Question

Please list key results for figure 6-7. Provide as much detail as possible.

Fig.4 Colonial morphology of Nocardia species on Blood AgarWhitish chalky adherent colonies of Nocardia species Laboratory investigations of blood demonstrated neuFig.5 Colonial morphology of Nocada species on Chocolane trophil leukocytosis (1250), reduced hemoglobin (10 g/ 9rwriteshchakadeent dl), C-reactive protein (positive), Rubella and CMV (Neg- ative: ELISA), CMV retinitis (negative), Cryptococcal antigen(negative), Toxosecretory IgM (positive ELISA) However the serological test for, Toxoplasma antibiotic therapy to follow. The same medication was con- -specific tinued for 12 months as the patient underwent progres- blood was redrawn two weeks after the first and second tested together with the first specimen. Latter test revealed was later considered to be not infected. The patients sive changes and no relapse was noted with his transplant function observed in a good state. Given the progressive recovery of the patient without any symptoms that would the patient to be negative for Toxoplasma-specific lgG alert the presence of disorder additional or alternative par- and positive for toxoplasma-specific IgMI confirming the enteral antimicrobial therapies of carbupenems (imipe- earlier result of positive ELISA for Toxosecretory lgM to nem or meropenem, but not ertapenem), third generation be false positive [8). RFTs (urea, creatinine, electrolytes) cephalosporins (cefotaxime or ceftriaxone), and amika- ranges were normal and Tumor markers within normal cin, alone or in combination were thought unnecessary to limits (PSA, CEA,CA19.9),Urinary albumin(1+) was seen include in regimen though recommended by some author on routine urine examination. In view of examination Duration of antimicrobial therapy was further extended to and investigations, a diagnosis of disseminated pulmo minimize risk of late relapse. He is under regular tollow-up nary nocardiosis with CNS manifestations was made on since then and we found him asymptomatik, with limited post renal transplant patient under therapy for pulmonary side effects of prolonged antimicrobial therapy. Figure tuberculosis. Stereotactic aspiration and craniotomy was graphically shows a time line of clinical history of patient performed for clinical management of the case and was and diagnostic approuches treated with BACTRIM. DS們-BD), 2 double strength tablets each containing 800 mg sulfamethoxazole and Discussion 160 mg trimethoprim were prescribed. The patient recov Post-transplantation TB is predominantly the result of ered well after operation without neurological defcits, reactivation of an earlier quiescent TB focus, previous TB and then was discharged with prescription of 3 months anamnesis and family history, nosocomial acquisition or FTO FB

Answer 1

Figure 6:

Nocardia species is a gram - positive aerobic,filamentous,branching , weekly acid fast bacilli..it was isolated on routine mycobacterium media..

Nocardia spp: ubiquitous soil saprophytic,route if infection can be through inhalation or by direct cutaneous innoculation..This infection can affect individual immune function.. Nocardia may colonize the respiratory tract of immunocompetent individual with compromised pulmonary function like asthma,TB,COPD..

Colonies can happen in 4 days,but it need upto 2_4weeks of culture..Nocardia will increase the time needed to form clinical isolates..pre treatment antibiotic can slowdown the infection process but it will not kill the Nocardia..it is difficult to be isolate by culture because overgrown,faster- growing non pathogenic colonies mask present..

Nocardia colonies will be smooth,moist mold like grey white waxy appearance from aerial hypnae..it have strong odor so microbiologist can suspect this..Nocardia growth that make negative gram strain and negative modified- acid - fast results if antibiotics provided( sub - optimal condition)