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Which organisms do you think are causing these infections?

Discussion in 'Case Studies' started by DR.G, Sep 4, 2011.

  1. DR.G

    DR.G Super Moderator

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    [​IMG]

    Complaint
    Two patients come in with related complaints: Patient A complains of a draining neck lesion and fever. He says he noticed a swelling in his neck a few weeks ago that started to drain out to the skin yesterday.
    Patient B complains of chest lesions and fever. He has pneumonia-type symptoms (productive cough, fever, chest pain) that started a few weeks ago, followed by the development of left chest wall lesions.
    History
    Patient A has a history of tooth extraction and poor dental hygiene. Otherwise, there is no significant past medical history
    Patient B is immunocompromised because of lymphoma and chemotherapy.
    Physical Exam
    Patient A: Exam reveals fever (102°F [39°C]) and a swollen, indurated lesion near the angle of the jaw with pus draining from a sinus tract leading from the skin into the lesion.
    Patient B: Exam reveals fever (102°F [39°C]) and fluctuant subcutaneous abscesses in the anterior left chest wall. Auscultation reveals decreased breath sounds and signs of consolidation in the underlying lung.
    Tests
    Examination of material from neck and chest lesions:
    Patient A: gram-positive rods with long, branching filaments. Sulfur granules present. Anaerobic culture positive
    Patient B: gram-positive rods with long, branching filaments. Organism weakly acid-fast and no sulfur granules noted. Aerobic culture positive
     

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  2. Rocket Queen

    Rocket Queen Super Moderator

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    Patient A-Actinomyces israelii
     


  3. DR.G

    DR.G Super Moderator

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    the correct answer:
    Actinomyces israelii (patient A) and Nocardia asteroides (patient B)
     


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