A 40 year old white male was admitted to the hospital with fever, chills and mal

Question

A 40 year old white male was admitted to the hospital with fever, chills and malaise two days after seeing his physician with the same symptoms. Eighteen months prior to admission, he had undergone a porcine prosthetic valve replacement to correct aortic regurgitation. On the day of admission, he suffered a syncopal episode in conjunction with a fever of 105 F. Presumptive subacute bacterial endocarditis was the admitting diagnosis. •

Two days prior to admission, two blood cultures had been drawn in the physician's office, and five blood cultures were collected on the day of admission. All seven cultures were positive in the aerobic bottle, the fist after seven days and the remaining six within 15 - 32 days. Antibiotic therapy in the form of intravenous penicillin and gentamicin was begun the morning after admission. Additional blood cultures were not drawn due to the ongoing antibiotic therapy, although the patient remained febrile for approximately 48 hours after admission.

LABORATORY DATA

Hematology WBC 16.5 x 106/l with a shift to the left Blood cultures x 7 collected

SLIDE #1: GRAM STAIN OF BLOOD CULTURE

SLIDE #2: GROWTH ON BAP, CHOC, MTM - 2 COLONIES

TESTS PERFORMED Catalase +

Oxidase +

Rapid sugars

glucose A gram stain: pure isolate

maltose A

sucrose - lactose -

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Please answer

question 1

CASE STUDY REPORT: (Quantity if required, Genus, Species) 8 pt

question 2

FURTHER TESTING REQUIRED: If no further testing is required please report that. 2 pt

Explanation / Answer

A 40 year old white male was admitted to the hospital with fever, chills and malaise two days after seeing his physician with the same symptoms. On the day of admission, he suffered a syncopal episode in conjunction with a fever of 105 F. Presumptive subacute bacterial endocarditis was the admitting diagnosis.

The causal organism is predicted to be a more virulent organism like Staphylococcus aureus has potential to cause infective endocarditis even a normal heart valve. Since, the patient undergone porcine prosthetic valve replacement to correct aortic regurgitation, he is highly susceptible to staphylococcal infection.

Organism: Staphylococcus aureus

Gram stain: Gram positive

Aerobic, Specific medium for growth is mannitol salt agar and forms yellow colored colonies after incubation.

Once the organism grown on specific medium, the observation of colonies can confirm the organism and further testing is required at species level and for identification of coagulase positive or negative etc.

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