Answer_Key_Zoonosis_lab - Zoonoses Lab: Answer Key Case 1:...

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Zoonoses Lab: Answer Key Case 1: Brucellosis 1. What is the differential diagnosis of this syndrome? This is a presentation of a subacute, undifferentiated, systemic febrile syndrome. The epidemiology history is essential to addressing the differential diagnosis. The differential diagnosis on the basis of symptoms alone is very broad, and would include tuberculosis, brucellosis, malaria, endemic mycosis (coccidioidomycosis, histoplasmosis), cancer (generally hematologic malignancies) and a fairly long list of other possibilities. In this case, blood cultures yielded small, aerobic but CO2-loving, Gram-negative coccobacilli at day 8, finally identified as Brucella abortus by biochemical and molecular methods. A. What tests should be ordered immediately to rule out the most serious infections? Malaria smears, blood cultures, chest xray, consider bone marrow biopsy B. What other sites besides blood could be considered for culture? Bone marrow Malaria smears were negative. Bone marrow biopsy and aspirate showed erythroid and myeloid hyperplasia and poorly formed granulomas. No organisms were seen. Blood and bone marrow cultures were positive on day 5 for a small gram negative coccobacillus. . 2. What genus and species of bacteria do you think were cultivated from this patient’s blood and bone marrow? What other species of this genus cause human zoonoses? Brucella abortus from her probable exposure to unpasteurized cheese. Other modes of transmission include direct exposure to animal products of parturition, abortions, meat processing plants (occupational). Also laboratory accidents. Both modes of transmission can be prevented by animal vaccination. The other species include B. melitensis, usually from goats or sheep. Also, B. suis (pigs) and, rarely, B. canis (rough, no LPS) from dogs. Syndromes include systemic and focal, localizing disease (hepatitis, endocarditis, orchitis, spondylitis). 3. Why is this organism considered capable of being transformed into a bioterrorism agent? Brucellae are resistant to drying and can be easily aerosolized. As few as 10 inhaled organisms can cause disease . 4. Why should you tell the clinical microbiology laboratory that Brucella might be present in the patient’s body fluids?
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Without handling the organism under a hood and without a mask, Brucella cultures are most common cause of laboratory-acquired infections among microbiologists. 5.What are the approaches to confirming this patient’s diagnosis? How is this organism isolated for microbiological diagnosis? What are the principles of the serological tests used for diagnosis? Culture and Brucella agglutinins. Culture requires prolonged cultivation (using
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This note was uploaded on 09/14/2011 for the course PHARM mb taught by Professor Staff during the Spring '11 term at UCSD.

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Answer_Key_Zoonosis_lab - Zoonoses Lab: Answer Key Case 1:...

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