Once upon a time… a long time ago… in a distant land… and a galaxy far, far away
The Microbiologist was busy authorising the laboratory results when his phone rang. The call identification showed it was Accident and Emergency (A&E) majors so it might be urgent…It was the A&E doctor.
“I have a patient with positive blood cultures who we sent home 4 days ago”, they said in a slightly panicked voice.
“What did the blood culture grow?” asked the Microbiologist.
“They had a temperature of 38.5 oC and so had blood cultures taken, but clinically it looked like they had a viral upper respiratory tract infection, so we discharged them”, came the reply.
“But what did the blood culture grow?” asked the Microbiologist again slightly louder this time.
“The patient was fine, the temperature settled with Paracetamol. But I think I need to get them back in, repeat the blood cultures and start IV Piptazobactam for sepsis” continued the doctor starting to border on the hysterical.
“STOP TALKING, JUST TELL ME WHAT THE BLOOD CULTURE GREW!” shouted the Microbiologist in a last ditch effort to break through the A&E doctors ranting.
“Oh! It grew a Cutibacterium spp. and I’ve never heard of it before so thought it must be significant”.
“Okay. Take a deep breath and calm down” said the Microbiologist “you might not have heard of Cutibacterium but I am sure you have heard of Propionibacterium acnes?”
“Yea, that’s a skin contaminant but it definitely says Cutibacterium” muttered the A&E doctor now frustrated at the Microbiologist!
“Good, now let me explain the joy that is changes in names…” replied the Microbiologist, "while you're on the phone do you know what these used to be called too?!? I'm doing a quiz for Friday lunchtime..."
I’ve had the dubious pleasure of dealing with various incidents and outbreaks over the years. They can be very stressful experiences for everyone concerned, but a clear methodical approach can go a long way to alleviating the levels of stress both in both you and your colleagues.
Imagine the scenario:
It’s 9am and the Senior Biomedical Scientist knocks on your door “ummm the laboratory has inadvertently processed a tissue sample containing Brucella melitensis on the open bench!”
It was another dull and dreary afternoon giving advice when an excited Dermatologist phoned about a patient with funny skin lumps. (Microbiologists get excited about bugs, Dermatologists get excited about rashes, so lumps and bumps together… what can I say…we were very excited!!)
Their patient was a keen gardener who had been clearing a large number of blackthorn trees (good for making sloe gin) and despite wearing thick gloves had managed to get pricked and scratched all the way up their arms. At the site of one of those puncture wounds they had developed a small red lump which had eventually turned into a small ulcer. The ulcer hadn’t got much better and over the next few weeks the patient had noticed a number of other lumps appearing up their arm and then hard swellings in their armpit.
Yep, it’s coming up to that time of year. All of Microbiology is excited as there is about to be a holiday and eggs are likely to feature in a big way… no not Easter!!! Its holiday time and people will be going to exotic countries and bringing back souvenir parasites and their eggs will be involved in working out what is wrong with them. Yep us Microbiologists’ love eggs, not just the chocolate variety. I don’t know, you lot all have chocolate on the brain :-)
Okay, so the Bug Blog is usually about the clinical and scientific aspects of microbiology but this week I’m going to do something a bit different. Now I’m not someone who watches much TV; there was very little on that interested me over the Christmas period. However, I did watch a short TV hospital dramatization called Charité on Netflix which I thought was brilliant and something that anyone interested in microbiology would also enjoy. OK so it’s in German with English subtitles, but it is the best show I have watched in a long time! Let me explain.
“I have a 3 year old patient with an infected ulcer on their leg which is proving particularly difficult to treat” was the opening statement from the Surgeon.
“What antibiotic are you giving?” asked the Microbiologist in a surly tone, thinking this was going to be a simple case of wrong antibiotic.
“I’ve been using Co-amoxiclav, but it doesn’t seem to be getting better” was the reply.
“Have you sent any samples to the lab?”
“I swabbed the wound and the result has come back showing a Coagulase-positive Staphylococcus; I wonder if this might be Staphylococcus pseudintermedius or possibly Staphylococcus aureus” said the Surgeon.
“Staphylococcus aureus is the most common bacterium we see in this situation” answered the Microbiologist, “why do you think it might be Staphylococcus pseudintermedius?”
“In our patients Staphylococcus pseudintermedius is often grown from these types of samples…oh, I forgot to mention, I’m a Veterinary Surgeon and the 3 year old patient is a Husky” was the reply…. “I should say too that the bacterium is resistant to beta-lactams… according to the report…
Looking down the blood cultures list whilst prioritising what needed phoning out first the Microbiologist noticed a blood culture positive on day 3 with a Gram-positive bacillus in the aerobic bottle only. Normally this wouldn’t provoke much interest as most pathogens grow within 12-24 hours and most Gram-positive bacilli are skin contaminants (Corynebacterium spp. and Cutibacterium spp.). However these were unlikely in this case: Corynebacterium spp. normally grow faster than this and would be in both bottles whereas Cutibacterium spp. although anaerobes tend to grow much slower. The clinical details just said “fever” (not overly helpful!) and considering the sample was 3 days old already, it didn’t seem that urgent, so the Microbiologist put it to the bottom of the list and got on busily calling out all of the Gram-negative bacilli and Gram-positive cocci, as these were more likely to be significant.
While sat in the cystic fibrosis multidisciplinary team (MDT) meeting a tricky clinical question was asked…
“We have a patient with an infective exacerbation of their cystic fibrosis with Burkholderia multivorans but she is allergic to Ceftazidime and Meropenem and gets bad gastrointestinal symptoms with tetracyclines. What do you think?” asked the Respiratory Consultant.
I really like these types of MDTs when I have to scratch my head and try to work out a solution but this one was a bit of a puzzler. I know Ceftazidime and Meropenem are often used to treat infections with Burkholderia spp. and that Minocycline is also an option, but what to do when these can’t be used? I had to admit I didn’t know for sure and that I would have to go and look at the literature and get back to them. So off I went to consultant the “Interweb”.
“Happy birthday to us, happy birthday to us, happy birthday dear Bug Blog, happy birthday to ussss…”
The Bug Blog is 5 years old! You may not realise it but we have been doing this together for 5 years. In that time we have written over 190 blogs on various microbiology related subjects as diverse as Proteus mirabilis (which Penny thinks smells like chocolate!), necrotising fasciitis and even Poldark’s Putrid Throat. It can be quite a challenge to find the time to write a blog every week but we strive to keep it up (on average we have managed about 40 per year). What makes it worthwhile is all of you out there taking the trouble to read what we have to say. So thank you for staying with us and reading all of our microbiological rambles…