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Microbiology Case Study

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by

Christina Kvistad

on 8 April 2014

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Transcript of Microbiology Case Study

Microbiology Case Study

Christina Kvistad

-51 Year Old Patient

-Ulcerative Colitis

-Whole blood
cyclosporin of
250-350 ng/ml

-Patient is discharged
-2 weeks later
-Fever
-Cough
-Dyspnea

-Patient is readmitted
-Chest x-ray

-Stop cyclosporin

-Start cefotaxime and erythromycin

-Did not improve

-Perform bronchoscopy with
bronchoalveolar lavage

-Send to lab
In the lab...
Diagnosis:
Invasive Aspergillosis
Aspergillus fumigatus
Problem:
-Too high dose of cyclosporine

-Favored the development of an opportunistic
infection

Where is Aspergillus found?
-Ubiquitous in environment

-Decomposing vegetable
material
How are humans infected?
-Constantly inhale conidia

-Not a problem in immunocompetent
hosts

-Affects 10-15% of patients with:
-Transplants
-Leukemia
-Advanced AIDS
-Autoimmune diseases

Portals of Entry
-Respiratory tract

-Open wounds

-Cornea

-Ear
Clinical Symptoms
-Dry cough

-Fever

-Low-grade chest pain

-Dyspnea

-Sometimes hemoptysis
Lab Results
-Hypoxemia

-Hypocapnea

-Elevated bilirubin

-Elevated lactate dehydrogenase

-Elevated serum fibrinogen

-Elevated c-reactive protein

Diagnosis
-Positive culture

-Sputum

-Needle biopsy

-Brochoalveolar lavage


-Serum galactomannan
Incidence and Prognosis
-1 to 2 cases per 100,000 people per year



-Without drug treatment leads to death
Treatment
-Voriconazole


-liposomal Amphotericin B


-Itraconazole
Prevention
-N95 Mask

-Avoid soil/dust

-HEPA filters

-Prophylactic antifungals

-Clean skin injuries
In the Hospital
At Home
In the Hospital
In the Hospital
Works Cited
Anonymous. Breakthrough Pulmonary Aspergillus Fumigatus Infection: Case Report. Reactions Weekly [Internet]. 2013 [cited 22 Feb 2014]; 85:1451. ProQuest. Auckland (United Kingdom): Wolters Kluwer Health Adis International. Available from: http://search.proquest.com.online.library.marist.edu/docview/1468428539. Document No.: 1468428539.

Denning DW. Invasive Aspergillosis. Infectious Diseases Society of America [Internet]. 1998 [cited 22 Feb 2014]; 26.4: 781-803. Oxford University Press. Available from: http://cid.oxfordjournals.org/content/26/4/781

Harman EM. Aspergillosis. Medscape [Internet]. 2013 [cited 22 Feb 2014]. WedMD. Available from: http://emedicine.medscape.com/article/296052-overview

Latge JP, Steinbach WJ. Aspergillus Fumigatus and Aspergillosis. [Book]. 2009 [cited 22 Feb 2014]. Washington (DC): ASM Press.

Latge JP. Aspergillus fumigates and Aspergillosis. Clinical Microbiology Reviews [Internet]. 1999 [cited 22 Feb 2014]; 12.2: 310-350. NCBI. American Society for Microbiology. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC88920/?tool=pmcentrez&report=abstract

Images
http://tellicherry0.tripod.com/body.jpg
http://www.cardiac-surgeon-india.com/Aspergillosis-of-Lung.php
http://kaahe.org/health/ar/284-%D8%AF%D8%A7%EF%BA%80-%D8%A7%D9%84%D8%B1%D8%B4%D8%A7%D8%B4%D9%8A%D8%A7%D8%AA.html?utm_source=mufasser.com&utm_medium=referral&utm_campaign=Mufasser
http://www.scielo.br/img/revistas/jbpneu/v38n1/en_a17fig01m.jpg
http://www.elsevier.pt/en/revistas/-/artigo/renal-abscess-due-to-iaspergillus-fumigatus-i-as-the-13155467
http://classconnection.s3.amazonaws.com/30/flashcards/2121030/jpg/a_fumigatus_s1366498412866.jpg
http://www.bio-rad.com/webroot/web/images/cdg/products/microbiology/product_detail/global/cmd_62794_pdp.jpg
http://www.scielo.br/img/revistas/bjid/v12n5/08f1.gif
http://img.medscape.com/slide/migrated/editorial/cmecircle/2003/2838/images/patterson/slide02.gif
http://www.uspharmacist.com/CMSImagesContent/2013/4/_USP1304-InvasiveAspergillosis-T2.gif
http://img.medscape.com/fullsize/migrated/460/694/iim460694.fig2.jpg
http://www.natlallergy.com/images/225/3m-9211-mask.jpg
http://www.walgreens.com/marketing/library/graphics/images/en/19338.jpg
http://content.everydayhealth.com/wte3.0/gcms/skin-wound-Common-Injuries-Article.jpg
http://www.kvsupply.com/cyclosporine-mod-25-mg-30-ct
http://stopmoldcold.com/wp-content/uploads/2013/05/invasive-aspergillosis-spreads-to-other-parts-of-body.jpg
http://www.scripps.org/encyclopedia/graphics/images/en/17263.jpg
http://upload.wikimedia.org/wikipedia/commons/9/9e/Blausen_0286_CysticFibrosis.png
http://cmr.asm.org/content/22/3/447/F1.large.jpg
http://memydr.com/cyclosporin/276/cyclosporine
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