Microbiology bacteria cases

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jaz_walker
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269209
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Microbiology bacteria cases
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2014-04-04 12:00:49
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microbiology pathology
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pathology
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Microbiology cases
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  1. Case 1. A 25 year old woman presents iwth an abortion. A blood culture shows b haemolysis on blood culture and is a gram positive bacillus. What is the causative organism and what is your management?
    Listeria monocytogenes - Ampicillin
  2. Case 2. A 54 year old man presents with confusion and night sweats. He also has photophobia.. A CSF shows lymphocytes, but few neutrophils, with a low CSF glucose. What is the most likely causative organism and what would you subsequently test for?
    Tuberculosis - HIV
  3. Case 3. A 45 year old woman presents with severe acid reflux.. A sample of gastric acid shows motile curved gram negative bacilli, which grow well on chocolate agar places. What is the causative organism and what is treatment?
    H. pylori - amoxicillin + clarithromycin. Also give a PPI.
  4. Case 4. A 45 year old woman presents with granulomatous nodular skin lesions. She has worked for the past 7 years with Medecins Sans Frontiers. A skin scraping shows acid fast bacilli on Ziehl Nielson staining. What is the likely causative organism?
    mycobacterium leprae -
  5. Case 5. A 78 year old man presents with acute ulcerations of his gums.. A swab shows gram positive anaerobes, which are spindleshaped. What is the causative organism?
    fusobacterium -
  6. Case 6. A 34 year old man presents with purulent urethrile discharge. He has regular casual sex, without protection.. A urethral smear shows intracellular gram negative diplocci What is the causative organism and what is treatment?
    Neisseria gonorrhoea - Azithromycin + ceftriaxone
  7. Case 7. A 36 year old woman presents with an inflamed knee, and a moderate fever.. An aspiration shows gram negative diplocci on selective culture. What is the causative organism and what is treatment?
    Neisseria gonorrhoea - Azithromycin + ceftriaxone
  8. Case 8. A 74 year old man presents with bloody diarrhoea on Boxing Day. He also has some back pain.. Blood Culture forms pale colonies on MacConkey's medium, which have black centres. What is the most likely organism and what complication is this patient likely to have?
    Salmenellosis - Salmonella osteomyelitis of spine.
  9. Case 9. A 17 year old male presents with a fever. On closer questioning, he has had toothache for the past 2 weeks.. Blood cultures - produces a greenish ring on blood agar. What is the causative agent, and what are you concerned about?
    Streptococcus viridans (a haemolytic group b streptococcus) - infective endocarditis
  10. Case 10. A 7 year old girl presents with diarrhoea a week after visiting a farm. 2 weeks later she develops haematuria.. Blood cultures are clear. What is the most likely causative organism?
    E. coli 0157 -
  11. Case 11. A 64 year old female is complaining of jaw spasms. She has recently had an infected hand wound, during a trip to Kazakstan. You notice that she is sweating excessively, and drooling.. Blood cultures are taken and an urgent immunoassay is performed. On culture, drumstick gram positive rods are isolated, which are motile and form a fine film of growth on blood agar (rather than discrete colonies) What is the causative organism and what would be your immediate management?
    Clostridium tetani - Tetanus immunoglobulin, wound debridement, penicillin
  12. Case 12. A 25 year old woman presents with shock and a fever.. Blood cultures show gram positive cocci which are TSST positive What is this condition called?
    S. aureus - Toxic shock syndrome
  13. Case 13. A 54 year old female with a prosthetic heart valve develops a fever.. Blood cultures show gram positive cocci which is coagulase negative. What is the most likely causative organism and what is first line treatment?
    S. epidermidis - Flucloxacillin or erythromycin
  14. Case 14. A 73 year old man who is also an IVDU presents with double vision and eyelid drooping. You notice he also has difficulty speaking, and reduced facial expression.. Blood cultures show toxoid from causative organism. What is the causative organisma and what is the management?
    Clostridium botulinum - Penicillin or metronidazole, supportive
  15. Case 15. A 78 year old female has been in hospital for 10 days following IECOPD. Her catheter site looks red and swollen, and she has a fever. The catheter is removed and sent for culture.. Catheter grows gram negative bacilli, which is resistant to ampicillin. What is the most likely organism and what is your first line treatment?
    Klebsiella - cefotaxime or ceftriaxone
  16. Case 16. A woman aged 32 presents with infertility.. Cervical swabs do not culture any organisms, but on gram staining there are 'clue cells' What is the likely causative organism and what is management?
    Chlamydia trachomatis - Azithromycin + doxycycline
  17. Case 17. A 5 year old boy from Kenya presents with a fever and sore throat, looking unwell.. Clearly unwell, sputum sample cultures only on enriched media, with poor growth on blood. Gram negative coccobaccili are isolated. What is the organism and what is first line treatment?
    H. influenzae - Cefotaxime or ceftriaxone
  18. Case 18. A 17 year old female presents with a fever and a positive Koernig's test.. CSF: cloudy with gram negative, kidney shaped diplococci What is the causative organism and what is treatment?
