Case 1

A diabetic 56-year-oldman developed àskin abrasion on the hand

while working in a garden. After four days, he noticed swelling and
inflammationover the area of abrasion, followed by swelling of the
another
hand. There was a purulent discharge from the lesion after
two days. A Gram stain of the discharge and culture on bloodagar
showed positive for Gram-positive cocci in clusters.
Mention the causative organis1m and diagnosis.
Case 2

A I5-year-old boy returned from a birthday party and began vomiting

6-7hours later. There was no fever and the boy passed loose stools.
Six other children who had attended the party had reported a similar
illness. On further questioning the common dish that all the affected
children had consumed was found to be a pineapple pastry.

Mention the causative organism and diagnosis

Case 3

A seven-year-oldgirl presented with severe sore throat and fever up

to 39°C for the past three davs with difficulty in swallowing. She did
not complain of coryza or earache. On examination, she was found to
have bilatera tender submandibular lymphadenopathy, enlarged
tonsils and pharyngeal exudates. A culture of the throat swab wa
performed. The culture after 24 hours was positive for beta hemo
bytic colonies, which were shown to be Gram-positive cocci in short
chains, on smear examination.

Mention the causative organism and diagnosis

Case 4

Anine-year-old girl had developed fever dsore throat. and group A

stroptococci had been cultured from her throat. Three weeks later., she
developed pain and tender swelling of both knees and ankles: a
palpable effusion of the right knee was drained, which yielded straw
coloured fluid. Culture of the aspirate was negative. Simultaneous the
girl began experiencing shortness of breath. Physical examination and
chest x-ray suggested mild congestive heart failure.

Mention the diagnosis

Case 5

A60-year-old man was brought in with a history of high-grade fever

with chillsand rigors for the previous as two days. He also had mild
chest pain and productivecough. The sputum was submitted for
investigations. X-ray chest showed consolidation in the right lower
lobe. The direct smear observed after Gram staining showed pus cells
culture
with Grampositive, lanceolate-shaped diplococcic. Sputum
after 24 hourswas positive for a Gram-positive bacteria growing as
greenish colonies on blood agar.

Mention the causativeorganism

Case 6

five-year-old child was brought to the Emergency department with

A
seizures following grade fever. He had also had |-2
a history of
in the hospital, he
episodes of projectile vomiting. Onexamination
rigidity, and Kernig's sign
was found have altered sensorium and neck
positive. A lumbar puncture was done. CSF cytology showed
was
showed low glucose and
high countsof polymorphs, biochemistry
presence of Gram
raised proteins, and Gram smear showed the
polymorphs. The culture
positive diplococci, someof them inside the
sheep blood agar which
was positivefor alpha hemolytic colonics on
had the typical "draughtsman colonies appearance.
Mention the causative organism
Case 6

Afive-year-old child was brought to the Emergency department with

a history of seizures following grade fever. He had also had |-2
episodes of projectile vomiting. On examination in the hospital. he
was found have altered sensorium and neck rigidity, and Kernig's sign
was positive. Alumbar puncture was done. CSF cytology showed
high counts of polymorphs, biochemistry showed low glucose and
raised proteins, and Gram smear showed the presence of Gram
positive diplococci, some of them inside the poly morphs. The culture
was positive for alpha hemolyticcolonies on sheep blood agar which
had the typical "draughtsman colonies appearance.

Mention thecausative organism

 Page No.
Datal

Case 7

Afive-ycar-old child
presented to the pediatrics outpatient
department with a history of pain in the throat and difficulty in
swallowing. He had had |low-grade fever for the past two days. On
examination, he was found to have cervical lymphadenopathy, and
the tonsillar pillars were covered by a
grey-white discharge. His
vaccination card showed that the child's immunisation was not
complete. A throat swab was collected and submitted for microscopy
and culture. Albert's stain showed the
presence rod-shaped
of
bacteria, green in colour, with bluish-black granules.
Mention the causative organism
Case 8

A25-year-old woman consulted her family physician,

complaining of
frequency of urination and dysuia. After (wo days of' no relief,
followed by fever with chills for the last 24 hours, she visited the
outpatient department a hospital. Microscopic analysis of urine in the
laboratory showed the presence of pus cells of>lper
field in an uncentrifuged specimen, and no
high-power
casts. Urine culture by
semi-quantitative method grew >10°/CFU/ml of lacto fermenting
colonies.

