Question

A 45-year-old homeless man who abuses alcohol presents to the emergency department with fever and cough of 4-day duration. The cough is productive with thick, bloody phlegm. He complains of pain in the right side of his chest with coughing or taking a deep breath. He denies any other medical history and says he cannot remember the last time he saw a doctor. He does not smoke cigarettes but says he drinks a pint of whiskey whenever he can get it, and denies drug use.

His temperature is 38.9oC, pulse 105 BPM, and respiratory rate is 30/breaths/minute. The lung examination is notable for decreased breath sounds and crackles in the right, lower posterior field. His WBC count is elevated. Chest radiography reveals a dense right lower lobe infiltrate with evidence of pulmonary abscess. Sputum samples are collected for gram stain and culture.

1. On which media would you plate or inoculate to grow the suspected organism?

2. If the gram stain reveals >25 squamous epithelial cells/low power field what would you do?

Answer 1

Answer 1- we have to used Solid: egg- and agar-based and Liquid: also often referred to as broth media.

Answer 2- If the gram stain revels > 25 white blood cells/low-power field was the better predictor for positive M. tuberculosis cultures and acid fast bacilli smears. The chance is that the patient has pulmonary tuberculosis. We have to decide to treat the patients with anti-TB drugs or DOT treatment.