Professional Documents
Culture Documents
A. Remove the brainstems from all of the raccoons and examine for cytopathic effects
B. Request immunofluorescent test for antibody on the saliva from all of the raccoons
C. Request immunofluorescent test for antigen in cutaneous nerves obtained by nuchal biopsy of the patient
D. Isolate the virus from the saliva of both the animals and the patient
C Using direct immunofluorescence, rabies antigen can be detected in the cutaneous nerves surrounding the hair follicles
of the posterior region of the neck (nuchal biopsy) and in epithelial cells obtained by a corneal impression. Antibodies to
rabies can be detected in the serum and CSF of infected persons within 8-10 days of illness; however, infection usually
occurs several months before the onset of symptoms. Isolation of virus from the saliva of the patient may be
accomplished by mouse inoculation or by inoculation of susceptible cell culture lines with subsequent detection by
immunofluorescent antibodies.
A 65-year-old woman was admitted to the hospital with acute respiratory distress, fever, myalgia, and headache. Influenza
A or B was suspected after ruling out bacterial pneumonia. Which of the following methods could be used to confirm
influenza infection?
A. Influenza virus culture in Madin-Darby canine kidney
B. Hemagglutination-inhibition test for antibodies in the patient's serum
C. Direct examination of nasal epithelium for virus using fluorescent antibody stain
D. All of these options
D Influenza virus types A, B, and C may be grown and isolated in embryonated hen eggs or cell cultures using Madin-
Darby canine kidney (MDCK), rhesus monkey, or cynomolgus monkey kidney cells. Cell culture using MDCK cells is the
most rapid technique, permitting identification within 1-3 days. The hemagglutination inhibition test can be used to titer
antibody to influenza virus and to distinguish virus subtypes, if specific antiserum is available. Direct fluorescent and
enzyme immunoassays using monoclonal antibodies to nucleoprotein antigens in infected nasal epithelium are used for
rapid diagnosis of both influenza A and influenza B infections.
The most rapid definitive diagnosis of a genital herpes simplex (HSV-2) infection in a 20-year-old man is made by which
method?
A. Direct immunofluorescence test for viral antigen in vesicle fluid
B. Titer of serum and seminal fluid for antibodies to herpes simplex
C. Detection of antiherpes simplex in seminal fluid
D. Cell culture of vesicle fluid
A Direct immunofluorescence testing of vesicle (lesion) fluid for virus using fluorescein-conjugated antibodies is the most
rapid method for diagnosis of genital herpes infection. Immunofluorescence and immunoperoxidase methods are also
used to distinguish HSV-1 and HSV-2. PCR and real-time PCR are more sensitive rapid methods for detection and
identification. Viral cell culture is also very sensitive and may yield a positive result within 24 hours when fluid contains a
high concentration of virus. Vero cells or primary human embryonic cells are inoculated with vesicle fluid and examined for
cytopathic effects (CPE), the most common of which are large "balloon" cells and multinucleated giant cells.
A 20-year-old female college student complained of a sore throat and extreme fatigue. The physician noted
lymphadenopathy and ordered a rapid test for infectious mononucleosis antibodies that was negative. Bacterial cultures
were negative, as were serological tests for influenza A and B, HIV-1, CMV, hepatitis B, and antistreptolysin O. What
would be the next line of viral testing to establish a diagnosis?
A. Herpes simplex
B. Rubella
C. Epstein-Barr
D. West Nile
C Epstein-Barr virus serological testing for IgM-VCA (viral capsid antigen) during the acute phase would be indicated
because testing for infectious mononucleosis antibodies may or may not be positive. Patients who present with an
infectious mononucleosis-like syndrome should be tested for both EBV and CMV. Both viruses cause the same symptoms
during the acute phase of the illness
A 60-year-old male gardener from New York State was hospitalized with flulike symptoms and eventually diagnosed with
encephalitis. While working in his garden, he noticed several dead birds around his bird feeder. The region was known to
be heavily infested with mosquitoes. What is the most likely cause of his illness?
