What are medical characteristics that doctors use to diagnose Pseudomonas aeruginosa infection? Is this case report caused by P. a?
Case Report: Unknown #2
A 65-year-old woman presented to the emergency department (ED) with headache and neck pain/stiffness that lasted 10 days. The patient's medical history was unremarkable. Initial vital signs included an arterial blood pressure of 120/70 mmHg, heart rate 80 beats/min, and body temperature of 37°C. Initial neurological examination revealed neck stiffness and a positive Babinski sign. An ECG and chest X-ray were unremarkable. Abdominal ultrasonography showed no active lesions. The patient indicated a previous diagnosis of diabetes mellitus.
The patient's initial white cell count was 16000/mm3 with a left shift and 4% band forms. Hemoglobin level was 13.1 mg/dL, and platelet count was 56000/mm3. Other abnormal laboratory findings were as follows: azotemia, metabolic acidosis, elevated erythrocyte sedimentation rate (ESR), prolonged prothrombin time, elevated fibrin degradation product, and positive D-dimer. The patient's overall clinical and laboratory findings clearly suggested the diagnosis of meningitis and concomitant disseminated intravascular coagulation (DIC). Fluid resuscitation and intravenous administration of empirical antibiotics (ceftriaxone and vancomycin) were started. A CT scan showed no abnormalities. Lumbar puncture was performed, and cerebrospinal fluid (CSF) sample showed the presence of 135 WBC/mm3 (89% neutrophils), protein, lactate dehydrogenase, lactate, and glucose 112 mg/dL versus blood glucose 514 mg/dL.
Four hours later, the patient became deteriorated. Intubation and ventilation were initiated. Unfortunately, she developed cyanosis and died 8 hours after arrival to the ED.
Only one of your unknowns is the causative agent of disease. Which do you believe it to be?
What are medical characteristics that doctors use to diagnose Pseudomonas aeruginosa infection? Is this case report caused by P. a?
Case Report: Unknown #2
A 65-year-old woman presented to the emergency department (ED) with headache and neck pain/stiffness that lasted 10 days. The patient's medical history was unremarkable. Initial vital signs included an arterial blood pressure of 120/70 mmHg, heart rate 80 beats/min, and body temperature of 37°C. Initial neurological examination revealed neck stiffness and a positive Babinski sign. An ECG and chest X-ray were unremarkable. Abdominal ultrasonography showed no active lesions. The patient indicated a previous diagnosis of diabetes mellitus.
The patient's initial white cell count was 16000/mm3 with a left shift and 4% band forms. Hemoglobin level was 13.1 mg/dL, and platelet count was 56000/mm3. Other abnormal laboratory findings were as follows: azotemia, metabolic acidosis, elevated erythrocyte sedimentation rate (ESR), prolonged prothrombin time, elevated fibrin degradation product, and positive D-dimer. The patient's overall clinical and laboratory findings clearly suggested the diagnosis of meningitis and concomitant disseminated intravascular coagulation (DIC). Fluid resuscitation and intravenous administration of empirical antibiotics (ceftriaxone and vancomycin) were started. A CT scan showed no abnormalities. Lumbar puncture was performed, and cerebrospinal fluid (CSF) sample showed the presence of 135 WBC/mm3 (89% neutrophils), protein, lactate dehydrogenase, lactate, and glucose 112 mg/dL versus blood glucose 514 mg/dL.
Four hours later, the patient became deteriorated. Intubation and ventilation were initiated. Unfortunately, she developed cyanosis and died 8 hours after arrival to the ED.
Only one of your unknowns is the causative agent of disease. Which do you believe it to be?