    Neisseria meningitidis - Penicillin + rifampicin to eradicate nasopharyngeal carriage.
  19. Case 19. A neonate is handling poorly, and appears drowsy. They have a fever, and the parent is concerned.. CSF: neutrophils, cloudy. CSF cultures grow on blood agar with a b-haemolytic area around them. What is the causative agent, and what is the treatment?
    Group B b-haemolytic streptococcal meningitis - Penicillin
  20. Case 20. A 57 year old man presents with vomiting and nausea after eating uncooked meat.. Culture of the food shows gram positive rods What is the most likely causative organism
    c. perfringens. -
  21. Case 21. A 42 year old female with a history of diabetes presents with blackened toes and a fever. She mentions her foot has been increasingly painful on walking over the past year.. Culture of the foot shows lipase production on Naglar place What is the causative organism?
    clostridium perfringens -
  22. Case 22. A 32 year old female presents with an infection of her episiotomy scar (2 weeks previous). On examination, there is a deep abscess, which is drained.. Culture shows a haemolysis on blood agar, and good growth on MacConkey's medium. What is the most likely causative organism?
    Enterococcus -
  23. Case 23. A 14 year old male presents with shortness of breath and syncope, 3 weeks after a skin infection.. Cultures are negative, but streptolysin O is positive. What are you concerned about?
    Rheumatic fever -
  24. Case 24. A woman aged 46 presents with a hot, swollen area of hand for the past week, and a 2 day history of rigors, fever and nausea. On examination of the area, it is superficial inflammation, which is oedematous and 'like orange peel'. Cultures on blood agar show b-haemolysis, and Lancefield grouping shows type 'A' What is the causative agent, and what is the disease?
    Group A b-haemolytic streptococci - Erysipelas
  25. Case 25. A 76 year old man presents with a fever, sore throat and soft warty lesions on his mouth. He also has a bilateral rash on his trunk, which is not itchy. 6 weeks ago he had an ulcer close to his anus.. Dark field examination of fresh material from skin lesions shows gram negative spirochaetes. Culture does not grow anything. What is the causative organism?
    t. pallidum - secondary syphillis
  26. Case 26. A 46 year old woman presents with trouble with her gait, and memory difficulties. She is otherwise well in herself, except for a skin lesion, which you scrape and culture.. Dark field examination of fresh material from skin lesions shows gram negative spirochaetes. Culture does not grow anything. What is the causative organism?
    t. pallidum - tertiary syphillis
  27. Case 27. A 85 year old woman has been in hospital for 7 days following a fall. She has developed diarrhoea.. Faecal anaerobic culture shows growth on cefoxitin and fructose selective media. ELISA confirms the results. What is the causative organism?
    C. difficile -
  28. Case 28. A 8 month old infant presents with poor handling and feeding. On further questioning, you discover a history of constipation, and recent altered cry, and that the infant has been fed honey recently.. Faecal culture shows toxin production from the causative organism What is the causative organism and what is the management?
    Clostridium botulinum - Penicillin or metronidazole, supportive
  29. Case 29. A 53 year old female farmer presents with severe bloody diarrhoea. Examination shows dehydration, fever and an unwell patient.. Faecal samples are cultured on charcoal selective media, which are grey with a metallic sheen. Further tests show that it is oxidase and catalase positive. An ABG shows metabolic alkalosis. What is the causative organism and management?
    campylobacter - erythromycin or ciprofloxacin
  30. Case 30. A Libyan man presents with rice water stool 3 days after arriving in the UK.. Faecal samples are cultured with alkaline broth, which shows gram negative, comma shaped bacteriae. Specific slide agglutination reactions show O antigen. What is the causative organism?
    v. cholera. - No treatment required, supportive only.
  31. Case 31. A 2 year old presents with suspected domestic violence - as though they have been dipped in boiling water.. Fever, swabs show gram positive cocci which are positive for exfoliative toxin What is this condition called?
    S. aureus - Scalded skin syndrome
  32. Case 32. A 56 year old female presents with vomiting and diarrhoea 1 hour after getting Chinese takeaway.. Food cultured shows gram positive rods. What is the causative organism?
    Baccilus cereus -
  33. Case 33. An 85 year old female has been in hospital for 15 days post-hip replacement, and has developed a fever.. Gram positive cocci which are coagulase positive and which are resistant to methicillin What is the causative organism and what is management?
    MRSA (methicillin staph. Aureus) sepsis - IV Vancomycin
  34. Case 34. A 38 year old man from Bangladesh presents with cervical lymphadenopathy and a fever.. Lowenstein-jensen medium grows acid-fast bacilli What is the most likely causative organism and what would you subsequently test for?
    Tuberculosis - HIV
  35. Case 35. A 9 month old child develops diarrhoea but is otherwise well.. On MacConkey's culture gram negative aerobic bacilli are identified. What is the most likely organism and what strain is likely to be involved?