A. West Nile virus
B. Epstein-Barr virus
C. Parvovirus
D. Hantavirus
A West Nile virus causes neurological diseases with meningitis and encephalitis at the top of the list. The animal
reservoirs are birds, with humans being accidental hosts. Transmission of West Nile virus is from mosquito to bird. The
primary site of infection for Norwalk and rotavirus is the gastrointestinal area and for hantavirus the pulmonary sector
A 30-year-old male patient who was a contractor and building inspector in the southwestern United States complained of
difficulty breathing and was admitted to the hospital with severe respiratory disease. The physician noted a high fever and
cough. Two days before, the patient had inspected an old warehouse, abandoned and infested with rodents. The patient
was given intravenous antibiotics, but 2 days into therapy the pneumonia worsened and he developed pulmonary edema.
Which organism should be suspected of causing his illness?
A. Hantavirus
B. Rotavirus
C. West Nile virus
D. Norwalk-like virus
A Hantavirus is transmitted by a rodent host, the deer mouse, and is endemic in the southwestern United States. The
name of the hantavirus responsible for outbreaks in this region is the Sin Nombre virus. Breathing in excrement from the
mouse is the most common route of infection, and the lung is the site of initial infection. Diagnosis is usually made using
an IgM ELISA assay.
A 3-year-old female was admitted to the hospital following a 2-day visit with relatives over the Christmas holidays.
Vomiting and diarrhea left the child severely dehydrated. No other members of the family were affected. All bacterial
cultures proved negative. A stool sample should be tested for which virus?
A. CMV
B. EBV
C. Hepatitis D
D. Rotavirus
D Rotavirus is one of the most common causes of gastroenteritis in infants and young children (6 months to 2 years old).
Vomiting and diarrhea are also common symptoms of Norwalk virus infections, but the prevalence of rotavirus during the
winter months and the lack of illness in other family members make rotavirus a more likely cause. Commercial availability
of immunoassays for rotavirus makes its diagnosis easier to establish and rule out than infection with Norwalk-like viruses
A 25-year-old male patient was diagnosed with HIV-1 by enzyme immunoassay, testing positive twice, and the diagnosis
was confirmed by Western blot testing. Which laboratory test should be performed prior to initiating antiviral therapy?
A. Quantitative plasma virus concentration (viral load testing)
B. Quantitation of CD4 lymphocytes
C. Phenotype/genotype resistance testing
D. All of these options
D The decision to initiate antiviral therapy is based upon the presence or absence of symptoms, CD4 lymphocyte count,
and the viral load. For example, treatment is usually withheld from patients with CD4 counts > 350/μL and viral load <
55,000/mL and is instituted in asymptomatic patients if the CD4 count is < 200/μL regardless of viral load. Treatment
failure within the first year with three-drug regimens is 35%-45%, and drug resistance testing (genotype and/or phenotype
testing) is recommended to identify drug-resistant strains prior to initiating treatment.
A 6-month-old male infant was hospitalized with a respiratory infection. He was diagnosed with apnea and bronchiolitis.
Further testing revealed congenital heart disease. Bacterial cultures were negative for Streptococcus pneumoniae and
Haemophilus influenzae. What further testing should be done?
A. Respiratory syncytial virus (RSV)
B. Rotavirus
C. Norwalk virus
D. HIV
A Respiratory syncytial virus (RSV) is spread by large particle droplets such as dust and is one of the most common
causes of hospitalization for respiratory illness of infants less than 1 year old. RSV causes bronchiolitis, pneumonia, and
croup in infants and upper respiratory illness in children. It has also been found to cause nosocomial infection in nursing
homes. Diagnosis is made by EIA, fluorescent antibody (FA) staining, and cell culture
A young male hunter encountered a fox in his path during a walk in the woods. The fox was staggering but appeared
nonthreatening. The man tried to avoid contact but was attacked and bitten on the leg. The bite broke the skin but was not
deep. Wildlife officials were unable to locate the fox for testing. What procedure should take place next for the hunter?
