(Case No; 1)

A Thai construction-site worker diagnosed as having HIV 3 years previously was found unconscious and
admitted to the intensive care unit. A chest X-ray taken on admission is shown in (A). Gram stain on a
sputum-specimen collected from the patient at admission was non-contributory. A further specimen was
obtained and a Ziehl-Neelsen stain performed, the result of which is shown in (B).

a. What respiratory infection does he have?

b. What does the Ziehl-Neelsen stain demonstrate?
c. Does he represent an infection hazard to other patient or staff in the ICU, and if so why?
d. Does his geographical origin suggest any specific issues regarding choice of antimicrobial therapy?
(A)

(B)
 (Case No; 2)

A 28-years-old backpacker developed a profuse watery diarrhea that led him to seek urgent medial
assistance. A faecal specimen was cultured on a range of selective bacteriological media. (A) shows the
results of culture on a thiosulphate citrate bile salt agar (TCBS) plate. A Gram stain of colonies from this
plate is shown in (B). (C) is a picture taken by the backpacker on his travels, showing a roadside water
seller from whom he obtained chilled water.

a. What species is the most likely cause of this mans infection?

b. Name at least two other bacterial infections commonly transmitted in potable water in developing
countries?
c. What feature in (C) would have alerted you to the unsuitability of this drinking water source?
(A)

(B)

(C)
 (Case No; 3)
A 68-year woman was admitted to hospital with sudden onset of fever,
breathlessness, a productive cough and episodes of severe shaking. A chest
X-ray taken at the time of her admission is shown in (A). A sputum
specimen also taken at this time was stained using Grams technique (B),
and the results of primary culture on blood agar with an optochin disc are
shown in (C).

a. What infection did the patient have?

b. What is the most likely pathogen responsible?
c. How would you treat this infection?
(A)

(B)

(C)
 (Case No; 4)
You are a physicians assistant at a local pediatricians office. Five year-old
Michael is brought to the office by his father. Michael is crying and
complaining that his mouth hurts. His father has been at work and does not
know whether the boy has had a fever during the day. Currently his
temperature is 39.44C. The physician notices that Michaels breath smells
rotten. Lymph nodes in this neck are swollen, and visual examination of the
throat reveals a white packet adhering to the left tonsil. Much of the soft
palate is red (fig A).

a. What laboratory tests are called for?

b. What types of infection are in the differential diagnosis?
c. What are the possible sequelae of untreated sore throat?
 (Case No; 5)

One autumn in the late 199s, a number of people became ill after working at a single
building at an industrial plant. Their symptoms ranged from simple coughing and other
respiratory symptoms to pneumonia. At least one of the 70 people reporting symptoms
died.
The company voluntarily closed the building upon the recommendation of the Health
hygiene. After all of the water systems were evaluated and disinfected, it reopened and no
new cases were reported.

a. What is your first guess for the possible bacterial infection?

b. Describe the transmission characteristics of the suspected bacterium.
c. Is there is a risk for a continuing community outbreak from these initial infections?
Why or why not?
 (Case No; 6)

A 27-year-old man presents to the hospital emergency room with a cough, chest pain, and
fever. Two days before admission he developed a nonproductive cough. Rales are heard.
Gram stain of sputum was negative. Sputa cultures on blood agar were also negative.
Culture on a special medium containing cholesterol, purines, and pyrimidines produced
colonies in 10 days that are shown on the following slide. Serology 3 weeks later (when
be returned because of persistent cough but feeling better) showed cold agglutinins.

A. What is the causative agent?

B. Why did the organism not show up on the Gram stain?
C. What antibiotics do you NOT use?
 (Case No; 7)

The Infectious Disease Service is asked to see a patient who had a history of COPD and
is an alcoholic. He was diagnosed as having pneumonia. Culture of the sputum revealed
many colonies as shown on the first slide. The second slide shows a Gram stain.

A. Why do the colonies appear as they do?

B. What is the identity of the organism?
C. Does it ferment lactose?
D. What would his sputum look like? Other distinctive features?
E. What is the most common causative agent of pneumonia in alcoholics?
(A)

(B)

(C)
 (Case No; 8)

A 2l-year-old male presents with sudden-onset of severe vomiting, nausea, abdominal cramps and
diarrhea. He had returned home about 2 hours after attending a birthday party at which meat and
milk were served in various forms. The friends who were celebrating his birthday reported similar
symptoms. A swap was cultured from nose of one of the cooker staff at the party and Gram
stained (A).

a. What is the name of this syndrome?

b. What is the likely organism?
c. What is the pathogenesis of this disease?
d. How you will manage this patient?
 (Case No; 9)
Upper gastrointestinal endoscopy was performed on a patient who had been complaining of
epigastric abdominal pain and who subsequently presented with a haematoemesis. At endoscopy
a dudodenal ulcer was seen. Gastric biopsies were taken fro a rapid urease test (Fig A), histology
(Fig B) and culture.

a. What is the organism that is present in the stomach?

b. What is the rapid urease test?
c. What relationship does the organism have to the ulcer?
d. How should the patient be managed?
(A)

(B)
 (Case 10)

A 65-year-old woman was operated upon for diverticulitis and whilst on the
ward was given a cephalosporin for a presumed chest infection. Several days
after starting the antibiotics, the patient became unwell with severe
abdominal pain and blood-stained diarrhea. A faecal sample was sent to the
laboratory to for testing.

a. What is the likely diagnosis?

b. How is the infection transmitted?
c. How should the patient treated?
 Case (11)

This prosthesis was removed from the right hip of a patient who had
undergone arthoplasty 6 months earlier (A). For the last 2 months she had
suffered chronic pain in the right hip. A swab of the intramedullary section
of the prosthesis was obtained and cultured in the laboratory. The bacteria
growing on blood agar from the specimen are shown in (B), and a Gram
stain of these bacteria is shown in (C).

a. What is this organism most likely to be?

b. What antibiotic would be most suitable for his infection?
 (A)

(B)

(C )
 Case (12)

This middle-aged man presented to his local doctor with fever and malaise.
He was thought to have a viral illness and was advised to take regular
paracetmol. He re-resented several days later severely ill and with the rash
demonstrated in (A). A lumbar puncture was performed and a Gram stain of
this is shown in (B). bacteria were recovered from subsequent CSF and
blood culture on blood agar and subjected to a carbohydrate utilization test
(C). despite appropriate therapy the patient died.

a. What is demonstrated in (A)?

b. What is the likely aetiology?
c. How do the carbohydrate reaction contribute to the confirmation of the
aetiology?
(A)

(B)

(C)