**CASE DISCUSSION # 2 

(**A case of Sepsis with unidentified microbe using conventional

methods.)

A 41-year-old Filipino man was admitted with a 3 day history of high fever and dry cough. His
initial symptoms progressed to include headaches, muscle aches, and confusion. Past history was
unremarkable except for being a chain smoker for the last 15 years. He had recently started
working in a home improvement center in the show room area with whirlpools and spas.

Vital signs: T 40 C, R 40/min, P 88/min, BP 110/60 mmHg

PE: A distressed patient with respiratory rales. He had a cough that was productive of scanty,

clear sputum.

CBC within normal except for WBC of 16,000

Chest X-ray showed patchy interstitial infiltrates on bilateral lower lobes.

Gram stain of sputum negative for Strep pneumonia,

PCR for viruses, Chlamydophila pneumonia and Mycoplasma pneumoniae negative.

The patient was admitted to the hospital. Bronchoalveolar lavage specimen and blood were
collected for microbiologic examination. The gram stain revealed a few polymorphonuclears but
no bacteria. Culture of the bronchoalveolar lavage specimen remained negative for 1 week, on
the other hand, cultures and work up sent to a referral center revealed Legionella pneumophila.

Guide Questions:

What bacteria are considered fastidious? Give the reasons why.

List bacteria which are intracellular and needs specialized equipment like MaldiTOF or special
culture media.

What is the principle of the Vitek machine? How about the MaldiTOF? Or the Direct or Indirect
Fluorescent Method ? what is the specificity of each? Is PRC highly specific? Give your
references(Do not give non-medical references).

If the gram stain yields a microbe but its not culturable in the hospital setting, will you use
empirical antibiotic treatment basing on the gram stain reaction? What is your opinion based on
your readings? State your references(Do not give non-medical references)

Give the reason why Legionella pneumophila did not grow on the conventional culture medium.