A. Spinal tap with CSF testing for rabies virus
B. Administration of hyperimmune antirabies globulin and rabies vaccine
C. Biopsy of the wound site
D. Throat culture and blood culture
B Rabies virus can be detected by FA staining and PCR testing. The virus replicates at the site of the bite and penetrates
the surrounding tissue, finding its way to the central nervous system. Since the source cannot be tested, the best course
of action is to initiate postexposure prophylaxis with antirabies globulin and to immunize the patient with rabies vaccine.
Upgrade to remove ads
Only $1/month
A 40-year-old female experienced a respiratory infection after returning home from a visit to her homeland of China. A
rapid onset of pneumonia in the lower respiratory area prompted the physician to place her in isolation. She was
diagnosed presumptively with severe acute respiratory syndrome (SARS) and placed on a respirator. What type of testing
should be done next to diagnose this disease?
A. Molecular technique and cell culture
B. Latex agglutination test
C. Blood culture
D. Complement fixation
A SARS virus was discovered in China in 2003. The virus belongs to the common cold group of coronaviruses, and is
easily transmitted to health care workers having close contact with infected patients. It is the cause of a severe lower
respiratory infection that can be fatal. Laboratory confirmation may be done by PCR testing that is available commercially,
cell culture, EIA, or IFA. Typically, PCR is used on two different specimen types or the same specimen type submitted at
least 2 days apart. If both tests are positive, the infection is confirmed.
A pregnant 25-year-old female with genital lesions delivered a premature newborn with complications. The baby tested
negative for bacterial infection (cultures of blood and urine). Antigen testing of the baby's urine proved negative for group
B streptococci and Streptococcus pneumoniae. The mother tested negative for bacterial sexually transmitted diseases
and for group B streptococci. The baby was treated with acyclovir and failed to survive. What was the most likely cause of
death?
A. CMV
B. Human immunodeficiency virus
C. Respiratory syncytial virus
D. Herpes simplex virus
D Herpes simplex virus type 2 infections produce genital lesions. Infants born prematurely with disseminated infection of
HSV type 2 from HSV-positive mothers have a mortality rate of 50%-60%. Testing of pregnant women for antibody and
Cesarean section delivery can prevent most neonatal HSV infections because the virus enters the fetus during the
delivery process
A young father of two small children complained of a rash on the torso of his body. The children had been diagnosed with
chickenpox and confined to their home. The father had experienced chickenpox as a child and knew he did not have the
same rash as his children. What is the most likely cause of the father's rash?
A. Herpes simplex 1 virus
B. Varicella-zoster virus
C. Herpes simplex 2 virus
D. Epstein-Barr virus
B Varicella-zoster virus is the cause of an infection with chickenpox. As an adult, the father is experiencing shingles, a
reactivation of the virus. The virus lies dormant in the sensory (dorsal root) ganglia of the spinal nerves, and its
reactivation produces a nonweeping blisterlike rash on an inflamed skin base that follows the path of the underlying
nerves.
The organs of a 65-year-old male were donated soon after a fatal auto accident. Three recipients of his corneas and
kidneys died within weeks after receiving his organs. Which of the following viruses most likely caused the death of these
recipients?
A. HIV
B. Rabies
C. Norwalk-like
D. Rotavirus
B Transmission of rabies (rhabdovirus) occurs primarily from the bite of a rabid animal, but in 20% of human rabies cases
there is no known exposure to rabid animals. Donor tissues are not routinely tested for rabies. Diagnosis is performed by
fluorescent antibody staining of the infected tissues, and electron microscopy that shows the presence of bullet-shaped
virus particles.
While on a 7-day cruise to Vancouver and Alaska, a number of passengers reported to the ship's medical staff
complaining of vomiting and diarrhea. Which is the most likely virus to have infected these mainly adult passengers?
