Looking through the positive blood cultures in the morning, the Microbiology Registrar noticed a set positive for Staphylococcus lugdenensis. There were no clinical details on the request form but checking the patient’s blood tests showed a high white blood cell count and C-reactive protein. There was clearly something going on so the registrar gave the ward team a call. The team said the patient was being treated for pyelonephritis with Gentamicin but further questioning revealed that they also had a prosthetic aortic valve. The registrar wondered whether the patient might have infective endocarditis but the team weren’t convinced at first. The registrar explained the risks and suggested repeating the blood cultures as well as asking the Cardiologists for an opinion about the possible diagnosis.
The GP sounded excited on the phone, “I’ve been told to ring you by the haematologist as they have just called me to tell me one of my patients has a really high eosinophil count”. This made a change from the normal type of call about UTIs or exacerbation of COPD and the Microbiologist pricked up there ears. It turned out that the patient spent much of their time living between the UK and Kenya where they taught English in a small rural school. The patient had been to see the GP because they had been losing weight and felt tired all of the time. The GP had started investigating for potential reasons and it was the initial blood tests which had thrown up the high eosinophil count.
A 3 year old boy had been referred to the Paediatricians with a history of intermittent fevers, weight loss and abdominal distension. On examination the child had an enlarged liver and spleen. The working diagnosis was lymphoma and a lymph node biopsy and bone marrow aspirate were planned. The child was discussed at the paediatric oncology multidisciplinary team meeting and the Microbiologist pricked up his ears when he heard the child was originally born in Brazil and came to the UK a year ago.
A discussion then took place about whether this might actually not be cancer at all but rather an infection. In particular, the Microbiologist suggested a diagnosis of leishmaniasis… everyone gave him “that” look… here we go again they thought! Another weird diagnosis from Microbiology!!