Sometimes we tend to detach ourselves from the reality that diseases can at any time afflict us, the ones we know, or those we love. We place around us an invisible protective shield of denial. The reality is that at any time we can and will have some type of disease process afflict us. Rarely is anyone spared. But armed with knowledge we can limit our chances of acquiring diseases. In the end how we are affected by a disease process will be determined by a multitude of factors. And those factors may ultimately determine whether the outcome of the disease process results in an uneventful recovery, morbidity, or mortality.
When we think about all the advances in healthcare and the knowledge of disease processes that have accumulated over the history of mankind, we have certainly come a long way. Improved sanitary conditions, antibiotics and vaccines have saved millions of lives. In addition, the recognition of risk factors both behavioral and environmental have provided us with the preventative knowledge base that is invaluable in the prevention of disease processes. And yet some diseases are of bad genetic luck. Most of us however have the decision making knowledge to not fall victim.
But alas we are human. Armed with knowledge we still run against what is proven to be true because of whatever reasoning we may have manufactured. We know texting and driving kills, but at any time driving down a highway we can see people texting and driving. We know that vaccines prevent disease, but we fail to immunize because of unfounded fears or listening to the rants of some charlatan calling themselves a doctor. Drugs of abuse destroy and kill, but we in the United States consume more than any other country. We know that unprotected casual sex is a gamble not worth taking, but millions still do. Cigarettes kill yet we still are willing to buy them at exorbitant prices and smoke them. The list goes on and on. Humanity is in away the ultimate paradox.
So, what does this have to do with this particular case study? Many of my past case studies are fictional vignettes while others are real life case studies that I have experienced in whatever laboratory I was working in. What is true about all the cases is that they involve humans that all have strengths and weaknesses that we all have in varying degrees. It’s what makes us all complex and different from one or the other. For better or for worse. This particular case study was a real-life experience, and an unfortunate one at that.
Many years ago, I had taken another job and was working close to 80 hours a week. I would work the first shift in one laboratory and drive a half hour to another and work the second shift. It was, to say the least, absolutely a terrible life schedule. But as I alluded to earlier, we humans tend to not do what is logical or correct sometimes. I had failed in my marriage and was having to pay the piper. Taking responsibility.
I became friends with the laboratory manager within the second week. He would stop in and chat with me and ask how things were going. It wasn’t a very long chat but nevertheless he seemed genuinely interested with the second shift personnel and the workload. I was unaccustomed to having a laboratory manager be as dedicated and concerned as he was.
About two months into the job, I was working one night when a delivery of specimens came in from the emergency room. I started to open and inspect each specimen to match with each requisition when I noticed it was the laboratory managers name on the specimens and requisitions. There were two sets of blood cultures, RSV and Flu tests, and two bronchial aspirates for culture.
I proceeded to process the blood culture into the blood culture instrument. I performed some rapid testing for RSV and influenza which were both negative. The bronchial specimens were cultured and Gram stains performed. The Gram stains were positive for white blood cells and no epithelial cells however there were no organisms present in significant numbers. It was odd to me that such a purulent and good specimen had no visible presence of organisms.
A physician from the emergency room called later that night requesting that I perform a silver stain on the bronchial specimen. The results of the stain are illustrated in the representative photograph below.
The patient was transferred to the intensive care unit and unfortunately expired on his third day there.
Can you answer the following questions pertaining to this clinical case study?
- What is the diagnosis of this patient based on the silver stain result?
- What are the predisposing factors to acquiring this parasitic disease?
- How is this parasite classified?
- What is the standard treatment for this parasitic disease?
Leave a Reply