Question

A 63 year old male visits his primary care physician complaining of fatigue and shortness of breathe, upper back pain, and a cough that has become productive in the last 2 days. The patient was febrile and appeared acutely ill. A chest x-ray revealed pnuemonia and the following significant laboratory results were found:

RBC count: 4.1 x 10 ^12 / L (reference range: 4.6 - 6.0 x10^12/ L)

HGB: 13g/dL (reference range: 14.0 -18.0 g/dL)

WBC count: 4.8 x 10^9 /L (reference range: 4.5 - 11.0 x 10^9/ L)

ESR: 12 mm/hr (reference range: 0 - 9 mm/hr)

Based on these results, the physician ordered serum immunoglobulin levels. The following results were reported:

IgG: 3,250 mg/dL (reference range: 600 - 1,500 mg/dL)

IgM: 48 mg/dL (reference range: 75 - 150mg/dL)

IgA: 102 mg/dL (reference range: 150 - 250 mg/dL)

1.) What disease(s) should you suspect? why?

2.) What additional tests could help confirm the diagnosis and what results would you expect to find?

A 7 month old child was diagnosed with bacterial meningitis. Previously he has been been hospitalized with bacterial pnuemonia. Laboratory testing results were as follows:

RBC count: normal

WBC count: 22 x 10^9/L (normal: 5 - 24 x10^9/L)

Differential: 70% neutrophils, 15% monocytes, 5% eosinophils, and 10% lymphocytes.

SPE: no gamma band present.

1.) What possible conditions do these results indicate?

2.) How are these conditions inherited?

3.) What type of further testing do you recommend?

Answer 1

1) pneumonia

Because the chest xray reveals that pneumonia and the following laboratory test shows increased values of immune system elevated ESR indicates presence of infection and positive igG result to mycoplasm pneumonia in the absence of igM antibodies, most often indicates previous immunological exposure and decreased igA indicates defective protection of mucous membrane . And also the patient had a symptoms of Shortness of breath, upper back pain,productive cough and these are the major symptom exhibit by pneumonia so this patient had these symptoms with postive laboratory and chest xray finding so we can suspect for pnemonia

2) sputum test (sputum culture)

A sample collected from lungs (sputum) through deep coughing and sent it to the microbiology lab to detect causative organism for infection

Pleural fluid culture

It expecially done for aged patients who are not able cough deeply. Here we take pleural fluid by inserting a needle into the ribs for analysis

CT scan also preferable

Bacterial meningitis

2) pnumococcal mengitis can occur when the streptococcus pnemonia bacteria invade blood stream and cross the blood brain barrior barrior and multiply in brain fluid

3) csf analysis (lumbar puncture)

Postive result resemble csf shows low sugar level and increased white cell blood count and increased protein