    E. coli - EPEC
  36. Case 36. A 52 year old female returns from Pakistan with diarrhoea and a slight fever.. On MacConkey's culture gram negative aerobic bacilli are identified. What is the most likely organism and what strain is likely to be involved?
    E. coli - ETEC
  37. Case 37. A 42 year old female sheep farmer presents with an ulcerated skin lesion with a necrotic centre.. On swab, a gram positive bacillus is isolated, which produces oval spores. What is the causative organism and what is your management?
    Baccilus anthracis - Penicillin
  38. Case 38. A 5 year old visits the GP with a 2 day history of ear ache.. Pharyngeal swabs show gram positive diplococci. Cultures only grew in the presence of 10% carbondioxide. What is the causative agent?
    Streptococcus pneumonia -
  39. Case 39. A 4 year old has been admitted for haematuria, proteinuria and uraemia, 3 weeks after a pharyngitis.. Positive streptolysin O and low C3 and C4. What two results are possible on biopsy?
    Post-infectious streptococcus - Proliferative disease (either diffuse or focal segmental) or minimal change disease.
  40. Case 40. A 69 year old man presents with a recurrent fever during which time he is fatigued. He lives in Norfolk.. Serological tests are positive, and subsequent cultures show gram negative, spiral bacteriae which are motile. What is the causative organism?
    B. burgdorferi - Lyme disease
  41. Case 41. A 7 year old boy with a history of atopic eczema presents with reddened, painful skin, with a yellow crusting, and a fever.. Skin swab - golden-yellow colonies, which are coagulase positive, deoxyribonuclease positive, novobiocin sensitive. What is the most useful management of this?
    S. aureus - Fluclozacillin
  42. Case 42. A 36 year old female with CF presents shortly after her last hospital admission with SOB.. Sputum culture shows gram negative bacilli, which form slightly green colonies. What is the organism and what is first line treatment?
    P. aeruginosa - Gentamycin, ciprofloxacin.
  43. Case 43. A 47 year old female smoker presents with shortness of breath and increased sputum production.. Sputum sample grew cultures in 10% carbon dioxide, which were disc shaped with raised edges, surrounded by a zone of a-haemolysis. This bacterium was sensitive to optochin, but resistant to penicillin. What is the causative agent, and which drug groups might you try?
    Streptococcus pneumoniae - macrolides, or cephalosporins
  44. Case 44. A 64 year old male has been in hospital for a day following catheterisation for urinary retention. He has developed a fever.. Urinalysis shows blood, protein, nitrates. Culture shows gram positive cocci which are coagulase negative, with resistance to erythromycin and fluclozacillin What is the most likely organism and what treatment would you prefer>
    S. epidermidis - IV Vancomycin
  45. Case 45. A 56 year old man has a long-term catheter. Urinalysis shows blood, protein, nitrates. Microscopy shows gram positive cocci arranged in clusters. Coagulase positive What is the most useful management of this?
    S. aureus - Fluclozacillin
  46. Case 46. A 3 year old presents with a fever and haematuria, 3 weeks after taking penicillin for a pharyngitis. On examination he has hypertension, and is unwell.. Urinalysis shows haematuria, proteinuria. On admission, his serology shows uraemia. What is the most likely causative organism and what investigation would be performed next?
    Group A b-haemolytic streptococci - Kidney biopsy.
  47. Case 47. A 87 year old female presents with dysuria, frequency and urgency. She is otherwise well.. Urine culture shows gram negative bacilli, which produce pale colonies on MacConkey's and 'swarm' on blood agar. What is the organism?
    Proteus -
  48. Case 48. A 23 year old woman presents with severe pain on urinating, frequency and haematuria.. Urine culture shows gram positive organisms which are coagulase and DNAse negative, and novobiocin resistant. What is the causative organism?
    S. saprophyticus -
  49. Case 49. A 23 year old female sewer worker presents with hepatic and renal damage, which is correctly identified as Weil's disease. Urine cultures grow gram-negative, coiled motile bacteriae. What is the causative organism and what is appropriate treatment?
    Leptospira - Penicillin
  50. Case 50. A 93 year old patient develops shortness of breath, cough and pleuritic chest pain over the course of a week, a year after their stroke.. X ray shows a round cavity with an air-fluid level, and good margins. Sputum is cultured and grows yellow colonies, with gram positive cocci. What is the causative organism and what are 3 other organisms which can cause the same problem?
    S. aureus causing an abscess - Pseudomonas, proteus, klebsiella
  51. Case 51. A diabetic 64 year old patient develops a fever and foot pain for 3 weeks.. X ray shows regional osteopaenia, with swelling of the adjacent muscles and soft tissues. What is the most likely causative organism?
    S. aureus - osteomyelitis. -
  52. Case 52. A 14 year old female presents with a fever, throat soreness and a diffusely swollen neck.. You send throat swabs in Hoyle's tellurite, which produces grey-black colonies. Elek test shows precipitation. What is the causative organism and what is management?
    Cornyebacterium diptheriae - Isolation, antitoxin, penicillin/erythromycin.

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