Posted: July 21st, 2015

Case Study Report

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A 65 year old woman, Mrs Smith, presented at her GP surgery with fever, a cough and a very sore, swollen and suppurating big toe. Mrs Smith was a known type 2 diabetic and her weight was 74kg, height 5ft 4in. Following a medical examination the GP took two blood samples – one EDTA sample for a full blood count (FBC) and one clotted sample for C-reactive protein (CRP) measurement. The GP also took a swab of her toe and a sputum sample was collected. The GP asked Mrs Smith to return to the surgery after three days for repeat blood tests
Two weeks after beginning her course of antibiotics Mrs Smith returned to her GP surgery. Her chest infection and her toe were much better; however she now had a three day history of diarrhoea.

The results from Mrs Smith’s test are in the tables below. You will need to determine the susceptibility of the organisms using the BSAC standards given in the tables. Use the information in the following tables to complete the case study.

Case Study Report
Introduction (Case study):
A 65 year old woman, Mrs Smith, presented at her GP surgery with fever, a cough and a very sore, swollen and suppurating big toe. Mrs Smith was a known type 2 diabetic and her weight was 74kg, height 5ft 4in. Following a medical examination the GP took two blood samples – one EDTA sample for a full blood count (FBC) and one clotted sample for C-reactive protein (CRP) measurement. The GP also took a swab of her toe and a sputum sample was collected. The GP asked Mrs Smith to return to the surgery after three days for repeat blood tests
Two weeks after beginning her course of antibiotics Mrs Smith returned to her GP surgery. Her chest infection and her toe were much better; however she now had a three day history of diarrhoea.

Results:
Table1: Identification of the isolated organism from Mrs Smith’s (toe sample):
Cultural appearance   Light yellow colour – ß hemolysis present
Gram stain   Gram positive
Microscopic appearance   Coccus, in clusters
Endospores   Negative
Motility   Non-motile
Catalase   Positive
Oxidase   Negative
Coagulase   Positive
DNAse   Positive
Fermentation of glucose   Positive
Identification of organism   Staphylococcus aureus

Table2: Identification of the isolated organism from Mrs Smith’s (sputum sample):
Cultural appearance   Dark and greenish colour under the colonies indicate (a hemolysis)
Gram stain   Gram positive
Microscopic appearance   Coccus, in chains
Endospores   Negative
Motility   Non-motile
Catalase   Negative
Oxidase   Negative
Optochin   Sensitive
Fermentation of glucose   Positive
Identification of organism   Streptococcus pneumoniae

Table3: Identification of the isolated organisms from Mrs Smith’s (faeces sample): From XLD plate
Plates   Organism 1   Organism 2
Cultural appearance   Lactose fermenter, circular and raised colonies   Non-lactose fermenter with black centres
Gram stain   Gram negative   Gram negative
Microscopic appearance   Rod-shaped   Rod-shaped
Endospores   Negative   Negative
Motility   Motile   Motile
Catalase   Positive   Positive
Oxidase   Negative   Negative
Fermentation of glucose   Positive   Positive
Identification of organism   Escherichia coli   Salmonellasp

Table4: Antibiotic sensitivities for Mrs Smith’s (toe):Staphylococcus aureus
Antibiotics   Zone diameter (mm)   Resistant =<
BSAC   Susceptible >
BSAC   Result
Fusidic Acid (FC 10µg)   27 mm   29   29
Erythromycin (E 5µg)   21.5 mm   19   19
Gentamicin (GM 10µg)   19.5 mm   19   19
Penicillin (PG 1units)   30 mm   24   24

Table5: Antibiotic sensitivity for Mrs Smith’s (sputum sample):Streptococcus pneumoniae
Antibiotics   Zone diameter (mm)   Resistant =<
BSAC   Susceptible >
BSAC   Result
Ampicillin (AP 10µg)   50 mm   17   17
Erythromycin (E 5µg)   30 mm   19   19
Cephalexin (CFX 30µg)   40 mm   23   23
Penicillin (PG 1units)   40 mm   24   24

Table 6: Antibiotic sensitivity for Mrs Smith’s (faeces sample):
Antibiotics   Escherichia coli: zone diameter (mm)   Salmonella: zone diameter (mm)   Resistant =<
BSAC   Susceptible >
BSAC   Results
Ciprofloxacin (CIP1µg)   26 mm   32mm   16   20
Ampicillin (AP10µg)   30 mm   35mm   16   20
Ceftriaxone(CRO30µg)   34 mm   35mm   23   28
Cotrimoxazole(TS25µg)   22 mm   30mm   15   16

Table 7: Full Blood Count and ESR results
Samples   Day 1 (FBC)   Day 3 (FBC)
Red cell parameters   Normal   Normal
White cell count   11.5×109/l   15×109/l
Blood film   Showed neutrophilia   Showed neutrophilia with many immature neutrophils
ESR (mm)   20mm   24mm

Table 8: CRP ELISA results
Standard curve
CRP standard concentration (mg/L)   Result 1   Result 2   Result 3   Mean Result
0   0.07   0.08   0.09
1   0.12   0.16   0.14
3   0.46   0.48   0.50
10   0.93   0.97   0.95
30   1.36   1.35   1.37
100   1.66   1.72   1.78
200   1.50   1.80   2.10
Sample   Result 1   Result 2   Result 3   Mean Result   CRP mg/L
Positive Control   1.263   1.325   1.333   1.307
Negative Control   0.051   0.082   0.078   0.070
Day 1 of infection   1.010   0.996   1.063   1.023
Day 3 of infection   1.726   1.624   1.762   1.704

Task;

To explore what has happened to Mrs Smith and to understand why

Introduction- give a brief description of the patient’s medical history, her presenting symptoms and the tests that were requested. Include information on subsequent symptoms and tests.

No need to write up the methods

In the results section, present the patient’s results

The discussion should be the main part of your report
Explain the patient’s diagnoses and justify them in the light of her symptoms and all her lab results; including any appropriate treatment
Discuss the significance of each of the tests
Suggest reasons why she may have developed several infections
Your report should be fully referenced in the Harvard style

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