Case Study Report

Case Study Report Order Description A 65 year old woman, Mrs Smith, presented at her GP surgery with fever, a cough and a very sore, swollen and suppurating big toe. Mrs Smith was a known type 2 diabetic and her weight was 74kg, height 5ft 4in. Following a medical examination the GP took two blood samples – one EDTA sample for a full blood count (FBC) and one clotted sample for C-reactive protein (CRP) measurement. The GP also took a swab of her toe and a sputum sample was collected. The GP asked Mrs Smith to return to the surgery after three days for repeat blood tests Two weeks after beginning her course of antibiotics Mrs Smith returned to her GP surgery. Her chest infection and her toe were much better; however she now had a three day history of diarrhoea. The results from Mrs Smith’s test are in the tables below. You will need to determine the susceptibility of the organisms using the BSAC standards given in the tables. Use the information in the following tables to complete the case study. Case Study Report Introduction (Case study): A 65 year old woman, Mrs Smith, presented at her GP surgery with fever, a cough and a very sore, swollen and suppurating big toe. Mrs Smith was a known type 2 diabetic and her weight was 74kg, height 5ft 4in.  Following a medical examination the GP took two blood samples – one EDTA sample for a full blood count (FBC) and one clotted sample for C-reactive protein (CRP) measurement. The GP also took a swab of her toe and a sputum sample was collected. The GP asked Mrs Smith to return to the surgery after three days for repeat blood tests Two weeks after beginning her course of antibiotics Mrs Smith returned to her GP surgery. Her chest infection and her toe were much better; however she now had a three day history of diarrhoea. The results from Mrs Smith’s test are in the tables below. You will need to determine the susceptibility of the organisms using the BSAC standards given in the tables. Use the information in the following tables to complete the case study according to the instructions in the practical handbook and practical PowerPoints on Blackboard. Results: Table1: Identification of the isolated organism from Mrs Smith's (toe sample): Cultural appearance    Light yellow colour - ß hemolysis present Gram stain    Gram positive Microscopic appearance    Coccus, in clusters Endospores    Negative Motility    Non-motile Catalase    Positive Oxidase    Negative Coagulase    Positive DNAse    Positive Fermentation of glucose    Positive Identification of organism    Staphylococcus aureus Table2: Identification of the isolated organism from Mrs Smith's (sputum sample): Cultural appearance    Dark and greenish colour under the colonies indicate (a hemolysis) Gram stain    Gram positive Microscopic appearance    Coccus, in chains Endospores    Negative Motility    Non-motile Catalase    Negative Oxidase    Negative Optochin    Sensitive Fermentation of glucose    Positive Identification of organism    Streptococcus pneumoniae Table3: Identification of the isolated organisms from Mrs Smith's (faeces sample): From XLD plate Plates    Organism 1    Organism 2 Cultural appearance    Lactose fermenter, circular and raised colonies    Non-lactose fermenter  with black centres Gram stain    Gram negative    Gram negative Microscopic appearance    Rod-shaped    Rod-shaped Endospores    Negative    Negative Motility    Motile    Motile Catalase    Positive    Positive Oxidase    Negative    Negative Fermentation of glucose    Positive    Positive Identification of organism    Escherichia coli    Salmonellasp Table4: Antibiotic sensitivities for Mrs Smith's (toe):Staphylococcus aureus Antibiotics    Zone diameter (mm)    Resistant =< BSAC    Susceptible > BSAC    Result Fusidic Acid (FC 10µg)    27 mm    29    29 Erythromycin (E 5µg)    21.5 mm    19    19 Gentamicin (GM 10µg)    19.5 mm    19    19 Penicillin (PG 1units)    30 mm    24    24 Table5: Antibiotic sensitivity for Mrs Smith's (sputum sample):Streptococcus pneumoniae Antibiotics    Zone diameter (mm)    Resistant =< BSAC    Susceptible > BSAC    Result Ampicillin (AP 10µg)    50 mm    17    17 Erythromycin (E 5µg)    30 mm    19    19 Cephalexin (CFX 30µg)    40 mm    23    23 Penicillin (PG 1units)    40 mm    24    24 Table 6: Antibiotic sensitivity for Mrs Smith's (faeces sample): Antibiotics    Escherichia coli: zone diameter (mm)    Salmonella: zone diameter (mm)    Resistant =< BSAC    Susceptible > BSAC    Results Ciprofloxacin (CIP1µg)    26 mm    32mm    16    20 Ampicillin (AP10µg)    30 mm    35mm    16    20 Ceftriaxone(CRO30µg)    34 mm    35mm    23    28 Cotrimoxazole(TS25µg)    22 mm    30mm    15    16 Table 7: Full Blood Count and ESR results Samples    Day 1 (FBC)    Day 3 (FBC) Red cell parameters    Normal    Normal White cell count    11.5×109/l    15×109/l Blood film    Showed neutrophilia    Showed neutrophilia with many immature neutrophils ESR (mm)    20mm    24mm Table 8: CRP ELISA results Standard curve CRP standard concentration (mg/L)    Result 1    Result 2    Result 3     Mean Result 0    0.07    0.08    0.09 1    0.12    0.16    0.14 3    0.46    0.48    0.50 10    0.93    0.97    0.95 30    1.36    1.35    1.37 100    1.66    1.72    1.78 200    1.50    1.80    2.10 Sample    Result 1    Result 2    Result 3    Mean Result    CRP mg/L Positive Control    1.263    1.325    1.333    1.307 Negative Control    0.051    0.082    0.078    0.070 Day 1 of infection    1.010    0.996    1.063    1.023 Day 3 of infection    1.726    1.624    1.762    1.704 Task; To explore what has happened to Mrs Smith and to understand why Introduction- give a brief description of the patient’s medical history, her presenting symptoms and the tests that were requested.  Include information on subsequent symptoms and tests. No need to write up the methods In the results section, present the patient’s results The discussion should be the main part of your report Explain the patient’s diagnoses and justify them in the light of her symptoms and all her lab results; including any appropriate treatment Discuss the significance of each of the tests Suggest reasons why she may have developed several infections Your report should be fully referenced in the Harvard style