A. Rotavirus
B. Parainfluenza
C. Respiratory syncytial
D. Norwalk or Norwalk-like viruses
D Adult gastroenteritis caused by Norwalk and Norwalk-like viruses follows a 1-2 day incubation. Diagnosis is usually
made on the basis of clinical criteria and confirmed by enzyme immunoassay, RT-PCR, or immune electron microscopy.
Hepatitis E virus, also of the Caliciviridae family, also causes gastroenteritis 1-2 days following exposure, but is not
endemic in the United States and other developed countries.
A patient tested positive for HIV-1 infection using a reverse transcriptase-polymerase chain reaction (RT-PCR) method.
However, 1 week later a second blood sample was collected and sent to a reference lab that performed a confirmatory
test by Western blot. The Western blot test was negative. What best explains these results?
A. The samples for RT-PCR and Western blot were not from the same patient
B. RT-PCR is more sensitive for early detection
C. The RT-PCR result was falsely positive
D. The RT-PCR test detected HIV-2 and the Western blot is specific for HIV-1
B Western blot is a test for antibodies to HIV, and sufficient antibodies are not usually present in the first 3-4 weeks of
infection to cause a positive test. In some persons, antibodies do not appear until 3 months after initial HIV infection. RT-
PCR detects viral RNA, and reduces the window phase of infection to approximately 1 week. Real-time PCR tests for HIV-
1 have 100% specificity at a cutoff of 20-40 copies RNA/mL. PCR is the preferred test for neonates because it avoids
detection of maternal antibody, and is replacing Western blot as the confirmatory test of choice.
A pregnant women was seen by her obstetrician with signs of flulike illness during her second trimester. NAT tests were
ordered for Toxoplasma gondii, rubella, cytomegalovirus, and herpes simplex 1 and 2. All test results were negative.
However, after delivery, the newborn exhibited signs of an infection and failed to survive. Which virus causes a 90%
transplacental infection rate when found in the mother?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis D
D. Hepatitis G
B Tests for toxoplasmosis, German measles, CMV, and HSV comprise a panel of infectious agents known at a TORCH
panel. The TORCH panel consists of serological tests for antibodies to these organisms, and has largely been replaced
by more sensitive NAT tests when infection is suspected. The "O" in TORCH stands for "other" and other viruses that
cause transplacental infection such as HBV and HIV should be considered.
An immunocompromised patient was admitted to the hospital with a diagnosis of hemorrhagic cystitis. Which combination
of virus and specimen would be most appropriate to diagnose a viral cause of this disorder?
A. BK virus—urine
B. Human papilloma virus—skin
C. Hepatitis B virus—serum
D. Epstein-Barr virus—serum
A The BK virus, a polyoma virus, is transmitted by direct contact with infected respiratory secretions. It has
tropism for the urinary system, and often causes a latent, asymptomatic infection in the kidney. However, in
immunocompromised patients, the virus is often implicated in renal and bladder infections. Kidney failure caused by BK
virus is a significant concern in bone marrow and renal transplant recipients
The incorrect match between organism and the appropriate diagnostic procedure is:
A. Onchocerca volvulus—examination of skin snips
B. Cryptosporidium—modified acid-fast stain
C. Echinococcus granulosus—routine ova and parasite examination
D. Schistosoma haematobium—examination of urine
sediment
C The appropriate procedure for the diagnosis of E. granulosus (hydatid disease) would involve the microscopic
examination of hydatid fluid aspirated from a cyst. Immature scolices and/or hooklets would be found in the centrifuged
fluid sediment and could be identified under the microscope.
