Diagnostic Techniques in Pathology - Case Study Example

? Diagnostic Techniques in Pathology Department: Question Explanation of the patient history History and Physical Examination Comments Patient Name: Date: Referral Source: Data Source: Patient Chief Complaint & ID: A twenty year old female patient who has suffered from a problem of productive cough for twenty four hours that got worse for a whole night. History of Present Illness The patient, a lady aged 20 years, who according to her report had been well until 24 hours ago when she suffered an acute case of productive cough. She kept fit and has had good health prior to the cough, given her regular work outs at the gym. The cough, she says started off as a common case. However, it got worse throughout the night a situation that forced her to seek medical attention from a General Practitioner. After pre-examination, the patient was asked to provide a sputum sample since hers was a productive cough. The sputum test results showed a characteristic yellow-green colour which formed part of the basis of her diagnosis. The patient was also found to produce chest sounds that pointed to a harsh rubbing and dull percussions notes on one side of her chest. Further tests for which she provided her blood sample and mid-stream urine were carried out. Question 2: Patient Data a) Basic observations Test Patients Result Normal Range Comments Temperature 38.1?C 37?C Fever Blood pressure 130/90 mmHg 120/90 mmHg Within normal range Pulse rate 120bpm 60-100bpm Tachycardia Heart sounds Normal - Normal b) Results of the Hematology test Pathological test Patient Result Normal Range Comments Erythrocyte count 4.9 x1012/l 3.8 – 5.0 x 1012/l Within normal range White blood cell count 15 x109/l 4.3 - 10.8 x 109 /l Moderate Leukocytosis Neutrophils 8.4 x109/l 2.0 -7.5 x 109/l Within normal range Lymphocytes 3.0 x109/l 1.0 - 4.8 x 109/l Within normal range ESR 9 mm/hr 0 - 20 mm/hr Within normal range i) Sputum Gram stain: Pathological Test Patient Result Normal Range Comments Pus cells +++ - Heavy Red blood cells + Normal Organisms Gram negative bacilli seen. Infection agents Key: – No cells seen or detected +/- 1 to 3 cells per field (scanty) + 4 to 10 cells per field (light) ++ 11 to 20 cells per field (moderate) +++ >20 cells per field (heavy) ii) Sputum Culture Agar Observations Blood Agar Heavy growth of large flat colonies, rough blue/grey sheen. Beta haemolytic. CLED Agar Heavy growth Green, matt, rough colonies. Anaerobic Agar No growth detected. Question 3: Description of Clinical Pathology Tests Basic Observations Using a sputum culture, as a core bacterial determinant pathology test, Klebsiella pneumonia was determined to be characterized as a gram-negative, non-motile, lactose fermenting, encapsulated, rod shaped, facultative anaerobic bacterium belonging to the family enterobacteriacease and detected in the normal flora of the mouth, intestines, and skin. It is known to go into the respiratory tract to result into pneumonia, blood to source a bloodstream end-organ damage and infection, or have to penetrate devitalized tissues to cause infection of wounds or burns. It further proved that this type of pneumonia is caused by aspiration of oropharyngeal microbes into the lower respiratory tract. Pneumonia caused by this organism is characterized by thick, bloody, mucoid sputum, but can also cause lung abscesses and pneumonia. Kledsiella infections are in immunosuppressed patients, such as alcoholics, diabetics, and patients who are intubated. A Klebsiella pneumonia bacterium is easily spread through person-to-person contact or, less commonly, by contamination of the environment. For instance, from patient to patient through any contaminated hands of healthcare personnel, or any other person who might have carelessly been in touch with the inpatient. Symptoms and sign of klebsiella pneumonia are; i. Pneumonia basically does show a number of characteristics such as, illness, shortness of breath, fever and cough, in most cases. ii. Meningitis is a second symptom that can be identified by characteristics such as; impaired memory and judgments, nausea, and persistent headache among such patients iii. Liver abscess, for instance; nausea, vomiting, weight loss, fever, night sweats, right upper quadrant pain. It is important to note that the pre-symptom prophylaxes for the klebsiella pneumonia are usually not routinely provided to the immunocompetent individuals. However, before exposure, any immunocompromised health works with potential exposure to the Klebsiella pneumonia because of the routine tasks are advised to self identify for any necessary discussions and evaluation. Question Four: Interpretation of Data The results as shown by the X ray diagram illustrates that the patient was suffering from pneumonia, a disease of airspace and consolidation. Airspace opacity as indicated by the arrows in the diagram below is a space that occupy lesion without any volume loss (Burke, 2010). In precise, this is a Klebsiella pneumonia which is community acquired nosocomial immunocompromised host. Complete blood count for the white blood cells is deceptively normal, indicating that the immune system of the patient may be having problems. Possibilities of low blood sodium in pneumonia indicates extra anti-diuretic hormones that are produce incase the lungs are diseased (McLuckie, 2009, p.51). Other test carried out for the test of pneumonia for specific blood serology test for any other bacteria included legionella and a urine test for any presence of influenza, respiratory syncytial, and adenoviruses. Further diagnostic results such as high temperatures (38 degrees C) above the normal rates, absence of asthma, decreased breath sounds, and crackles are enough symptoms of pneumonia. Among the pathogenic Klebsiella species, Klebsiella pneumonia is categorized as the most clinically fundamental and prevalent. Based on all the major