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.

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