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Micro Wound/BC Case Study – Day 1 A 59-year-old man, Fred C., presented to the emergency room complaining of fever and chills of 4 days' duration, with dizziness over the last 24 hours. He also complained of intermittent diarrhea and constipation over the past 6 months with occasional bloody stool. Fred had been a heavy smoker for 45 years and admitted to drinking alcohol regularly, "Two or three beers a night." The patient's breathing was rapid, but his lung sounds were clear. His temperature was recorded as 102.3°F. Fred was hypotensive, tachycardic, and had an appreciable heart murmur. Blood was drawn for a complete blood count (CBC) and culture. A stool specimen was collected to test for occult blood, and a chest x-ray was performed. Results of the laboratory tests are shown in Table 5-1 and in the following list. Table 5-1: HEMATOLOGY RESULTS Complete Blood Count Fred C. Reference Range WBC 9.1 5-10 X 10^9/L RBC 4.00 5-6 X 10^12/L Hb 122 135-180 g/L Hct 0.40 0.41-0.53 L/L MCV 100 80-100 fl MCH 32 26-34 pg MCHC 30 31-37% RDW 15.6 11.0-14.5 Platelets 458 150-400 x 10^9/L MPV 7.2 fl 6.5-12.0 fl RBC morphology 2+ microcytosis 1+ macrocytosis 1+ ovalocytosis 1+ basophilic stippling 2+ hypochromia 1+ polychromatophilia 2+ toxic granulation Rare Dohle bodies Rare hypersegmentation 2 nucleated RBCs Differential Fred C. Reference Range Polymorphonuclear neutrophils 52 25-60% Bands 10 0-10% Lymphocytes 35 20-50% Monocytes 1 2-11% Metamyelocytes 2 0% Abbreviations: Hb, hemoglobin; Hct, hematocrit; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; MCV, mean corpuscular volume; MPV, mean platelet volume; RBC, red blood cell; RDW, red blood cell distribution width index; WBC, white blood cell. The stool was positive for occult blood. All blood cultures were positive within 24 hours. Gram's stains from the bottles revealed gram-positive cocci in chains. Subcultures grew readily on BAP and produced small gray gamma-hemolytic colonies. Additional biochemical testing yielded the following: catalase, negative; bile esculin agar, growth with black precipitate; growth in 6.5% NaCl, negative; L-Pyrrolidinyl-naphthylamide PYR test, negative. Explain treatment options and prognosis of the disease?

Micro Wound/BC Case Study – Day 1

A 59-year-old man, Fred C., presented to the emergency room complaining of fever and chills of 4 days' duration, with dizziness over the last 24 hours. He also complained of intermittent diarrhea and constipation over the past 6 months with occasional bloody stool. Fred had been a heavy smoker for 45 years and admitted to drinking alcohol regularly, "Two or three beers a night." The patient's breathing was rapid, but his lung sounds were clear. His temperature was recorded as 102.3°F. Fred was hypotensive, tachycardic, and had an appreciable heart murmur. Blood was drawn for a complete blood count (CBC) and culture. A stool specimen was collected to test for occult blood, and a chest x-ray was performed. Results of the laboratory tests are shown in Table 5-1 and in the following list.

Table 5-1: HEMATOLOGY RESULTS

Complete Blood Count
Fred C.
Reference Range
WBC
9.1
5-10 X 10^9/L
RBC
4.00
5-6 X 10^12/L
Hb
122
135-180 g/L
Hct
0.40
0.41-0.53 L/L
MCV
100
80-100 fl
MCH
32
26-34 pg
MCHC
30
31-37%
RDW
15.6
11.0-14.5
Platelets
458
150-400 x 10^9/L
MPV
7.2 fl
6.5-12.0 fl
RBC morphology
2+ microcytosis
1+ macrocytosis
1+ ovalocytosis
1+ basophilic stippling
2+ hypochromia
1+ polychromatophilia
2+ toxic granulation
Rare Dohle bodies
Rare hypersegmentation
2 nucleated RBCs

Differential
Fred C.
Reference Range
Polymorphonuclear neutrophils
52
25-60%
Bands
10
0-10%
Lymphocytes
35
20-50%
Monocytes
1
2-11%
Metamyelocytes
2
0%

Abbreviations: Hb, hemoglobin; Hct, hematocrit; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; MCV, mean corpuscular volume; MPV, mean platelet volume; RBC, red blood cell; RDW, red blood cell distribution width index; WBC, white blood cell.

The stool was positive for occult blood. All blood cultures were positive within 24 hours. Gram's stains from the bottles revealed gram-positive cocci in chains. Subcultures grew readily on BAP and produced small gray gamma-hemolytic colonies.

Additional biochemical testing yielded the following: catalase, negative; bile esculin agar, growth with black precipitate; growth in 6.5% NaCl, negative; L-Pyrrolidinyl-naphthylamide PYR test, negative.

Explain treatment options and prognosis of the disease?

Added by Philip S.

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