case reports

Question 1

The patient was 46-year-old man, workless, alcoholic, smoker, The patient presented with progressive shortness of breath, a persistent, productive cough, purulent sputum, and fever 38,5 °C for 2 days.

Answer 1

ANSWER:
Specimen: Sputum
Microscopy and cultivation
TREATMENT: penicillin G

Question 2

25-year-old woman with a sore throat and fever for one day, does not know any allergy. Fever 37.5C, red anterior pharynx, tonsillar region and soft palate.

Answer 2

ANSWER:
Specimen: Throat swab  Heamophilus influenzae - non life threatening.
But it cannot be causative agent for for patient’s complaints (because its a normal microflora)

TREATMENT: (amoxicillin – recommended)

No antibiotics, the causative agent might be virus, so we tell patient to drink hot tea, with lemon and honey.

Question 3

23-year-old man,
19p.m. to 4a.m. disco-club.
From 11 a.m. vomiting and headache
from 10p.m. petechiae and fever 39.2C.

Answer 3

ANSWER
Specimen: CSF + blood
microbiological tests: CSF + blood and PCR and cultivation
Organism: Neisseria meningitides, or meningococcemia, and it is gram negative cocci in pairs.

TREATMENT: penicillin G and 3rd generation cephalosporins

Question 4

27-year-old male, travelled to Nepal and china (in the Gobi Desert). Immediately after returning he became ill with a fever 39C and Pneumonia symptoms. From this trip he brought 3 boas (animal skin).

Answer 4

ANSWER:
Specimen:
Organism - bacillus anthracis
Microbiological tests: culture+ microscopy. “spore forming. Ag detection!!

TREATMENT: penicillin G

Question 5

7-year-old boy with a sore throat and fever for 1 day. His mother doesn’t know any allergy.
Fever 38.4C, red anterior pharynx, tonsilar region and soft palate. (anterior cervical lymph nodes are enlarged and tender)

Answer 5

ANSWER:
Specimen: throat swab + blood culture.
Organism: streptococcus pyogenes  pharyngitis and it is a gram positive cocci. we use bacitracin test and pyr test and it has beta haemolysis.
Microbiological test: microscopy, culture, serology

TREATMENT: penicillin G or V are recommended!
Alternative: macrocodes, all beta lactams
directly to prevent post streptococcal autoimmune disease (glomerulonephritis). But 10% might be strp. Pyogenes and 90% viruses.

Question 6

75-year-old man, 2 weeks in spa, non productive cough for one week.
treatment with amoxicillin/clavulanic acid for 3 days without any effect. Fever 40C, pneumonia. Admission to the faculty hospital in plzen.

Answer 6

ANSWER:
Specimen: sputum and BAL
Organism: legionella pneumophilia, gram negative and it is community acquired. “Possible by streptococcus pneumonia”
Microbiological tests: cultivation, Ag test, direct fluorescence antibody

TREATMENT: fluouroquniolones

Question 7

25-year-old women with developed left flank pain with fever and chills, frequent urination. Allergy to Nitrofurantoin.

Answer 7

ANSWERS:
Specimen: Middle stream urine.
Organism: E.COLI if (10^7CFU/ml)
Microbiological tests: microscopy and cultivation.
Empiric therapy before. 
no waiting for microscopical results

TREATMENT: Nitrofurantoin is recommended, but we give her co-trimaxaol or amoxicillin.

Question 8

18-year-old male with headache, fever 39C for 8hours, meningeal symptoms.

Answer 8

ANSWER:
Specimen: CSF + blood
Organism: haemophilus influenza (if G- rods)

TREATMENT: 3rd generation cephalosporins e.g. cefotaxime or ceftriaxone. You give medication as soon as possible; bacterial meningitis has a high mortality rate.

Question 9

56-year-old man with polytrauma after a crash accident, fever, necrotic wound, still without antibiotic therapy. Allergy to antibiotics is not known.

Answer 9

ANSWER:
Specimen: wound swab
Organism: staphylococcus aureus.
Microbiological test: WBC+++, G+ cocci. (inflammation)
Blood culture (3 days)  staphylococcus aureus.

TREATMENT: Oxacilline (directly)

Question 10

18-years-old boy with a sore throat and fever for one day. He does not describe any allergy. Fever 38.4 °C, red anterior pharynx, tonsillar region and soft palate.

Answer 10

ANSWER:
Specimen: throat swab and noodle swab
Throat cultivation: normal bacterial flora
Nasal swab cultivation: Staphylococcus aureus
 Staphylococcus aureus is a normal microflora in nose so noodle swab was probably performed wrong.
TREATMENT: no antibiotics, causative agent might be a virus.

Question 11

35-year-old man with artificial heart-valve, fever 38.5 °C for one week. Fever has started after teeth extraction without antibiotic profylaxis. Uroinfection and pneumonia are not manifested as well as manifestation of the common infections is not observed.

Answer 11

Specimen: blood  streptococcus constellatus

The infection is Endocarditis.

Question 12

50-year-old man, alcoholic, smoker, fever 39.5C for 2 days, Dyspnoeic. Allergy is not known.

Answer 12

ANSWER:
specimen: sputum, blood culture
Organism: streptococcus pneumonia or legionella.
Microscopy test: (it is G+ diplococci and alpha- haemolysis)
“and optochin+”. And WBC +++ (inflammation)

TREATMENT: penicillin ‘G’ and amoxicillin (directly because pneumonia can be life threatening)
Alternative: 3rd generation cephalosporins

Question 13

Diarrhea (12h after eating uncontrolled chiken)

Answer 13

Specimen: rectal swab , for PCR and Ag detection.
campylobacter jejuni
treatment: