MICROBIOLOGY TUTORIAL – 20/5/2022
1. Yes, Bacterial. WBC count shows leukocytosis,
2. GI tract: Symptoms are primarily of GI tract origin, Vaginal tract.
3. Used Tampons for her periods thus can because Infection can be associated with Tampon use.Also history taking of her family members experiencing same symptoms, what food she may eat.
In terms of sanitary use- because of menstruation infections
4. Yes, she did use tampons for her periods. Her blood pressure is low indicating that she may be
in shock. What are the types of shock you can encounter with infection?
Septic Shock - results from bacteria multiplying in the blood and releasing toxins.
Toxic Shock - It's caused by the release of toxins from an overgrowth of bacteria
5. Which shock do you think the patient is in and why did you come to that conclusion?
Toxic shock syndrome affects menstruating women, especially those who use super-absorbent
tampons. She has the classical symptoms of toxic shock characterized by
•Fever higher more than (38.9°C) – patient’s fever was 39.9°C
•Low blood pressure – 76/45 Hgmm
•GI symptoms - diarrhea
•Erythematous rash
6. What type of infections can lead to Toxic shock syndrome? Toxic shock syndrome is caused
by strains of Staphylococcus aureus producing a toxin (TSST-1) Streptococcus pyrogenes
producing pyrogenic exotoxin A, B. or C.
7. I would consider obtaining blood, stool and also a skin sample since the patient has
erythematous rash.
8. The vaginal culture was positive for many catalase positive, Gram positive cocci. What
organism do you expect this to be? The organism is most probably Staphylococcus aureus.
9. The finding of many S. aureus in the vaginal tract is supportive but does not prove the
diagnosis of toxic shock syndrome. S. aureus can be normal vaginal flora in 8-10% of females,
although heavy vaginal growth of S. aureus is unusual.
10) Diagnosis: Toxic Shock syndrome and the causative agent is staphylococcus aureus.Vaginal
swab- Bacterial
11. Group A- Streptococcus pyrogenes (Beta haemolytic)
12. Beta- hemolysis- Transparent (clear), Alpha Hemolysis (Green color), Gamma HemolysisNo Hemolysis seen.
13. CAMP test- Christie-Atkins-Munch-Petersen test. CAMP test identifies group B
Streptococcus = Streptococcus agalactiae where there will be a distinctive arrowhead formed.
14. Staphylococcus aureus since the test was coagulase positive, vaginal swab revealed grampositive cocci and culture on blood agar revealed golden-yellow colonies.
15. Since the CAMP test was negative, you can rule out group B beta-hemolytic streptococcus =
Streptococcus agalactiae.
16. TSST-1 is a true exotoxin because it is secreted during cell growth rather than after cell lysis.
This toxin is a super antigen which activates T cells ,super antigens can activate 5-25 % of the
total T-cell population rather that 1-2% activated by the more physiological mechanism of
processed antigen causing excessive release of cytokines (IL-2, TNF), that leads to many signs
and symptoms of the illness.
17. Pathophysiology of Toxic shock syndrome (TSS) it is caused from intoxication by one of
several related Staphylococcus aureus exotoxins or Streptococcus pyrogenes producing
pyrogenic exotoxin A, B. or C. How does toxin leads to clinical manifestations? The exotoxins
produced by the bacteria causes the individual to experience the characteristic symptoms of the
syndrome, such as shock and fever.
18. Isolate is the etiologic agent of toxic shock syndrome, it should be demonstrated that the
isolate produced Toxic Shock Syndrome Toxin-1 (TSST-1)
19) The virulence factor shown in the patient was the use of tampons. It is speculated that
tampons act to absorb various ions including magnesium, providing optimal conditions for
production of toxic shock syndrome. It is known that toxic shock syndrome is produced under
low magnesium ion concentration. It is known that toxic shock syndrome is produced under low
magnesium ion concentration.
20) Tampons (especially super-absorbent varieties) that are left in the vagina for a long time may
encourage the bacteria to grow. Tampons can stick to the vaginal walls, especially when blood
flow is light, causing tiny abrasions when they are removed. Toxic shock syndrome can be a risk
of using tampons.
21) Though, there was a suspension of tampons sales but there also some ways in which a person
can get the toxic shock syndrome such as having cuts or burns on the skin, having a recent
surgery and having a viral infection, such as the flu or chickenpox. Therefore, toxic shock
syndrome was encountered.
22. Therapy- consists of fluid and electrolyte replacement and identification and drainage of any
focally infected site (abscess). Antibiotic therapy- based on the susceptibility pattern. Antibiotics
to be used nafcillin, oxacillin, dcloxacillin (penicillin), (Pecillin resistance- Mithicillin
(vancomycin, trim ethoprim)
23. Clinical manifestations- pneumonia, deep abscesses, osteomyelitis, endocarditis, phlebitis,
mastitis and meningitis. 23. Some other clinical presentations include Impetigo Deep infections:
(Abscess, Osteomyelitis, Cellulitis, Lung abscess etc) Toxic shock syndrome, Acute infective
endocarditis. Both Staphylococcus aureus and Streptococcus pyrogenes (group A strep) have
many enzymes which act as virulence factors allowing these bacteria to invade tissue from
patients with normal immunity and spread from infection at a local site to the bloodstream.