This case study examines four patients exhibiting a respiratory infection at the

Question

   This case study examines four patients exhibiting a respiratory infection at the local health department from November 27 to February 20. Each exhibited similar symptoms, but each had distinguishing characteristics. Laboratory diagnosis confirmed four distinct infections.

            Patient A is an 86-year-old female of good general health. She had recently, however, fallen and injured her back. This resulted in a one week bed rest during which time she became ill. She was referred to the hospital by the health clinic with fever, dyspnea, and chest pain. The sputum sample collected on her first morning there was tinged with blood.

            Patient B is a 58-year-old male of generally fair health. He has a history of alcoholism and is a heavy smoker. His nutritional status was assessed as poor at the admission interview. His symptoms include fever, dyspnea, chest pain, and a severe cough. His sputum was not bloody, but his chest X-ray revealed a large area of abscess. He also was admitted to the hospital.

            Patient C is a 35-year-old female who presented herself at the health clinic with low-grade fever, mild upper respiratory infection, cough and headache. After listening to chest sounds, the attending physician ordered a sputum culture, which revealed the presence of a bacterial infection. This patient was treated at home.

            Patient D is a 40-year-old female, employed with the evening janitorial service at a large corporate headquarters. Within 12 hours after the completion of her shift, she developed a high fever (102°F), cough and general weakness. She was immediately admitted to the hospital. It was later reported that local physicians had seen three other employees of this same company with similar symptoms, but they all had different shifts and no contact with each other.

Laboratory Diagnosis

            The microscopic examination of expectorated sputum is the primary means of diagnosis of these bacterial pneumonias. The primary disadvantage is the confusion that results from contamination of the sputum with oropharyngeal flora and excessive saliva. Gram-stained smears of this sputum may reveal the presence ofpolymorphonuclear leukocytes and large numbers of a particular morphological type of bacteria in the mixed specimen.

            Some of these causative agents of pneumonia are not readily identified by Gram reaction. In this case, serological testing is more practical.the question is

1)Describe four instructions for collecting a sputum culture which minimize the problems that can be experienced in the laboratory examination of sputum

2)

For which of these pneumonias is a vaccine available? Who usually receives this vaccine?

Klebsiella pneumoniae; at 15 months of age and high risk groups of older adults

Mycoplasma pneumoniae: for elderly adults only       

Streptococcus pneumoniae; at 2 years of age   

Streptococcus pneumoniae;children below 2 years of age and adults generally over age 65

3)

Which of these describes the microscopic and gram strain results that would lead you to diagnose Primary Typical Pneumonia.

Gram positive spheres in long chains

Gram positive bacilli in chains

Gram positive ovoid bacteria typically found in pairs surrounded by a dense capsule

Gram negative cocci in chains

Klebsiella pneumoniae; at 15 months of age and high risk groups of older adults

Mycoplasma pneumoniae: for elderly adults only       

Streptococcus pneumoniae; at 2 years of age   

Streptococcus pneumoniae;children below 2 years of age and adults generally over age 65

3)

Which of these describes the microscopic and gram strain results that would lead you to diagnose Primary Typical Pneumonia.

Gram positive spheres in long chains

Gram positive bacilli in chains

Gram positive ovoid bacteria typically found in pairs surrounded by a dense capsule

Gram negative cocci in chains

Explanation / Answer

For the best results, collect each specimen first thing in the morning before eating breakfast.

1. Rinse the mouth out with water to reduce specimen contamination. Do not use mouthwash or toothpaste. If you wear dentures, remove the dentures first.

2. Sit on a chair or at the edge of the bed.

3. Hold breath a few seconds, then cough directly into the specimen container.

4.make sure the sputum comes as a thick consisitency and not mixed with much saliva

5. Send specimen with laboratory requisition immediately to the lab.

2. Vaccines are avilable for the following pneumonias

Pneumococcal vaccines are vaccines against the bacteria Streptococcus pneumoniae. Their use can prevent some cases of pneumonia, meningitis, and sepsis. There are two types of pneumococcal vaccines: conjugate vaccines and polysaccharide vaccines. They are given by injection either into a muscle or just under the skin.

The World Health Organization recommends the use of the conjugate vaccine in the routine immunizations given to children. This includes those with HIV/AIDS. The recommended three or four doses are between 71 and 93% effective at preventing severe pneumococcal disease The polysaccharide vaccines, while effective in healthy adults, are not effective in children less than two years old or those with poor immune function.

Children under the age of two years fail to mount an adequate response to the 23-valent adult vaccine, and so the 7-valent Pneumococcal Conjugated Vaccine (PCV) (e.g. Prevnar) is used.

There is no such vaccine for mycolasma pneumonia. There are trials going on for the vaccination of klebsiella pneumonia.

3.Gram positive cocci(sphere)in long chains. which will be confirmatory for Sterptococcus pneumoniae.

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