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Case 14

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					                    Case 1

A 10 year old boy was
 examined in the hospital with
conditions of fever and painful
red and swollen joints.
Two weeks earlier he had
developed a severe sore
 throat infection which showed
gram positive cocci in chains




 Balgees almaeena
            Case 1.
Describe the morphology of
   the organism below.
  Gram positive cocci in
          chains




   Balgees Almaeena
Case 1
Mention the effect of the
disease on the organ below
A.Cross reacting streptococcal
antibodies against the heart
can lead to
pericarditis,myocarditis etc

                     .




  Balgees Almaeena
Case1.
1.What is your provisional
diagnosis?
A.Rheumatic fever

2.What is the primary infection
in this case?
A.streptococcal sore throat

3.What other complications can
rise by the primary infection?
A.Acute glomeronephritis

4.What further lab tests can be
done to confirm the secondary
condition?
A.ASO(measurement of
antisreptolysin antibody titre is
important in investigation of
post streptococcal disease
  Balgees Almaeena
Case 1.
What is the possible clinical
picture below?
A.Rare complication of
rheumatic fever leads to
rheumatic nodules on the elbow
seen below




  Balgees Almaeena
 Case 2
A young girl was examined in
hospital with a fever of 101F
and chills.
A tiny rash was observed on
the chest and the stomach.
She also had a whitish
coating on the surface of the
tongue and it gave the
appearance of strawberry
shape
                   ….




Balgees Almaeena
Case 2.
What can be the most likely
disease?
A.Scarlet fever

Did she develop an earlier
disease?
AStreptococcal
pharyngitis(organism releases
pyrogenic toxin)

Is the rash contagious?
A.No-Develops 2 days after
                   .
pharnygitis till about 7 days

Does the child develop permanent
immunity?
Yes-for this disease

   Balgees Almaeena
                   Case 2
  Describe the media,the
 reaction and the possible
      organism below
 Blood agar plate showing
Complete heamolysis around
   colonies(B-hemolysis)




Balgees Almaeena
Case 2
What are the complications of
the clinical picture below?The
throat swab showed gram
positive cocci in chains
A.Rheumatic fever,acure
glomerulonephritis




 Balgees Almaeena
             Case 3

Four hours after eating a
cake ,a group of students
developed a sudden
attack of acute diarrhoea,
vomiting, and abdomainal
cramps.




 Balgees Almaeena
          Case 3

1.What is your provisional
diagnosis?
Food poisoning
2.What is the factor involved
in causing the disease?
Stapylococcus areus toxin

3Can the causative agent be
destroyed by normal cooking
procedures?
A.yes to the organism no to
the toxin
4.What is the difference
between food borne disease
and food poisoning?
A.Different concepts
1.Cross contamination or
improper cooking
2.Multiplication of bacteria in
the food


Balgees Almaeena
          Case 3.
Describe the morphology of
 the microorganism below
  A.gram positive cocci in
     clusters(groups)




Balgees Almaeena
             Case 4
A menstruating woman
using tampons presented
herself to a clinic with
symptoms of sudden high
fever,hypotension,and a
rash like sunburn on her
palms and soles.
Gram stain of cervical
samples showed gram
positive cocci in clusters




Balgees Almaeena
                   Case 4
1.What is your provisional
diagnosis?
A.
Toxic shock syndrome

2.What is the risk factor
involved in this case?
A.Tampons.May have high
levels of toxigenic stapylococci

3.Name complications of the
disease.
A.involves central nervous
system,gastrointestinal
hepatic, renal,failure)


Balgees Almaeena
         Case 12
   A male patient was
 examined in the clinic for
 dysuria.On examination
  he had some urethral
        discharge.
    A Gram stain was
    performed on the
       discharge.




Balgees Almaeena
This direct smear is from a urethral
discharge on a male; how would
you report it out?

A.Direct smear showing
extracellular gram negative
diplocooci(you will proceed with
further lab tests




Balgees Almaeena
What is the selective plate
that can be used for isolation
of Neisseria gonorrhoeae &
Neisseria meningitidis?.
Thayer-Martin media




Balgees Almaeena
What would be the
expected oxidase test
result if the organism is
a Neisseria .
A.oxidase positive




Balgees Almaeena
  The presence of gram
   negative diplococci
    intracellularly and
     extracellularly is
diagnostic in acute male -
         urethritis
              .




Balgees Almaeena
               Case 12
 What complications can this •
 untreated condition in females
         progress to?
Chocolate agar •
A.sapingitis pelvic •
inflammatory disease(PID) are
some examples




                                  •.




  Balgees Almaeena
               Case 13

A patient with symptoms •
of a fever, headache, and
stiff neck which took two
days to develop came to
the clinic.
Other symptoms were •
nausea and vomiting,
sensitivity to lights,
drowsiness, confusion,
and sleepiness.
 A more serious •
complication had
developed.

Balgees Almaeena
              Case 13
1.What is your provisional •
diagnosis?
Meningitis •
2.Should antibiotics be given •
immediately on suspicion of
the case?
Yes •
3.How is the infection spread? •
Droplet infection-leading to •
meningitis or meningoceamia
4.What precaution is taken •
while performing Haj?
A.immediate isolation with •
antibiotic therapy
 Balgees Almaeena
 Carbohydrate tests
   Which member of this •
 genus gives GLUcose +
         and MALtose -?
   A.Neisseria meningitis •




Balgees Almaeena
               Case 13

What is this clinical condition •
called
Large heamorrhagic skin •
lesions leading to Water-house
friederichsen syndrome




Balgees Almaeena
                    Case 14


A patient was admitted to •
the clinic with complaints
of sore throat,fever,and
headache.Clinical
examanation showed a
formation of a
psuedomembrane on the
tonsils.




 Balgees Almaeena
           Case 14
1.What is your provisional •
diagnosis?
Suspected case of diphtheria •
2.How is the disease spread? •
By asynptomatic carriers through •
droplet infection.
Skin contact for cutaneous •
diphtheria
3.Name the vaccine for the disease. •
Diphtheria toxoid given in childhood •
as DPT in combination with polio
and tetanus
4.What are volutin or •
metachromatic granules?
Energy releasing cont phosphatase •
Case 14

What is the name of this stain
and what is it used for?

A.Alberts stain to show the
presence of volutin granules




 Balgees Almaeena
Case 14
Bull neck appearance is a
complication of diptheria




Balgees Almaeena
                   Case 14




Balgees Almaeena
              Case 14

Name the stain and the •
arrangement of the
organism.
A.gram stain showing gram •
positive bacilli with chinese
letter arrangement




 Balgees Almaeena
                   Case 14

Which is the most serious •
type of diphtheria strain?
A. C.diphtheria gravis •




Balgees Almaeena
               Case 14

Name and describe this •
medium .
A.Loefflers serum slant agar is •
an enriched medium for growth
of C.diphtheria can show
metachromatic granules




Balgees Almaeena
Case 14

Name the test
What is the reaction called.

A.this is an Elek test .
Double diffusion reaction
between toxin and antitoxin to
test the presence of toxin
producing C. diptheria




Balgees Almaeena
                   Case A

A 48 year old patient was •
examined at the clinic after
showing symptoms of crampy
abdominal pain,nausea,vomiting
,diarrhoea and fever.
There was no blood in the stool •
He had not eaten any raw or •
unprocessed food except for
eggs at a friends place one day
earlier.




Balgees Almaeena
                   Case A

What is your provisional •
diagnosis?
Salmonella food poisoning •

Name a common bacterial
agent that causes this
condition
Salmonella typhi

What are the most common •
sources of human infection
with this organism?
Poultry,eggsdairy •
productsfoods on
contaminated work surfaces

Balgees Almaeena
 Balgees Almaeena


                    Case A
 XLD agar with         Flagellar stain
 black colonies        showing petrichous
                       flagella




                        Gram stain showing
TSI slant showing
                        Gram negative
H2S production
                        bacilli
                   Case B

A young woman was •
examined in the clinic
showing symptoms of
dysuria, frequency during
micturation and suprapubic
pain.




Balgees Almaeena
                   Case B

 1.What is your provisional •
         diagnosis?
  Urinary tract infectionA. •

   2.What is the possible •
causative agent, if it showed
   A.Indole test positive? •
 Probably E.coli if it shows •
  lactose fermentation on
      Macconkeys agar

  3.What is the most likely •
 mechanism by which this
organism infects the urinary
            tract?
     A.Originate in the •
 colon,contaminate urethra
  ,ascend into the bladder
Balgees Almaeena
                   Case B
                        E.coli Gram stain

Are Gram •
 negative
  Motile •
Some are •
capsulated
Facultative •
                      E.coli on blood agar
anearobes




Balgees Almaeena
                   Case B
                      EMB agar showing green
   Indole positive       metalic colonies
     in right tube




                          Pink lactose
    E.Coli in GIT
                      fermenting colonies




Balgees Almaeena
                   Case C

A patient with renal colic •
was admitted to the
hospital.
He was diagnosed as •
having pyelonephritis (UTI
infection)




Balgees Almaeena
                   Case C
   Biochemical tests first row proteus-
                  API




  Swarming of Proteus species on
           blood agar




Balgees Almaeena
                   Case C

Urease •
positive test
left tube •




Antimicrobial •
sentivity tests
to detect
urinary
pathogens


Balgees Almaeena
                   Case C

1.What could the possible •
causative organism be?
Proteus •

2.Name two laboratory •
characteristics of this
organism
Swarming on Nutrient •
agar,positive urease test

Describe the morphology of •
this bacteria
Gram negative,highly •
pleomorphic,actively motile
and non-capsulated
Balgees Almaeena
Balgees Almaeena



             Case C
Non-lactose fermenting colonies on
               right




  Swarming on blood agar
                   Case C

Proteus •
vulgaris Gram
stain




Proteus •
flagella




Balgees Almaeena
                   Case D

A child at the nursery •
school was admitted to
the clinic.
Her symptoms were •
abdominal cramps ,fever,
and diarrhoea
 Stool examination •
revealed pus ,blood and
mucus




Balgees Almaeena
            Case D
1.What is your provisional   •
diagnosis?
Dysentery bacillary •

2.State the virulence factors of the •
organism causing this disease.
.Endotoxin and genes(adherence •
,invasion,intracellular
replication.Shiga toxin disrupts
protein synthesis and produces
endothelial damage.

3.Describe its growth on •
MacConkeys agar
Non-lactose fermenters •


4.State the differences •
between diseases caused by
S.typhi and S.sonnei
                   Case D

XLD agar •
showing no
H2S
production




Shigella on •
MacConkeys
agar-non
lactose
fermenting
colonies

Balgees Almaeena
  Some laboratory culture pictures
      Kliebsiella       TCBS agar for Vibrio
    pneumoniae on            cholera
     Macconkeys




          .
    Salmonella on
                        Pyocin pigment on
  salmonella shigella
                          nutrient agar
        agar
                          P.aeroginosa




Balgees Almaeena

				
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