post-Exposure) * Systemic Symptoms: Acute fever (≥38°C/100.4°F) accompanied by chills and malaise. Generalized fatigue and lethargy. * Gastrointestinal Symptoms: Profuse watery diarrhea. Nausea and occasional vomiting. Moderate-to-severe abdominal cramping. * Localized Dermatological Signs: Erythema (redness) and tenderness at minor wounds or abrasions. Initial swelling without discharge at lesion sites. ----------------------------------------------------------------------------------------------- 2. Intermediate Stage * Dermatological Progression: Development of hemorrhagic bullae (blisters) in ~30-40% of cases. Painful swelling and darkening of affected skin, often around extremities. * Systemic Complications: Hypotension (systolic BP < 90 mmHg). Tachycardia and persistent fever. Mild confusion in isolated cases, suggesting potential early sepsis. ----------------------------------------------------------------------------------------------- 3. Severe or Advanced Stage * Necrosis and Tissue Damage: Rapid tissue necrosis requiring immediate debridement in severe cases. High risk of limb amputation in untreated individuals. * Systemic Deterioration: Onset of septic shock in approximately 20% of cases. Acute renal failure and metabolic acidosis in critically ill patients. ----------------------------------------------------------------------------------------------- * ''Overall Case fatality rate exceeds $fatality%'' * ''Case fatality rate for advanced presentations exceeds $fatality1%'' ----------------------------------------------------------------------------------------------- ''Actionable Recommendations:'' Ensure all healthcare providers in affected regions are aware of the rapid progression of symptoms and importance of early intervention. Advise immediate empirical treatment for sepsis in suspected cases. Strengthen data collection on patient histories, exposures, and outcomes. Prioritize collection of environmental and biological samples for laboratory analysis. Limit external dissemination of findings until a causative agent is confirmed to avoid public alarm. The laboratory is currently prioritizing pathogen identification and antimicrobial susceptibility testing. Updates will follow as results become available. Prepared By: Dr. Yu Nakamura Team Lead, Outbreak Response – Hiroshima Centers for Disease Control and Prevention ''FOR INTERNAL DISSEMINATION ONLY - CONFIDENTIAL''] (set: $visited1 to true) [[Back to Start|Background]]

(font: "Courier New")[//''Primary report on Observed Demographics and Similarities between suspected patients with severe symptoms''// We have received a series of graphs detailing the demographics of the patients. It is your job to analyse the graphs provided, and begin to identify trends in our patients experiencing severe symptoms.] <img alt="Graph of Patient Age Ranges" src="https://raw.githubusercontent.com/jacobdar21/Virtual-Escape-Room/refs/heads/main/AGERANGETABLE.png"> <img alt="Graph of Patient Genders" src="https://raw.githubusercontent.com/jacobdar21/Virtual-Escape-Room/refs/heads/main/GENDERTABLE.png"> <img alt="Graph of Patient Underlying Conditions" src="https://raw.githubusercontent.com/jacobdar21/Virtual-Escape-Room/refs/heads/main/UNDERLYINGTABLE.png"> Prepared By: Dr. Jun Kiyora Team Lead, Outbreak Response – Hiroshima Centers for Disease Control and Prevention (set: $visited2 to true) [[Back to Start|Background]]

(font: "Courier New")[//''Transcripts of Interviews with suspected patients of Hiroshima gastroenteritis outbreak''// We have received recordings of a series of interviews, each one with a patient or the family member of a patient infected by our unknown pathogen. Most of the patients had moderate symptoms that were able to be managed relatively easily in hospital, however some patients were unable to provide an interview as a result of severe symptoms. Your job is to draw commonalities between the patient accounts, in order to attempt to trace the cause of our outbreak, helping us to better identify the causative agent of this outbreak and treat other and more severely unwell patients. ----------------------------------------------------------------------------------------------- ''Interview 1'' Subject: Male, Age 44, Occupation: Delivery Driver Location: Hiroshima, Japan [[Interview 1|Interview 2-1]] ----------------------------------------------------------------------------------------------- ''Interview 2'' Subject: Husband of Deceased Patient Patient: Female, Age 58, Homemaker (Deceased) Location: Hiroshima, Japan [[Interview 2|Interview 2-2]] ----------------------------------------------------------------------------------------------- ''Interview 3'' Subject: Female, Age 29, Occupation: Student Location: Hiroshima, Japan [[Interview 3|Interview 2-3]] ----------------------------------------------------------------------------------------------- ''Interview 4'' Subject: Male, Age 37, Office Worker Location: Hiroshima, Japan [[Interview 4|Interview 2-4]] ----------------------------------------------------------------------------------------------- ''Interview 5'' Subject: Son of Patient Patient: Male, Age 59, Businessman Location: Hiroshima, Japan [[Interview 5|Interview 2-5]] -----------------------------------------------------------------------------------------------] (set: $visited3 to true) [[Back to Start|Background]]

(font: "Courier New")[Good call. Judging by the interviews, it's safe to say that the oyster truck by the train station is the source of our outbreak. Now, in addition to determining the source of the outbreak, it is crucial to examine the demographics most severely impacted by the illness. Using the data you were shown in the [[Demographic Report|Demo Q2]] please answer the following three questions: Which Age Range is worse affected? (dropdown: bind $q1Choice, "Choose an option", "0-17", "18-24", "25-34", "35-44", "45-54", "55-64","65+") Which sex is worst affected? (dropdown: bind $q2Choice, "Choose an option", "Male", "Female", "Both are affected equally") Pre-existing problems with which organ are most commonly associated with severe outcomes? (dropdown: bind $q3Choice, "Choose an option", "Heart", "Lungs", "Brain", "Kidneys", "Liver", "Stomach") [[Click for hint|Hint 1]] (link: "Submit Answers")[ (set: $q1Correct to ($q1Choice is "65+")) (set: $q2Correct to ($q2Choice is "Male")) (set: $q3Correct to ($q3Choice is "Liver")) (if: $q1Correct and $q2Correct and $q3Correct)[ (goto: "Question 3") ] (else:)[ Not quite... Have another look at the data and (link: "Retry")[(goto: "Question 2")]! ] ]]

(font: "Courier New")[Tuesday, 4th February 20XX Our investigation into the outbreak in Hiroshima has entered it's critical second phase. Following the initial collection of data, patient interviews, and preliminary identification of a potential source: the Oyster Truck outside of the Train Station. Phase II focuses on laboratory validation. Samples collected from both suspected patients and the oysters themselves have been dispatched for rigorous analysis to confirm the causative agent and establish a definitive link between the outbreak and the implicated source. This matter remains of grave importance, as it has been confirmed that a total of $deaths2 people have now passed away from this unknown infection. Since we now have a potential source identified, your team have done some research into common pathogens and illnesses associated with the consumption of oysters, as well as a list of procedures carried out on the oyster and patient samples: [[Research Findings]] [[List of Laboratory Techniques]] //''Once you are ready, press the link below to further your investigation.''// (if: $visited4 and $visited5)[ [[View Laboratory Results|Raw Lab Results]] ] (else:)[ Our lab results aren't in yet... why not read the research reports while we wait? ] (if: $visitedQ4)[ [[Back to Question|Question 4]] ]]

(font: "Courier New")[Nicely done. As our investigations into the source and affected demographics progress, immediate action is needed to contain the outbreak and minimize further loss of life. Understanding the rapid onset and high mortality rate associated with the illness necessitates swift and decisive measures to curb its spread. Given the information you now know from the previous reports and the [[Symptomatic Report|Symptomatic Report Q3]], what do you think the most appropriate measures we should take in order to curb the spread of this dangerous outbreak? Regarding the Oyster Truck itself: (dropdown: bind $q4Choice, "Choose an option", "Do Nothing", "Give the Owner a stern warning", "Close the Oyster Truck outside the Train Station", "Close All Oyster Trucks in Hiroshima") What warnings should be sent out to the public? (dropdown: bind $q5Choice, "Choose an option", "No warnings need to be sent out yet, as we do not know the causative pathogen yet", "All residents should avoid eating oysters at all costs", "Advise High Risk Groups to avoid oysters and other raw seafood", "Encourage High Risk Groups to eat more raw seafood in order to build immunity") Regarding further investigation: (dropdown: bind $q6Choice, "Choose an option", "Take samples from the Oyster Truck causing the outbreak", "Dispose of all oysters that came from the Oyster Truck causing the outbreak ", "Take samples from the Oyster Truck causing the outbreak and then dispose of remaining oysters") [[Click for hint|Hint 2]] (link: "Submit Answers")[ (set: $q4Correct to ($q4Choice is "Close the Oyster Truck outside the Train Station")) (set: $q5Correct to ($q5Choice is "Advise High Risk Groups to avoid oysters and other raw seafood")) (set: $q6Correct to ($q6Choice is "Take samples from the Oyster Truck causing the outbreak and then dispose of remaining oysters")) (if: $q4Correct and $q5Correct and $q6Correct)[ (goto: "Further Investigation 1") ] (else:)[ Not quite... Have another look at the data and (link: "Retry")[(goto: "Question 3")]! ] ]]

