Monday, 3 December 2007

MMIC - case 4

Name: Tong Wei Hong
Age: 68 yrs old
Sex: Male

Complaints: Fever, chills, excessive phlegm, breathing problems
Diagnosis: Bronchitis
Specimen: Sputum

Bronchitis is a respiratory disease in which the mucous membrane in the lungs' bronchial passages becomes inflamed. As the irritated membrane swells and grows thicker, it narrows or shuts off the tiny airways in the lungs, resulting in coughing spells accompanied by thick phlegm and breathlessness. There are two main types of bronchitis: acute and chronic.

- Several viruses cause bronchitis, including influenza A and B.

- A number of bacteria are known to cause bronchitis, such as Mycoplasma pneumoniae.

- Bronchitis also can occur when you inhale irritating fumes or dusts. Chemical solvents and smoke, including tobacco smoke, have been linked to acute bronchitis.

- People at increased risk both of getting bronchitis and of having more severe symptoms include the elderly, those with weakened immune systems, smokers, and anyone with repeated exposure to lung irritants.

Microorganisms commonly isolated from sputum include:
- Streptococcus pneumonia,
- Haemophilus influenzae
- Staphylococcus aureus
- Legionella pneumophila
- Mycoplasma pneumonia
- Klebsiella pneumoniae
- Pseudomonas aeruginosa
- Bordetella pertussis
- Escherichia coli

Cultures and tests are done on the sputum to help identify the bacteria that are causing an infection in the lungs or the airways (bronchi).
· Bacterial culture - gram stain or acid fast stain of the sputum done at the same time can help make the diagnosis.

· Fungal culture - The sputum sample is spread on special culture plates that will encourage the growth of mold and yeast. Different biochemical tests and stains are used to identify molds and yeast. Cultures for fungi may take several weeks.

· Viral culture - sputum is mixed with commercially-prepared animal cells in a test tube. Characteristic changes to the cells caused by the growing virus help identify the virus.

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