Study Case- Miscellaneous Urine and Body Fluid tests

Question 1

Case 19-1 A 32-yea r-old man with acquired immunodeficiency syn d rome developed fever, chils, shock, b lood clots, and
punctu ate skin lesions during hospita l ization. A bronchoscopy with b ronchoa lveolar lavage (BAL) and a skin biopsy were performed and we re sent to the laboratory for bacterial and fungal smears and culture and for h istological stains. The BAL and the
skin biopsy showed the same organisms, shown in Figs. 1 9- 1 1 and 1 9-12.

1. What organisms might be expected in a BAL sample from
   an immunocompromised patient?
2. What structures are seen in Figs. 19-14 and 19-15?
3. What group of organisms does this belong to?

Answer 1

1. What organisms might be expected in a BAL sample from an immunocompromised patient?
   => Pneumocystis jiroveci, Aspergillus species, or other lower respiratory pathogens
2. What structures are seen in Figs. 19-14 and 19-15?
   =>Fungal hyphae. These hyphae are suggestive of Aspergillus species as they are septate and branched at a 45-degree angle.
3. What group of organisms does this belong to?
   =>This organism is one of the opportunistic fungi that more often affect the immunocompromised host.

Question 2

A 5 1 -year-old man was complaining of a 30-lb weight loss in the past month, cou gh, feve r, shortness of b reath, abdom inal pain, ch est pa in, d ecreased appetite, and feeling weak
and fa i nt when ambul atory. X-rays showed pul monary lesions. He had been traveling in Africa, so his physician ordered tests
for malaria, which were neg ative. A slig htly el evated wh ite blood cell count was noted. The patient underwent a b ronchoscopy
with bronchoa lveolar l avage and bronch ial wash i ngs. A ca l cofl uor wh ite with KOH was performed and bacterial, fungal, and mycobacterial cultures were ordered as well as histolog ic exami nation using special sta ins. The cal cofl uor wh ite prepa ration showed small encapsu lated i ntracellular yeast. Figures 1 9- 1 6 to 1 9- 1 8 are from
this patient.

1. What types of conditions can be detected using bronchoscopy with bronchial washings and BAL collections?
2. What group of organisms is causing this patient’s conditionbacteria, fungi, or mycobacteria?

Answer 2

1. What types of conditions can be detected using bronchoscopy with bronchial washings and BAL collections?
   =>Bronchoscopy is used to examine the
   tracheobronchial tree and can help detect
   obstructions, pneumonia, carcinoma, hemoptysis, foreign bodies, or abscesses. Bronchial washings and bronchoalveolar lavage are used for cytological studies and for culture and stains for detecting infectious organisms.
2. What group of organisms is causing this patient’s condition bacteria, fungi, or mycobacteria?
   =>It is definitely a fungus as yeast cells were seen. The morphology of the intracellular yeast is and the stain findings are suggestive of Histoplasma capsulatum.