A 32 year old patient was admitted to the ER with severe left leg pain, hemorrhagic bullae on the left leg, vomiting, and fever. The patient just returned from a summer holiday in the Florida Keys where he had hit his leg on a rock while snorkeling 2 days before. The initial impact did not visibly penetrate the skin so the patient thought it was just sore from the impact. The bullae were opened, swabbed, and the patient was put on doxycycline and a cephalosporin.
The technician plated on BAP, CHOC, and MAC, and also did a gram stain. Here are your results:
BAP: Mac:
Gram Stain: Gram Negative Rods (slightly curved)
Oxidase:Positive
Ok so you can just shout out what you think, email me what you think, what should the next diagnostic steps be (I dont want to hear Vitek, Phoenix, Microscan, API, etc.!!!) and you can solve this, tommorow I will check back give you some more clues and by friday we have a positive ID!
Update: Ok so were back, sorry for the delay, lab audits as you know are hell!!!!
So our one poster...come on people this is interesting! Recommended that we do a TSI and UREA, and a wet mount for motility
Results:
Urea - Negative
Motility - Motile
TSI - No H2S, Acid over Acid
That is what we have so lets review our results, Gram Negative -Curved Rods, Lactose Fermenters on Maconkey, Urea -Neg, Motile, No H2S with Acid Production, Oxidase Positive
It doesn't get any easier!!! Lets hear it if you come check out the page chat it up!
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3 comments:
Set up: Urea, KIA, and Acetate slants. Also do a wet prep to see if the organism is motile or not.
I think you are looking at a vibrio species, but I thought that they were all non lactose fermenters on mac. Very strange....
There is ONLY ONE specie of Vibrio that is a LACTOSE FERMENTER: V.vulnificus
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