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Case Study Report

Case Study Report

Order Description

A 65 year old woman, Mrs Smith, presented at her GP surgery with fever, a cough and a very sore, swollen and suppurating big toe. Mrs Smith was a known type 2 diabetic and her weight was 74kg, height 5ft 4in. Following a medical examination the GP took two blood samples – one EDTA sample for a full blood count (FBC) and one clotted sample for C-reactive protein (CRP) measurement. The GP also took a swab of her toe and a sputum sample was collected. The GP asked Mrs Smith to return to the surgery after three days for repeat blood tests
Two weeks after beginning her course of antibiotics Mrs Smith returned to her GP surgery. Her chest infection and her toe were much better; however she now had a three day history of diarrhoea.

The results from Mrs Smith’s test are in the tables below. You will need to determine the susceptibility of the organisms using the BSAC standards given in the tables. Use the information in the following tables to complete the case study.

Case Study Report
Introduction (Case study):
A 65 year old woman, Mrs Smith, presented at her GP surgery with fever, a cough and a very sore, swollen and suppurating big toe. Mrs Smith was a known type 2 diabetic and her weight was 74kg, height 5ft 4in.  Following a medical examination the GP took two blood samples – one EDTA sample for a full blood count (FBC) and one clotted sample for C-reactive protein (CRP) measurement. The GP also took a swab of her toe and a sputum sample was collected. The GP asked Mrs Smith to return to the surgery after three days for repeat blood tests
Two weeks after beginning her course of antibiotics Mrs Smith returned to her GP surgery. Her chest infection and her toe were much better; however she now had a three day history of diarrhoea.

The results from Mrs Smith’s test are in the tables below. You will need to determine the susceptibility of the organisms using the BSAC standards given in the tables. Use the information in the following tables to complete the case study according to the instructions in the practical handbook and practical PowerPoints on Blackboard.

Results:
Table1: Identification of the isolated organism from Mrs Smith’s (toe sample):
Cultural appearance    Light yellow colour – ß hemolysis present
Gram stain    Gram positive
Microscopic appearance    Coccus, in clusters
Endospores    Negative
Motility    Non-motile
Catalase    Positive
Oxidase    Negative
Coagulase    Positive
DNAse    Positive
Fermentation of glucose    Positive
Identification of organism    Staphylococcus aureus

Table2: Identification of the isolated organism from Mrs Smith’s (sputum sample):
Cultural appearance    Dark and greenish colour under the colonies indicate (a hemolysis)
Gram stain    Gram positive
Microscopic appearance    Coccus, in chains
Endospores    Negative
Motility    Non-motile
Catalase    Negative
Oxidase    Negative
Optochin    Sensitive
Fermentation of glucose    Positive
Identification of organism    Streptococcus pneumoniae

Table3: Identification of the isolated organisms from Mrs Smith’s (faeces sample): From XLD plate
Plates    Organism 1    Organism 2
Cultural appearance    Lactose fermenter, circular and raised colonies    Non-lactose fermenter  with black centres
Gram stain    Gram negative    Gram negative
Microscopic appearance    Rod-shaped    Rod-shaped
Endospores    Negative    Negative
Motility    Motile    Motile
Catalase    Positive    Positive
Oxidase    Negative    Negative
Fermentation of glucose    Positive    Positive
Identification of organism    Escherichia coli    Salmonellasp

Table4: Antibiotic sensitivities for Mrs Smith’s (toe):Staphylococcus aureus
Antibiotics    Zone diameter (mm)    Resistant =<
BSAC    Susceptible >
BSAC    Result
Fusidic Acid (FC 10µg)    27 mm    29    29
Erythromycin (E 5µg)    21.5 mm    19    19
Gentamicin (GM 10µg)    19.5 mm    19    19
Penicillin (PG 1units)    30 mm    24    24

Table5: Antibiotic sensitivity for Mrs Smith’s (sputum sample):Streptococcus pneumoniae
Antibiotics    Zone diameter (mm)    Resistant =<
BSAC    Susceptible >
BSAC    Result
Ampicillin (AP 10µg)    50 mm    17    17
Erythromycin (E 5µg)    30 mm    19    19
Cephalexin (CFX 30µg)    40 mm    23    23
Penicillin (PG 1units)    40 mm    24    24

Table 6: Antibiotic sensitivity for Mrs Smith’s (faeces sample):
Antibiotics    Escherichia coli: zone diameter (mm)    Salmonella: zone diameter (mm)    Resistant =<
BSAC    Susceptible >
BSAC    Results
Ciprofloxacin (CIP1µg)    26 mm    32mm    16    20
Ampicillin (AP10µg)    30 mm    35mm    16    20
Ceftriaxone(CRO30µg)    34 mm    35mm    23    28
Cotrimoxazole(TS25µg)    22 mm    30mm    15    16

Table 7: Full Blood Count and ESR results
Samples    Day 1 (FBC)    Day 3 (FBC)
Red cell parameters    Normal    Normal
White cell count    11.5×109/l    15×109/l
Blood film    Showed neutrophilia    Showed neutrophilia with many immature neutrophils
ESR (mm)    20mm    24mm

Table 8: CRP ELISA results
Standard curve
CRP standard concentration (mg/L)    Result 1    Result 2    Result 3     Mean Result
0    0.07    0.08    0.09
1    0.12    0.16    0.14
3    0.46    0.48    0.50
10    0.93    0.97    0.95
30    1.36    1.35    1.37
100    1.66    1.72    1.78
200    1.50    1.80    2.10
Sample    Result 1    Result 2    Result 3    Mean Result    CRP mg/L
Positive Control    1.263    1.325    1.333    1.307
Negative Control    0.051    0.082    0.078    0.070
Day 1 of infection    1.010    0.996    1.063    1.023
Day 3 of infection    1.726    1.624    1.762    1.704

Task;

To explore what has happened to Mrs Smith and to understand why

Introduction- give a brief description of the patient’s medical history, her presenting symptoms and the tests that were requested.  Include information on subsequent symptoms and tests.

No need to write up the methods

In the results section, present the patient’s results

The discussion should be the main part of your report
Explain the patient’s diagnoses and justify them in the light of her symptoms and all her lab results; including any appropriate treatment
Discuss the significance of each of the tests
Suggest reasons why she may have developed several infections
Your report should be fully referenced in the Harvard style