Question

Case Study #4

A 35 yr old woman presents to the emergency department with right flank pain. She reports that she had a few days of urinary urgency, frequency, and burning which she tried to treat herself by drinking cranberry juice. Earlier that same day she started having a severe, colicky pain on her whole right side. She has a fever, and when she urinated this morning she noticed that it appeared to have blood. She has had a few UTI’s in the past but nothing like this. She is not on any medications and has no other significant medical history. On examination, she has a temperature of 99.5F and her other vital signs are normal, despite her pain. Notable on examination is some tenderness, on her right flank, but no other abnormal results. The CBC results indicate an elevated WBC count, and a urinalysis panel indicates the presence of leukocyte esterase, blood, and an abnormally high pH. A check of the LIS database indicates the patient has an obstructing kidney stone.

What organisms are likely responsible for this infection?

What is the cause of the high pH of the patients urine (its not the cranberry juice)?

What are the hallmark tests or characteristics for this organism?

What test could you do to separate the two main species that would cause this infection?

Diagram how you would set up a urine plate on this individual? Approximately how many colonies would be considered significant?

Why are having qualified laboratory staff collecting urine samples vitally important to isolating the pathogen in the laboratory setting?

What are some things that could have gone wrong during specimen collection? How can you tell?

Answer 1

1.Proterus mirabilis is the likely organism responsible. Other causes of UTI can be e coli, staphylococcus, klebsiella.

2.High ph is due to the splitting of urea by proteus mirabilis organism.

3.Hallmark test or characteristics of proteus : Swarming mobility on agar plate

Urease positive.

4.test used to separate the two main species causing this is urease test and lactose fermentation.