This is the case to work on: Mrs. Juan Sagan, URINE SAMPLE: Case History: Mrs. Juan Sagan is experiencing frequency of urination, a burning sensation when passing urine, back pain, bloating and abdominal pain. She is 24 years old and has just returned from her honeymoon in the Maldives. Dr. Noital provides you with a midstream specimen of urine. MICROSCOPY: 50 X 103 white blood cells/ mL
PRACTICAL ONE: a) Using the midstream specimen and a calibrated loop, inoculate a HBA plate (see technique section). b) Dilute the urine specimen 10-1, 10-2, 10-3 and 10-4 in 9mL saline tubes provided (see technique section). LABEL THE BOTTLES. DO NOT LABEL THE LIDS. Discard urine once used c) Accurately measure 100 µL of each of the last three dilutions, and spread over the surface of a 3 HBA plates using a sterile disposable spreader, one plate for each dilution. d) Place one drop of the 10-3 dilution on a section of a MAC plate and streak out for single colonies e) Accurately measure 100 µL of the 10-3 dilution, and spread carefully over the surface of the Chromogenic Urinary Tract Infection (UTI) agar plate, using a sterile disposable spreader. f) Incubate at 37ºC aerobically for 24 hrs.
This is the guideline:
CASE REPORT NUMBER
CASE DETAILS: (2.5 mark)
Microbiologist-in-charge: your name (provide partner’s name also)
Patient Name: the patient’s name
Type of specimen: e.g. Urine
Microscopy: This is of original specimen; please copy as written in manual, don’t include the key. Write “N/A” if none performed/supplied.
LAB RESULTS:(10 marks)
(i) Here, list the organism/s isolated and how much of each organism was grown: (e.g. Heavy growth of E. coli).
? EXCEPT FOR URINE, where you have to say the number per ml (e.g. 7.2 X 104 E. coli/ml but if more than 105, then e.g. >105 E. coli/ml).
(ii) If antimicrobial susceptibilities performed they are reported here, in a table format. These allow the doctor to decide on the appropriate treatment.
(iii) Place all your results here: in a table format, set out in sequence as they were done.
? colony morphology
? growth conditions
? Gram stain
? all ID tests (list controls used)
? include zone diameters for antimicrobial susceptibility tests for isolates and controls used etc.
DISCUSSION/REPORT: (No more than 500 words)
(i) Discuss your results and include the following in your discussion: (25 marks)
? How did you arrive at your identification?
? Importance of pure cultures, any problems you experienced.
? Suggestions for improving the procedure you used.
? Suggestions for any other media that could be used or tests that could be done.
? Were any problems experienced with susceptibility tests?
? Did looking at one week old, refrigerated, cultures affect the results?
? Any other thoughts?
? Does the culture result correlate with the specimen’s original microscopy?
? Is/are the isolated organism/s significant? i.e. suggestive of infection or is it normal flora, skin contaminant, environmental contaminant, etc., give a concise reason.
? Is/are the organism/s normally a pathogen, an opportunistic pathogen, part of the normal flora?
? What infections/diseases can it cause? List only a couple. ? If it was to be to be treated, list one antimicrobial that could be used.
(ii) Compare your report with the corresponding real-world report provided (10 marks)and:
? identify at least two differences (in tests/techniques used; results obtained);
? discuss the differences, explaining possible reasons for them.
REFERENCES: At least two references (2.5 marks)
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