BloodBank.MedMic.Haematology

Monday, December 10, 2007

MMIC CASE 6


Particulars of Patient
Name: Wong Fei Fei
Sex: Female
Age: 37
Complaints: Fever, pain during urination, vaginal discharge

List of possible organismTest requiredExpected resultstreatment

Bacteria

Pseudomonas aeruginosa


1) Gram Stain

2) Biochmical Tests:
- Catalase test
- Oxidase test
- TSI agar test


3) Aerobic culture on plates like MacConkey agar plate, blood agar plate or differential media


4) Antibiotic Susceptibility (aminoglycoside + penicillin)


1) Shows gram negative rod

2) Catalase and oxidase positive
TSI medium no colour change (K/K/g-/H2S-)

3) Colourless colonies on MacConkey plateColonies grown on blood agar.






Antibiotics that have activity against P. aeruginosa include:
- aminoglycosides
- quinolones (ciprofloxacin)
- cephalosporins (ceftazidime and cefoperazone)

Escherichia coli

1) Gram Stain


2) Biochemical Tests:
- TSI agar test
- Methyl red test
- VP reaction test
- Citrate test


3) Aerobic culture on MacConkey agar or EMB agar (or both), blood agar


4) Serology is done using the SSS-Coagglutination test


5) Antibiotic Susceptibility (fluoroquinolone)


1) Gram negative rods


2) • Grows on TSI slant with a (A/A/g+/H2S-) profile
• Indole (+)
• Methyl red (+)
• VP (-)
• Citrate (-)


3) On MacConkey agar, deep red colonies are produced.


Growth on EMB agar would show black colonies with greenish-black metallic sheen.


Hemolysis on blood agar


4) Serology detects O55:K5:H21


Antibiotics which may be used to treat E. coli infection:
- nitrofurantoin
- fluoroquinolones
- meropenem
- aminoglycosides
- ciprofloxacin

Enterococcus spp.

1) Gram Stain

2) Biochemical tests:
- Catalase test


3) Antibiotic Susceptibility (gentamicin + vancomycin)


1) Cocci in tetrad and clusters

2) (-) to weakly (+) catalase


Can treat with vancomycin and gentamicin






Proteus mirabilis

1) Gram stain

2) Biochemical tests:
- Indole test
- Methyl red test - VP test
- Catalase test
- Oxidase test
- Urease test


3) Aerobic culture on XLD plate, blood agar or differential media


4) Antibiotic Susceptibility (ampicillin)


1) Gram negative rod

2) Indole test (-)
Methyl red (+)
VP (-)
Catalase (+)
Oxidase (-)
Urease (+)


3) Colonies growns on the agar plates


Antibiotics which may be used to treat:

- ampicillin
- aminoglycoside
- TMP-SMZ
- fluoroquinolone
- cephalosporin


Chlamydia Trachomatis




1) McCoy cell culture


2) Fluorescent Antibody test/Enzyme-linked Immunoassay


3) DNA probe test


4)Antibiotic Susceptibility (Doxycycline or azithromycin)


1) Cytoplasmic inclusions observed by immunofluore-scence after few days of incubation in cell culture


2) Detect the presence of genus-specific lipopolysaccharide antigen


Can be cured with antibiotics like:


- Azithromycin
- Doxycycline
- Tetracycline

Neisseria Gonorrhoeae

1) Gram stain


2) Biochemical Test
- Oxidase test


3) Serology Antibiotic Susceptibility (Penicillin)


1) Gram negative, diplococcus


2) Oxidase (+) IgG and IgA antibodies against gonococcal pili, outer membrane proteins and LPS detected



Recommended treatment:

- cephalosporin
- Fluoroquinolone plus an antibiotic e.g. ceftriaxone, cefixime, ciprofloxacin

Klebsiella pneumoniae

1) Gram stain


2) Biochemical test:
- Citrate test
- VP test


3) Aerobic culture on blood agar, MacConkey agar and differential media


4) Antibiotic susceptilibilty (cephalosporin)


1) Gram negative, large and regular capsules


2) Citrate (+)
VP (+)


3) Large colonies and very mucoid






Can be cured with antibiotics like:


- cephalosporine
- aminoglycoside
- imipenem

Providencia species

1) Gram stain


2) Biochemical test:
- Urease test


3) Aerobic culture on blood agar and differential media


4) Antibiotic susceptilibilty (ceftazidime and cefepime)


1) Gram negative


2) Urease (-)


3) Circular, convex, smooth colonies






Recommended treatment with:

- ceftazidime
- cefepime
- aztreonam
- imipenem

Citrobacter

1) Gram stain


2) Aerobic culture on blood agar and differential media


3) Biochemical test:Citrate test



1) Gram negative


2)Circular, convex, smooth colonies


3) Citrate (+)




Antibiotics which may be used to treat:

- ampicillin
- cephalosporins
- fluoroquinolones

Viruses

Herpes simplex virus type 2 (HSV-2)

1) Virus isolation using inoculation of tissue culture


2) Serology


1) Viral DNA identified


2) Antibodies of HSV-2 detected






Several antiviral drugs are effective against such infection:
- Acyvlovir
- Valacyclovir
- Vidarabine

Parasites

Trichomonas vaginalis

1) Microscopic examination – vaginal discharge examined microscopically in a drop of saline


2) Anaerobic culture


1) Characteristic motile trichomonads observed in wet mount


2) Colonies growth on agar plates






Successful treatment requires destruction of trichomonads by medicine like:
- metronidazole (e.g. Flagy)
- tinidazole and ornidazole

Fungi

Candida albicans

1) Potassium hydroxide (KOH) preparation of the vaginal discharge


2) Culture on fungal or bacteriologic media at room temperature or 37oC


1) Hyphae and pseudo spores of Candida are visible under microscopic examination


2) Culture medium is incubated for several days, during which time colonies of yeast and/or bacteria develop










Usually treated with antimycotics—antifungal drugs e.g. topical clotrimazole, topical nystatin, fluconazole, and topical ketoconazole



Images of possible microorganisms:



Pseudomonas aeruginosa
on mac conkey plate (1)



P. mirabilis on an XLD agar plate (2)





C. trachomatis inclusion bodies (brown) in a McCoy cell culture (3)



trichomonas vaginalis wet mount (4)



Candida albicans (4)


K. pneumoniae on a MacConkey agar plate (5)



References:
1. http://www.austincc.edu/microbugz/html/ > macconkey_agar
2. http://en.wikipedia.org/wiki/Main_Page > Proteus_mirabilis
3. http://en.wikipedia.org/wiki/Main_Page > Chlamydia_trachomatis
4. http://www.google.com/ > image search > "microorganism name"
5. http://en.wikipedia.org/wiki/Main_Page > Klebsiella_pneumoniae



Doreen Ng (TG 01)

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