Introduction
The Final Lab Project is an active-learning, problem-based activity that enables you to work collectively in a small group to diagnose an infectious disease and apply what was learned in this course. The goal of this final project is for you and your lab partners as a group to:
1. Come up with a valid diagnosis of the type of infectious disease seen in your case study and identify the bacterium causing that infection; and
2. Support your group’s diagnosis based on:
a. Any relevant facts in the patient’s history. (A reliable on-line source will be used to support this.)
b. The patient’s signs and symptoms. (A reliable on-line source will be used to support this.)
c. Each of the individual lab tests given in your case study.
d. All microbiological lab tests you performed as part of the project.
The due date for this report can be found on the class calendar. Remember, you are working as a group to solve a problem. Your grade for this lab is based on the completeness of your report and written evidence of the critical thinking process that went into making and supporting your diagnosis. Remember, you are trying to convince your instructor that you understand how the diagnosis was made by supporting that diagnosis with data.
Grading:
The Final Lab Project Lab Report is worth 52 points.
These case studies are based in part on your in-class participation as part of your group. Therefore:
a. If you were not in labs when the inoculations with your unknown were performed, 6 points from your Lab Report score for the Final Project.
b. If you were not in labs when the results of your lab tests were observed, 6 points from your Lab Report score for the Final Project.
c. For each day your Lab Report is late, 4 points from your Lab Report score for the Final Project.
You must write your own individual lab report.
Do not submit the same exact lab report as other members that worked in your group. That is plagiarism! The reports must be individually written!
You will first choose one of the unknown bacteria provided by your instructor. Look your unknown number up in the instructor’s case study key to determine which case study goes with your unknown.
The rubric that will be used to grade your Final Lab Project Report will be found under this Assignment on Blackboard.
Your name:
Your unknown number:
Your case study letter:
Your lab section:
Others in your group:
Be sure to handle all the bacterial cultures you are using in lab today as if they are pathogens! Be sure to wash and sanitize your hands well at the completion of today’s lab.
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Case Studies
Case Study A
A 66-year old female with a history of recurring urinary tract infections and multiple antibiotic therapies presents with frequency and urgency of urination, dysuria, suprapubic discomfort, unilateral costovertebral angle (CVA) tenderness, fever and chills, and nausea. She currently has a temperature of 103°F. A complete blood count (CBC) shows leukocytosis with a left shift. A urine dipstick shows a positive leukocyte esterase test, a negative nitrite test. Microscopic examination of centrifuged urine shows 30 white blood cells, as well as 7 red blood cells and 18 bacteria per high-power field.
Assume that your unknown is from the urine of this patient.
Case Study B
A 61-year old male who has type 2 diabetes, a history of alcoholism, and is a heavy smoker was admitted to the hospital with a leg wound that is not healing - for which he was previously treated for two weeks ago but was subsequently released against medical advice. He was brought to the ER by a brother who noticed he was febrile and appeared confused, disoriented, and anxious. He exhibits flushing and peripheral vasodilatation. He has a temperature of 102° F, a heart rate of 130 beats per minute, a respiration rate of 42 breaths per minute, a blood pressure of 90/40 mm Hg, a urine output of only 110 cc for the last 8 hours, and a total white blood cell count of 2500/µL with a marked left shift. Lactic acid levels measure 3.5 mmol/L.
Assume your unknown is from a blood sample.
Case Study C
A 78-year old female who for several days had a severe productive cough and chest pain when breathing deeply, is admitted to the hospital by her sister with whom she lives. Symptoms include confusion and agitation, difficulty in breathing, peripheral edema, and shaking and chills. She has a temperature of 96.1° F, a heart rate of 112 beats per minute, a respiration rate of 45 breaths per minute, a blood pressure of 105/60 mm Hg, and a total white blood cell count of 13,000/µL. chest X-ray reveals a right lower lobe infiltrate.
Assume your unknown is from a blood sample.