(font: "Courier New")[//''Pathogen Risk Overview: Common Pathogens Associated with Raw Oyster Consumption''// Raw oysters are a widely consumed delicacy around the world, but they pose significant risks as potential vectors for foodborne pathogens. Due to their filter-feeding behavior, oysters can accumulate harmful microorganisms, including bacteria, viruses, and parasites, from contaminated water. Understanding the common pathogens associated with raw oyster consumption is critical to our identification of our unknown pathogen and starting treatment as soon as we can. Your job is to look at the types of pathogens that our research has uncovered that could be our unknown, and refer to the [[Symptomatic Report|Sym RF]] in order to ascertain what type of organism is the causative agent in our outbreak. ''//Key Pathogens Linked to Raw Oysters//'' ----------------------------------------------------------------------------------------------- 1. //Vibrio// Species Oysters harvested from coastal waters, especially in warmer climates, are often linked to infections caused by //Vibrio // bacteria. They cause severe gastrointestinal and occasionally bloodstream infections (sepsis). They are Gram-negative, comma shaped rod (vibrio) shaped bacteria. Negative result after acid-fast staining. They are both Oxidase and Catalase positive. ----------------------------------------------------------------------------------------------- 2. //Escherichia coli// Typically a sign of contamination with fecal matter, //E. coli// is the most notorious cause of food related illness, known mainly for its gastrointestinal symptoms. //E. coli// appear as Gram-negative, straight rod shaped bacteria. Negative result after acid-fast staining. They are Oxidase negative and Catalase Positive. ----------------------------------------------------------------------------------------------- 3. //Salmonella// Species Another indicator of contamination from human or animal waste, Salmonella can cause gastroenteritis and, in severe cases, systemic infections. They appear as Gram-negative, straight rod shaped bacteria. Negative result after acid-fast staining. They are Oxidase negative and Catalase Positive. ----------------------------------------------------------------------------------------------- 4. Hepatitis A Virus A severe viral infection that targets the liver that can be contracted from consumption of human fecal-matter contaminated water. ----------------------------------------------------------------------------------------------- 5. Norovirus A highly contagious virus renowned as a leading cause of acute gastroenteritis, can be transmitted by oysters harvested from polluted waters. ----------------------------------------------------------------------------------------------- 6. Parasitic Contaminants While less commonly associated with oysters, parasite species such as //Cryptosporidium// species are often found in contaminated waters, and cause prolonged gastrointestinal symptoms. Particularly dangerous for immunocompromised individuals. Oocysts (The infective form of the parasite) will be visible under a microscope after acid-fast staining. ----------------------------------------------------------------------------------------------- (set: $visited4 to true) [[Back|Further Investigation 1]]]

(font: "Courier New")[//''Overview of Laboratory Techniques used in identification of Unknown Pathogen.''// As the investigation into our outbreak deepens, the laboratory team has reached a critical juncture. With patient samples and environmental specimens from the suspected source—the oyster truck—now in our possession, the challenge lies in identifying the pathogen responsible for the wave of illnesses. Each sample holds vital clues, and the tools at our disposal must be deployed with precision and urgency. This phase of the investigation is not merely a matter of science; it is a race against time. Survivors cling to life, families demand answers, and the public grows increasingly fearful. The laboratory’s findings will shape the next steps in containment and treatment. Firstly, the laboratory will perform microscopic and phenotypic analysis, alongside rapid testing to isolate, identify, and confirm the microorganism at the heart of this crisis. The success of the operation depends on the meticulous work of the lab, and the consequences of failure could extend far beyond this outbreak. Your job is to familiarise yourself with these initial techniques that the lab team are using, in order to take the next step in identifying our causative agent. Here is a list of the intial techniques utilised by the laboratory team: ----------------------------------------------------------------------------------------------- //''1. [[Gram Staining]]''// ----------------------------------------------------------------------------------------------- //''2. [[Acid-fast Staining]]''// ----------------------------------------------------------------------------------------------- //''3. [[Direct Microscopy]]''// ----------------------------------------------------------------------------------------------- //''4. [[Oxidase Test]]''// ----------------------------------------------------------------------------------------------- //''5. [[Catalase Test]]''// ----------------------------------------------------------------------------------------------- (set: $visited5 to true) [[Back|Further Investigation 1]]]

(font: "Courier New")[//''Reports of results obtained in rapid testing.''// Initial results have returned from our lab, which should allow us to vastly narrow down what our unknown pathogen could be. Your job is to compare the [[Research Findings]] with our results, and ascertain which of the researched pathogens our causative agent is likely to be. The raw results are as follows: <img alt="Raw Lab Results" src="https://raw.githubusercontent.com/jacobdar21/Virtual-Escape-Room/refs/heads/main/table1.jpg"> Now, once you feel ready to make a hypothesis, please continue to the next step of our investigation. [[Continue|Question 4]] [[Back|Further Investigation 1]]]

(font: "Courier New")[Interviewer: “Can you describe what happened to your husband?” Emiko: “Kenji was the strongest man I’ve ever known. He worked so hard for us, always made sure we had everything we needed. That day, he stopped somewhere on his way home. He said he wanted to bring something special for dinner. He knew that I love oysters. I… I wish I had stopped him... I can't help but think that this is all my fault-” Interviewer: “I am so sorry Mrs Tanaka, I promise you that you don't need to blame yourself for what happened. Could I ask when you noticed his symptoms begin?” Emiko: “That night. He couldn’t stop vomiting, and he was burning up. He told me not to worry, that it was just bad seafood, but then he started shaking. By the morning, his legs were swollen, and his skin looked… it looked like he was dying. I called for help, but when the ambulance came, it was already too late. He died before we even reached the hospital.” *Emiko began to cry softly.* Interviewer: “Thank you for sharing that with me Mrs Tanaka. Is there anything you want people to hear about your husband?” Emiko: “Kenji was a good man. A kind man. He didn’t deserve to die like this. No one does. I just want people to know how dangerous this is. How quickly it can take someone you love.”] (align:"<==")+(box:"=======XXXXXXXXXX===")[IN MEMORIAM] <img alt="Kenji Tanaka" src="https://raw.githubusercontent.com/jacobdar21/Virtual-Escape-Room/refs/heads/main/freepik__candid-image-photography-natural-textures-highly-r__69550.jpeg"> (align:"<==")+(box:"=======XXXXXXXXXX===")[MR KENJI TANAKA BORN 5th June 19XX - DIED 2nd February 20XX A beloved Husband, Father and Brother] [[Back|Interviews3]]

(font: "Courier New")[Interviewer: “Can you share what happened to Mr. Kato?” Yumi: “Hiro is- was... my little brother. Always full of life, always smiling. He was a chef, so he loved trying new food. That’s why he stopped at that truck by the station. He called me that night to tell me how good the oysters were. He said he wanted to learn their recipe.” Interviewer: “When did you realize it was serious?” Yumi: “The next morning. He didn’t show up for work, which never happens. I went to his apartment and found him lying on the floor. He was burning up, and his legs looked… I don’t even know how to describe it. They were black and swollen. I called an ambulance, but by the time we got to the hospital, it was looking really bad. They rushed him to the ICU, But- But it was no use. He was gone in a matter of hours.” Interviewer: “What do you want people to know about Hiroki?” Yumi: *Yumi's brow furrowed, tears welling in her eyes.* “He was so ''so''full of potential. He had dreams. He was about to open his own restaurant and everything! He was taken from us because of one meal. It’s not fair. It’s just not fair.”] (align:"<==")+(box:"=======XXXXXXXXXX===")[IN MEMORIAM] <img alt="Hiro Kato" src="https://raw.githubusercontent.com/jacobdar21/Virtual-Escape-Room/refs/heads/main/freepik__candid-image-photography-natural-textures-highly-r__69551.jpeg"> (align:"<==")+(box:"=======XXXXXXXXXX===")[MR HIRO KATO BORN 8th September 19XX - DIED 2nd February 20XX A much loved and truly missed Brother, Son and Friend. Gone from our lives, but lives forever in our hearts] [[Back|Interviews3]]

