Case 1 A 10 year old boy was examined in the hospital with conditions of fever and painful red and swollen joints. Two weeks earlier he had developed a severe sore throat infection which showed gram positive cocci in chains

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Case 1 A 10 year old
boy was examined in the hospital with conditions
of fever and painful red and swollen joints.Two
weeks earlier he had developed a severe sore
throat infection which showed gram positive
cocci in chains
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Case 1.Describe the morphology of the organism
below.Gram positive cocci in chains
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Case 1Mention the effect of the disease on the
organ belowA.Cross reacting streptococcal
antibodies against the heartcan lead to
pericarditis,myocarditis etc

• .

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Case1.1.What is your provisional
diagnosis?A.Rheumatic fever2.What is the
primary infection in this case?A.streptococcal
sore throat3.What other complications can rise
by the primary infection?A.Acute
glomeronephritis4.What further lab tests can be
done to confirm the secondary condition?A.ASO(mea
surement of antisreptolysin antibody titre is
important in investigation of post streptococcal
disease
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Case 1.What is the possible clinical picture
below?A.Rare complication of rheumatic fever
leads to rheumatic nodules on the elbow seen below
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Case 2A young girl was examined in hospital
with a fever of 101F and chills.A tiny rash was
observed on the chest and the stomach.She also
had a whitish coating on the surface of the
tongue and it gave the appearance of strawberry
shape

• .

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Case 2.What can be the most likely
disease?A.Scarlet feverDid she develop an
earlier disease?AStreptococcal
pharyngitis(organism releases pyrogenic
toxin)Is the rash contagious?A.No-Develops 2
days after pharnygitis till about 7 daysDoes
the child develop permanent immunity?Yes-for
this disease

• .

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Case 2Describe the media,the reaction and the
possible organism belowBlood agar plate showing
Complete heamolysis around colonies(B-hemolysis)
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Case 2What are the complications of the clinical
picture below?The throat swab showed gram
positive cocci in chainsA.Rheumatic fever,acure
glomerulonephritis
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Case 3

• Four hours after eating a cake ,a group of
  students developed a sudden attack of acute
  diarrhoea,
• vomiting, and abdomainal cramps.

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Case 3

• 1.What is your provisional diagnosis?
• Food poisoning
• 2.What is the factor involved in causing the
  disease?
• Stapylococcus areus toxin
• 3Can the causative agent be destroyed by normal
  cooking procedures?
• A.yes to the organism no to the toxin
• 4.What is the difference between food borne
  disease and food poisoning?
• A.Different concepts
• 1.Cross contamination or improper cooking
• 2.Multiplication of bacteria in the food

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Case 3.Describe the morphology of the
microorganism belowA.gram positive cocci in
clusters(groups)
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Case 4

• A menstruating woman using tampons presented
  herself to a clinic with symptoms of sudden high
  fever,hypotension,and a rash like sunburn on her
  palms and soles.
• Gram stain of cervical samples showed gram
  positive cocci in clusters

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1.What is your provisional diagnosis?A.Toxic
shock syndrome2.What is the risk factor
involved in this case?A.Tampons.May have high
levels of toxigenic stapylococci3.Name
complications of the disease.A.involves central
nervous system,gastrointestinal hepatic,
renal,failure)

• Case 4

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Case 12A male patient was examined in the clinic
for dysuria.On examination he had some urethral
discharge.A Gram stain was performed on the
discharge.
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This direct smear is from a urethral discharge
on a male how would you report it out?A.Direct
smear showing extracellular gram negative
diplocooci(you will proceed with further lab tests
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What is the selective plate that can be used for
isolation of Neisseria gonorrhoeae Neisseria
meningitidis?.Thayer-Martin media
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What would be the expected oxidase test result if
the organism is a Neisseria .A.oxidase positive
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The presence of gram negative diplococci
intracellularly and extracellularly is diagnostic
in acute male -urethritis.
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Case 12

• What complications can this untreated condition
  in females progress to?
• Chocolate agar
• A.sapingitis pelvic inflammatory disease(PID) are
  some examples

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Case 13

• A patient with symptoms of a fever, headache,
  and stiff neck which took two days to develop
  came to the clinic.
• Other symptoms were nausea and vomiting,
  sensitivity to lights, drowsiness, confusion, and
  sleepiness.
• A more serious complication had developed.

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Case 13

• 1.What is your provisional diagnosis?
• Meningitis
• 2.Should antibiotics be given immediately on
  suspicion of the case?
• Yes
• 3.How is the infection spread?
• Droplet infection-leading to meningitis or
  meningoceamia
• 4.What precaution is taken while performing Haj?
• A.immediate isolation with antibiotic therapy

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Carbohydrate tests

• Which member of this genus gives GLUcose and
  MALtose -?
• A.Neisseria meningitis

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Case 13

• What is this clinical condition called
• Large heamorrhagic skin lesions leading to
  Water-house friederichsen syndrome

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Case 14

• A patient was admitted to the clinic with
  complaints of sore throat,fever,and
  headache.Clinical examanation showed a formation
  of a psuedomembrane on the tonsils.

