This week in lab we were given CSF samples that were plated on chocolate agar, SBA, and in thioglycolate broth. The source of the CSF was from a 19-year old male showing classic signs of meningitis. When I gram stained the CSF sample it was apparent that I had gram negative diplococci which led me to suspect Neisseria sp. The gram stain finding correlated well with the age and symptoms of my patient, considering Neisseria meningitidis is the most common cause of purulent meningitis in young adults. Unfortunately I was not able to make a definitive identification due to insufficient inoculation of the specimen used for the API NH...Lesson Learned!
In addition we were given a urine sample plated on SBA, MAC and Chromagar. One day #1 I invested too much time on the significance of the turquoise colonies that appeared on my Chromagar. The organism that shows this colony morphology on Chromagar is Enterococcus.
But the confusion set in when I checked out my MAC agar...
It may be hard to tell by this picture but it appeared I had a NLF gram negative rod! Hmmmm, definitely wasn't the gram positive cocci Enterococcus. So after much confusion and and searching through flowcharts I set up an API 20E for definitive identification of my organism.
Day #2:
The next day when I arrived in lab I check out my MAC and Chromagar plates again. Things started to make more sense.
It was revealed that I had a slow WLF on MAC, which alleviated some of the confusion. And secondly, my colonies on Chromagar were metallic blue, suggestive of Citrobacter sp. It was starting to come together!
My suspicions were confirmed by the API 20E results. Phew! So, as Dr Greenup would say...it's time for reflection. My experience in lab this week taught me that when working with living organisms things may not always go by the book (or be what they seem). Identifying organisms is tricky. It takes patience, diligence, and experience!
Also I found a paper that summarizes clinical bacteriology quite well. It has some helpful flow charts that you may find useful when studying for your certification exam.
http://pmj.bmj.com/content/77/905/148.full
See you all next week!
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