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Final Project Lab Report
1. Patient’s history and predisposing factors
Read the case study. Explain how any relevant parts of the patient’s history contributed to your final diagnosis as to the type of infectious disease seen here. The patient's history refers to anything given in the case study prior to that patient seeking medical attention for the current medical condition. You are urged to use the computers in lab to search reliable medically oriented Internet sources to support this. Reliable sources you might consider are Medscape (http://emedicine.medscape.com/infectious_diseases)
and The Centers for Disease Control and Prevention (CDC) at http://www.cdc.gov/. Cite any sources you use at the end of this Patient's History section in APA style (https://www.scribbr.com/apa-examples/website/).
The patient's history should suggest a general type of infectious disease that is present, such as a urinary tract infection, a wound infection, gastroenteritis, pharyngitis, pneumonia, septicemia, etc. Do not look up the bacterium you eventually identify as the cause of this infectious disease. You do not know the causative bacterium at this point. You need to determine the general type of infection in order to determine what microbiological tests to perform to identify the bacterium causing the infection. Search at least one medically oriented reference article from a reliable site such as Medscape and use this article to support your diagnosis of the type of infectious disease seen here. Don't forget to cite any sources you used in APA style directly under this Patient's History and Patient's Symptoms sections of this Lab Report.
2. Patient’s signs and symptoms
Read the case study. Explain how the patient’s signs and symptoms contributed to your final diagnosis as to the type of infectious disease seen here. Signs refer to anything being measured by a medical professional during a physical exam such as blood pressure, respiration rate, heart rate, oxygen saturation, and temperature. Symptoms refer to symptoms being reported by the patient. You are urged to use the computers in lab to search reliable medically oriented Internet sources to support this. Reliable sources you might consider are Medscape (http://emedicine.medscape.com/infectious_diseases)
and The Centers for Disease Control and Prevention (CDC) at http://www.cdc.gov/. Cite any sources you use at the end of this Patient's Symptoms section in APA style (https://www.scribbr.com/apa-examples/website/). Also see appendix F (SIRS and Sepsis) in your lab manual for an indication of whether or not the patient has SIRS.
The patient's signs and symptoms should suggest a general type of infectious disease that is present, such as a urinary tract infection, a wound infection, gastroenteritis, pharyngitis, pneumonia, septicemia, etc. Do not look up the bacterium you eventually identify as the cause of this infectious disease. You do not know the causative bacterium at this point. You need to determine the general type of infection in order to determine what microbiological tests to perform to identify the bacterium causing the infection. Search at least one medically oriented reference article from a reliable site such as Medscape and use this article to support your diagnosis of the type of infectious disease seen here. Don't forget to cite any sources you used in APA style directly under this Patient's History and Patient's Symptoms sections of this Lab Report.t.
3. Vocabulary list for medical terms used in the case study under signs and symptoms
List and define any medical terms used in your case study that describe the patients’s signs and symptoms that the average person not in the medical profession might not know.
4. Results of laboratory test given in the case study
List each lab test given in the case study that are done in a lab, such as total white blood count, differential white blood cell count, urinalysis, and X-ray, and explain how the results of that test helps to contribute to your diagnosis. Refer to appendix C (Complete Blood Count) and appendix D (Urinalysis) in your lab manual.
5. Gram stain
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Videos reviewing techniques used in this section:
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Give the Gram reaction (Gram-positive or Gram-negative and how you reached this conclusion) and the shape and arrangement of the unknown you were given. Remember that Staphylococci and Enterococci can look similar in a Gram stain when using a plate culture. If the result of the arrangement is inconclusive after seeing Gram-positive cocci, try doing the catalase test described in Lab 8 and state specifically how the results of the catalase test helped to confirm the arrangement. The catalase test will help you differentiate an Enterococcus from a Staphylococcus.
State how this contributed to your choice of microbiological tests and/or media to use next and why. The Gram stain is discussed in Lab 6.
