Question 2

Forty-five years old man of  Bangladesh origin presented to the A&E with a 2-month history of cough, fever, haemoptysis and weight loss. Chest X-ray (CXR) revealed upper right lobe haziness and a cavity. WCC – 13 x10^9/L (Normal 4 – 11 x10^9/L ), normal renal function, mildly raised Alanine aminotransferase (ALT) and bilirubin, CRP of 50 mg/L (Normal<5 mg/L) . Sputum was acid-fast bacilli (AFB) negative and had been sent for AFB culture.  CT abdomen thorax pelvis– confirmed the cavitation and showed some hypodense area in his spleen.
He has been to Bangladesh recently to visit his flood affected family members. The patient has a background history of diabetes and on
Sputum culture grew this bacteria(see picture for the colony).
It is an aerobic, gram-negative bacillus, sensitive to co-amoxiclav but resistant to amoxicillin, gentamicin, erythromycin, aztreonam.

Bps close.JPG

Q –
Would you consider the bacteria significant?
What is your provisional diagnosis?
What treatment would you consider?
What infection control or precautionary measure would you take considering the epidemiology and the sputum culture result? read more