Clinical Case Studies (1)

Question 1

Case 1: This 2-year-old male child experienced an upper respiratory infection 2 weeks prior to hospital admission. Four days prior to admission, anorexia and lethargy were noted. The patient was seen in the emergency room 3 days prior to admission. At that time he had a fever of 39.9°C. Physical examination revealed a clear chest, exudative pharyngitis, and bilaterally enlarged cervical lymph nodes. A throat culture was taken, and a course of penicillin was begun. The child’s course worsened, and he became increasingly lethargic; he developed respiratory dis-
tress on the day of admission. It was noted that the throat culture from 3 days prior to admission had not grown any group A streptococci. On examination, the patient was febrile to 38.9°C and had an exudie in the posterior pharynx that was described as a yellowish, thick membrane which bled when scraped and removed. The patient’s medical history revealed that he had received no immunizations. The patient was admitted to the hospital and treatment was begun.
A) What was the pathogen?
B) Which medium is used to isolate this organism?

Answer 1

A) Corynebacterium diphtheriae
B) Inoculating sheep blood agar, Loeffler serum slope and tellurite agar are used to isolate the organism

Question 2

Case 1: This 2-year-old male child experienced an upper respiratory infection 2 weeks prior to hospital admission. Four days prior to admission, anorexia and lethargy were noted. The patient was seen in the emergency room 3 days prior to admission. At that time he had a fever of 39.9°C. Physical examination revealed a clear chest, exudative pharyngitis, and bilaterally enlarged cervical lymph nodes. A throat culture was taken, and a course of penicillin was begun. The child’s course worsened, and he became increasingly lethargic; he developed respiratory dis-
tress on the day of admission. It was noted that the throat culture from 3 days prior to admission had not grown any group A streptococci. On examination, the patient was febrile to 38.9°C and had an exudie in the posterior pharynx that was described as a yellowish, thick membrane which bled when scraped and removed. The patient’s medical history revealed that he had received no immunizations. The patient was admitted to the hospital and treatment was begun.
C) To cause disease, does this organism invade the bloodstream?
D) If not what way does it cause disease?

Answer 2

C) Rarely reaches blood stream, if it does it causes death or coma.
D)