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

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

   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


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1.What is your provisional
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
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

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Case 2.
What can be the most likely
A.Scarlet fever

Did she develop an earlier
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
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

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

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             Case 3

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

 Balgees Almaeena
          Case 3

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

3Can the causative agent be
destroyed by normal cooking
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

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          Case 3.
Describe the morphology of
 the microorganism below
  A.gram positive cocci in

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             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

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                   Case 4
1.What is your provisional
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
A.involves central nervous
hepatic, renal,failure)

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

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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

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

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

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  The presence of gram
   negative diplococci
    intracellularly and
     extracellularly is
diagnostic in acute male -

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


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               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

Balgees Almaeena
              Case 13
1.What is your provisional •
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
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 Carbohydrate tests
   Which member of this •
 genus gives GLUcose +
         and MALtose -?
   A.Neisseria meningitis •

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               Case 13

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

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                    Case 14

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

 Balgees Almaeena
           Case 14
1.What is your provisional •
Suspected case of diphtheria •
2.How is the disease spread? •
By asynptomatic carriers through •
droplet infection.
Skin contact for cutaneous •
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
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

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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

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                   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

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                   Case A

What is your provisional •
Salmonella food poisoning •

Name a common bacterial
agent that causes this
Salmonella typhi

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

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 Balgees Almaeena

                    Case A
 XLD agar with         Flagellar stain
 black colonies        showing petrichous

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

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

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                   Case B

 1.What is your provisional •
  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
     A.Originate in the •
 colon,contaminate urethra
  ,ascend into the bladder
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                   Case B
                        E.coli Gram stain

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

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

                          Pink lactose
    E.Coli in GIT
                      fermenting colonies

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                   Case C

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

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                   Case C
   Biochemical tests first row proteus-

  Swarming of Proteus species on
           blood agar

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                   Case C

Urease •
positive test
left tube •

Antimicrobial •
sentivity tests
to detect

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                   Case C

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

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

Describe the morphology of •
this bacteria
Gram negative,highly •
pleomorphic,actively motile
and non-capsulated
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             Case C
Non-lactose fermenting colonies on

  Swarming on blood agar
                   Case C

Proteus •
vulgaris Gram

Proteus •

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                   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

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            Case D
1.What is your provisional   •
Dysentery bacillary •

2.State the virulence factors of the •
organism causing this disease.
.Endotoxin and genes(adherence •
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

Shigella on •

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

    Salmonella on
                        Pyocin pigment on
  salmonella shigella
                          nutrient agar

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