“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…

A recent conversation got me thinking… a rare occurrence some would say… about the identification of bacteria. The patient I was discussing had two bacteria growing in his blood cultures and we weren’t sure if both were genuine or whether one was a skin contaminant. There was both a Staphylococcus spp. and a Proteus mirabilis growing, but the P. mirabilis was growing all over the Staphylococcus spp. preventing its further identification. I suggested putting up a CLED agar plate (see later in the blog) and a number of people looked at me like I was crazy… and whilst I do occasionally come up with some crazy ideas this really wasn’t one of the them. To understand my logic you have to know a bit about P. mirabilis, especially its laboratory identification. Let me explain further…

Last week saw an event of great celebration and much excitement and even made it onto the national TV news… No, I’m not talking about the marriage of Prince Harry and Megan Merkel... I’m talking about the birth of a little baby boy who turned up unexpectedly 3 months post-term!
 
Okay, so clearly 3 months post-term is not going to be a human baby. This baby weighed somewhere between 90-120 kg and took over 22 months to “cook” in his 35-year-old mum Thi-Hi-Way. Yep, he’s an elephant calf, and his keepers at Chester Zoo were caught completely by surprise when they came in to work on Friday morning to find a new-born elephant calf amongst their herd of Asian elephants. Wow what a job! They had thought his mum had miscarried as she had gone long past her due date, but low-and-behold they were wrong… I hope they call him Harry for obvious reasons!
http://www.chesterstandard.co.uk/news/16239014.Surprise_baby_elephant_birth_at_Chester_Zoo_astonishes_keepers/ 

In 1941 John Rex Whinfield and James Tennant Dickson of Calico Printers' Association of Manchester, England, patented a new compound that changed the way foods are packaged, the clothes we wear and many other manufacturing processes. The compound was poly(ethylene terephthalate) (PET), and is the most widely used polyester plastic worldwide. About 60% of the world’s PET is used to produce polyester often in the context of clothing production, with about 30% being used to produce plastic drinks bottles.

The Microbiology Consultant was waiting for the new Microbiology Registrar to finish the authorisation before going through any problems or questions they had. They started with their first question, a urine isolate which was identified as Pseudomonas aeruginosa but the antibiotic sensitivities didn’t make sense. The bacterium was sensitive to Co-amoxiclav and Ceftriaxone but resistant to Gentamicin and Amikacin. Pseudomonas aeruginosa is normally resistant to Co-amoxiclav and Ceftriaxone and sensitive to Gentamicin and Amikacin. A “nonsensical” or “incorrect” result like this should normally prompt further investigation as to what might be wrong before it is authorised or released.

The patient’s mother was at her wits end. Her little boy’s head was covered in scaly skin. At first she thought his scaly hair was dandruff so she had washed his hair in medicated shampoo but this was met with screams and tears. She thought he was being a bit extreme “it’s only dandruff” but guessed kids can be funny about having soap in their eyes. He just kept saying “mummy my head is really sore”. Tonight he had refused to have his hair washed and while trying to get him into bed, she noticed he was going bald! She was so alarmed that she brought him in to the Emergency Department for help.

Gosh nearly 2,000 of you read last weeks’ blog on cholera (that’s a record) and it sparked a couple of really good questions to Nuts & Bolts.
 
One from Virginia related to the use of TCBS agar to grow Vibrio cholerae, so I thought that this week I would cover some “old fashioned” microbiology and talk about agar. Really! I hear you cry “that’s not very interesting”! Well, as “interesting” is banned when discussing microbiology, I’ll use “actually very clever” to describe the reasons why we use different types of agar in the laboratory… here goes…

​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 Microbiologist recently received a letter from a colleague asking for advice about how to manage a patient with Helicopter pylon. After a little pondering, it was decided that in fact advice was really required for a patient with Helicobacter pylori who had had failed two courses of treatment and was still symptomatic for peptic ulcer disease. It was clear that the automatic spell checker had made its own diagnosis! Spell checkers are a nightmare in medicine but often lead to some interesting questions. The colleague was asking whether the microbiology laboratory could perform culture and sensitivity on a biopsy sample and if so how the sample should be sent. There was also a question about what antibiotics to use next to treat the patient.