Current Topics in Clinical Microbiology

Elmer W. Koneman, MD; Christie A. Grueser MSS, MT

Nine interactive microbiology case studies by Dr. Elmer Koneman, covering practical topics such as ESBL-producing bacterial strains, MRSA, Clostridium septicum enteritis, and many others. Perfect as CE for busy clinical microbiologists.

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Continuing Education Credits

• P.A.C.E.® Contact Hours: 6.5 hour(s)
• Florida Board of Clinical Laboratory Science Credit Hours: General (Microbiology/Mycology/Parasitology): 6 hour(s)

Objectives

• Overall Objective 1: To provide home access to on-line clinical microbiology case studies.
• Overall Objective 2: To correlate the clinical histories of select bacterial infectious diseases with laboratory culture results.
• Overall Objective 3: To provide home-base, on-line opportunities to acquire continuing education credits.
• Learning Objectives: At the completion of this case study review, the student will be able to:
• 1. Correlate presenting clinical signs and symptoms with the organism identifications for the cases being presented.
• 2. Outline the presumptive and definitive characteristics for the laboratory identification of the bacterial species being presented.
• 3. Discuss the diagnostic and therapeutic implications of making a correct organism identification.
• 4. Recommend key current literature citations for each of the infectious diseases and bacterial species included in the program.

Course Outline

Click on a link in the outline to view a sample page from this course.