Make sure you check your Gram stain results with your instructor before determining which microbiological lab tests you will perform.
6. Based on the results of your Gram stain, determine which of the following isolation media you will inoculate and why. Refer back to Labs 12, 14, and 15 to help determine your selection.
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Videos reviewing techniques used in this section::
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a. MacConkey agar (Lab 12)
b. Blood agar with NB disc (Lab 15)
c. Bile Esculin Azide agar (Lab 14)
Also inoculate a tube of Trypticase soy broth (TSB) with your unknown to be used next time for antibiotic susceptibility testing.
Inoculate each medium you chose, making sure to streak all petri plates for isolation. Incubate the plates upside down and stacked in the petri plate holder on the shelf of the 37°C incubator corresponding to your lab section. Incubate the TSB and Bile esculin agar tube (if used) in your test tube rack on the shelf of the 37°C incubator corresponding to your lab section.
Isolation Results
Explain why you chose to use or not use each of the isolation media.
a. Maconkey agar (Lab 12)
Why did you choose to use or not use this medium?
If you used this medium, describe the results of the MacConkey agar plate you inoculated with the sample from the patient.State specifically how this contributed to your decision as to what bacterium is causing the infection.
b. Blood agar with NB disc. (Lab 15)
Why did you choose to use or not use this medium and disc?
If you used this medium, describe the results of the Blood agar plate you inoculated with the sample from the patient. State specifically how this contributed to your decision as to what bacterium is causing the infection.
c. Bile Esculin Azide agar (Lab 14)
Why did you choose to use or not use this medium?
If you used this medium, describe the results of the Bile Esculin Azideagar you inoculated with the sample from the patient. State specifically how this contributed to your decision as to what bacterium is causing the infection.
7. Based on the results of your isolation media used in step 5 above, determine which of the following media you will inoculate or tests you will perform and why. Refer back to Labs 12, 14, and 15 to help determine your selection of media/tests and how to correctly perform the lab procedures.
a. Oxidase Test (Lab 12)
b. Cetrimide agar (Lab 12)
c. EnteroPluri-Test (Lab 12)
d. Mannitol Salt agar (Lab 15)
e. Coagulase test (Lab 15)
f. Bauer-Kirby antibiotic susceptibility testing on Mueller-Hinton agar (Lab 18)
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Videos reviewing techniques used in this section:
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Incubate the plates upside down and stacked in the petri plate holder on the shelf of the 37°C incubator corresponding to your lab section. Incubate the tubes in your test tube rack on the shelf of the 37°C incubator corresponding to your lab section.
Results of Additional Lab Media or Lab Tests Performed
Explain why you chose to use or not use each of the following tests or media.
a. Oxidase test (Lab 12)
Why did you choose to use or not use this test?
If you used this test, describe the results of the oxidase test and state specifically how this contributed to your decision of media to use.
b. Cetrimide agar (Lab 12)
Why did you choose to use or not use this medium?
If you used this medium, describe the results of the Cetrimide agar and state specifically how this contributed to your decision as to what bacterium is causing the infection.
c. EnteroPluri-Test (Lab 12)
Why did you choose to use or not use this test?
Using your Enterotube®II, identify the unknown you were given.
1. In the table below, put a (+) or a (-) in the Result row for each test.
2. Add up the value of each positive test in a group and put that number in the code for each group.
3. The 5 digit number is the CODICE number. Look that number up in the Codebook and identify your unknown.
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Group 1 |
Group 2 |
Group 3 |
Group 4 |
Group 5 |
Test |
Glucose |
Gas |
Lysine |
Ornithine |
H2S |
Indole |
Adonitol |
Lactose |
Arabinose |
Sorbitol |
VP |
Dulcitol |
PA |
Urea |
Citrate |
Value |
4 |
2 |
1 |
4 |
2 |
1 |
4 |
2 |
1 |
4 |
2 |
1 |
4 |
2 |
1 |
Result |
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Code |
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CODICE NUMBER: |
