Date post: | 20-Dec-2014 |
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Mifrah ZiyardAHS/ MLS/ 05/ 53
Faculty of Allied Health SciencesUniversity of Peradeniya.
A 35 years old man presented to the emergency room from an outside hospital with general malaise, low-grade fever, and purplish discoloration on his hands. He also had headache and hypotension. 10 days prior, he had return from a trip to sub Saharan Africa. Blood cultures were drawn and he was admitted to the intensive care unit. Blood culture bottles were sent to the microbiology laboratory along with a proper request form for culture and ABST.
• Appearance• Fair man with Generalized purpura• Edematous eye lids• Entire hands are purpuric• Malaise
• Temperature 38oC
• Lungs• Clear and equal breath sounds
• Cardiac• Tachycardia
• Blood Pressure• 70/50 mmHg
• FBC• RBC 3.63 X 1012/L• WBC 14.3 X 109/L• Differential count
• Neutrophils 35 %
• Immature forms 52%
• Lymphocytes 10%• Hb 10.8 g/dL• HCV 30.6 %• PLT 20 X 109/L
Sodium 134 mmol/ L Potassium 4.8 mmol/ L Creatinine 1.5 mg/ dL Glucose 51 mg/dL Amylase 117 U/L
Specimen Blood
Gram stain
Culture Media Blood Agar
▪ Convex, Grey, Translucent, non pigmented
and non Hemolytic colonies Chocolate Agar Selective Media
▪ Thayer Martin Medium
Oxidase Positive Catalase Positive DNAse Test Negative
Acid Production Glucose: Ferment Maltose: Ferment Fructose: not Ferment Sucrose: not Ferment
Modified Thayer Martin Agar Convex, glistening, elevated colonies mucoid colonies
Gram stain smear from aspirate of petechiae
Ampicillin/Penicillin Ceftriaxone Chloramohenicol Rifampicin Ciprofloxacin Meropenem
Clinical Medicine; kumar P and Clark M; Elsevier Saunders; 6th edition; Page 75 – 76.
Laboratory Exercise in Microbiology; Prescott H; The MacGraw – Hill; 5th edition; Page 355 -357.
http://path.upmc.edu/cases.html