Fever may be a symptom in the initial presentation of such patients. Vancomycin and cefotaxime were continued for an additional 13 days. The patient was treated with only intravenous acyclovir for possible herpes simplex meningoencephalitis. Explanation and Consequences This case illustrates morphologic changes that can be seen in gramnegative bacilli that are exposed to certain beta-lactam agents. Surgical treatment of the abscess resulted in material that was acid-fast positive and grew M. Three weeks prior to admission, the patient had traveled to Cape Cod, Massachusetts.
The slides evaluated from the frozen section did not show sarcoma, but instead revealed a fungal osteomyelitis with only a few fungal microorganisms being seen. Her physical examination on admission to the referral medical center was unremarkable; there were no neurologic deficits. The patient was treated with fluconazole and had marked symptomatic improvement; an uncomplicated prostatectomy was also successfully done. Analytic Errors in the Clinical Microbiology Laboratory Explanation and Consequences This case illustrates three important points. On admission, the patient complained of weight loss, irregular bowel movements with constipation alternating with diarrhea, polyarthralgias, stiffness of the proximal limbs, episodes of pleuritic pain, and a patchy rash.
A computed tomography scan of the head showed no abnormalities. There was no history of tick bites during either of these trips. This escar typically precedes the onset of fever by several days. Postanalytic Errors in the Clinical Microbiology Laboratory thought that this patient did not have Lyme disease. Clinically, babesiosis resembles malaria and is endogenous to the United States. A bronchoscopy with fine-needle aspiration of the pulmonary nodules plus a paratracheal lymph node was done to confirm the presumed diagnosis of malignancy. Initial laboratory values were normal.
A lumbar puncture demonstrated cloudy cerebrospinal fluid with a Gram stain revealing many gram-negative bacilli. Culture of the cerebrospinal fluid was negative for bacteria and fungi. Cultures of the cerebrospinal fluid for bacteria, mycobacteria, and fungi were sterile. In this case, lack of budding in the frozen section stain made B. A diagnostic laparotomy was performed and revealed intestinal adhesions and bilateral tubo-ovarian abscesses; all pelvic structures were covered with marked fibrosis.
National Committee for Clinical Laboratory Standards. Bacterial cultures of blood, urine, and cerebrospinal fluid were obtained. Blood cultures and sputum cultures were not obtained. Thus, the interpretation of the cerebrospinal fluid Gram stain was reasonable. Each of these can have an adverse impact on the laboratory performance if a management error occurs. Potential management errors are described and discussed in a clinical case-based learning format to effectively illustrate the conditions that contribute to these errors and enable the laboratory manager to recognize and avoid them in daily practice. There was a 2 cm violaceous lesion located on the left heel at the site of a healed incision.
Her liver function studies were slightly elevated. Rapidly growing mycobacteria can easily be misidentified as Nocardia spp. In clinical microbiology, the preanalytic phase involves selecting and ordering the test, collecting the specimen, and transporting the specimen to the laboratory. Analytic Errors in the Clinical Microbiology Laboratory between the Gram-stain smears from the blood culture bottles and the microorganisms growing from subcultures. Cerebrospinal fluid and blood were cultured, and the child was treated with empiric meropenem.
Follow-up colonoscopy revealed decreased colitis, but three new fistulas were seen in the ascending colon. The patient was treated with fluid resuscitation and had multiple escharotomies and graft placements during the first 2 weeks of hospitalization. A serologic test for L. Case with Error A healthy 36-year-old man involved in a motor vehicle accident was admitted to the trauma unit with a high-energy, open fracture of the lower third of his right tibia. In this case, multiple episodes of a febrile illness went undiagnosed until a routine blood smear and an alert medical technologist allowed the diagnosis of babesiosis to be made. In addition, the physician should be notified by telephone.
Explanation and Consequences Failure to consider an uncommon parasitic infection such as disseminated strongyloidosis that may present with concomitant gramnegative meningitis might seem to be a rare event. The other cultures were negative. Had the excised lymph nodes and sinus tract not been cultured, this diagnosis might have been missed. The cerebrospinal fluid culture grew A. Antimicrobial susceptibility testing using a disk diffusion method showed resistance to imipenem and ertapenem, which was an unexpected resistance pattern for E. All cultures were negative for any growth. On the 10th day, the intravenous penicillin was stopped and oral tetracycline was started.