Presumptive DX: Pneumonia (Pneumococcal Pneumonia) (Usually Sudden, With Fever, Chills

DISCLAIMER: All my answers came from Jawetz.
Kung may mahahanap kayo or

dagdag or arguments or ano pa, gora. Tapos pala kailangan ng powerpoint nito,
huhuhuhuhuhu hassle sa bangs pls. Thanks guys. - Paulene
MICROBIO SGD
SGD Case 2:
A 60 y/o male resident from a nursing home presents to the emergency room with a fever of
41 C, shaking chills, severe pain to the right side of his chest that worsens with breathing and
a productive cough.
Presumptive dx: Pneumonia (Pneumococcal pneumonia) (usually sudden, with fever, chills
and sharp pleural pain (Jawetz)).
1. Give the appropriate specimen/s that may be collected for microbiological
examination.
Blood (for culture)

CSF and sputum (smear and culture)
CSF
and
urine
(to
detect
pneumococcal
immunochromatographic membrane assays)
C-polysaccharide
by
2. State the rules to be observed for collection of such specimens.

A few general rules apply to all specimens:
1. The quantity of material must be adequate.
2. The sample should be representative of the infectious process
3. Contamination of the specimen must be avoided by using only sterile equipment
and aseptic technique.
4. The specimen must be taken to the laboratory and examined promptly. Special
transport media may be needed.
5. Meaningful specimens to diagnose bacterial and fungal infections must be
secured before antimicrobial drugs are administered. If antimicrobial drugs are
given before specimens are taken for microbiologic study, drug therapy may be
stopped and repeat specimens obtained several days later.
All specimens should be sent to microbiology laboratory as soon as possible after
collection because pneumococci tend to autolyse and delay will significantly impact recovery
by culture. Sputum may be examined in several ways:
1.
Stained Smears a gram stained film of rusty-red sputum shows typical
organisms, many PMNs and many RBCs.
2.
Capsule Swelling Tests fresh emulsified sputum mixed with antiserum causes
capsule swelling (the quelling reaction) for identification of pneumococci.
3.
Culture created by inoculating sputum to blood agar and incubating the plate in
CO2 at 37 C.
3. What are the criteria to determine whether the proper specimen was collected?
4. Describe the collection of specimen.

Blood Collection
1.
Use strict aseptic technique. Wear glovesthey do not have to be sterile.
2.
Apply a tourniquet and locate a xed vein by touch. Release the tourniquet while the skin is
being prepared.
3.
Prepare the skin for venipuncture by cleansing it vigor- ously with 7095% isopropyl alcohol.
Using 2% tincture of iodine or 2% chlorhexidine, start at the venipuncture site and cleanse the
skin in concentric circles of increas- ing diameter. Allow the antiseptic preparation to dry for at
least 30 seconds. Do not touch the skin a er it has been prepared.
4.
Reapply the tourniquet, perform venipuncture, and (for adults) withdraw approximately 20 mL
of blood.
5.
Add the blood to aerobic and anaerobic blood culture bottles.
6.
Properly label and promptly transport the specimens to the laboratory.

Urine Collection
For Females:
1. Have at hand a sterile, screw-cap specimen container and two to three gauze sponges
soaked with nonbacteriostatic saline (antibacterial soaps for cleansing are not
recommended).
2. Spread the labia with two fingers and keep them spread during the cleansing and collection
process. Wipe the urethra area once from front to back with each of the saline gauzes.
3. Start the urine stream and, using the urine cup, collect a midstream specimen. Properly
label the cup.
For Males: The same method is used to collect specimens from males; the foreskin should
be kept retracted in uncircumcised males.
CSF Collection
To obtain CSF, perform lumbar puncture with strict aseptic technique, taking care not to risk
compression of the medulla by too rapid withdrawal of uid when the intracranial pres- sure is
markedly elevated. CSF is usually collected in three to four portions of 25 mL each, in sterile
tubes.
5. Discuss how to handle the specimen after collection.
CASE 3
A 19 y/o military recruit who lives in the barracks develops a macular popular rash, severe
headache, photophobia, fever, stiff neck and blurred vision.
Presumptive dx: Bacterial Meningitis (clinical features vary with age; usually presents fever,
headache, vomiting, photophobia, altered mental status ranging from sleepiness to coma, and
neurologic signs ranging from abnormalities of cranial nerve to seizures)
1. Give the appropriate specimen/s that may be collected for microbiological
examination.
- CSF (lumbar puncture; culture)
- Blood (culture)
2. State the rules to be observed in collection of such specimens.
1. The quantity of material must be adequate.
2. The sample should be representative of the infectious process
3. Contamination of the specimen must be avoided by using only sterile equipment
and aseptic technique.
4. The specimen must be taken to the laboratory and examined promptly. Special
transport media may be needed.
5. Meaningful specimens to diagnose bacterial and fungal infections must be
secured before antimicrobial drugs are administered. If antimicrobial drugs are
given before specimens are taken for microbiologic study, drug therapy may be
stopped and repeat specimens obtained several days later.
*again, same na naman sa sagot sa taas, kung may mahanap kayong iba, gora! - Pau
3. Describe the collection of specimen (use PPT, pictures or animation)
CSF Collection
To obtain CSF, perform lumbar puncture with strict aseptic technique, taking care not to risk
compression of the medulla by too rapid withdrawal of fluid when the intracranial pres- sure is
markedly elevated. (actually same lang dun sa sagot sa case #2 Pau)
Blood Collection
1. Use strict aseptic technique. Wear glovesthey do not have to be sterile.
2. Apply a tourniquet and locate a xed vein by touch. Release the tourniquet while the
skin is being prepared.
3. Prepare the skin for venipuncture by cleansing it vigor- ously with 7095%
isopropyl alcohol. Using 2% tincture of iodine or 2% chlorhexidine, start at the
venipuncture site and cleanse the skin in concentric circles of increas- ing diameter.
Allow the antiseptic preparation to dry for at least 30 seconds. Do not touch the skin a
er it has been prepared.
4. Reapply the tourniquet, perform venipuncture, and (for adults) withdraw
approximately 20 mL of blood.
5. Add the blood to aerobic and anaerobic blood culture bottles.

6. Properly label and promptly transport the specimens to the laboratory.
4. How many samples are usually collected for laboratory studies? What is
usually the volume?
CSF is usually collected in three to four portions of 25 mL each, in sterile tubes.
5. Discuss how to handle the specimen after collection.

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DISCLAIMER: All my answers came from Jawetz.

Kung may mahahanap kayo or

Blood (for culture)

2. State the rules to be observed for collection of such specimens.

4. Describe the collection of specimen.

Use strict aseptic technique. Wear glovesthey do not have to be sterile.

Add the blood to aerobic and anaerobic blood culture bottles.

Properly label and promptly transport the specimens to the laboratory.

5. Add the blood to aerobic and anaerobic blood culture bottles.

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