SETTINGS CALCULATOR DAY 1, 08:02 SCORE: 10 PROGRESS: \( 6 \% \) Interact with the LabPad to answer the quiz. HOME THEORY MEDIA MISSION How can the doctor rapidly determine if there are bacteria present in the CSF? a) Send the patient for a chest X-ray b) Send the CSF sample for culture and antibiotic sensitivity testing c) Collect a few milliliters of CSF and send it for a Gram stain d) Treat the patient with antibiotics and await the response VIEW THEORY
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CASE STUDY M-5 An 18-year-old female college student complains of fever, chills, headache, and vomiting. She presents to the college health service ED, where she is examined. She appears lethargic, and her temperature is 102°F. Blood is drawn for a CBC and culture, urine is collected for analysis, and a serum chemistry profile is ordered. A lumbar puncture is performed, and cloudy CSF is collected. Laboratory data follow: Complete Blood Count WBC count: 20.0 x 10⁹ (normal range 5-10 x 10⁹) Differential: Marked neutrophilia with shift to immature forms (shift to the left) CSF Results WBC count: 1200 cells/mL with 95% neutrophils (reference value: 0-5 lymphocytes) Glucose: 25 mg/dL (decreased, compared with blood glucose value) Protein: 150 mg/dL (increased) Other Data Gram stain: Many neutrophils, Gram-negative diplococci in pairs Urinalysis: Increased protein, few RBCs, few granular casts Serum chemistries: Within reference values Critical Thinking Questions 1. What characteristics of the patient presented in the case history would provide clues as to the potential infectious agent? 2. Explain why the physician ordered the chemistry panel in conjunction with the other tests.
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A 68-year-old woman was admitted because of headaches of about a one-month duration. She also complained of vertigo, photophobia, drowsiness, and forgetfulness. Physical examination revealed a slight fever, stiff neck, crackles in her lungs, and a tendency to overreach objects. Because of the signs of meningeal irritation, a lumbar puncture was performed. To complicate matters, it was learned that the patient has malignant lymphoma. She had an elevated peripheral white blood cell (WBC) count. A chest X-ray revealed diffuse interstitial infiltrates of both lower lungs. The CSF examination revealed the presence of WBCs, a decreased glucose level, and a slightly increased protein level. While performing the WBC count, the technician noticed spherical objects that did not resemble WBCs. These objects ranged from 10 to 20 μm (micrometers) in diameter. What cause of meningitis should be suspected? If this pathogen is suspected of being the cause of the patient's meningitis, what test should be performed on the CSF? If this pathogen is the cause of the patient's meningitis, what should be observed when an India ink preparation is examined? Should this pathogen also be suspected of being the cause of the patient's pulmonary infection?
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A young mother who recently emigrated from Uganda brought her sick 18-month-old infant, Mirembe, to a New York City emergency room. The infant was crying uncontrollably, especially when the physician tried to move her head. Meningitis (an infection of the spinal fluid and membrane surrounding the brain) was suspected, and a spinal tap was performed to collect cerebrospinal fluid (CSF). The fluid, which appeared cloudy, was sent to the laboratory. CSF should be free of microbes, but a microscopic examination revealed Gram-negative bacilli. The technician cultured the sample on various solid media. The organism failed to grow on blood agar plates containing intact red blood cells (RBCs) but did grow on a medium containing lysed RBCs (called chocolate agar because of its color). The organism recovered from the CSF also grew on a relatively simple medium containing growth factors known as X and V. The diagnosis was meningitis caused by the bacterium Haemophilus influenzae. The child received antibiotics and made a full recovery. The blood agar plates used to culture Mirembe's sample contain intact red blood cells and agar. Organisms that are capable of lysing the red blood cells may produce green-appearing zones of partial hemolysis or clear-appearing zones of complete hemolysis around colonies that are easily visually distinguishable. This medium is best described as:
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