In a patient with diarrhea, occasionally Entamoeba histolytica/E. dispar (four nucleated cysts, no chromatoidal bars) are
identified as being present; however, these cells, which are misdiagnosed as protozoa, are really:
A. Macrophages
B. Polymorphonuclear leukocytes
C. Epithelial cells
D. Eosinophils
B As polymorphonuclear leukocyte (PMN) nuclei in stool begin to fragment and appear to be four nuclei, they will
resemble E. histolytica/E. dispar cysts. However, E. histolytica/E. dispar cysts are rarely seen in cases of diarrhea. The
species name E. histolytica is reserved for the true pathogen, whereas E. dispar is used for the nonpathogenic species.
Unfortunately, morphologically they look identical. The only time E. histolytica could be identified morphologically would be
from trophozoites containing ingested red blood cells (RBCs). Nonpathogenic E. dispar would not contain ingested RBCs.
The correct way to report these organisms is Entamoeba histolytica/E. dispar (no trophozoites containing ingested RBCs)
or Entamoeba histolytica (trophozoites seen that contain ingested RBCs). Physicians may treat based on patient
symptoms.
Charcot-Leyden crystals in stool may be associated with an immune response and are thought to be formed from the
breakdown products of:
A. Neutrophils
B. Eosinophils
C. Monocytes
D. Lymphocytes
B When eosinophils disintegrate, the granules reform into Charcot-Leyden crystals.
Parasitic organisms that are most often transmitted sexually include:
A. Entamoeba gingivalis
B. Dientamoeba fragilis
C. Trichomonas vaginalis
D. Diphyllobothrium latum
C T. vaginalis has been well documented to be a sexually transmitted flagellate.
The incorrect match between the organism and one method of acquiring the infection is:
A. Trypanosoma brucei rhodesiense—bite of sand fleas
B. Giardia lamblia—ingestion of water contaminated with cysts
C. Hookworm—skin penetration of larvae from soil
D. Toxoplasma gondii—ingestion of raw or rare meats
A East and West African trypanosomiasis (T. b. rhodesiense and T. b. gambiense) are caused when infective forms are
introduced into the human body through the bite of the tsetse fly, not sand fleas
Upon examination of stool material for Cystoisospora belli, one would expect to see:
A. Cysts containing sporozoites
B. Precysts containing chromatoidal bars
C. Oocysts that are modified acid-fast variable
D. Sporozoites that are hematoxylin positive
C C. belli oocysts in various stages of maturity would be seen in the concentration sediment or possibly the direct, wet
preparation; these oocysts would stain positive with modified acid-fast stains.
Which specimen is the least likely to provide recovery of Trichomonas vaginalis?
A. Urine
B. Urethral discharge
C. Vaginal discharge
D. Feces
D T. vaginalis is site specific. The organisms are found in the urogenital tract; thus, the intestinal tract is not the normal
site for these organisms
Which of the following is the best technique to identify Dientamoeba fragilis in stool?
A. Formalin concentrate
B. Trichrome-stained smear
C. Modified acid-fast-stained smear
D. Giemsa's stain
B Because there is no known cyst form, the best technique to recover and identify D. fragilis trophozoites would be the
trichrome-stained smear
One of the following protozoan organisms has been implicated in waterborne and foodborne outbreaks within the United
States. The suspect organism is:
A. Pentatrichomonas hominis
B. Dientamoeba fragilis
C. Giardia lamblia
D. Balantidium coli
C For a number of years, G. lamblia has been implicated in both waterborne and foodborne outbreaks from the ingestion
of infective cysts within contaminated water and food.
A Gram stain from a gum lesion showed what appeared to be amoebae. A trichrome smear showed amoebae with a
single nucleus and partially digested PMNs. The correct identification is:
A. Trichomonas tenax
B. Entamoeba histolytica/E. dispar
C. Entamoeba gingivalis
D. Entamoeba polecki
C E. gingivalis is known to be an inhabitant of the mouth and is characterized by morphology that resembles Entamoeba
histolytica/E. dispar. However, E. gingivalis tends to ingest PMNs, whereas Entamoeba histolytica/E. dispar do not.