(font: "Courier New")[Interviewer: "Mr. Fushiguro could you describe what happened to your father in the days before his passing?" Megumi: “My dad… my dad was a strong man. He was always so active—teaching, volunteering, taking care of everyone. He never slowed down. The day he fell ill was just another one of those days. He said he felt like treating himself, so he stopped to get food with a few of his friends. He didn't say where, but I didn't even think twice about it.” Interviewer: "When did you realize something was wrong?" Megumi: “It started with his stomach. He said he felt bloated, but that was just a few hours after he’d eaten. By the next day, he was curled up in bed. His fever spiked, and I had to call an ambulance. They rushed him in, but it was so fast. They said his organs were failing, that the infection had taken over. He died in the hospital that afternoon. Just like that. I couldn’t believe it. My father was gone in less than 24 hours.” Interviewer: "How has your family been coping?" Megumi: *voice breaking* “We’re shattered. he didn’t deserve this. No one deserves to go like that, so quickly. My mother… my mother can’t even get out of bed. She’s so heartbroken. My father… he was everything to her. To all of us.”] (align:"<==")+(box:"=======XXXXXXXXXX===")[IN MEMORIAM] <img alt="Toji Fushiguro" src="https://raw.githubusercontent.com/jacobdar21/Virtual-Escape-Room/refs/heads/main/freepik__candid-image-photography-natural-textures-highly-r__69552.jpeg"> (align:"<==")+(box:"=======XXXXXXXXXX===")[MR TOJI FUSHIGURO BORN 17th March 19XX - DIED 3rd February 20XX A man of his own making, a guiding light to so many. A loving Father, Husband and Teacher.] [[Back|Interviews3]]

(font: "Courier New")[Interviewer: "Mr. Baker, thank you for agreeing to speak with us. Can you tell us about your experience with your illness?" Mani: *voice soft but steady* “It’s hard to talk about, but I’ll do my best. I was in Hiroshima with some friends, just visiting from Texas. I’ve always been active—I’ve been an athlete since I was a kid, you know? I was planning to compete professionally in track and field. That day, I stopped by the truck to get oysters. I didn’t think much of it. It was just food. It was supposed to be a normal day.” Interviewer: "What happened after you ate the oysters?" Mani: “It started with stomach cramps. I thought it was nothing, maybe just indigestion. But then my legs… my legs started to hurt so bad. Swelling. Pain. I thought I was going to die. The doctors said the infection spread fast. I was in the hospital for days. They kept telling me they were doing everything they could, but nothing worked. Eventually, they told me they had no choice but to amputate.” Interviewer: "How has your life changed since then?" Mani: *choking up, voice wavering* “I’ve lost everything. I don’t know how to describe it. I was training for the Olympics, and now… now I’m a person who can’t even walk. I don’t know who I am anymore. I don’t know what to do with myself. I keep thinking, ‘Why me?’ I was just having lunch, and now… everything’s gone. I can’t even go home and show my parents. I don’t know how to face them.” Interviewer: "Do you have anything you’d like to say about what’s happened?" Mani: “I just want people to understand. I want them to know that this isn’t just a ‘bad day.’ This is something that has changed my life forever. I’ve lost my legs, my dreams… I don’t want anyone else to go through what I did. No one should have to lose everything because of a meal. It’s not fair. Now I don't have a clue how I'm gonna get home.”] [[Back|Interviews3]]

(font: "Courier New")[Interviewer: "Mr. Takahashi, can you describe your wife’s experience leading up to her death?" Tetsuya: *voice firm but emotional* “My wife was a nurse. She’d seen a lot of things in her life, but she was always healthy. She didn’t get sick, not like this. That day, she was on her way home from work and stopped at that truck. She called me afterwards, saying she’d treated herself to oysters. I didn’t think much of it at the time.” Interviewer: "When did she start showing symptoms?" Tetsuya: “It was the next morning. She told me she felt dizzy, nauseous. By midday, she couldn’t walk, and her body started to swell. We called an ambulance, but it was too late. I’m still not sure how it all happened so fast. She was gone within hours. The doctors said it was the bacteria. She couldn’t fight it. I… I didn’t think something like this could happen to her.” Interviewer: "What has this done to your family?" Tetsuya: *sighs deeply* “We’re broken. My daughter can’t even get out of bed because of the grief. How do you move on after something like this? My Hana didn’t deserve this.”] (align:"<==")+(box:"=======XXXXXXXXXX===")[IN MEMORIAM] <img alt="Hana Takahashi" src="https://raw.githubusercontent.com/jacobdar21/Virtual-Escape-Room/refs/heads/main/img-ozKK1729VxrQuHJjsb3GX.jpg"> (align:"<==")+(box:"=======XXXXXXXXXX===")[MRS HANA TAKAHASHI BORN 1st March 19XX - DIED 3rd February 20XX A selfless woman who gave her life to care for others. A dearly missed Wife, Mother and Friend.] [[Back|Interviews3]]

{ (set: $fatality to (either: 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80)) (set: $fatality1 to ($fatality +10)) (set: $deaths1 to (200/100*$fatality)) (set: $deaths2 to ($deaths1+57)) (set: $deaths3 to ($deaths2+61)) (set: $hospitalisations1 to 200 - $deaths1) (set: $category to 0) (if: $fatality >= 20 and $fatality <= 40)[ (set: $category to 1) ] (else-if: $fatality > 40 and $fatality <= 60)[ (set: $category to 2) ] (else-if: $fatality > 60 and $fatality <= 80)[ (set: $category to 3) ] (set: $visited1 to false) (set: $visited2 to false) (set: $visited3 to false) (set: $visited4 to false) (set: $visited5 to false) (set: $visited6 to false) (set: $visited7 to false) (set: $visitedQ4 to false) (set: $visitedFinal to false) }

(font: "Courier New")[//''Transcripts of Interviews with suspected patients of Hiroshima gastroenteritis outbreak''// We have received recordings of a series of interviews, each one with a patient or the family member of a patient infected by our unknown pathogen. Every patient experienced extreme symptoms, with all but one interview being with the relatives of a now deceased patient. Your job is to draw commonalities between the patient accounts, in order to attempt to trace the cause of our outbreak, helping us to better identify the causative agent of this outbreak and attempt to save other severely unwell patients. ----------------------------------------------------------------------------------------------- ''Interview 1'' Subject: Mrs. Emiko Tanaka, Female, Age 51, Wife of Patient Patient: Mr. Kenji Tanaka, Male, Age 55, Carpenter (Deceased) Location: Hiroshima, Japan [[Interview 1|Interview 3-1]] ----------------------------------------------------------------------------------------------- ''Interview 2'' Subject: Ms. Yumi Kato, Female, Age 42, Sister of Patient Patient: Mr. Hiro Kato, Male, Age 34, Chef (Deceased) Location: Hiroshima, Japan [[Interview 2|Interview 3-2]] ----------------------------------------------------------------------------------------------- ''Interview 3'' Subject: Mr. Megumi Fushiguro, Male, Age 18, Son of Patient Patient: Mr. Toji Fushiguro, Male, Age 38, School teacher (Deceased) Location: Hiroshima, Japan [[Interview 3|Interview 3-3]] ----------------------------------------------------------------------------------------------- ''Interview 4'' Subject: Mr. Mani Baker, Age 20, Aspiring Athlete Location: Hiroshima, Japan [[Interview 4|Interview 3-4]] ----------------------------------------------------------------------------------------------- ''Interview 5'' Subject: Mr. Tetsuya Takahashi, Male, Age 54, Husband of Patient Patient: Mrs. Hana Takahashi, Age 58, Nurse (Deceased) Location: Hiroshima, Japan [[Interview 5|Interview 3-5]] -----------------------------------------------------------------------------------------------] (set: $visited3 to true) [[Back to Start|Background]]

