LORMA COLLEGES

Carlatan, City of San Fernando, La Union

COLLEGE OF MEDICAL LABORATORY SCIENCE

CASE STUDY NO. 1

Case Narrative:

Mang kanor, a 30- year old fisherman and ice cream vendor, with a 5 year residency near the seaside village
of lingsat, CSFLU, Philippines was admitted to Malor Medical Center due to complaints of nausea, severe
dehydration, vomiting, generalized cramps, oliguria, prominent abdominal pain followed by vomiting and watery
diarrhea. These symptoms persist a week prior to his hospitalization. His family noted that what they ate everyday
comes from Mang Kanor’s living.

One week after Mang Kanor was admitted, an estimate of 30 children from their village was also rushed to
the hospital with the same symptoms. They are said to have drank water from the seaside where they play. 20 are
admitted while 10 are under treatment and observation. Similar cases were reported to the DOH by the first 3
months of 2019 in the Philippines.

The stool specimen of the patient was collected and transported using both Thioglycolate broth and Cary-
Blair medium. But after the transportation and examination to the lab, microorganisms was only isolated from the
Cary-Blair medium. Then inoculation of the stool sample was made into the Alkaline peptone water and cultured
to TCBS, MAC, and BAP.

Vital Signs
Blood pressure: 90/60 mmHg
Breathing: 15 to 20 bpm
Pulse: 120 to 130 bpm
Temperature: 37.5°C

Hematology
Test Value Units
Hgb 12 g/dl
Hct 0.36 %
WBC 6.70 %
SegNeutrophils 0.22 %
Lymphocytes 0.70 %
Eosinophils 0.04 %
Monocytes 0.04 %
Platelets 220 mm3
ESR 12 mmHg

Electrolyte Profile
Test Value NV
Na 120 mmol/L 135-145 mmol/L
K 3 mmol/L 3.5-5.1 mmol/L
Ca 2.20 mmol/L 2.15- 2.50 mmol/L
Cl 95 mmol/L 98-107 mmol/L
 LORMA COLLEGES
Carlatan, City of San Fernando, La Union
COLLEGE OF MEDICAL LABORATORY SCIENCE

Fecalysis

Physical Exam
Color Yellow brown
Consistency Rice-watery
Microscopic exam
NOPS
WBC 6-10/HPF
RBC 0-2/HPF

Gram Stain

• Gram negative curved rods

• Facultative anaerobe
• Non- spore forming
• Motile (shooting star motility)
• (+) Oxidase
• (-) Nitrate Reduction

Culture media

TCBS BAP MAC

String Test
 LORMA COLLEGES
Carlatan, City of San Fernando, La Union
COLLEGE OF MEDICAL LABORATORY SCIENCE

Biochemical Test

(+) OXIDASE TEST

TSI A/A
(+) LYSINE DECARBOXYLASE
CHOLERA RED TEST
(+) ORNITHINE DECARBOXYLASE
 LORMA COLLEGES
Carlatan, City of San Fernando, La Union
COLLEGE OF MEDICAL LABORATORY SCIENCE

CASE STUDY NO. 2

Case Narrative:

A rectal sample submitted by a 2005 Nobel Prize in Physiology awardee, Barry

Marshall is said to contain this organism: Note that is under an electron microscope. As
observed, the helical bacteria lacks peptidoglycan but, exhibits lophotrichous flagella thus
conforms to a possibility of motility.

Barry Marshall, out to his own curiosity proceeded to a test known as antibody panel. He is blood type A,
Rh positive. Furthermore, a Sciana, Lewisb, and Diego antibodies positive. Patient history suggests that he is a mad
scientists performing tests, even submitting himself as the lab guinea pig. His biggest “achievement” is ingesting
an unknown bacteria. He later noticed frequent dull pain in the stomach but the most observed symptom is his heart
burn and acid reflux, intense hyperchlorhydria develops.

From rectal culture, the scientist tested biochemically his small, translucent, circular colonies isolated from
microaerobic Chocolate agar, Brucella agar with 5% sheep blood, and Modified Thayer Martin and results are as
follows:
OXIDASE POSITIVE
CATALASE POSITIVE
UREASE STONGLY POSITIVE
H2S NEGATIVE
CEPHALOTHIN SUSCEPTIBLE

After metronidazole treatments, he became well and good.

CBC:

WBC: Elevated

Blood Chemistry :

Fasting glucose: 4.0mmol/L (NV:3.9 to 5.6 mmol/L)

Total cholesterol: 150 mg/dL (NV: <200mg/dL)
Triglycerides: 120 mg/dL (NV:<150mg/dL)
HDL: 50 mg/dL (NV:<40mg/dl but not >60mg/dl)

Histopathology:

Epithelial collapse, possible of exposure to extremely acidic environment.