Mention the causative organism

Case 9

An adult male was admitted to the ICUfollowing a road traffic

accident. He was put on a ventilator due to respiratory distress. On the
third day, hiscondition worsened with symptoms of high fever and
pneumonia. A blood culture yielded growth of lactose-fermenting
mucoidcolonies and were multidrug resistant.

Mention the causative organism

Case 10

A 40-year-old man had travelled to aperipheral village in southern

Indiawhere he stayed for three days. After returning, he developed
abdominal cramps with mild fever which was followed by increased
frequency of stools with blood and mucus. He visited the hospital
where a stool sample was sent to the Microbiology lab. On
microscopic examination, short non-motile organisms with plenty of
pus cells were found and culture was positive for non-lactose
fermenting bacteria on MacConkey agar.

Mention he causative organism

Case 11

A 10-year-old boy was ad1mitted to the Pediatrics ward with a history

of remittent fever which increased gradually in a step-ladder pattern
over the previous 10 days. He had taken antipyretics
ciprofloxacin. prescribed by a local private practitioner. At
presentation to the hospital, he complained of lack of appetite, pain in
the abdomen and lethargv. On exami- nation, he was found to have

fever with anemia and hepatosplenomegaly. Ablood sample was

obtained for culture and serology. His blood culture was positive for
Gram negative rods, on Wilson and Blair bismuth sulphite medium.
jet black colonies with metallic sheen was observed. The Widal test
was negative.

Mention the causative organis1m

Case 12

A 10-year-old child from a

suburban slum presented to the Pediatric
Emergency department during the monsoons complainingof
diarrhea - frequency of 10-15 times for the profuse
previous two days - and
vomiting times the previous day. There was no
2-3
history of fever,
abdominal pain or passage of blood in stools. The child
of decreased urine output, complained
intense thirst and legcramps. On
examination, he was found to be moderately dehydrated. On
further
questioning, the family mentioned that some of the other
the slum were also suffering residents of
from a similar condition. The stool on
gross examination had a
characteristic 'rice water' appearance, and
was sent for direct
microscopy and culture. Hanging drop
examination was positive for bacteria showing darting
motility.
Case 13

young adult male aged 20 vears was admitted to Medicine

An
cvstic fibrosis. Very mucoid colonies with diffuse bluish
ward with
sputum culture. Gram
green pigmentation were grown in his
negative rods.
stained smear from the colonies revealed Gram
positive.
Catalase and oxidase test done from the colonies were
Mention the causative organism
 PageNo.
Data

Case 14

A
20-year-old
and
male who works as a
truck driver
Venereal Disease clinic with a presented to the Skin
for the previous 10 genital ulcer which was
days. He had had painless
a unprotected sexual contact with
commercial sex worker about two weeks
examination, the ulcer was found to be previously. On
partially healed. The inguinal circumscribed, indurated and
lymph nodes were enlarged.
Mention the causative organism
Case 17

course of Tetanus
In ANC period, a pregnant woman was given full
toxoid, sothat the baby can be protected from tetanus
neonatorum after delivery.

The type of immunity involved in thiscase was

 Page N
Date

Case 18

A
35-year-ol
with
d commercial sex worker
history of weight loss, presented to the medical OPD
expectoration for a decreased appetite and cough with
sputum AFB was
duration of one
month. Total WBC count
positive and graded 2t, was low;
What is the most
probable diagnosis?
Case study 4:

major soft tissue injury and open fracture of his

Ayoung man sustains examination the leg is swollen
motor cycle accident. On
right leg after
tense with thin dark serous fluid draining from the wound, crepilus
&
can be feel in his leg.
Case 4

nine-year-old girl had developed fever and sore throat, and group A
A
been cultured from her throat. Three weeks later, she
streptococci had
pain and tender swelling of both knees and ankles; a
developed
the right knee was drained, which yielded straw
palpable effusion of
Simultaneous the
coloured fluid. Culture of the aspirate was negative.
experiencing shortness of breath. Physical examination and
girl began
failure.
chest x-ray suggested mildcongestive heart

Mention the diagnosis

Case study 7:

A 23-year-old male having a history of sexual exposure with a

commercial sex worker is presented to a STD clinic with painless hard
indurated genital ulcer and painless hard lymph node.
Case study 5;
27 yr old female was come to OPD with H/o low grade fever, loss of
weight, chronic cough for past one month. Sputum examination
reveals long slender beaded bacilli.
Case study 9:
3-5 days following a bullet injury, aperson developed trismus
followed by muscle pain and stiffness, back pain, and difficulty in
swallowing. Excised tissue bits from the necrotic depths of the wound
revealed gram- positive bacilli with terminal and spherical spores.