Question

NATIONAL CENTER FOR CASE STUDY TEACHING IN SOER Part lll-The Physician une 9 Three weeks had passed. The swelling was still prasent and it had become even more difficult for Margo to move her finget. In addition, che amount of fluid oozing from the wound had increased, suggesting that the medication hadn't worked. It was now time to visit a local physician. Following the advice of a neighbor, Margo set up an office appointment with Dr. Chan, an internist. After the usual battery of questions, Dr. Chan sent in the nurse to collect a specimen from Margo finger. Dr. Chan mentioned to Margo that the specimen would be sent off to the regional hospital laboratory for analysis and that he would provide her with another prescription for Keflex, which she should continue to take until test resules came back June 15 The test results arrived in Dr. Chan's office on June 15h and were as follow No yeast or fungal elements were noted * Gram-stain reaction: no organisms seen Culture of anacrobes and acrobes @48 hours yielded no growth Enrichment aulture results: moderate growh on day 5 of an acid-fast bacterium (AFB). Growch idenified as Mycobacterim fertuinuam by the Florida State Laboratory. Armed with a microbial identification, Dr. Chan prescribed Desycycline and Bactrim to be taken for four months. Dr Chan also mentioned that the isolated organism was known to be found in tap water. Consequendly, Margo planned to ask her condo community why an organism chat could cause so much pain would be living in che water that was coming out of her faucets. And although she was annoyed to learn of the source of the organism, at least she could ake some comfort in the fact that she finally had an accurate diagnosis and that by taking her medicine she could fully recover from her injury and start to enjoy her new home Questions 1. Compare and contrast acrobes and anacrobes Why were no microbes noted upon acrobic and anacrobic culture 2. Inventigte the properies and characteristics of Mt. fornatum. Where is this onganism typically found 3. Why must the acid fast stain be performed to identify organisms of the genus Mycobacteriame 4. Why did Dr. Chan prascribe two ansbiotics rather than only one 5. How does doxycycline kill baczeria (eelular tange) 6. Why were the antibiotics prescribed for an extended period (4 months)? 7. No organisms were noted upon Gram staining, yet the enrichment culture yielded M. fertuitumi after several days. Provide an explanation. Group Discussion/ Assignmert Having completed all chree parts of the cae, you are now ready to re-address the questions, poird in Part Iof the case and nestrospectively cvaluate why it took almoast two months to coriectly identify the implicated ctiolegical apent and reat the infection appropriately

Answer 1

Ans 1) The aerobic microbes are those which require oxygen for their growth whereas anaerobic organism are those which grow in absence of the oxygen. There were no microbes found upon the checking the aerobic and anaerobic culture because the bacteria takes time to grow and its growth is seen only from the 5^th day onwards. Since the anaerobic and aerobic culture was checked within 48 hours, the growth was not observed as it required more days to start growing.

Ans 2) M.fortuitum is a fast growing species which is able to grow within 3 to 4 days. It is mostly found in water sources majorly from sewage and polluted water and hence it is a water borne microbe. It is able to cause a number of infection. It is a acid fast bacterium which grows after 48 hours and does not take gram staining.

Ans 3) The acid stain must be performed as the organism cannot be identified using the gram staining. This helps in identifying the bacteria as it grows. It does not grow on any other medium and hence it is important to grow it in enrichment culture .

Ans 4) Two antibiotic are prescribed for this because a dose of single antibiotic cannot help in eliminating the microbial infection. Both the antibiotic works together to kill the microbe and ensure that there is no reoccurrence without impacting the immune system. one antibiotic kill the microbe by cellularly targetting it and the other assist in the whole process of doing so