HES 032- Microbiology and Parasitology
College of Nursing – RADL (AY 2021-2022)
Laboratory
Case Analysis (Week 3)
Group Activity
Case 1
Dr. Tokyo is a surgeon and has a private clinic at SWUMed. This morning, he arrived late to work
because he had to take his sick son to his mother's house and drop off his dog at the vet
because of an ear infection. When Dr. Tokyo arrived at the clinic, many patients were waiting
for him, so he immediately consults his patients. At one point, he thought about washing his
hands, but he felt guilty about coming to work late and did not want to keep his patients
waiting any longer. Besides, his hands did not look dirty.
After reading the case history, consider and answer the following questions:
1. What are the potential risks that the physician is taking in spreading germs to his
patients? List the possible infectious diseases that can be transferred to the patients?
2. Explain the importance of handwashing and the use of an appropriate antiseptic.
3. As an infection control nurse in the future, plot a control plan to minimize the risks to
the patient.
Case 2
Bright V., a 29-year-old male, presented to the
emergency room suspected of myocardial
infarction. The patient's past medical history
was significant for hypertension,
hypercholesterolemia. He developed septic
shock with acute renal and respiratory failure
requiring intubation on the ninth day in the
hospital. On CBC, it revealed an increase in
WBC count. Two blood cultures were obtained.
On the 12th day in the hospital, pus was noted
to be seeping from his sternal wound. The
blood drainage from his chest tube, tracheal
aspirates, pus from his sternal wound was
cultured. The bacterium isolated from the
specimens was a gram-positive, catalase-positive, coagulase-positive coccus resistant to
methicillin.
After reading the case history, consider and briefly answer the following:
1. Identify the causative agent. [State the Gram stain and morphology]
2. What is the mode of entry of the agent, and how does it spread within the body and
from person to person?
3. Briefly explain the host response to the infection.
4. Briefly discuss the disease pathogenesis.
5. Why do the doctors request two blood cultures? What is the purpose?
6. Based on the standard precaution, how do you tagged this patient?
7. How do you manage the patient's disease? How can you prevent it?
Case 3
D. Rodman, a 50-year-old man, is brought
to the emergency room with a cough
productive of bloody sputum. He first
noticed a cough approximately two
months ago, but there was not much
sputum; just recently, his sputum
production has increased, and it is mixed
with blood in the past. He also notices he
lost weight, and at night his sweat is
drenching. Upon history taking, he
admitted that he is a heavy smoker. His
vital signs are normal on physical
examination, and no palpable adenopathy
in both neck and axilla. Upon auscultation
of the lungs, there is a decreased breath
sounds diffuse. A chest X-ray shows a
cavitary infiltrate of the left upper lobe (See
picture).
After reading the case history, consider and briefly answer the following:
1. What is your final diagnosis?
2. Identify the causative agent. Describe its microscopy.
3. Mode of entry. How does it spread within the body and to another person?
4. Briefly discuss the disease pathogenesis.
5. How do you distinguish sputum specimens from saliva?
HES 032- Microbiology and Parasitology
College of Nursing – RADL (AY 2021-2022)
Laboratory
6. As a nurse, state the disease management and prevention
7. Based on the standard precaution, how do you tagged this patient?
8. Briefly discuss the DOTS-TB program of the Department of Health. What is the impact
of this program on our country? And how is it beneficial to TB-positive patients?
Case 4
IU, a 28-year-old woman, was referred to
SWUMed reproductive health clinic because of
contact tracing in a case of chlamydia. She
recently had unprotected sexual intercourse,
had no symptoms. The doctor's assessment of
PE was normal. On pelvic examination, white
vaginal discharge was noted. A cervical swab
was obtained and tested for Chlamydia
trachomatis and Neisseria gonorrhoeae using
PCR (NAAT). The result is not detected or
negative. Examination on a wet mount of the
discharge showed a protozoan with
characteristic jerky motility. A stained smear
also showed pear-shaped trophozoite with
flagella (See picture).
After reading the case history, consider and briefly answer the following:
1. What is your final diagnosis? Identify the causative agent. Describe its microscopy.
2. Mode of entry. How does it spread to another person in both sexes?
3. Briefly discuss the disease pathogenesis based on its life cycle.
4. Can you isolate this agent in a urine specimen?
5. As a nurse, state the disease management and prevention.
Case 5
Ashin, a 35-year-old male, presents to the SWUMed ER with dyspnea, myalgia, rhinorrhea, and
high-grade fever. His symptoms started two days ago and are continuous and getting worse
but with minimal cough. The nurse in the ER wrote in the chart that the patient has no
significant past medical history and no routine medications taken. She had a flu vaccine three
days ago. Microbiologic examinations revealed negative for bacterial pathogen but positive for
influenza A.
After reading the case history, consider and briefly answer the following:
1. Identify the causative agent. What are the key virulence factors of this agent?
2. Mode of entry. How does it spread to another person?
3. Briefly discuss the disease pathogenesis.
4. What are the common complications associated with this infection that led to increased
morbidity and mortality? How are these complications diagnosed?
5. What antiviral drugs are available to treat this infection, and how do they work? Is there
any concern for antiviral resistance?
6. Identify prevention and control.
Case 6
A 5-year-old boy who lived in a slum area
in Cebu City presents to the ER with
abdominal pain and vomiting. He was ill for
a day, but his symptoms have worsened in
the past few hours, and his parents
panicked when they saw a reddish-yellow
worm in his vomitus. He has no significant
medical history and has taken no
medications. On examination, his abdomen
has high-pitched, tinkling bowel sounds on
auscultation and is diffusely tender to
palpation. An abdominal x-ray shows air-
fluid levels consistent with a small bowel
obstruction. Stool examination reports
revealed positive for parasite ova/egg
(unfertilized ova)
1. What is your final diagnosis? Identify the causative agent. Describe its microscopy.
2. Mode of entry. How does it spread to another person?
3. Briefly discuss the disease pathogenesis based on its life cycle.
4. What is the diagnostic and infective stage of this parasite?
5. As a nurse, state the disease management and prevention.
NOTE:
This is a group activity.
