Case 1 Posting 2

Subject: MMIC
Case: Case 1 - Khong Fay Seah
Complaints: Fever, chills, dysuria,
Diagnosis: Urinary Tract Infection

List of Organisms	Tests Required to Identify	Expected Test Results	Treatment
Escherichia Coli	Culture Gram stain and Microscopy Biochemical test test – TSI, IMViC (Indole, Methyl red, Voges-Proskauer, citrate), motility	Lactose-fermenting (Yellow colonies in CLED); Flat, grey colonies on BAP Gram-negative bacilli Biochemical test TSI - Acid slant acid butt with gas but no H2S Indole – Positive (Bright red interface) Methy red – Positive (Red) Voges-Proskauer - Negative Citrate – Negative (Remains green)Motility – Motile (Turbidity out of line of inoculation stab)	Trimethoprim-sulfamethoxazole ampicillin
Klebsiella spp.	Culture Gram stain and Microscopy Catalase test Biochemical test – IMViC (Indole, Methyl red, Voges-Proskauer, citrate), motility	Lactose-fermenting (Yellow colonies in CLED); Mucoid, convex, white colonies on BAP Gram-negative bacilli Positive catalase test (Effervescence) 1) Biochemical test Indole – Negative (No colour change) Methy red – Negative (Yellow) Voges-Proskauer – Positive (Colour change) Citrate – Positive (Deep blue)Motility – Nonmotile (Growth along stab line)	Cephalosporins Aminoglycosides
Streptococcus spp.	Culture Gram stain and Microscopy Catalase test	Lactose-fermenting (Yellow colonies in CLED); Small, white colonies on BAP Haemolysis: α-haemolytic: eg. Streptococcus pneumoniae β-haemolytic: Streptococcus group A, B etc Non-haemolytic: E.g. Enterococcus spp.(Greyer appearance) Gram-positive cocci Negative catalase test	Penicillin Eryhromycin Aminoglycoside
Staphylococcus spp. Eg. S saprophyticus, Staphylococcus aureus	Culture Gram stain and Microscopy Catalase test	Lactose-fermenting (Yellow colonies in CLED); Small, white colonies on BAP Can be hemolytic positive or negative Gram-positive cocci Positive catalase test (effervescence)	Penicillins /with clavulanic acid Cephalosporins Vancomycin
Pseudomonas spp.	Culture Gram stain and Microscopy Oxidase test Biochemical test - TSI	Non-lactose-fermenting; Swarms on BAP; Spready colonies on CLED; Pungent smell Gram-positive bacilli Positive oxidase test Biochemical testTSI - Alkaline slant acidic butt	Penicillin Aminoglycoside
Proteus spp.	Culture Gram stain and Microscopy Oxidase test Biochemical test - TSI, Urease	Non-lactose-fermenting; Swarms on BAP; Glossy colonies; Pungent smell Gram-negative bacilli Negative oxidase test 1) Biochemical test TSI - Alkaline slant acidic butt with H2SUrease – Positive (Purple/pink)	Aminoglycosides Trimethoprim-sulfamethoxazole Ampicillin Cephalosporins
Candida spp.Eg. Candida albicans	Culture Gram stain and Microscopy	Non-lactose-fermenting; Small, flat, white colonies on BAP and CLED; Slightly spready, not glossy Fungus; pseudohyphae	-
Enterococcus faecalis	Culture Gram stain and Microscopy Catalase test Biochemical test – Motility, Indole	Large white colonies; alpha-, beta-, nonhemolytic colonies Gram-positive cocci Negative catalase test Biochemical test Motility – Nonmotile (Growth along stab line)Indole – Negative (No colour change)	Penicillin Vancomycin Gentamicin
Morganella	Culture Gram stain and Microscopy	Large, gray, moist colonies (beta haemolytic) Gram-negative bacili	Aminoglycosides Trimethoprim-sulfamethoxazole
Serratia	Culture Gram stain and Microscopy Catalase test Biochemical test – IMViC (Indole, Methyl red, Voges-Proskauer, citrate), motility	Lactose-fermenting but may produce negative results; Red-pigmented colonies Gram-negative bacilli Positive catalase test (effervescence) 1) Biochemical test Indole – Negative Methy red – Variable Voges-Proskauer - Positive Citrate – PositiveMotility – Motile (Turbidity out of line of inoculation stab)	Cephalosporins Aminoglycosides

Photos of Various Microorganism on Agar Plates:
E.Coli
Klebsiella spp.
Pseudomonas & Klebsiella spp.
Proteus spp.
Candida spp.


Photos are taken by our bacteriology group to "xinjiapo"-GH (Andre,Azhar,Valerie,Boonching)

References:
1. MedlinePlus. (2007) Urinary Tract Infection. Retrieved December 02, 2007, from http://www.nlm.nih.gov/medlineplus/ency/article/000521.htm
http://www.nlm.nih.gov/medlineplus/ency/article/000521.htm > >urinary tract infection
2. MedicineNet, Inc. (2007) Definition of Dysuria. Retrieved December 02, 2007, from http://www.medterms.com/script/main/art.asp?articlekey=3163
http://www.medterms.com/script/main/hp.asp > dysuria
3. Levinson, W. (2006). Review Of Medical Microbiology and Immunology. (9th ed.). US: The McGraw-Hill Company

Boon Ching
TG01