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Case Study

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by

Sara Bowen

on 7 January 2014

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Transcript of Case Study

Haemophilus influenzae
Grows at 35-37° C CO2 @ 24 hours
Requires X (Hemin) & V (NAD) Factors
Oxidase Positive
No growth on BAP* (note satellitism)
Laboratory Results
Temperature: 39.5 °C (103.1°F
CSF Protein: 989 mg/dL (normal 15-45 mg/dL)
CSF Glucose: 12 mg/dL (normal 40-80 mg/dL)
WBC in CSF: 20,000/mm3 with 90% polymorphonuclear cells
Methods for Identification
Kovak's reagent
Supplemented Muller-hinton agar
RapidID NH panel
Haemophilus
ID Quad plate
Slide agglutination serotyping (used in areas with an established
Haemophius influenzae
vaccination programs.)
Prevention & Treatment
Complete all recommended vaccinations
Avoid close contact with the sick
Antibiotics, cefotaxime and ceftriaxone, are used as treatment.
Case Study
Why?
Risk Factors
What?
Streptococcus pneumoniae
Neisseria meningitides
Haemophilus influenza

Scenario
An 18-month-old boy, Bobby H., was rushed to the emergency room by ambulance after his mother found him unresponsive. When he did not wake up at his isual time from a nap, she became concerned. When she tried to wake him, he would not respond and is currently lethargic and listless. His mother reported that he had had a fever for 2 days and had been cranky and irritable. The mother stated, "I think he might have an earache, because he started pulling at his ear yesterday." The family is from an extremely rural area and does not have medical insurance for easy access to health clinics. Bobby had not had any routine pediatric wellcare visits or immunization.
Microbiology Results
Gram stain of the CSF showed gram-negative pleomorphic coccobacilli, and many neutrophils.
The spinal fluid culture yielded abundant growth on chocolate agar after overnight incubation. The colonies are small, round, and translucent with a glistening wet appearance.
The microbiologist working up the culture recognized a familiar mousy odor to the culture.
by PFC Bowen
Bacterial Meningitis
Sudden onset of fever
Headache/stiff neck
Nausea/vomiting
Photophobia
Altered state of mind/confusion
Typically 3-7 days after exposure
Lethargic/irritable
Age
Lack of immunization
Neutrophils in CSF
Causative agents
Full transcript