observations, community-acquired invasive primary liver abscess syndrome, that is normally associated with those patients with no any underlying predisposing medical conditions, while some patients can as well develop metastatic infections at any other parts of the body. Very accurate and brisk detections of Enterobacteriaceae harboring the Klebsiella Pneumonia Carbapenemases enzymes is of clinical significance in making sure that the approved antimicrobial therapy is provided to all patients who are infected with these organisms and that appropriate infection control measures are initiated. Historically, automated systems have struggled to accurately identify Klebsiella Pneumonia Carbapenemases-producing organisms. Expectorated sputum is identified as the largest part of lower respiratory tract sample collected by the microbiology laboratories. Additionally, it is the most problematic to evaluate. In the initial instance, the most imperative steps in evaluation are the Gram stain. Gram stains are helpful to aid in assessing the suitability of the sputum specimen for further processing and interpretations, and; Prediction of the likely etiologic agents by the intensified identification of predominant bacterial morphologies within an adequate specimen. Any culture result is accounted for in a semiquantative manner of 1+ to 4+ in some biological laboratories, while rare-few-moderate-abundant in other laboratories. A number of true pathogens are detected in at least 3+ (moderate) quantities. Sputum cultures may in some instances give rise to a specific pathogen. The oropharynx and upper airways are virtually colonized with indigenous flora as shown on the x-ray illustration; expectorated sputum culture will in most cases nurture mixed flora, despite the absence of infections within the bacterial lower respiratory tract. Potential pathogens can also colonize the respiratory tracts, mostly among patients with chronic illnesses or recent hospitalization. The yield of sputum cultures is further moderated incase the patients have received antibiotics prior to producing the specimen, which are experienced in approximately 25% of the total number of cases (Reimer, & Carroll, 1998). Question Five: Patients Prognosis (Reflective Summary) Pneumonia is known to be a common lung infection that is in most instances result from fungal, bacterial, or viral infections. Its symptoms vary from mild to severe. X ray examinations are mostly used because it helps in precise detection of the infection but cannot determine the type of germs, a situation which calls for the use of sputum. All the characteristics as discussed in the section of data interpretation are evidence enough to prove that the case patient was suffering from pneumonia (Murray & Nadel, 2010). An individual identified to be having fever and a continuing cough that produces pus-like material or blood is likely to be having an infection of the lungs and bronchial tubes. These infections may be as a result of several types of germs, including bacteria, fungi (molds and yeast), and viruses. Chest x rays assist doctors to see the infections, while a culture can grow the germ causing the infections so it can be identified. Basing on such symptoms, doctors can then make proper decisions on what group of germ caused the infections, and order for one or more specific types of cultures: viral, bacterial, or fungal. In the case of culture types, the sputum have to be carefully collected into a sterile container so that germs normally in the mouth do not contaminate the sample, and each culture type is handled differently. GLOSSARY Anaerobic Agar- Growth media used for microorganisms which do not require oxygen for growth Blood Agar- A special type of growth media used to isolate gram positive bacteria and fastidious bacteria. CLED Agar- Valuable growth medium that is non-inhibitory used to isolate and differentiate urinary tract infection agents. C-reactive proteins - A blood protein whose levels rise when the body is experiencing an inflammation C-reatinine Kinase- An enzyme expressed by various tissues and cells and acts as receptors. Dull percussion notes – palpation is fundamental in revealing increased vibration and dullness on percussion. ESR – It stands for erythrocyte sedimentation rate, a test that measures inflaming in the body. Gram negative bacteria- Bacteria which do not retain the purple counter staining agent because they do not contain peptidoglycan layer. Harsh rubbing – sounds experienced whenever patients’ chest walls move. Klebsiella pneumonia – a gram-negative, encapsulated, non-motile, lactose fermenting, rod shaped facultative anaerobic bacterium that is classified under the family of enterbacteriaceae and mostly detected within the normal flora of the skin, intestines and mouth. Lymphocytes - A type of white blood cells whose major role is to protect the body against foreign substances Mild-stream (specimen for urine) – used as samples in diagnosing pneumonia bacteria Neutrophils - A type of white blood cells which are the most abundant. Also called polymorpho nuclear leukocytes Sputum- Mucus usually colored that originates from the lower respiratory tract system during coughing. Bibliography Bond, C., Hastings, P., Pollack, A., & Kling, J. (2010). 68W advanced field craft: combat medic skills. Boston, Jones and Bartlett Publishers Burke A.C. (2010). Pneumonia essentials (3rd Ed.). Sudbury, MA: Physicians' Press. ISBN 0763772208 Holloway, N. M. (2004). Medical-surgical care planning. Philadelphia, Lippincott Williams & Wilkins McLuckie, A. (2009). Respiratory disease and its management. New York: Springer. P.51 ISBN 978-1-84882-094-4 Murray & Nadel (2010). Respiratory medicine (5th Ed.). Philadelphia, PA: Saunders/Elsevier. ISBN 1416047107 Reimer, L. & Carroll, K. (1998) Roles of the microbiology laboratories in the diagnosis of lower respiratory infection of tracks: Clin Infect Dic. Read More