Question

A 34 y/o male with a history of tobacco and alcohol abuse (12 cans of beer per day) was admitted to the hospital. Two months prior to admissi have a necrotic in his right upper lobe. He was PPD (purified protein derivative) negative and three sputum cultures were negative for acid fast Mycobacterium spp. He had no risk factors for hum on he was seen at an outside hospital, where he was found to Four weeks prior to admission, he presented with fever, productive cough, night sweats, chills, and a 10 lb. (4.5 K8) weight loss. He was treated with ampicilli clavulinic acid for 1 firm right chest wall mass (4 by 4 cm), which was as extremely viscous. Two days later, the nurses found him urinating on the wall of his room. Because th was unusual behavior for him, it was decided to perform a computed tomogram (CT scan) of h the scan revealed multiple lesions. The patient was taken to surgery and the central nervous system (CNS) lesions were drained. A Gram stain of the material recovered from the brain aspirate showed a branching, beaded, gram positive filamentous bacteria. (See figure.) 4 days. Fever, chills, and night sweats decreased. On admission, he presented with a pirated. The aspirated material was dark green and is head; Explain the relationship between his chest wall lesion and his brain lesions. Which lifestyle factors predisposed this patient to the chest wall lesions? What two genera of organisms are likely based on the results of the Gram stain? Which test could be performed on the brain aspirate to determine the genus to which this organism belongs? What is the origin of the organism causing this patient's infection? 1. 2. 3. 4. 5. Which anaerobic organism fits the gram stain (microscopic) morphology of this organism? What 6. If long, thin, fusiform, anaerobic, gram negative organisms had been seen on the Gram stain of 7. Which encapsulated fungal pathogen can be associated with brain abscesses? characteristic colony (macroscopic) morphology is associated with this organism? the aspirated material what organism would be suspect?

Answer 1

1. The branching, beaded gram-positive bacteria is coming under the classification of Actinomycosis.

At the early stages of the disease, a focal pulmonary consolidation occurs, which can be surrounded by pulmonary nodules, but there are often no associated physical symptoms at this stage. This primary pulmonary involvement could secondly lead to the constitution of a peripheral mass, with or without cavitation, which could invade adjacent tissue. At this stage, pulmonary actinomycosis is usually characterized by fibrotic lesion with slow contiguous growth passing through the anatomical barriers. Thus is pass to the brain and cause infection to the brain and form lesions.

This is the spreading that spread is continuously and progressively of the actinomycosis from the chest wall to the brain by the anatomical barriers.

2. For the present scenario, the patient is having the lifestyle of tobacco and alcohol use prior to the admission. Due to the increased alcoholism and tobacco use results in the chest wall lesions with the infection.

3. Actinomyces can be initially suspected by colony morphology and biochemical profiling. For example, A. israelii forms a “molar tooth” colony on agar and grows as clumps within broth, whereas A. odontolyticus forms rust-brown or red-coloured colonies.

From the brain aspirate, to confirm the organism we can go for Gram stain of the specimen is usually more sensitive than culture, especially if the patient had received antibiotics and or cultured on blood agar media.

4. The origin of the organism mainly may be due to the bad lifestyle changes may be associated with poor dental and or oral hygiene may result in the infection.

5.  A. meyeri, are strictly anaerobic, so cultures must be incubated in an anaerobic atmosphere. These are filamentous, branching, gram-positive, pleomorphic, non–spore-forming, catalase-negative, anaerobic or microaerophilic/capnophilic bacilli.

6. if long thin fusiform, gram-negative, anaerobic organism indicates fusiform bacteria

7, Cryptococcus neoformans:

Cryptococcus neoformans is an encapsulated yeast and an obligate aerobe that can live in both plants and animals. Its teleomorph is Filobasidiella neoformans, a filamentous fungus belonging to the class Tremellomycetes