Question

Microbiology Case #1 (M-6) A homeless, 59- year-old man, Ganiyu Hassan, presented to the emergency room...

Microbiology Case #1 (M-6)

A homeless, 59- year-old man, Ganiyu Hassan, presented to the emergency room complaining of fever and chills of 4 days’ duration, with dizziness over the last 24 hours. He also complained of intermittent diarrhea and constipation over the past 6 months with occasional bloody stool. He told the physician that he ate what he could due to his circumstances. The patient’s breathing was rapid, but his lung sounds were clear. His temperature was 103oF. Hugh was hypotensive, tachycardic, and had an appreciable heart murmur. Blood was drawn for a complete blood count (CBC) and culture. A stool specimen was collected to test for occult blood, and a chest x-ray was performed. Results of the laboratory tests are shown in Table 1A and in the list following the chart.

Table 1A: Hematology Results

Complete Blood Count

Ganiyu Hassan

Reference Range

WBC

9.1

5-10 x 109/L

RBC

4

5-6 x 1012/L

Hb

122

135-175 g/L

Hct

0.4

.41-.53 L/L

MCV

100

80-100 fL

MCH

32

26-34 pg

MCHC

30

31-37 g/dL

RDW

15.6

11.0-14.5

Platelets

458

150-400 x 109/L

MPV

7.2 fL

6.5-12.0 fL

RBC morphology

2+ microcytosis

1+ macrocytosis

1+ ovalocytosis

1+ basophilic stippling

2+ hypochromia

1+ polychromatophilia

2+ toxic granulation

Rare Döhle bodies

Rare hypersegmentation

2 nucleated RBCs

Differential

Polymorphonuclear neutrophils

52

25-60%

Bands

10

0-10%

Lymphocytes

35

20-50%

Monocytes

1

2-11%

Metamyelocytes

2

0%

The stool was positive for occult blood.

All blood cultures were positive within 24 hours.

Gram’s stains from the bottles revealed gram-positive cocci in chains.

Subcultures grew readily on BAP and produced small gray gamma-hemolytic colonies.

Additional biochemical testing yielded the following:

  • catalase: negative
  • bile esculine agar: growth with black precipitate
  • growth in 6.5% NaCl: negative
  • L-Pyrrolidonyl ß-naphthylamide PYR test: negative.

Questions

  1. what would be the appropriate timing and number for the collection of routine blood cultures for this patient?
  1. Contamination in blood cultures can be a problem. What step(s) should be followed to keep contamination rate low?
  1. What criteria might be used to determine if a positive blood culture is due to contamination or bacteremia?
  1. Does Ganiyu have bacteremia? Does Ganiyu have septicemia? What is the difference between the bacteremia and septicemia?
  1. Given the Gram’s stain reaction and morphology of the bacteria, what might be some possibilities for the identity of the organism?
  1. Given Ganiyu history, physical findings, other clinical data, and the further biochemical testing that was performed on this isolate, what is the likely identification of this organism?
  1. If latex agglutination testing was performed, to which group would this organism belong?
  1. What other testing methods might be employed to get a definitive identification of this organism by genus and species?
  1. Hugh has a complex medical history and presentation.
    1. Describe his blood picture results in correct hematological terms?
    2. Give an explanation for toxic granulation.
    3. Give 2 reasons for macrocytes and ovalocytes
    4. Give reason for microcytes
    5. What other tests might be indicated for his occult blood results?

Homework Answers

Answer #1

1.The appropriate time for routine blood cultures for Hassan should be starting from the day following 24hrs time frame.The count depends on the results of first four cultures.If the first four cultures were negative then the test can be once every day.If those are positive the cultures can be repeated once after the treatment course.

2. Steps to be taken to avoid blood culture contamination

Wipe the skin of the patient with antiseptic solution.

Avoid prolonged storage of blood in the labs that gives false results.

Education of phlebotomist about the best practices to avoid contamination.

Practicing of collecting blood cultures by Nurses is necessary as they are well trained.

Do not mix up the containers with stool and other cultures which may probably leads to contamination

Know the answer?
Your Answer:

Post as a guest

Your Name:

What's your source?

Earn Coins

Coins can be redeemed for fabulous gifts.

