CASE STUDY 4

Particulars of Patient
Name: Tong Wei Hong
Sex: Male
Age: 68 years old

Clinical Diagnosis
Signs and symptoms: Fever, chills, excessive phlegm, breathing problems Diagnosis: Bronchitis
Specimen collected: Sputum

Description of Bronchitis
Bronchitis is an inflammation of the bronchi (medium-size airways) in the lungs. Acute bronchitis is usually caused by viruses or bacteria and may last several days or weeks. Acute bronchitis is characterized by cough and sputum (phlegm) production and symptoms related to the obstruction of the airways by the inflamed airways and the phlegm, such as shortness of breath and wheezing. Diagnosis is by clinical examination and sometimes microbiological examination of the phlegm.

Chronic bronchitis is not necessarily caused by infection and is generally part of a syndrome called chronic obstructive pulmonary disease (COPD); it is defined clinically as a persistent cough that produces sputum (phlegm) and mucus, for at least three months in two consecutive years.

Possible Causative Agents

1. Adenovirus
Non-enveloped double-stranded linear DNA
Icosahedral nucleocapsid with a fiber protruding from each of the 12 vertices
Causes Bronchitis in the lower respiratory tract

2. Bordetella
Small, coccobacillary, encapsulated gram negative rod
Restricted to the respiratory tract (negative blood culture)

3. Haemophilus influenzae
Non-motile gram-negative coccobacillus
Found in the upper respiratory system of humans
Major cause of lower respiratory tract infections, associated with pneumonia

4. Moraxella catarrhalis
Gram-negative, aerobic, oxidase-positive diplococcus
May colonise and cause respiratory tract-associated infection in humans
Known to cause Bronchitis

5. Streptococcus pneumoniae
Gram positive lancet-shaped cocci
Arranged in pairs or short chains
Higher mortality in persons aged 65 and above


Investigations
The colour of the sputum may indicate the kind of microorganism in the sputum; yellow to green may indicate bacteria while white may indicate viruses. The sputum should be cultured to isolate the microorganisms listed above. In addition,

Biochemistry
-Gram staining
-Citrate test
-Catalase test
-Oxidase test
-Urease test

Microbiology
-Culture aerobically on blood agar plates

Antibiotic Suspectibility testing

Serology (Virus detection)
-Enzyme-Linked ImmunoSorbent Assay (ELISA)
-Haemagglutination


References
www.wikipedia.org > English > search > Bronchitis
www.wikipedia.org > English > search > Adenovirus
www.wikipedia.org > English > search > Bordetella
www.wikipedia.org > English > search > Haemophilus influenzae
www.wikipedia.org > English > search > Moraxella catarrhalis
www.wikipedia.org > English > search > Streptococcus pneumoniae


Desmond Heng
0503179D