Assignment: A medical case report, or case study, is a

Assignment: A medical case report, or case study, is a written text or presentation that details the illness and treatment of a single person or group of people to document and advance current knowledge about the subject. Usually, case studies are unique and serve as an important example for others in the medical or microbiological research field from which to learn in the event that a similar problem presents itself. As a microbiology or health care professional, it is vital that you be able to interpret and even prepare case study writeups and presentations. You have completed several laboratory experiments to analyze an unknown pathogen collected and isolated from a patient with the goal of identifying it and making a diagnosis. The entire process – from background about the patient to final diagnosis and treatment – should now be documented in a case study presentation. The presentation should tell a cohesive story. Instructions – *Staphylococcus Epidermis* Treatment Plan and Expected Outcome Outline a plan for care, listing any applicable medications and dosage. (Please decide between tetracycline and bacitracin) Indicate the expected outcome for the patient after treatment. Conclusion Present the most significant findings from the case. Re-highlight the uniqueness of the case. Describe the relevance for the microbiology and medical world. Background Information: *Staphylococcus Epidermis* You work as a microbiologist in a hospital. An urgent case requires your attention. A toddler arrived this morning with a long-lasting high fever, with no known reason. Blood and urine samples were collected. It is your job to analyze the bacteria in the urine sample by culturing and identifying the pathogen. Case Presentation A 13-month old girl presented to the emergency room for examination at 6:15 AM with a fever of 39 ºC, lasting for over two days with rapid onset and no other symptoms or known reasons. Her perinatal and family history was unremarkable, and there were no known immunological issues. The family denies any sick contacts. The child has no known food, environmental, or medication allergies. The child is not currently taking any medications. Bloodwork revealed leukocytosis (a high white blood cell (WBC) count) at a value of 17,478/μL. The absolute neutrophil counts were also high (ANCs: 8,455/μL), as was the C-reactive protein (CRP: 4.72 mg/dL). Blood culture was negative for bacteria. Contrast-enhanced computed tomography (contrast CT scan) showed that part of the child’s left renal tissue had reduced contrast enhancement, indicating pyelonephritis. Urine samples were collected via catheterization following proper procedure. Urine samples were cultured, indicating the presence of a seemingly single, unknown bacterial species. Experiment Summary It is imperative that you identify the unknown organism cultured from the child’s urine sample in order to give a diagnosis and treatment plan. To begin this process, you will complete this week’s lab activities to aseptically culture the organism in broth (LAB | Aseptic Technique and Use of Media #1) and then do a quad streak to obtain isolated colonies of the organism (LAB | Isolation Streak Plate Technique) Good work! You have successfully cultured the unknown pathogen in broth and also now have isolated colonies on an agar plate. The child was admitted and her conditioned has not worsened, though her fever has not resolved. The patient is under observation, is receiving intravenous fluids, and has vitals recorded every four hours. You will streak one of your isolated colonies onto a new plate to create a pure culture plate. Differential staining is one of the next steps for identification. Background Your quad streak plate should contain isolated colonies. To be sure you have a pure culture, and to have a “stock” plate from which to pull biomass for future tests, you will want to use some of the biomass from a single colony to streak a fresh plate. Differential stains are used to distinguish between different microbe types or structures and aid in the identification of unknown species. You will learn about simple stains and the most common differential staining technique – the Gram Stain. The shapes (morphology) and groupings (arrangement) of microbes is also covered. Experiment Summary To diagnose and treat the ill child, you will need to work with a pure culture and perform a differential stain to aid in the organism’s identification. You have now isolated and Gram stained the unknown pathogen. Some of the data you have collected includes the colony morphology of the organism, and its cell shape, arrangement and Gram status. To gather additional data for identification, you will now grow the pathogen on differential media. Background The use of differential and selective media helps identify unknown microbes. While selective media either selects for or inhibits a particular organism, differential medium contains certain chemicals along with dyes to show a color change distinct to certain groups of organisms. Common types of differential medium are Mannitol Salt Agar, Eosin Methylene Blue agar, and MacConkey’s Agar, Blood Agar, and Chocolate Agar. Experiment Summary To diagnose and treat the ill child, you will more data for pathogen identification. You will inoculate your unknown organism onto two selective and differential media – Mannitol Salt Agar (MSA) and Eosin Methylene Blue (EMB) agar. Your efforts thus far have provided valuable data for identification. You need only a few more tests to be able to confidently name the pathogen, provide a diagnosis, and suggest a treatment plan for the patient. Completing a few biochemical tests is the next step. Background Biochemical tests are important tools for organism identification. Bacteria produce various enzymes and chemicals during growth, which can be detected via biochemical methods. Biochemical tests are relatively inexpensive and mostly straightforward, thus reducing the amount of time, energy, and funds that are required for identifying unknown samples. Additionally, biochemical tests can be sensitive enough to detect the development of disease (a pathogen), allowing for quicker diagnosis and action. When conducting and reading results of biochemical tests, one must keep in mind there is always some level of error. However, if the same materials are used and the same methods are carefully followed the same way for each sample, a test should be reliable. The first step in ensuring dependable results is to choose a valid test, or one that will measure the desired variable or trait. When reading test results, accuracy and precision must be considered. Accuracy indicates the closeness of the measurement to the true value, while precision indicates the test method’s consistency (with multiple measurements all being similar). There will be a certain amount of variability, or spread, in multiple, repeat measurements. The variability in measurements informs you of the precision of a test. Experiment Summary You will perform two biochemical tests using biomass from your pure plate culture. The data you collect from these tests will bring you another step closer to identifying the pathogen. With the data you have collected thus far from your experiments, you may already have identified the unknown pathogen. However, the final test that you will now complete will not only provided the information needed to solidify your identification, but it will reveal which antibiotic treatment will or will not be effective against the pathogen. You will now perform the Kirby-Bauer Disk Diffusion Assay for antibiotic susceptibility. Once you complete this activity, you will begin your case study presentation, providing background, the methods you used, results you obtained, and interpretation for a diagnosis. Background The Kirby-Bauer Assay tests the susceptibility and resistance of bacteria (usually a pathogen) to numerous antimicrobial compounds in order to aid a medical practitioner in choosing a treatment option for a patient. The organism is grown with filter paper disks that are impregnated with an antibiotic, and the presence or absence of the organism around the disc is related to the ability of the antibiotic to inhibit that particular organism. Experiment Summary You will determine which of two antibiotics – bacitracin or tetracycline – is effective against the pathogen by conducting a Kirby-Bauer Assay. The data you collect from this assay will confirm the identification of the unknown pathogen and allow you to form a treatment plan for the ill child. Activities The following text, videos, and activities will guide you through carrying out a Kirby-Bauer Assay and inform you on how antibiotics work. You will also learn about antibiotic resistance and why antibiotics do not work against viruses.

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