MMIC CASE 6

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

List of possible organism	Test required	Expected results	treatment
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)