(font: "Courier New")[//''Transcripts of Interviews with suspected patients of Hiroshima gastroenteritis outbreak''// We have received recordings of a series of interviews, each one with a patient infected by our unknown pathogen. All of the patients had mild symptoms that were able to be managed relatively easily in hospital. Your job is to draw commonalities between the patient accounts, in order to attempt to trace the cause of our outbreak, helping us to better identify the causative agent of this outbreak and treat our more severely unwell patients. ----------------------------------------------------------------------------------------------- ''Interview 1'' Subject: Male, Age 52, Occupation: Fisherman Location: Hiroshima, Japan [[Interview 1|Interview 1-1]] ----------------------------------------------------------------------------------------------- ''Interview 2'' Subject: Female, Age 64, Occupation: Retired Teacher Location: Hiroshima, Japan [[Interview 2|Interview 1-2]] ----------------------------------------------------------------------------------------------- ''Interview 3'' Subject: Male, Age 29, Occupation: Student Location: Hiroshima, Japan [[Interview 3|Interview 1-3]] ----------------------------------------------------------------------------------------------- ''Interview 4'' Subject: Female, Age 29, Occupation: Tourist Location: Hiroshima, Japan [[Interview 4|Interview 1-4]] ----------------------------------------------------------------------------------------------- ''Interview 5'' Subject: Male, Age 37, Occupation: Office Worker Location: Hiroshima, Japan [[Interview 5|Interview 1-5]] -----------------------------------------------------------------------------------------------] (set: $visited3 to true) [[Back to Start|Background]]

(font: "Courier New")[//''Pathogen Risk Overview: Common Pathogens Associated with Raw Oyster Consumption''// We have gathered that our Unknown Pathogen is most likely a member of the //Vibrio// genus. Now our final step before we begin treatment is finding out which species it is that has caused our outbreak. Your job is to look at the species our research has found to most likely be our unknown, and refer to the [[Symptomatic Report|Sym RF2]] and Lab Results in order to ascertain what the unknown species of the //Vibrio// genus is the causative agent in our outbreak. The research team have managed to narrow our choices down to three options. ''//Main Vibrio species found in oysters//'' ----------------------------------------------------------------------------------------------- 1. //Vibrio cholerae// To learn about this species, please [[click here.|Vibrio cholerae]] ----------------------------------------------------------------------------------------------- 2. //Vibrio vulnificus// To learn about this species, please [[click here.|Vibrio vulnificus]] ----------------------------------------------------------------------------------------------- 3. //Vibrio parahaemolyticus// To learn about this species, please [[click here.|Vibrio parahaemolyticus]] ----------------------------------------------------------------------------------------------- (set: $visited6 to true) [[Back|Further Investigation 2]]]

(set: $answerCorrect1 to false) (font: "Courier New")[Now that you've read through the preliminary reports and read the transcriptions of the interviews, we need to make our first move. A good first step would be to ascertain where the outbreak started, so we can prevent more people getting infected. Given what you learned in the (link: "Interview Records")[ (if: $category is 1)[(goto: "Interviews1")] (else-if: $category is 2)[(goto: "Interviews2")] (else:)[(goto: "Interviews3")]]: Where do you think the outbreak started? (input-box: bind $userAnswer1) (link: "Submit")[ (if: (lowercase: $userAnswer1) is "the oyster truck by the station" or (lowercase: $userAnswer1) is "the oyster truck" or (lowercase: $userAnswer1) is "oyster truck")[ (set: $answerCorrect1 to true) (goto:"Question 2") ] (else-if: (lowercase: $userAnswer1) is "oyster" or (lowercase: $userAnswer1) is "oysters")[You're on the right track, it was indeed oysters that started the outbreak. But where did the patients all purchase these oysters? (link: "Retry")[(goto: "Question1")]] (else:)[ That's not quite right... (link: "Retry")[(goto: "Question1")] ] ]]

(font: "Courier New")[Wednesday, 5th February 20XX Congratulations on successfully identifying the pathogen as part of the Vibrio genus. This is a significant milestone in the investigation, bringing us one step closer to understanding the source and nature of the outbreak. Your thorough analysis has allowed us to narrow down the family, which is crucial in determining the most likely source and transmission route, particularly as Vibrio species are commonly associated with contaminated seafood. The next phase of the investigation will focus on identifying the specific species responsible for the outbreak. Given the potential danger posed by Vibrio vulnificus and other species within the Vibrio genus, we will conduct a series of biochemical and genetic tests to distinguish between them. Additionally, we will analyze environmental samples, including oysters from the suspected truck, to confirm the source of contamination. This will help ensure that the outbreak is contained and prevent further spread. However, it is not all good news. There are now a total of 350 cases of our unknown //Vibrio// species, with a worrying $deaths3 of those cases resulting in fatal outcomes. That number is only going to keep increasing if we don't find a suitable treatment plan soon. The teams over at the labs have been running more tests overnight and, based on your conclusion that our causative agent is a //Vibrio// species, have performed more research that will help us pin down the exact identity of our pathogen. [[Research Findings 2]] [[List of Laboratory Techniques 2]] //''Once you are ready, press the link below to further your investigation.''// (if: $visited6 and $visited7)[ [[View Laboratory Results|Raw Lab Results 2]]] (else:)[ Our lab results aren't ready yet... why not read the research reports while we wait?] (if: $visitedFinal)[ [[Back to Final Guess|Final Guess]] ]]

(font: "Courier New")[(align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:PURPLE)[//''GRAM STAINING''//] Gram staining is a technique used to classify bacteria into two groups: Gram-positive and Gram-negative. Developed by Hans Christian Gram in 1884, it involves applying a purple dye (crystal violet), followed by iodine to help the dye stick. Alcohol or acetone washes the bacteria, with Gram-positive bacteria retaining the purple color and Gram-negative bacteria losing it. A pink dye (safranin) is then used to stain the Gram-negative bacteria. This method helps quickly identify bacteria, aiding in infection diagnosis and antibiotic selection. (align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:PURPLE)[If the bacteria are Gram positive, the cells will stain (color:blue)[blue]/(color:purple)[purple.] If the bacteria are Gram negative, the cells will stain (color:magenta)[pink]/(color:red)[red.]]] [[Back|List of Laboratory Techniques]]]]

(font: "Courier New")[(align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:YELLOW)[''//DIRECT MICROSCOPY//'']] Direct microscopy is a technique used in microbiology to quickly observe microorganisms in clinical or environmental samples. By examining samples under a microscope without culturing, it allows rapid identification of pathogens. Key features such as bacterial shape (cocci, bacilli, spirilla), arrangement (clusters, chains, pairs), and motility can be observed. Special stains or media can identify motile bacteria with flagella, and Gram staining helps differentiate bacteria based on their cell wall structure. Other features like endospores or capsules may also be seen. While direct microscopy provides useful initial information, further tests are usually needed for a definitive diagnosis. [[Back|List of Laboratory Techniques]]]

(font: "Courier New")[(align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:cyan)[''//ACID-FAST STAINING//'']] Ziehl-Neelsen staining is used to identify bacteria with waxy cell walls, like *Mycobacterium* species. The process involves staining with a red dye (carbol fuchsin), followed by decolorization with an acid-alcohol solution. Acid-fast bacteria retain the red stain, while non-acid-fast bacteria lose it and are stained blue with methylene blue. This method is especially useful for diagnosing tuberculosis and identifying mycobacterial infections. (align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:cyan)[If the organisms are acid-fast the cells will appear (color:red)[red.] If the organisms are non-acid-fast, the cells will appear (color:cyan)[blue.]]] [[Back|List of Laboratory Techniques]]]

(font: "Courier New")[(align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:navy)[''//OXIDASE TEST//'']] The oxidase test is used to detect the presence of the cytochrome c oxidase enzyme in bacteria, which is involved in cellular respiration. The test differentiates oxidase-positive bacteria, like Pseudomonas and Neisseria, from oxidase-negative ones, like Enterobacteriaceae (e.g., Escherichia coli). A sample is applied to a reagent strip with tetramethyl-p-phenylenediamine (TMPD). If the bacteria produce the enzyme, TMPD oxidizes and turns purple or dark blue. A positive result indicates the presence of the enzyme, while no color change means the test is negative. This quick test helps identify bacterial species, though additional testing may be needed in some cases. (align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:navy)[If the organisms are oxidase positive, the strip will change to a (color:navy)[dark blue] or (color:purple)[purple.] If the organisms are oxidase negative, the strip will not change colour.]] [[Back|List of Laboratory Techniques]]]

