Microbiology students

1. Case presentation
Mohd Bakar

2. Case history
• A case AA, 40 years male from Kigamboni Dar es
Salaam was admitted to emergency care at MNH
on 2nd May, 2023 with shortness of breath, cough
and fever
• Before arriving to MNH, the patient had periodic
fever and chest pain where he used to take
brufen for more than a month
Triage impression: Pneumonia suspect
Disposition : Infectious Disease

3. Management at MNH
Secondary survey
 Impression:
 Pneumonia viral Vs bacteria
DDx: PTB
 Sepsis r/o Malaria
DDx: Urosepsis
 Renal insufficiency r/o Electrolyte imbalance/A-B
disorder
Plan: CXR (done 4 days ago)
IV ceftriaxone

4. Management cont..
03/05/2023
Lab test results
HBV-was negative , HCV- was negative and HIV-
was negative
• Temp 39.4 0C
Provisional diagnosis
Atypical pneumonia
Drug induced liver injury
Treatment: IV Amoxyclav

5. Management cont..
03/05/2023
• Plan: Tests ordered
Sputum gene Xpert, culture
• Pt. isolated to ICU

6. Lab result and management
04/05/2023
Gene Expert test detected presence of MTB,
rifampicin resistance not detected
Sputum culture/fastidious culture was done
Gram stain was done

7. Lab result and management
Test /04/05/2023 Isolate AST
Fastidious culture Normal flora isolated -

8. Lab result and management cont..
Test/04/05/2023 Results
Macroscopy Purulent
Microscopy Polymorphs 10-25
Epithelial cells <10
Eosinophils Absent
GPC Absent
GNC Absent
GNB Absent
GPB Absent
Yeast Absent
Hyphae Absent

9. Management cont..
• WDx:
 Atypical pneumonia R/O disseminated TB
 Pulmonary embolism
 Drug induced liver injury
• Temp 38.5 0C
• Condition of Pt. Very sick
Plan:
 IV tazobactum
 Azithromycin tbs.
 Pt. was put in ventilator

10. Management cont..05/05/2023
• Revised Pt. in the ward ICU
• Pt. with c/c fever and DIB
• Current issue: Gene expert: MTB detected
rifampicin resistance not detected
• Plan:
• Start anti TB liver friendly
Ethambutol 1200mg od lovofloxacillin 1000mg
and clotomizin

11. Lab results and management in ICU..
• Clinical note: Pt. with TB and liver toxicity
Test /08/05/2023 Isolate AST
Blood culture
Aerobic blood culture No growth after 5 days -
Anaerobic blood culture No growth after 5 days -
Mid stream urine culture No growth after 24 hours -

12. Lab results and management in ICU..
Microscopy/08/05/2023 Organisms Results
GPC Absent
GNC Absent
GNB Absent
GPB Absent

13. Lab result and management
Clinical note: Pt. had cough and DIB
Other Clinical diagnosis
 Pulmonary oedema
 Pulmonary embolism
Test /11/05/2023 Results AST
Mid stream urine culture -
Blood culture No growth after 24 hours
Aerobic blood culture No growth after 5 days -
Anaerobic blood culture No growth after 5 days -

14. Working diagnosis 13/05/2023
• Ptb
Drug induced liver injury
Secondary viral pneumonia with superimposed
secondary bacterial infections
• Plan
Continue with anti TB
Meropeneme

15. Management cont..14/05/2023
Pt. status
Ptb
Resolving ARDS, Viral pneumonia with
superimposed bacterial co-infections
Plan
Continue with anti TB
Stop IV Meropeneme

16. Current status
• Pt. status: Improved
• Discharged to TB clinic

17. Challenges and Strengths
• Patient remain with spikes of fever and DIB
several investigation were done with no bacterial
isolated but Pt. was still in antibiotic and antiviral
• Strengths
• Gene Xpert test provided valid results leading to
successful improvement of Pt.