MENINGITIS CASE STUDY FINAL REPORT #13

MENINGITIS CASE STUDY FINAL REPORT #13 Floremae Pidut PATIENT A: TERRENCE R. PATIENT BACKGROUND & SYMPTOMS A 79 year old male presented with a history of fever, headache and neck pain. He lives on a farm where he grows his own food and has frequent contact with goats and cows. He has a medical history of hypertension and type 2 diabetes. His niece stated that his memory and overall health has worsened and recently, he’s been in a state of confusion. CSF ANALYSIS Terrence’s CSF analysis shows high Leukocyte count of 1160/mm3, low glucose level of 24 mg/dL, high protein level of 402 md/dL and a 72% of neutrophils present. These are all indicators that Terrence may have bacterial meningitis. For this type of meningeal infection, the common CSF analysis patterns are the cell count is predominantly neutrophils, glucose levels less than 45 mg/dL and protein levels greater than 250 mg/dL. TESTING GRAM STAINING Gram staining determines the morphological characteristics and gram reaction of a pathogen. Since Terrence R.’s infection may possibly be bacterial, this testing is very useful for pathogen classification. Results showed the pathogen is a small, gram positive (purple) diplococcus indicating this is likely Streptococcus pneumoniae . HEMOLYSIS PATTERN + OPTOCHIN SENSITIVITY - BLOOD AGAR PLATE This differential medium determines what type of hemolysis pattern the pathogen has and since many of Streptococcus species are hemolytic, this testing would be useful for identification. Results on the BAP shows alpha-hemolysis present. Additionally, optochin sensitivity is another useful test to determine the type of antibiotic sensitivity of the pathogen. If the results show a clear zone of inhibition or no growth surrounding the optochin disc, then the pathogen is sensitive to optochin. Results on the BAP shows the pathogen has optochin sensitivity. CATALASE TEST This enzyme test is used to differentiate Streptococci and Staphylococci. Since the likely pathogen of Terrence R.’s is a Streptococci, this test will help determine that. Result showed that the pathogen is catalase-negative. FINAL DIAGNOSIS, TREATMENT + PROGNOSIS DIAGNOSIS Based upon the results above, the pathogen Terrence R. has is the Streptococcus pneumoniae. The CSF analysis indicates that he has bacterial meningitis. The morphological characteristics of this pathogen are small, gram negative diplococcus sensitive to optochin. This pathogen is alpha-hemolytic and catalase-negative. This type of bacteria is one of the most common causes of meningitis in immunocompromised adults especially with people like Terrence R. who have diabetes and is constantly exposed to bacterial breeding grounds in his farm. His symptoms of confusion, memory