Continuous medical education activities; Case No. 3

Ahmed Asaad
2020 Microbes and Infectious Diseases  
A 25-year-old male with a history of spina bifida in the lumbar region, type II diabetes mellitus, solitary left kidney, neurogenic bladder and bowel presented to the emergency department with fever, nausea, and vomiting. On examination, there were multiple sacral ulcers, with the largest stage 4 ulcer present on the left buttock and measuring 5 cm in diameter by 5 cm deep with purulent drainage. A swab specimen of the wound from the left buttock ulcer was initially sent for culture. Following
more » ... culture. Following processing and incubation in the laboratory, this culture grew seven different colony-types with no predominant type. A more representative specimen was requested. The patient was subsequently taken to the operating room for debridement. Tissue obtained during this procedure from the ulcer bed was sent for culture. The specimen was cultured on blood agar and chocolate agar. The media were incubated at 35°C in 5% CO 2 for 24-48 hours. Following incubation, there was a predominant growth of many tiny grey colonies on chocolate agar. These colonies were small and β-hemolytic on blood agar (To be continued). A 25-year-old male with a history of spina bifida in the lumbar region, type II diabetes mellitus, solitary left kidney, neurogenic bladder and bowel presented to the emergency department with fever, nausea, and vomiting. On examination, there were multiple sacral ulcers, with the largest stage 4 ulcer present on the left buttock and measuring 5 cm in diameter by 5 cm deep with purulent drainage. A swab specimen of the wound from the left buttock ulcer was initially sent for culture. Following processing and incubation in the laboratory, this culture grew seven different colony-types with no predominant type. A more representative specimen was requested. The patient was subsequently taken to the operating room for debridement. Tissue obtained during this procedure from the ulcer bed was sent for culture. The specimen was cultured on blood agar and chocolate agar. The media were incubated at 35°C in 5% CO2 for 24-48 hours. Following incubation, there was a predominant growth of many tiny grey colonies on chocolate agar. These colonies were small and β-hemolytic on blood agar (Figure 1) . At this point, the major consideration was a possible Streptococcus spp. A Gram stain, catalase test, and latex streptococcus grouping test to identify Lancefield streptococcal groups A, B, C, D, F and G were performed.
doi:10.21608/mid.2020.120153 fatcat:54lbgjzbsfhdnnzgkiccclggne