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Case 14

• 1.What is your provisional diagnosis?
• Suspected case of diphtheria
• 2.How is the disease spread?
• By asynptomatic carriers through droplet
  infection.
• Skin contact for cutaneous diphtheria
• 3.Name the vaccine for the disease.
• Diphtheria toxoid given in childhood as DPT in
  combination with polio and tetanus
• 4.What are volutin or metachromatic granules?
• Energy releasing cont phosphatase

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Case 14What is the name of this stain and what
is it used for?A.Alberts stain to show the
presence of volutin granules
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Case 14Bull neck appearance is a complication of
diptheria
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Case 14
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Case 14

• Name the stain and the arrangement of the
  organism.
• A.gram stain showing gram positive bacilli with
  chinese letter arrangement

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Case 14

• Which is the most serious type of diphtheria
  strain?
• A. C.diphtheria gravis

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Case 14

• Name and describe this medium .
• A.Loefflers serum slant agar is an enriched
  medium for growth of C.diphtheria can show
  metachromatic granules

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Case 14Name the testWhat is the reaction
called.A.this is an Elek test .Double
diffusion reaction between toxin and antitoxin to
test the presence of toxin producing C.
diptheria
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Case A

• A 48 year old patient was examined at the clinic
  after showing symptoms of crampy abdominal
  pain,nausea,vomiting ,diarrhoea and fever.
• There was no blood in the stool
• He had not eaten any raw or unprocessed food
  except for eggs at a friends place one day
  earlier.

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Case A

• What is your provisional diagnosis?
• Salmonella food poisoning
• Name a common bacterial agent that causes this
  condition
• Salmonella typhi
• What are the most common sources of human
  infection with this organism?
• Poultry,eggsdairy productsfoods on contaminated
  work surfaces

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Case A
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XLD agar with black colonies
Flagellar stain showing petrichous flagella
Gram stain showing Gram negative bacilli
TSI slant showing H2S production
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Case B

• A young woman was examined in the clinic showing
  symptoms of dysuria, frequency during micturation
  and suprapubic pain.

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Case B

• 1.What is your provisional diagnosis?
• Urinary tract infectionA.
• 2.What is the possible causative agent, if it
  showed
• A.Indole test positive?
• Probably E.coli if it shows lactose fermentation
  on Macconkeys agar
• 3.What is the most likely mechanism by which this
  organism infects the urinary tract?
• A.Originate in the colon,contaminate urethra
  ,ascend into the bladder

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Case B
E.coli Gram stain

• Are Gram negative
• Motile
• Some are capsulated
• Facultative anearobes

E.coli on blood agar
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Case B
EMB agar showing green metalic colonies
Indole positive in right tube
Pink lactose fermenting colonies
E.Coli in GIT
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Case C

• A patient with renal colic was admitted to the
  hospital.
• He was diagnosed as having pyelonephritis (UTI
  infection)

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Case C
Biochemical tests first row proteus-API
Swarming of Proteus species on blood agar
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Case C

• Urease positive test
• left tube
• Antimicrobial sentivity tests to detect urinary
  pathogens

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Case C

• 1.What could the possible causative organism be?
• Proteus
• 2.Name two laboratory characteristics of this
  organism
• Swarming on Nutrient agar,positive urease test
• Describe the morphology of this bacteria
• Gram negative,highly pleomorphic,actively motile
  and non-capsulated

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Case C
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Non-lactose fermenting colonies on right
Swarming on blood agar
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Case C

• Proteus vulgaris Gram stain
• Proteus flagella

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Case D

• A child at the nursery school was admitted to the
  clinic.
• Her symptoms were abdominal cramps ,fever, and
  diarrhoea
• Stool examination revealed pus ,blood and mucus

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Case D

• 1.What is your provisional diagnosis?
• Dysentery bacillary
• 2.State the virulence factors of the organism
  causing this disease.
• .Endotoxin and genes(adherence ,invasion,intracell
  ular replication.Shiga toxin disrupts protein
  synthesis and produces endothelial damage.
• 3.Describe its growth on MacConkeys agar
• Non-lactose fermenters
• 4.State the differences between diseases caused
  by S.typhi and S.sonnei

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Case D

• XLD agar showing no H2S production
• Shigella on MacConkeys agar-non lactose
  fermenting colonies

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Some laboratory culture pictures
Kliebsiella pneumoniae on Macconkeys
TCBS agar for Vibrio cholera
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Salmonella on salmonella shigella agar
Pyocin pigment on nutrient agar P.aeroginosa
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