(font: "Courier New")[(align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:lIME)[''//CATALASE TEST//'']] The catalase test detects whether a bacterial species produces the enzyme catalase, which breaks down hydrogen peroxide into water and oxygen. To perform the test, a small sample of bacteria is placed on a slide, and hydrogen peroxide is added. If catalase is present, oxygen bubbles will form. A positive result is indicated by bubbling, while no bubbles suggest a negative result. This quick and reliable test is often used alongside other tests for bacterial identification. (align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:lime)[If the organisms are catalase positive, bubbling and/or fizzing will be observed. If the organisms are catalase negative, no bubbles will be observed.]] [[Back|List of Laboratory Techniques]]]

(enchant:?page,(font: "Courier New")) <tw-sidebar> <tw-icon> {display: none;} </tw-icon> </tw-sidebar>

(font: "Courier New")[Now that you've read through the initial results and compared them to the research findings, it's time to make your first rough guess at the identity of our causative agent. Once we gather this, we can start to perform more specific tests while we wait for more results to come back from the lab. Based on the initial [[Symptomatic Report|Sym Q4]] and the results we obtained from our rapid testing: What do you propose the identity of our Unknown Pathogen to be? (dropdown: bind $q7Choice, "Choose an option", "A Vibrio species", "//Escherichia coli//", "A //Salmonella// Species", "Hepatitis A", "Norovirus", "A //Cryptosporidium// species","None of the above") [[Click for hint|Hint 3]] (link: "Submit Answer")[ (set: $q7Correct to ($q7Choice is "A Vibrio species")) (if: $q7Correct)[ (goto: "Further Investigation 2") ] (else:)[ Not quite... Have another look at the data and (link: "Retry")[(goto: "Question 4")]! ] ] [[Back|Further Investigation 1]]] (set: $visitedQ4 to true)

(font: "Courier New")[//''Reports of results obtained in intensive testing.''// Final lab results have now been received, which should allow us to determine which of the three species of //Vibrio// is the causative agent behind our outbreak. Using these results, the initial [[Symptomatic Report|Sym LR2]] and what we learned in [[Research Findings 2]], we now need to determine once and for all what our unknown pathogen is, in order for us to begin selecting appropriate means of treatment. The raw results are shown below: <img alt="Raw Lab Results 2" src="https://raw.githubusercontent.com/jacobdar21/Virtual-Escape-Room/refs/heads/main/table2.jpg"> Once you are ready to make your final decision, please press [[Continue|Final Guess]]]

(font: "Courier New")[(align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:orange)[//''PCR''//] Polymerase Chain Reaction (PCR) is a technique used to make multiple copies of a specific DNA segment. Developed in the 1980s by Kary Mullis, PCR is widely used in genetics, microbiology, and diagnostics. It allows the detection of tiny amounts of DNA, making it possible to identify pathogens even when they are present in small quantities. The process involves heating the DNA to separate its strands, then adding primers (short DNA sequences) that bind to the target DNA. A heat-stable enzyme, Taq polymerase, synthesizes new strands, doubling the DNA quantity with each cycle. This is repeated multiple times, amplifying the target sequence exponentially. PCR is especially useful in microbiology for detecting bacterial, viral, or fungal DNA in samples, even when traditional culturing methods would be too slow or fail. It can also differentiate between closely related species or strains by targeting unique genetic markers. PCR is a highly sensitive and accurate method, making it invaluable in diagnosing infections and guiding treatment decisions. [[Back|List of Laboratory Techniques 2]]]]

(font: "Courier New")[(align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:green)[//''SELECTIVE GROWTH MEDIA (TCBS)''//]] Thiosulfate-Citrate-Bile Salts-Sucrose (TCBS) agar is a selective and differential medium used to isolate and differentiate Vibrio species, such as //Vibrio cholerae//, //Vibrio vulnificus//, and //Vibrio parahaemolyticus//. The medium contains bile salts and sodium thiosulfate, which inhibit the growth of most other bacteria, allowing //Vibrio// species to thrive. TCBS agar is differential due to the presence of sucrose and a pH indicator (bromthymol blue). Vibrio cholerae, which ferments sucrose, produces yellow colonies, while other Vibrio species, like Vibrio vulnificus and Vibrio parahaemolyticus, which do not ferment sucrose, produce green colonies. The medium is selective because it creates a toxic environment for non-Vibrio bacteria, allowing Vibrio species to grow easily. TCBS agar is particularly useful in diagnosing Vibrio infections from foodborne illness outbreaks or environmental samples, providing rapid identification and aiding in treatment decisions. (align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:green)[If the bacteria are sucrose-fermenting, their colonies will appear (color:yellow)[yellow.] If the bacteria are non-sucrose-fermenting their colonies will appear (color:green)[green.]]] [[Back|List of Laboratory Techniques 2]]]

(font: "Courier New")[(align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:red)[//''HAEMOLYSIS TESTING ON BLOOD AGAR''//] Haemolysis testing on blood agar is a common microbiological method to identify bacteria based on their ability to lyse (rupture) red blood cells. Blood agar is a nutrient-rich medium containing sheep or horse blood, supporting the growth of many bacteria while revealing haemolytic activity, a key characteristic in bacterial identification. There are three main types of haemolysis: Alpha (α)-haemolysis: Partial breakdown of red blood cells, resulting in a greenish discoloration around colonies. Example: Streptococcus pneumoniae. Beta (β)-haemolysis: Complete red blood cell lysis, creating a clear zone around colonies. Example: Streptococcus pyogenes or Vibrio vulnificus. Gamma (γ)-haemolysis: No red blood cell breakdown, leaving the medium unchanged. Example: Enterococcus faecalis. This test helps differentiate bacterial species, particularly in genera like //Streptococcus//, //Staphylococcus//, and //Vibrio//, providing valuable diagnostic information in clinical microbiology. (align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:RED)[If the bacteria are Alpha haemolytic, there will be a greenish/brownish discolouration around the growth. If the bacteria are Beta haemolytic, there will be a transparent area around the growth. If the bacteria are non-haemolyic, there will be no changes in the medium.]] [[Back|List of Laboratory Techniques 2]]]]

(font: "Courier New")[(align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:magenta)[//''LACTOSE TESTING ON MACCONKEY AGAR''//]] Lactose testing on MacConkey agar is a common method used to differentiate bacteria based on their ability to ferment lactose. MacConkey agar is both selective and differential. It contains bile salts and crystal violet, which inhibit the growth of most Gram-positive bacteria, making it selective for Gram-negative bacteria like *Escherichia coli*, *Salmonella*, *Shigella*, and *Vibrio* species. The differential aspect comes from the inclusion of lactose and a pH indicator (neutral red). Lactose-fermenting bacteria produce acid, lowering the pH and turning the colonies pink, such as with *E. coli*. Non-lactose fermenters, like *Salmonella* and *Shigella*, produce colorless colonies. MacConkey agar's selective and differential properties help isolate and identify Gram-negative bacteria, making it a useful tool in diagnosing gastrointestinal infections and identifying pathogens in mixed samples. (align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:magenta)[If the bacteria are lactose-fermenting, the colonies will appear (color:magenta)[pink.]. If the bacteria are non-lactose-fermenting, the colonies will appear (color:gray)[pale]/colourless]] [[Back|List of Laboratory Techniques 2]]]

(set: $GuessCorrect to false) (font: "Courier New")[Based on the evidence you have gathered throughout our investigation, what do you believe the Unknown Pathogen in our Outbreak to be. (align:"=><=")+(box:"X")[The Unknown Pathogen is (dropdown: bind $FinalGuess, "Choose an option", "Vibrio cholerae", "Vibrio vulnificus", "Vibrio parahaemolyticus") [[Click for hint|Hint 4]] (link: "Submit")[ (if: ($FinalGuess is "Vibrio vulnificus"))[ (set: $GuessCorrect to true) (goto: "Congratulations") ] (else-if: ($FinalGuess is "vibrio vulnificus" or (lowercase: $FinalGuess) is "v. vulnificus"))[Almost there! Please use the full binomial name of the species and proper capitalisation. (For example: Escherischia coli) (link: "Retry")[(goto: "Final Guess")]] (else:)[ That's not quite right...(link: "Retry")[(goto: "Final Guess")] ] ] [[Back to Information|Further Investigation 2]]]] (set: $visitedFinal to true)