Clinical microscopy:

Fecalysis: WBC: 11-23/hpf ; RBC: 5-19/hpf ; NOPS

 LORMA COLLEGES
Carlatan, City of San Fernando, La Union
COLLEGE OF MEDICAL LABORATORY SCIENCE

CASE STUDY NO. 3

Case Narrative:

Dyre, a 70-year old retired teacher was rushed to the hospital after suffering from intense neck, back and chest
pain, lightheadedness, nausea and blurred vision. She was diagnosed with diabetes mellitus and acute irradiated
myocardial infarction.

Three weeks after the diagnosis, the patient experienced anxiety, dizziness, nausea, shortness of breath and
sweating associated with continuous and worsening body pain, especially in the chest. The physician examined
the patient and discovered that the patient’s coronary arteries are narrowed by a blood clot. Thus, a need for an
open heart surgery was scheduled. After the operation, she was admitted in the ICU requiring intubation for
respiratory support. Two days after the surgery, physicians observed deterioration of the patient’s lung function.

PHYSICAL EXAMINATION (POST-OPERATION)

RESULT NORMAL VALUE
TEMPERATURE (⁰C) 38.6 35.8-37.0
BLOOD PRESSURE (mmHg)
 SYSTOLIC 135 90-132
 DIASTOLIC 90 60-85
PULSE (beats per min) 65 60-100

CHEST CARDIOGRAPH

Interpretation:
 Persistent Lung Opacity

SPECIMEN:
BAL specimens were collected and analyzed by culture. Blood was also taken for laboratory examination.

Gram Staining was performed from the BAL specimen. It was further incubated on BAP and MAC at 37°C for 48
hours. Selective Media Isolation and Antimicrobial Susceptibility Testing were also done.
 LORMA COLLEGES
Carlatan, City of San Fernando, La Union
COLLEGE OF MEDICAL LABORATORY SCIENCE

The Gram Stain results showed the presence of gram negative rods. After incubation, colorless colonies were
observed in MAC and smooth, round, green colored colonies showing β-hemolysis were seen on BAP. Colonies
manifest a distinct fruity, grape-like odor.

GRAM STAIN

BAP

MAC
 LORMA COLLEGES
Carlatan, City of San Fernando, La Union
COLLEGE OF MEDICAL LABORATORY SCIENCE

SELECTIVE MEDIA

NUTRIENT AGAR

CENTRIMIDE AGAR

BIOCHEMICAL AND CARBOHYDRATE UTILIZATION TEST:

UNI-N/F-TEK PLATE

OXIDASE Positive
PYOCYANIN Positive
FLUORESCEIN Positive
METHYL RED Negative
VOGES-PROSKAUR Negative
LYSINE DECARBOXYLASE Negative
AESCULIAN HYDROLYSIS Negative
ARGININE DIHYDROLASE Positive
CITRATE UTILIZATION Positive
GLUCONATE PRODUCTION Positive
MOTILITY Positive
 LORMA COLLEGES
Carlatan, City of San Fernando, La Union
COLLEGE OF MEDICAL LABORATORY SCIENCE

FLAGELLA Polar Monotrichous

GROWTH ON 42⁰C Positive

ANTIBIOTIC SENSITIVITY TEST:

GENTAMICIN Resistant
AMPICILLIN Resistant
TETRACYCLINE Resistant
TOBRAMYCIN Resistant
CEFOTAXIME Resistant
CIPROFLOXACIN Resistant
LEVOFLOXACIN Resistant

LABORATORY ASSESSMENT:

HEMATOLOGY
RESULT NORMAL VALUE
HEMOGLOBIN (g/dL) 10.6 12.0-15.5
HEMATOCRIT (%) 32 37-47
WBC 8.62 5-10
 SEGMENTERS 0.78
 LYMPHOCYTES 0.13
 EOSINOPHILS 0.04
 MONOCYTE 0.05
PLATELET 354 150-450
CLINICAL CHEMISTRY
SODIUM (mmol/L) 141 136-145
POTASSIUM (mmol/L) 4.6 3.5-5.1
CREATININE (µmol/L) 101.66 49-90
GLYCATED HEMOGLOBIN (%) 7.8 4.0-6.3
CLINICAL MICROSCOPY
COLOR Yellow
TURBIDITY Turbid
PROTEIN 1+ 0
GLUCOSE 3+ 0
WBC 8-10 0-1/hpf
RBC 6-8 0-1/hpf