An Entamoeba histolytica trophozoite has the following characteristics:
A. Paragonimiasis—hemoptysis
B. Cryptosporidiosis—watery diarrhea
C. Toxoplasmosis in compromised host—central nervous system symptoms
D. Enterobiasis—dysentery
D Infections with E. vermicularis (the pinworm) may cause anal itching, sleeplessness, and possibly some vaginal irritation
or discharge; however, dysentery (bloody diarrhea) has not been associated with this infection.
The formalin-ether (ethyl acetate) concentration procedure for feces is used to demonstrate:
A. Motility of helminth larvae
B. Protozoan cysts and helminth eggs
C. Formation of amoebic pseudopods
D. Trophozoites
. B The ova and parasite examination contains three components: the direct wet film (demonstrates protozoan trophozoite
motility), the formalin-ethyl acetate concentration (demonstrates protozoan cysts, coccidian oocysts, and helminth eggs),
and the trichrome or iron hematoxylin stained smear (confirms protozoan cysts and trophozoites)
Cysts of Iodamoeba bütschlii typically have:
A. Rapid erythrocytic cycle (24 hr), will infect all ages of RBCs, and can cause serious disease
B. Erythrocytic cycle limited to young RBCs and causes a relatively benign disease
C. The possibility of a true relapse from the liver, infection in older RBCs, and causes serious disease
D. Extended life cycle (72 hr), will infect all ages of RBCs, and disease is similar to that caused by P. ovale
A Key characteristics of an infection with Plasmodium knowlesi include a rapid life cycle (24 hr), the potential to infect all
ages of RBCs, and the possibility of serious symptoms similar to those seen with P. falciparum infections. There is no
relapse from the liver with this species.
Microsporidial infections can be confirmed using:
A. Light microscopy and modified trichrome stains
B. Phase contrast microscopy and routine trichrome stains
C. Electron microscopy and modified acid-fast stains
D. Fluorescence microscopy and hematoxylin stains
A An infection with microsporidia can be confirmed using modified trichrome stains (10X the normal dye content found in
routine trichrome stains) and light microscopy. The internal polar tubule will be visible within some of the spores; this will
serve as confirmation of the infection.
Although the pathogenicity of Blastocystis hominis remains controversial, newer information suggests that:
A. Most organisms are misdiagnosed as artifacts
B. Numerous strains/species are included in the name, some of which are pathogenic and some are nonpathogenic
C. The immune status of the host is solely responsible for symptomatic infections
D. The number of organisms present determines
pathogenicity
B The name Blastocystis hominis contains approximately
10 different strains/species that are morphologically identical; some are pathogenic and some are nonpathogenic.
Because we cannot separate these organisms by morphology, this probably explains why some patients are symptomatic
and some remain asymptomatic with this infection.
Potential problems using EDTA anticoagulant and holding the blood too long prior to preparation of thick and thin blood
films include:
A. Changes in parasite morphology, loss of organisms within several hours, and poor staining
B. Loss of Schüffner's dots, poor adherence of the blood to the glass slide, and parasites beginning the vector cycle within
the tube of blood
C. Neither A nor B
D. All of these options
D There are many changes that occur if blood is held longer than 1-2 hours prior to thick and thin blood film preparation.
These include changes in parasite morphology, loss of parasites, poor staining, poor adherence of the blood to the slide,
and the parasites beginning that portion of the life cycle that normally occurs within the vector. These changes are merely
one reason that the ordering, specimen collection, processing, examination, and reporting for thick/thin blood films are
considered STAT procedures.
Which of the following is a key characteristic of the thick blood film?
A. The ability to see the parasite within the RBCs
B. The ability to identify the parasites to the species level
C. The examination of less blood than the thin blood film
D. The necessity to lake the RBCs during or prior to staining
D With the thick blood film, there is more blood per slide than on the thin film, resulting in greater sensitivity. It is difficult to
identify the parasite to the species level from the thick blood film. The RBCs are "laked" while drying or during staining,
making it impossible to observe the parasites within the RBCs