(font: "Courier New")[Thursday, 6th February 20XX While the investigative phase is complete, the work to combat this outbreak is far from over. The responsibility now lies with healthcare providers to implement treatment plans that can save lives. *Vibrio vulnificus* infections often require a combination of aggressive medical interventions, tailored to the severity and progression of the disease. For localized infections, wound care and debridement are critical. Removing infected or necrotic tissue helps to slow the spread of the bacteria and gives the patient’s immune system a better chance to respond. In more severe cases, where necrotizing fasciitis has developed, amputation of affected limbs may be necessary to prevent the spread of infection. Meanwhile, for aggressive and systemic cases, rigorous drug regimens will be required to combat and quell infections. However due to the nature of *Vibrio vulnificus*, despite medical interventions, many of our patients will still unfortunately succumb to their illness. But at the same time, there are potentially thousands of lives that your actions have saved by identifying the source of the infection, isolating it, identifying it, and giving healthcare professionals an easier job at treating our patients. (OPTIONAL) To learn more about the drugs involved, please [[click here.|Drug Treatments]] If you are ready to end your journey, please [[click here.|Conclusion]]]

(font: "Courier New")[Thursday, 6th February 20XX ''Congratulations on successfully identifying the unknown pathogen as //Vibrio vulnificus//!'' Your efforts in narrowing down the family of the pathogen and conducting a thorough investigation into its characteristics have paid off. You've been able to both identify the source of the outbreak, and distinguish //Vibrio vulnificus// from other similar species through key diagnostic tests, pinpointing the specific biochemical markers and growth patterns unique to this pathogen. This is no small feat, and your careful attention to detail has undoubtedly saved valuable time in understanding the nature of this outbreak. At this stage, your work is effectively complete. You've provided the essential information required to identify the pathogen and confirm its presence in the affected population. However, while you may have concluded your investigation, the next critical steps lie in the hands of healthcare providers and treatment specialists. With your identification in place, they now face the complex task of determining the appropriate drug cocktails and treatment regimens to manage this outbreak effectively. //Vibrio vulnificus// is a particularly dangerous pathogen, and its virulence factors—such as the production of cytotoxins and its rapid progression in vulnerable individuals—make it a serious threat, especially for those with compromised immune systems or underlying health conditions. Healthcare professionals will now need to consider a combination of antibiotics, possibly including cephalosporins or tetracyclines, and other supportive treatments, depending on the severity of each patient's symptoms. The right combination of drugs will be crucial in improving the outcomes for the remaining patients. Your role in identifying this pathogen has been invaluable, but now it is up to the healthcare providers to implement the necessary therapeutic strategies and continue monitoring the patients closely. Their swift actions, guided by your work, will determine the effectiveness of the treatment and ultimately the success in containing this outbreak. Your contribution has set the stage for the next phase—ensuring that appropriate interventions are put in place to save as many lives as possible. While the crisis is far from over, your successful identification of //Vibrio vulnificus// has provided the foundation for the next steps in the treatment process. It’s time to step back and let the medical team do what they do best. Thank you for your dedication and expertise. [[Continue|Drug Decisions]]]

(font: "Courier New")[(align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)[//''DRUG TREATMENTS''//] *Vibrio vulnificus* is an incredibly aggressive infection, with symptoms often progressing rapidly in affected patients. In order to combat this relentless assault, a multi-faceted drug treatment plan is often utilised by healthcare providers in order to cover multiple bases and to provide synergistic drug interactions. A typical treatment plan will include the use of a 3rd-generation Cephalosporin and a tetracycline antibiotic. The most common choices are a paired treatment of Ceftadizime and Doxycyline respectively. 3rd-Generation Cephalosporins, such as Ceftadizime and Cefotaxime, act by inhibiting a target organism's ability to synthesise its cell wall, leading to cell lysis (rupture) and subsequent cell death. Coupled with treatment with a tetracycline antibiotic such as Doxycycline, which works to inhibit bacterial protein synthesis itself, stopping any further cell growth or replication, this course of potent antibiotics stand the greatest chance at halting a severe *V. vulnificus* infection.]] [[Back|Drug Decisions]]

(font: "Courier New")[Saturday, 8th February 20XX And so our investigation concludes. From the first reports of an outbreak to our final identification of *Vibrio vulnificus*, your expertise, perseverance, and attention to detail have been the foundation of this investigation. This wasn’t just about science, it was about people. Every step you took, every test you ran, and every clue you pieced together brought us closer to the truth. You’ve not only identified the pathogen responsible, but also provided the clarity needed for healthcare providers to act decisively. Because of your work, lives will be saved, and families will find answers in their darkest moments. It’s hard to overstate the importance of what you’ve achieved. Outbreak investigations are never easy; they are a race against time, a balance between meticulous analysis and urgent action. Yet, you rose to every challenge with unwavering focus and determination. This victory belongs to you as much as anyone else. While my role here was to guide and support, it is you who truly carried the weight of this investigation. On behalf of those who were affected, those who will recover, and those we will protect in the future, I extend my deepest gratitude. The work that epidemiologists like us do is often unseen, but its impact ripples outward, saving lives and building resilience. You’ve proven yourself to be not just a skilled investigator but an invaluable ally in the fight against infectious disease. Thank you for your dedication, your precision, and your resolve. Though the investigation has ended, your contribution will not be forgotten. I hope this experience has been as rewarding for you as it has been for me to witness. I wish you all the best in all of your future endeavours. With heartfelt appreciation, Your Grateful Partner] (link: "END.")[ (if: $category is 1)[(goto: "END1")] (else-if: $category is 2)[(goto: "END2")] (else:)[(goto: "END3")]

(font: "Courier New")[Interviewer: “Can you walk me through what happened before you started feeling ill?” Subject: “It was just a normal workday. I deliver packages all over Hiroshima. I passed by the oyster truck near the station – you know the one? Everyone says it’s the best. I grabbed a quick plate before heading back to work. Didn’t even think twice about it.” Interviewer: “When did the symptoms begin?” Subject: “That night. My stomach felt like it was twisting in knots, and then the fever hit. I thought I could tough it out, but by morning, my legs were red and swollen, like someone had set them on fire. I went to the clinic, but it just got worse. They had to rush me to the hospital.” Interviewer: “Have you eaten from that truck before?” Subject: “All the time. It’s kind of a local thing, you know? Everyone trusts it. I didn’t think something like this could happen.”] [[Back|Interviews2]]

(font: "Courier New")[Interviewer: “I’m so sorry for your loss. Could you possibly tell me anything you remember about your wife’s illness?” Subject: “She was the strongest person I knew. She’d always make sure everyone was taken care of before herself. That night, we had oysters– a family treat y'know? She didn’t even eat that many, just a few. It just doesn't make sense... they looked and tasted fine.” Interviewer: “I'm so sorry sir, could I ask when she started showing symptoms?” Subject: “The next day. It started with stomach pain, then a fever. By the time we got her to the hospital, her skin was turning purple around her legs. They said it was her blood. It was poisoning her, and there was nothing they could do. They said it was something to do with her liver.” Interviewer: “I see... Could you possibly recall where you got the oysters?” Subject: “From the truck, y'know the one at the station? They’re supposed to be fresh from the estuary near here, the best you can get. I don't understand how we've been fine every time before this, but they're all of a sudden bad enough to kill someone??”] [[Back|Interviews2]]

(font: "Courier New")[Interviewer: “Can you tell me what you were doing before you fell ill?” Subject: “I don’t know exactly. I was eating out a lot that week. Street food, seafood… maybe it was the beach? We didn’t go swimming, but we hung out there for a while. I had sushi that day, too. Could’ve been anything.” Interviewer: “What were your symptoms?” Subject: “It hit me like a truck. Stomach cramps, fever, chills. My skin hurt, like I’d been sunburned, but I hadn’t even been in the sun, it's like February?! It just… kept getting worse. They said I was lucky I got to the hospital when I did.”] [[Back|Interviews2]]

(font: "Courier New")[Interviewer: “Can you tell me about your day leading up to your illness?” Subject: “It was a normal day. Work was busy, so I grabbed something quick from the oyster truck near the office. I’ve eaten there plenty of times—it’s always been fine. The guy who runs it even recognized me. I didn’t think twice about it.” Interviewer: “When did you notice something was wrong?” Subject: “The next morning, I woke up feeling awful. Stomach cramps, fever, the works. Then my hand—where I’d cut myself last week—started swelling. By the time I got to the hospital, my skin looked… wrong. They said I was lucky to have gotten there when I did.” Interviewer: “How do you feel now?” Subject: *Subject laughs weakly* “Like I dodged a bullet. But every time I think about it, I wonder… how many other people ate those oysters that day? How many of them weren’t as lucky?”] [[Back|Interviews2]]

