MICROBIOLOGY Student Practical Work Book P3

INDIVIDUAL INTERIM REPORT

BMS 4A (MICROBIOLOGY) PRACTICAL WORK

CLASS :
GROUP :
NAME :

FACULTY OF MEDICINE
UNIVERSITAS BRAWIJAYA
2020

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LEARNING OUTCOME :

1) To know and understand one of the manifestation of Gram positive and negative
cocci infection

2) To know and understand the laboratory workflow of diagnostic procedures in Gram

positive and negative cocci infection

CASE ONE :

A 10-year-old girl complained about pain of the left knee after an accident sustained during
trampoline jumping. The patient had a superficial skin abrasion but due to decreasing pain
no doctor was consulted. Three weeks later she walked 35 kilometres in three days during
a school trip causing moderate pain of her left knee mainly during night-time. However, the
pain was not associated with swelling, redness, or fever. The family consulted a medical
practitioner, a pediatrician, and an orthopaedic surgeon. Radiographs of the left knee were
performed and no alterations of the patella were described. The patient was treated with
NSAID.

Due to persisting pain the local hospital was consulted eight weeks after the first symptoms.
Physical examination did not reveal any abnormalities except a painful leg extension. The
erythrocyte sedimentation rate was 19 mm/h (normal range: 1–10 mm/h) and the
antistreptolysin-titer was 352 IU/ml (normal value: −200 IU/ml). For further diagnostics,
another radiograph and a subsequent MRI of the left knee were performed showing an
osteolytic lesion with a diameter of 1.5 cm of the patella with central necrosis (Figures 1
and 2). Radiologists and an orthopaedic surgeon interpreted the lesion as a
chondroblastoma of the patella and a follow-up with MRI was planned within 3 months.

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Five days later the girl returned because of increasing pain of her left knee. Clinical
inspection showed swelling and hyperthermia of the left knee. The white blood cell count
was 8.750/μl (normal values 5.50–13.50/μl), the erythrocyte sedimentation rate was
61 mm/h (normal range 1–10 mm/h), and the C-reactive protein (CRP) was 9.3 mg/dl
(normal range 0.0–1.1 mg/dl). A CT scan revealed a 2.0 × 1.1 × 1.0 cm osteolytic lesion of
the patella associated with a destruction of the ventral corticalis (Figure 3).

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The girl was now referred to our Pediatric Orthopedic Centre. The girl presented with slight
swelling of the prepatellar soft-tissue and local hyperthermia of her left knee without
joint effusion or fever. Biopsy and a swap were performed in general anaesthesia using a
ventral approach. Histological examination showed signs of acute osteomyelitis.
Therefore, debridement and curettage were indicated. Intraoperatively, the bone defect
measured 1 × 1.5 × 1 cm. A gentamicin chain (Septopal Minikette, Pharmalog Pharma
Logistik GmbH, Boennen, Germany) was placed into the defect and removed after seven
days. The histological examination of the curettage verified acute osteomyelitis and
Staphylococcus aureus was grown from the culture. Additionally, the patient was treated
with intravenous cefuroxime (100 mg/kg bodyweight in three doses) and fosfomycin
(190 mg/kg bodyweight in three doses) for 12 days followed by 16 days of oral antibiotics
using amoxicillin and clavulanic acid (37 mg/kg bodyweight in three doses). The left leg was
immobilized in a long leg cast. Following a hospital stay of 17 days the girl was discharged
free of pain and the immobilization was continued for another two weeks.

Two weeks later the patient was seen in the outpatient department. She was free of pain
and the clinical examination of the knee was unremarkable. CRP and the white blood cell
count were within normal ranges. The cast was removed and the patient was sent home
without restrictions for daily life activities.

At the latest follow-up examination after 17 months the girl was symptom-free with full
range of knee joint motion. Radiographs showed a nearly full osseous recovery of the
patella (Figure 4).

Source :

https://www.hindawi.com/journals/crior/2017/6573271/

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QUESTIONS :

1) What happened to the patient?

2) What is the pathogen?

3) How the pathogen can cause the disease?

4) What specimens need to be taken to get the patogen?

5) What kind of laboratory workout to establish the microbiology diagnosis?

ANSWERS :

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LABWORK RESULTS :

Observation Result Additional Information

mark the bacteria inside your picture
Gram Staning Total magnification:

Shape of organism:

Color of organism:

Gram :

Catalase Test Interpretation :

Positive / Negative

Coagulase Test Interpretation :

Positive / Negative

Colony S. aureus on MSA Description of the colony :

Shape :

Size :

Color :

Surface :

Margin :

Special characteristic :

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Colony S. aureus on NAP Description of the colony :

Shape :

Size :

Color :

Surface :

Margin :

Special characteristic :

Disc diffusion test (Kirby Bauer Test) of S. Code Name Diameter Interpretation
aureus (MSSA strain) AB (mm) (R/ I/ S)

Disc diffusion test (Kirby Bauer Test) of S. Code Name Diameter Interpretation
aureus (MRSA strain) AB (mm) (R/ I/ S)

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CASE TWO :

A 36-year-old woman was referred by the ophthalmology team for screening and treatment
of Neisseria Gonorrhoeae infection. She presented with right eye redness and pain dating
back a month, associated with thick, yellowish discharge. She denied visual impairment.
Her condition was worsening despite antibiotic eye drops that were prescribed by doctors
from three different clinics. During the fourth week of the illness, her eyes condition
remained the same. In our clinic, further history revealed that she had just learned that her
husband, who is currently a prisoner, had multiple sexual partners previously. She also
had a yellowish, smelly vaginal discharge over the past 3 months, associated with pain on
urination and vaginal itchiness.

On examination, her right eyelid was swollen, her right eye conjunctiva was red and
copious yellowish discharge was present. There was chemosis, as well. Her left eye
conjunctiva was not swollen and no discharge was seen. Bilateral pupils were equal, round
and reactive and there was no evidence of keratitis. She was also afebrile. A vaginal
examination revealed yellowish vaginal discharge. However, there was no ulceration or
rash over the genital area.

Right eye and vaginal swabs were sent for gram stain and culture and sensitivity. The gram
stain was done immediately and revealed the presence of gram-negative diplococci.

She received a single dose of intramuscular Ceftriaxone 1 gram and a tablet of

Azithromycin 1 gram immediately. Notification for contact tracing was done on the same
day. With her permission, we contacted the doctor in charge of the prisoner to counsel and
treat her husband and reassured the patient regarding the maintenance of confidentiality.

She was given appointments at the primary care and ophthalmology clinics. One week after
she completed treatment, her eye symptoms were completely resolved with no visual
problems. The culture and sensitivity proved the presence of a Neisseria gonorrhoeae
infection, the vaginal swab was positive for Neisseria gonorrhoeae, and both the vaginal
swab and urine culture were negative for Chlamydia trachomatis. Infective screenings for
Human Immunodeficiency Virus (HIV), Hepatitis B, Hepatitis C and Syphilis were negative.

SOURCE :

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382084/

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QUESTIONS :

1) What happened to the patient?

2) What is the pathogen?

3) How the pathogen can cause the disease?

4) What specimens need to be taken to get the patogen?

5) What kind of laboratory workout to establish the microbiology diagnosis?

ANSWERS :

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LABWORK RESULTS :

Observation Result Additional Information

mark the bacteria inside your picture
Gram Staning Total magnification:

Shape of organism:

Color of organism:

Gram :

Special characteristic :

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