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CASE STUDY
PATHOGENIC BACTERIOLOGY
2009
Edmund Yeo
Case # 52
Team Members:
Tania Guevara
Anthony Obisesan
CASE SUMMARY
Age: 39
 Intravenous Drug User
 Cellulitis of right arm after several weeks of fevers
 Used outpatient antibiotics without relief
 1-cm vegetation on ventral surface of the aortic valve
 2 sets of blood cultures obtained with microorganism
present
 “needle track” marks on upper and lower extremities
 Cardiac exam showed a grade II/VI systolic murmur
 Spleen tip was palpable
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DIAGNOSIS/ ISOLATION/
IDENTIFICATION OF
ENTEROCOCCUS
Gram stain
 Growth in CO2 rich environment on a variety of
media, including blood agar
 Able to survive in oxygen rich environments
 Growth in high salt concentration environment
 Hydrolization of esculin in the presence of bile
 Catalase negative
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CLASSIFICATION, GRAM STAIN
RESULTS, AND MICROSCOPIC
APPEARANCE OF ENTEROCOCCUS
Enterococcus species
 Gram positive cocci in chains
 Growth in broth containing 6.5% NaCl
 Hydrolyzed esculin in the presence of bile
 Catalase negative
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KEY INFORMATION POINTING TO
DIAGNOSIS
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Intravenous Drug Usage
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Opens up body to infections from blood infecting
organisms because of needle usage and open wounds
Antibiotic use without relief
 1-cm vegetation on aortic valve
 Gram stain
 Growth in high salt concentration broth
 Esculin hydrolyzation with bile present
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THE DIAGNOSIS FOR CASE # 52
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Endocarditis
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Caused by:
Enterococcus species (IVDU)
 HACEK organisms (IVDU)
 Candida albicans (IVDU, immunocompromised)
 S. aureus (IVDU, contaminated surgery, catheterisation)
 Pseudomonas species (contaminated water or drugs)
 S. bovis, Clostridium septicum (breakdown of barrier
between gut lumen and blood vessels that drain the bowel)
 Alpha hemolytic strep species (Dental work)
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DISEASES AND PATHOGENESIS OF
DISEASE CAUSED BY
ENTEROCOCCUS
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Diseases
Endocarditis
 Bladder infection
 Prostrate infection
 Epididymal infection
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Pathogensis
Adherance
 Platelet aggregation
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Causes swelling and inflammation due to cell aggregation
Tissue factor-dependant fibrin production
THERAPY, PREVENTION AND
PROGNOSIS OF PATIENT INFECTED
WITH ENTEROCOCCUS
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Therapy
 Vancomycin should be tested before administered
 Vancomycin resistant strains should be treated with Linezolid
Prevention
 Be careful with contaminated hospital equipment
 Stay away from street drugs, may be contaminated
 Don’t share needles, might have been used by infected person
Prognosis
 High doses of antibiotic should be administered through IV to
maximize the diffusion of the antibiotic into the bloodstream.
PRIMARY RESEARCH ARTICLE
CONTRIBUTING TO THE UNDERSTANDING OF
THE DISEASE CAUSED BY PATHOGEN X
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Ulrich Sagel, Berit Schulte, Peter Heeg, Stefan Borgmann, 2008,
“Vancomycin-Resistant Enterococci Outbreak, Germany, and Calculation
of Outbreak Start”, Emerging Infectious Diseases, vol 14: 317-319.
They observed incoming and outgoing patients with infections from
organism and set up a method to be able to calculate when an outbreak
would occur.
They found that their model of predicting outbreaks was accurate and
could be used to alert hospitals to increase their preparations in
admitting infected patients and to double check to make sure they do not
have or use contaminated tools.
This relates to the case because the patient in this case had been to the
hospital many times and was given antibiotics that had no effect on
relief. This would show that he might have a resistant strain of some
kind of bacterial infection that should have been checked up on.
TAKE HOME MESSAGE
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Endocarditis involves inflammation of the inner layer of the heart due to vegation of
platelets, fibrin, microorganisms, and inflammatory cells.
Typical symptoms are chills, cough, fever, fatigue, loss of appetite, weight loss,
sweating, muscle aches, and joint pains
Pathogen is Enterococcus
Diagnostics:
 Blood test for organism presence
 Gram stain
 Biochemical tests
Therapy is based on the strain of organism, which can have different resistances to
different antibiotics
Antibiotic sensitivity testing should be done on the organism, then once an effective
antibiotic is found, the patient should be treated with it.
To prevent infections of this type, avoid contaminated needles or drugs which give
the organism easy access to your bloodstream. Also double check hospital equipment
for cleanliness.
This pathogen can be transmitted in a variety of ways because it is able to live in
oxygen rich areas. It can be transmitted through any contact with infected blood
with open wounds.
Threat is medium to high dependant on the strain. Chance of microbial resistance is
high and increasing more and more, so it is getting harder to treat.
REFERENCES
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"Endocarditis - cardiologychannel." Cardiologychannel, Your Cardiology
Community - Physician-Developed - Cardiovascular Health Info cardiologychannel. 12 Mar. 2009
<http://www.cardiologychannel.com/endocarditis/index.shtml>.
"Enterococcus faecalis -." Wikipedia, the free encyclopedia. 12 Mar. 2009
<http://en.wikipedia.org/wiki/Enterococcus_faecalis>.
"Infective endocarditis -." Wikipedia, the free encyclopedia. 12 Mar. 2009
<http://en.wikipedia.org/wiki/Bacterial_endocarditis>.
Leboffe, Michael J., and Burton E. Pierce. A Photographic Atlas for the
Microbiology Laboratory. Null: Not Avail, 2004.
"The pathogenicity of enterococci -- Johnson 33 (6): 1083 -- Journal of
Antimicrobial Chemotherapy." Oxford Journals | Medicine | Journal of
Antimicrobial Chemotherapy. 12 Mar. 2009
<http://jac.oxfordjournals.org/cgi/content/abstract/33/6/1083>.
Sagel, Ulrich, Berit Schulte, Peter Heeg, and Stefan Borgmann.
"Vancomycin-Reistant Enterococci Outbreak, Germany, and Calculation of
Outbreak Start." Emerging Infectious Diseases 14 (2008): 317-19.