• Acute urethral discharge
• Clinical history
• A 25 year-old female presented in the emergency room with an acute urethral discharge of 2 days dura
• Lab ID presumptive
• The positive oxidase reaction as shown in the photograph (yellow arrow) rules out the following two
• The Superoxol Test
• Lab ID definitive
• The carbohydrate utilization reaction seen in the QuadFerm system shown in the picture provides a de
• Literature Reviews and Queries
• Review 2
• Acute gonorrhea is the most common cause of septic arthritis in patients under 30 years of age.
• The recovery of an oxidase-positive, gram-negative diplococcus that tests DFA-nonreactive should be
• Acute onset pneumonia
• Clinical History
• Acute Onset Pneumonia
• The Gram stain report to be issued based on the microscopic characteristics seen in the accompanying
• Based on the gram stain morphology observed before, the possible presumptive identifications might i
• Laboratory Identification
• The patient was admitted to the hospital. The sputum specimen was inoculated to sheep blood agar.
• The name of the rapid test as illustrated in this photograph, often used to differentiate S. pneumo
• The zone of inhibition around the disk shown in the photograph has been measured at 23 mm. Based on
• The oxacillin screen test alone is not sufficient for determining the susceptibility to penicillin
• MIC susceptibility tests should also be performed against other select beta lactam antibiotics on im
• Pneumococcal Resistance
• Literature Reviews and Queries
• Review 2
• Streptococcus pnemoniae is the most common cause of fatal community-acquired pneumonia.
• Middle ear damage in cases of S. pneumoniae infections are caused primarily by:
• Pneumococcal vaccine is particularly effective in children less than two years of age.
• Gram-negative sepsis
• Clinical History
• Clinical History
• Laboratory Identification
• The colonies shown in the blood agar (upper) and MacConkey agar (lower) biplate are a 24 hour growth
• The reactions seen in the portion of the API strip shown in the photograph, effectively rules out Es
• Clinical isolates of Escherichia coli and Klebsiella pneumoniae may possess ESBL activity. Therefor
• ESBL Activity
• Extended Spectrum Beta Lactamases
• Literature Reviews and Queries
• Review 1
• The prevalence of ESBL's may be underestimated because NCCLS has set resistance break-points too lo
• The hands of hospital personnel represents one of the major reservoirs for the persistence and poten
• Recurrent urinary tract infection
• Clinical History
• Clinical History
• The bacterial species shown growing on 5% sheep blood agar was recovered from the spun sediment of a
• Laboratory Identification
• PYR Differential
• The spot test that is helpful in separating Enterococcus species (positive as shown in the photograp
• Enterococcus ID
• Enterococcus faecium ID
• Vancomycin Resistance
• Illustrated in this photograph is a quadrant plate containing brain heart infusion agar plate supple
• Literature Reviews and Queries
• Review 1
• Review 2
• The most important modifiable risk factor for enteric colonization with vancomycin-resistant Enteroc
• Acute enteritis with sepsis
• Clinical History
• Case History
• Gas gangrene may be seen in infections with all the following clostridia except:
• Laboratory Identification
• The gram stain shown in the photograph was prepared from a positive anaerobic blood culture bottle a
• Colony Morphology
• Clostridium Quad Plate
• Clostridium septicum RapID ANA
• It is important to establish a species identification of C. septicum in blood culture isolates becau
• Literature Reviews and Queries
• Review 1
• Review 2
• Review 3
• Match the species of anaerobes and frequently associated conditions.
• Each of the following statements is true concerning Clostridium septicum infections except:
• Post Traumatic Wound Infection
• Clinical History
• Clinical History
• A gram stain of the serous exudate is shown in the photograph. The appropriate report would read:
• Laboratory Identification
• Staph on BA
• The bacterial cells shown in the photograph were observed in a smear prepared from the colony shown
• The tube coagulase test, shown in this picture (upper tube positive), should be performed on all S.
• Staph aureus Mannitol
• Testing for Methicillin Resistance
• MRSA Screen
• MRSA Disk Test
• Literature Reviews and Queries
• Review 1
• Review 2
• Review 3
• Factors predisposing to infections with methicillin resistant Staphylococcus aureus (MRSA) include:
• Decreasing the risk of staphylococcal colonization of indwelling catheters in the future may involve
• Patients with infections with MRSA have uniformly poorer outcomes than those infected with sensitive
• The staphylococcal toxins causing the scalded skin syndrome (SSSS) have as their site of action in w
• Splenic abscess
• Clinical History
• Spleen Specimen
• Laboratory Identification
• Illustrated in the upper photograph are tiny pinpoint 24-hour colonies recovered from one of the spl
• Most strains of S. milleri (anginosus) carry the F antigen (see photograph). Rare strains that carr
• S. milleri CO2
• S. milleri Biochemicals
• Literature Reviews and Queries
• Review 1
• Review 2
• Most infections caused by S. milleri (S. anginosus) can be effectively treated with penicillin or a
• The epidural and subdural abscesses in the two patients reported by Gelfand, et al, are clinical man
• A clinical condition often associated with Streptococcus milleri (anginosus) is:
• Cellulitis
• Clinical History
• Cellulitis Skin
• Laboratory Identification
• The Gram stain prepared from the positive blood culture is shown in the photograph. The appropriate
• Beta hemolytic colonies grew from the blood culture bottle after 18 hours incubation (see photograph
• Group A Strep A Disk/SXT
• Thus, in follow-up to the previous discussion, the reaction shown in the photograph establishes the
• Literature Reviews and Queries
• Review 1
• Review 2
• A major complication of toxic shock syndrome related to group A streptococci, leading to 50% mortali
• Factors related to the strong resistance of certain strains of group A streptococci to phagocytosis
• Neonatal meningitis
• Clinical History
• Clinical History
• Histology of Brain Biopsy
• A Brown and Brenn gram stain was performed on one of the tissue biopsy specimens. Organisms were se
• Laboratory Identification
• Colony Morphology
• Shown in the photograph is a close-in view of the colony growth after 48 hours incubation. Possible
• The test(s) which may be performed to establish a presumptive differential identification between gr
• Listeria gram stain
• Shown in the photograph are three tubes-(1) motility agar (note subsurface flare--see arrows); (2) e
• Listeria motility
• Literature Reviews and Queries
• Review 1
• Review 2
• Review 2
• Review 3
• Each of the following is related to the virulence of Listeria monocytogenes except:
• Each of the following factors has led to the current increase in incidence of listeriosis except:
• A characteristic of the virulence of L. monocytogenes is its unique ability to invade peripheral ner
• Cellulitis of the arm
• Clinical History
• Cellulitis Lesion
• Laboratory Identification
• Eikenella BAP
• A bacterial isolate that produces pitting of the agar and has a bleach-like odor is probably E. corr
• Eikenella - catalase & oxidase
• Eikenella biochemicals
• Most Eikenella cellulitis infections result from:
• In view of the feedback to the previous question, the clinical correlation does not seem to fit in t
• Literature Reviews and Queries
• Review 1
• Review 2
• Review 3
• Human bite wound infections are categorically more severe and more often lead to complications than
• To avoid infection with E. corrodens, patients with insulin-dependent diabetes mellitis (IDDM) are a
• We can conclude from Robinson & Kourtis' "Tale of the Toothpick", that, "it is unwise to place a u

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Additional Information

Level of instruction: Intermediate

Intended Audience: Medical technologists, and instructors experienced in bacteriology, graduate students in microbiology, clinical pathologists, and infectious disease physicians.

General Information: This program provides 10 outstanding interactive case studies which cover pertinent current topics in clinical microbiology. Numerous excellent photomicrographs enhance the text, and interactive questions help the student master the material.

Author Credentials: Elmer W.Koneman M.D. is Professor Emeritus, Department of Pathology, University of Colorado School of Medicine. Residing in Breckenridge,CO, Dr. Koneman is a Board Certified Pathologist, former full Professor of Pathology University of Colorado School of Medicine. He is author of numerous journal articles and books, including Color Atlas and Textbook of Diagnostic Microbiology, Fifth Edition,1997(Lippincott). Ms. Grueser and Dr. Koneman are both presently affiliated with Instructional Design Consultants, a consulting firm specializing in interactive training and distance learning for the clinical microbiology.

Current Topics in Clinical Microbiology Keywords

These are the most common topics and keywords covered in Current Topics in Clinical Microbiology:

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