(font: "Courier New")[Interviewer: “Can you describe what your father was doing before he fell ill?” Subject: “I remember he said he was going out with his colleagues, celebrating some sort of sales target they'd made or something. I remember he was so happy that day. Knowing him, he probably got drunk and went to a food stall. He's always been a pretty big drinker after all. He loves seafood, so I wouldn't be surprised if that's what did it... Interviewer: “When did he start showing symptoms?” Subject: “The very next day. He woke up and said his stomach hurt, he thought it was just a bad hangover. But then he started shivering, sweating. By the evening, he couldn’t even stand. His legs were swelling, and his skin… it just didn’t look right. I took him to the hospital as fast as I could.” Interviewer: “How is he now?” Subject: *Subject notably paused* “He’s still in the ICU. The doctors don’t say much, but I can tell from their faces it’s serious. He hasn’t woken up in two days. I keep thinking about it... what if he just hadn't gone out at all?"] [[Back|Interviews2]]

(font: "Courier New")[Interviewer: “Can you tell me about your symptoms and when they first began?” Subject: “I was fine until the afternoon. I remember a strange taste in my mouth, but I didn’t think much of it. The day was hot, and I was thirsty, so I had a few oysters from the truck near the station. The truck’s been there for weeks now, and everyone says they get fresh stuff, so I thought it would be safe.” Interviewer: “When did you start feeling unwell?” Subject: “The next morning, I had stomach cramps – not too bad at first, just a little nausea. By the afternoon, I was shaking and running a fever. My leg started feeling sore, and when I looked, there was some redness. The next thing I knew, I was in the hospital.” Interviewer: “Was the food truck the only new thing you’d encountered?” Subject: “Yes, I’ve been fishing and eating seafood from here for years. But this truck... I hadn’t had oysters from them before. They were the only new thing that day.”] [[Back|Interviews1]]

(font: "Courier New")[Interviewer: “Please describe your symptoms and how they progressed.” Subject: “It started with the fever. I had some oysters from that truck – I think it’s called ‘Fresh Pearl,’ near the train station. I’d been there a couple of times before. Nothing unusual, but it was the first time I’d had raw oysters from them.” Interviewer: “How did you feel after eating?” Subject: “I felt fine for a while, but by evening, I started feeling weak. My stomach hurt, but I thought it was just from the heat. The next day, the fever got worse. I didn’t realize how bad it was until I noticed my legs – they were swollen and red, then they turned black by afternoon.” Interviewer: “Was there anything else you think could have caused this?” Subject: “I don’t think so. I stay close to home mostly. Just those oysters... I don’t usually eat that much seafood raw, but I thought they were fresh.”] [[Back|Interviews1]]

(font: "Courier New")[Interviewer: “Can you describe when your symptoms first started?” Subject: “It was sudden. I had a fever and chills right after dinner, but I can’t remember what I ate, everything is all fuzzy from this whole weekend... I didn’t feel too bad, just nauseous, but then I started to feel worse. My legs swelled up and turned purple by the second day. It felt like it happened all at once.” Interviewer: “What do you think triggered it?” Subject: “Honestly, I’m not sure. Maybe it was something I ate, but I didn’t notice anything strange. I didn’t eat much seafood recently, so I don’t know if that’s it.”] [[Back|Interviews1]]

(font: "Courier New")[Interviewer: “Can you describe what you were doing in the days before you started feeling unwell?” Subject: “I was visiting Japan with some friends. We went sightseeing, mostly around the city, and then we went to a beach on the outskirts. We didn’t swim, but we spent time near the water. We ate a lot of street food, too—nothing specific stands out, though.” Interviewer: “When did you start experiencing symptoms?” Subject: “It was actually a couple of days later, after I returned to my hotel. At first, I just felt a little off, you know? Like tired and dehydrated. But then the next morning, I had this really weird feeling in my stomach, and I started sweating. That’s when I decided to go see a doctor.” Interviewer: “When did you go to the hospital?” Subject: “It was the next day. I just couldn’t shake the headache and the nausea. By the time I got there, I had a high fever, but they said it was just a bad flu. They gave me some fluids and sent me on my way. Haven’t had any issues since.”] [[Back|Interviews1]]

(font: "Courier New")[Interviewer: “Tell me about your experience leading up to your illness.” Subject: “I was at work all day, didn’t think anything of it. Afterward, I saw the oyster truck near the station and decided to grab a quick snack. I’ve had them before, and they were fine. Nothing unusual.” Interviewer: “When did you start feeling unwell?” Subject: “The next morning, I felt weak. Stomach cramps, then fever. My skin started feeling sore, then I noticed some swelling on my legs. I don’t remember much after that, but it all went downhill fast.” Interviewer: “Did you do anything different that day or night?” Subject: “No, just had oysters from the truck. No swimming, no exposure to anything else. I didn’t think much about it at the time.” ] [[Back|Interviews1]]

(font: "Courier New")[//Vibrio cholerae// is a well-known pathogen responsible for causing Cholera, a severe diarrheal disease. Symptoms typically include profuse, watery diarrhea (often described as "rice water stools"), vomiting, and dehydration, which can lead to shock and death if untreated. The disease primarily affects the gastrointestinal system, leading to rapid fluid loss. //V. cholerae// is usually transmitted through contaminated water or food, particularly in areas with poor sanitation. While //V. cholerae// can also cause mild infections, severe cases can progress very quickly. Under the microscope, //V. cholerae//appears as Gram-negative, curved, comma-shaped rods, similar to other Vibrio species. //V. cholerae// has several key virulence factors that can be identified through PCR. The most important virulence factor is the cholera toxin (ctx), which is encoded by the ctxA and ctxB genes. This toxin causes the characteristic watery diarrhea seen in cholera. The presence of the ctx gene can be confirmed through PCR, making it a primary marker for //V. cholerae// identification. //V. cholerae// typically grows well on alkaline media such as thiosulfate-citrate-bile salts-sucrose (TCBS) agar, where it forms yellow colonies due to its ability to ferment sucrose. This is a distinguishing feature from other species. //V. cholerae// displays either non-haemolytic or Alpha haemolytic behaviour when cultured on blood agar, depending on the strain.] [[Back|Research Findings 2]]

(font: "Courier New")[//Vibrio vulnificus// is a highly pathogenic species associated with severe infections, particularly in individuals with underlying liver disease, diabetes, or weakened immune systems. It is typically contracted through the consumption of raw or undercooked seafood, especially oysters, or through wound exposure to contaminated seawater. Symptoms of //V. vulnificus// infection can include fever, chills, nausea, vomiting, abdominal pain, and in severe cases, septicemia, necrotizing fasciitis (rapid tissue death), and septic shock. This pathogen is distinctive for its ability to cause severe systemic infections, and in some cases, limb amputation may be necessary to stop the spread of tissue damage. On laboratory testing, //V. vulnificus// shares similar microscopic and staining characteristics with other //Vibrio// species, but its pathogenicity can be differentiated through its virulence factors, such as the production of a cytolysin (VvhA). In contrast to //V. cholerae//, which mainly causes gastrointestinal issues, //V. vulnificus// frequently causes more invasive, life-threatening infections. The vvhA gene is often used as a target for PCR-based detection of //V. vulnificus//. Another important virulence factor is the capsular polysaccharide that helps the bacteria evade host immune responses, though the genes for capsule synthesis can be more challenging to detect. //V. vulnificus// grows on TCBS agar as green colonies because it does not ferment sucrose, unlike //V. cholerae//. Additionally, ;//V. vulnificus// also exhibits characteristic beta hemolytic activity when cultured on blood agar, further distinguishing it from other Vibrio species.] [[Back|Research Findings 2]]