Not the answer you're looking for?
Ask your own homework help question
Similar Questions
A 38-year-old white woman was treated in the emergency department for severe lacerations and possible abdominal...
A 38-year-old white woman was treated in the emergency department for severe lacerations and possible abdominal injuries sustained in an automobile accident. She was admitted to the hospital for observation and further evaluation. On admission, a complete blood count (CBC), urinalysis, and radiograph series were ordered. ■ Laboratory Data Her CBC results were as follows: Hemoglobin 10.5 g/Dl Hct 34% RBC 3.8 × 1012/L WBC 12.0 × 109/L The RBC indices were as follows: MCV 89.6 fL MCH 27.6 pg...
A 59-year-old female presented to the emergency room with a four-day history of intermittent fever, fatigue,...
A 59-year-old female presented to the emergency room with a four-day history of intermittent fever, fatigue, and chills. There was no history of illicit drug use or recent travel. She noted that her urine was very dark and her stools were very light in colour. On presentation she was febrile at 39ºC, had a pulse rate of 80 beats/minute, blood pressure of 130/64 mmHg. Biochemical results are as follows: Laboratory investigation: Test                                                                        Result      Reference range Bilirubin                                               (µmol/L)          ...
Read the Case Study and answer the questions that follow This 19-year old student was in...
Read the Case Study and answer the questions that follow This 19-year old student was in his usual state of health until the evening prior to admission, when he went to bed with a headache. He told his mother that he felt feverish, and on the following morning his mother found him in bed, moaning and lethargic. He was brought to the emergency room, where he appeared toxic and drowsy but oriented. His temperature 40'C, his heart rate was 126/min,...
Hematology Case   a 65- year-old African-American male, was previously healthy but went to his physician complaining...
Hematology Case   a 65- year-old African-American male, was previously healthy but went to his physician complaining of abdominal discomfort, tiredness, unexplained weight loss, on the advice of his wife. The physical examination confirmed the patient’s complaints and he also noted splenomegaly. The physician ordered a CBC and the results are below: (see Table 2A). Table 2A: Complete Blood Count readings Adult Male Reference Range Reference Range for Absolute Values (x109/L) WBC count 112 5-10 x 109/L RBC count 2.10 5-6...
1. Case history: A 36-year-old Mediterranean man presents to your clinic with increased fatigue and weakness...
1. Case history: A 36-year-old Mediterranean man presents to your clinic with increased fatigue and weakness of 2 days duration. He was recently tested for tuberculosis exposure and was PPD positive with a normal chest x-ray film. He just started anti-TB prophylaxis medications the week before. On physical exam, he is tachycardic, appears jaundiced, and has mild splenomegaly. You order blood studies, which show low hemoglobin, low hematocrit, and precipitates in RBC. You begin to suspect that this patient suffers...
Joe Harrison, a 62-year-old bank executive, presents to the emergency room with severe abdominal pain. He...
Joe Harrison, a 62-year-old bank executive, presents to the emergency room with severe abdominal pain. He describes the pain as excruciating, and indicates it is located in the mid epigastrium with radiation into his back. The patient states he has not eaten anything in the past 24 hours, but 2 days ago attended a wedding dinner and consumed a large meal and about 4 to 5 alcoholic beverages. Mr. Harrison admits to being a “social drinker,” ingesting 2 to 3...
Case 1 A 45-year-old man presented with a complaint of an increasingly persistent cough that produced...
Case 1 A 45-year-old man presented with a complaint of an increasingly persistent cough that produced moderately thick, white mucus. The patient stated that the cough had been present for several years and was particularly severe in the morning on awakening. His wife was more bothered by the cough than he was and had sent him to the physician so that he might be convinced to stop smoking. On questioning, the patient, who was about 30 lb overweight and had...
Hypovolemia The wife of C.W., a 70-year-old man, brought him to the emergency department (ED) at...
Hypovolemia The wife of C.W., a 70-year-old man, brought him to the emergency department (ED) at 0430 this morning. She told the ED triage nurse that he had had dysentery for the past 3 days and last night he had a lot of “dark red” diarrhea. When he became very dizzy, disoriented, and weak this morning, she decided to bring him to the hospital. C.W.’s vital signs (VS) were 70/- (systolic blood pressure [BP] 70 mm Hg, diastolic BP inaudible),...
Patient Profile A.S. is a 70-year-old white woman who presented to the emergency department because of...
Patient Profile A.S. is a 70-year-old white woman who presented to the emergency department because of a 4-day history of increased shortness of breath and generalized weakness. A.S. stated that she has been able to do her daily chores at home independently, but for the past few days, it was getting difficult for her to get around and that she needed to take frequent breaks because she was short of breath and had no energy. She has a long history...
A 52-year-old male presented to the emergency department complaining of muscle pain and weakness for the...
A 52-year-old male presented to the emergency department complaining of muscle pain and weakness for the last two day. He also noticed that his urine is becoming dark (red to brown). The patient has no history of accidents or trauma and no symptoms of anemia. The patient is known to have history of hypertension, Type II diabetes, hypercholesterolemia, and ischemic heart disease. 5-weeks before he came to the emergency he had suffered a myocardial infarction. He was treated in the...
ADVERTISEMENT
Need Online Homework Help?

Get Answers For Free
Most questions answered within 1 hours.

Ask a Question
ADVERTISEMENT