(font: "Courier New")[//Vibrio parahaemolyticus// is another pathogen within the //Vibrio// genus, primarily linked to gastrointestinal illness, particularly foodborne outbreaks from consuming raw or undercooked seafood, especially shellfish. Infections typically cause symptoms like watery diarrhea, abdominal cramps, nausea, vomiting, and low-grade fever. Unlike //V. cholerae//, V. parahaemolyticus is less likely to cause the extreme dehydration seen in cholera, but the illness can still be quite severe, especially for those with compromised immune systems. On a microbiological level, //V. parahaemolyticus// is a halophilic organism, meaning it requires salt for optimal growth, which helps distinguish it from other //Vibrio// species in certain environmental tests. Additionally, //V. parahaemolyticus// is unique for its production of a hemolysin (thermostable direct hemolysin, or TDH), which can be detected through PCR targeting the tdh gene. In terms of selective growth media, //V. parahaemolyticus// typically grows on TCBS agar as green colonies, similar to //V. vulnificus//, because it does not ferment sucrose. In addition, when grown on blood agar, //V. parahaemolyticus// exhibits Beta haemolytic behaviour, again drawing similarities with //V. vulnificus//. Ergo, the most reliable way to distinguish //V. parahaemolyticus// from //V. vulnificus// is by PCR.] [[Back|Research Findings 2]]

(font: "Courier New")[//''AUTHOR'S NOTE''// Dear Player, As the creator of this experience, I'd just like to personally extent my gratitude for playing my game. Your time and engagement mean more to me than I can express. I created this game as part of my Honours Project, exploring the intersection of microbiology, gamification, and learning. By playing, you’ve contributed to something deeply personal and important to me, helping me bring my ideas to life and refine my understanding of how people interact with complex scientific concepts in a dynamic, engaging way. I hope you found the experience rewarding—whether it sparked your curiosity, tested your problem-solving skills, or just gave you a little sense of satisfaction as you solved the outbreak. I will again reiterate how grateful I am that you have chosen to spend a portion of your time to take part in this research project, and I hope you enjoyed playing, and maybe even learned a thing or two. Below is a link to a survey, which is what I will use to collect the information I will analyse for my dissertation. The survey will consist of three sections: A brief memory test, a demographic survey and a space for feedback. If you have the time and would like to contribute to my own little investigation, I would ask that you please take a moment to complete it. (link:"Take the survey")[ (goto-url:"https://strathsci.qualtrics.com/jfe/form/SV_aWrbNCyO5qitsMK") ] And if not, I have thoroughly enjoyed spending this little bit of time with you vicariously through my game, and would like to yet again express my thanks. This project would have never been possible without you, the Player. Yours sincerely, Jacob Darroch 4th Year Microbiology and Pharmacology Student University of Strathclyde, Glasgow]

(font: "Courier New")[//''AUTHOR'S NOTE''// Dear Player, As the creator of this experience, I'd just like to personally extent my gratitude for playing my game. Your time and engagement mean more to me than I can express. I created this game as part of my Honours Project, exploring the intersection of microbiology, gamification, and learning. By playing, you’ve contributed to something deeply personal and important to me, helping me bring my ideas to life and refine my understanding of how people interact with complex scientific concepts in a dynamic, engaging way. I hope you found the experience rewarding—whether it sparked your curiosity, tested your problem-solving skills, or just gave you a little sense of satisfaction as you solved the outbreak. I will again reiterate how grateful I am that you have chosen to spend a portion of your time to take part in this research project, and I hope you enjoyed playing, and maybe even learned a thing or two. Below is a link to a survey, which is what I will use to collect the information I will analyse for my dissertation. The survey will consist of three sections: A brief memory test, a demographic survey and a space for feedback. If you have the time and would like to contribute to my own little investigation, I would ask that you please take a moment to complete it. (link:"Take the survey")[ (goto-url:"https://strathsci.qualtrics.com/jfe/form/SV_3k4Ts8uzwSIWMBg") ] And if not, I have thoroughly enjoyed spending this little bit of time with you vicariously through my game, and would like to yet again express my thanks. This project would have never been possible without you, the Player. Yours sincerely, Jacob Darroch 4th Year Microbiology and Pharmacology Student University of Strathclyde, Glasgow]

(font: "Courier New")[//''AUTHOR'S NOTE''// Dear Player, As the creator of this experience, I'd just like to personally extent my gratitude for playing my game. Your time and engagement mean more to me than I can express. I created this game as part of my Honours Project, exploring the intersection of microbiology, gamification, and learning. By playing, you’ve contributed to something deeply personal and important to me, helping me bring my ideas to life and refine my understanding of how people interact with complex scientific concepts in a dynamic, engaging way. I hope you found the experience rewarding—whether it sparked your curiosity, tested your problem-solving skills, or just gave you a little sense of satisfaction as you solved the outbreak. I will again reiterate how grateful I am that you have chosen to spend a portion of your time to take part in this research project, and I hope you enjoyed playing, and maybe even learned a thing or two. Below is a link to a survey, which is what I will use to collect the information I will analyse for my dissertation. The survey will consist of three sections: A brief memory test, a demographic survey and a space for feedback. If you have the time and would like to contribute to my own little investigation, I would ask that you please take a moment to complete it. (link:"Take the survey")[ (goto-url:"https://strathsci.qualtrics.com/jfe/form/SV_6ofPmAM94RZji8C") ] And if not, I have thoroughly enjoyed spending this little bit of time with you vicariously through my game, and would like to yet again express my thanks. This project would have never been possible without you, the Player. Yours sincerely, Jacob Darroch 4th Year Microbiology and Pharmacology Student University of Strathclyde, Glasgow]

(font: "Courier New")[//''Overview of Laboratory Techniques used in identification of Unknown Pathogen.''// As our investigation into our unknown causative agent nears its conclusion, the laboratory team has one final task. After narrowing down our potential culprits to just three species of the //Vibrio//genus, we now have to find a way to make a final conclusion. Despite their obvious similarities, the three species have key features that we must take advantage of in order to distinguish them, such as virulence factors, clinical presentation and differences in growth on selective media. The three species in question are as follows: //Vibrio cholerae//, //Vibrio vulnificus// and //Vibrio haemolyticus//. Our task is now to carefully evaluate the biochemical, molecular, and growth properties of the pathogen in question. By examining these features, you'll be able to differentiate between the species and pinpoint the exact cause of the outbreak. Use all available diagnostic tools, including selective agar, PCR assays, and growth tests, to gather the evidence needed. Our pathogen's characteristics—ranging from its reaction to different media to its genetic markers—will provide the final clues in our investigation. Your job is to familiarise yourself with these selective techniques that the lab team are using, in order to take the last step in identifying our causative agent. Here is a list of the techniques utilised by the laboratory team: ----------------------------------------------------------------------------------------------- //''1. [[PCR]]''// ----------------------------------------------------------------------------------------------- //''2. [[Selective Growth Media (TCBS Agar)]]''// ----------------------------------------------------------------------------------------------- //''3. [[Lactose Testing on MacConkey Agar]]''// ----------------------------------------------------------------------------------------------- //''4. [[Haemolysis Testing on Blood Agar]]''// ----------------------------------------------------------------------------------------------- (set: $visited7 to true) [[Back|Further Investigation 2]]]

(font: "Courier New")[(align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:orange)[//''HINT''//] HINT: It isn't neccessary to close every Oyster Truck in the City. What warnings should be sent out to the public? HINT: This disease mainly affects vulnerable people. HINT: You need to take samples, but we probably shouldn't keep bad seafood around... [[Back to Question|Question 3]]]]

(font: "Courier New")[(align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:orange)[//''HINT''//] Which Age Range is worse affected? - HINT: Older people are worst affected. Which sex is worst affected? - HINT: Men are worst affected. Pre-existing problems with which organ are most commonly associated with severe outcomes? - HINT: The Liver is vitally important for manging this infection. [[Back to Question|Question 2]]]]

(font: "Courier New")[(align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:orange)[//''HINT''//] <img alt="Raw Lab Results" src="https://raw.githubusercontent.com/jacobdar21/Virtual-Escape-Room/refs/heads/main/table1.jpg"> ---------------------------------------------------------------------------------------------- Vibrio - Gram-negative, curved rod shaped bacteria. Negative result after acid-fast staining. They are both Oxidase and Catalase positive. ---------------------------------------------------------------------------------------------- [[Back to Question|Question 4]]]]

(font: "Courier New")[(align:"=><=")+(box:"X")[(b4r:"solid")+(b4r-size:4)+(b4r-color:orange)[//''HINT''//] HINT: Based on the PCR results, we can rule out //Vibrio parahaemolyticus// [[Back to Final Guess|Final Guess]]]]