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Case of the Married Minister: Francisella tularensis

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Case of the Married Minister: Francisella tularensis

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Gram stain showing gram-negative bacteria

Holds onto the Safranin (gram-negative) better than crystal violet (gram-positive)

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Small, slow-growing aerobic (with oxygen) gram-negative (red/pink) coccobacilli

Coccus = sphere shape

Bacillus= rod shaped

Very short rods that look like spheres- look like lumpy footballs to me :)

They're that unique "in between" shape

They look clustered together but they're single (cocci), so it's not staphylo-, diplo-, etc.

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Staining Technique Used to Characterize the Bacteria in the Case

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Staining Technique Used to Characterize the Bacteria in the Case

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Gram staining was used!

Summary of steps:

Crystal violet (primary stain) - 1min

Gently rinse with distilled water

Iodine- 1min

Gently rinse with distilled water

Squirt decolorizer over slide until runoff is clear (removes crystal violet from gram-negative bacteria but not from gram-positive)

Gently rinse with water immediately

Safranin (counterstain for gram-negative bacteria) - 1min

Gently rinse with distilled water

Blot dry

Gram-positive will be purple (Chlamydia trachomatis) & gram-negative is the red/pink (Francisella tularensis)

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Chlamydia Gram-Positive Stain for Further Comparison

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Chlamydia Gram-Positive Stain for Further Comparison

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The purple is cool, but the minister has a gram-negative bacteria causing his symptoms!

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The patient presented with swollen lymph nodes (including redness) in the groin area (inguinal lymphadenopathy)

The physician had thought that it was LGV (lymphogranuloma venereum) caused by Chlamydia trachomatis

Francisella tularensis causes tularemia (6 forms: ulceroglandular, glandular, oculoglandular, pharyngeal, typhoidal, pneumonic)

Tularemia is also known as "rabbit fever" because a majority of cases come from rabbits or wildlife

Patient may have had a fever, chills, malaise, anorexia, & fatigue

Patient did come in contact with a sick rabbit that could have been a carrier of the bacteria that causes tularemia

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Yes, a sick little rabbit can also get you sick! I know... super sad :(

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There were so many names, right?! Here is a little concept map that helped me!

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A lymph node biopsy was ordered & showed a granulomatous abscess consistent with lymphogranuloma venereum (LGV)

A tissue specimen was submitted to a lab for bacterial, Chlamydia-specific, fungal, & mycobacterial cultures

The physician started the patient on doxycycline, which treats C. trachomatis & F. tularensis

Chocolate agar is heated blood agar that ruptures RBCs and releases nutrients to help grow fastidious bacteria (Tankeshwar 2021).

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Think of what causes inguinal lymphadenopathy & narrow it down (causes, gram stain results, etc.)

No growth was observed on the Chlamydia culture

Bacterial culture showed a small, gram-negative rod that grew on chocolate agar

The medical technologist used pyrosequencing to identify the organism

"Pyrosequencing is a sequencing-by-synthesis method that quantitatively monitors the real-time incorporation of nucleotides through the enzymatic conversion of released pyrophosphate into a proportional light signal" (Tost & Gut 2007).

Result 85% consistent with Francisella tularensis

All work on the organism was stopped by the Select Agent Program protocol

"The Federal Select Agent Program oversees the possession, use and transfer of biological select agents and toxins, which have the potential to pose a severe threat to public, animal or plant health or to animal or plant products" (Federal Select Agent Program 2021).

The gram stain showed cells larger than typical Francisella

The organism was sent to the state public health lab for confirmation by polymerase chain reaction (PCR)

"PCR, or the polymerase chain reaction, is a chemical reaction that molecular biologists use to amplify pieces of DNA. This reaction allows a single or a few copies of DNA to be replicated into millions or billions of copies. And by amplifying that DNA, it allows us to study that DNA molecule in detail in the laboratory" (Biesecker 2021).

Confirmed it was F. tularensis!

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Patient was prescribed doxycycline at the very beginning

Patient responded well to antibiotic

Usually an aminoglycoside antibiotic like gentamicin would be prescribed for F. tularensis, but a tetracycline antibiotic like doxycycline is an acceptable treatment for tularemia (MedlinePlus 2021).

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Doxycycline is given orally while gentamicin is injected!

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Doxycycline worked well and the patient made a full recovery

Patient did not have a sexually transmitted microorganism, which was a relief for himself and his wife

Had tularemia caused by F. tularensis

The patient learned to not pick up sick rabbits anymore

The marriage became peaceful again- ft Uk prime minister & wife

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Don't pick up sick rabbits, even if you are sad for them! You do not want to go through what the minister had to go through!

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What I'm Looking Forward to Learning More About

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What I'm Looking Forward to Learning More About

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I am looking forward to continuously learning why I will need microbiology as a nurse through more clinical applications & case files. I really think this helps me understand how I will be using this class "in the real world." I like going through the process of looking at the information & identifying the microbe causing illness, & I hope that this skill will help me advocate for my patients one day. I love trying to solve cases and helping others.

I am also looking forward to learning about metabolism & genetics of microorganisms. I am to the point where I have to know why & how they thrive & survive from their insides! WHY & HOW?!?! I know overall human metabolism well, but what about these small organisms that are everywhere & are in humans too? What is really inside them that also differentiate them from one another? I like to know how things work (also together) as I have a very curious mind, & I did this in anatomy last year & want to do this even more in microbiology! After this case, it truly has me wondering about the make-up of microbes. It is like I know the "anatomy" & want to know the "physiology." Why do they do the things then do?! Also, what inside them makes them cause illness & are certain people more at risk for certain ones?

Overall, I am looking forward to a lot after this case file project & learning more about microbiology! :)

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Biesecker, L. (2021). Polymerase chain reaction (PCR). National Human Genome Research Institute, https://www.genome.gov/genetics-glossary/Polymerase-Chain-Reaction

Federal Select Agent Program. (2021). Federal select agent program. CDC USDA, https://www.selectagents.gov/

MedlinePlus. (2021, August 23). Doxycycline. U.S. National Library of Medicine, https://medlineplus.gov/druginfo/meds/a682063.html#:~:text=Doxycycline%20is%20in%20a%20class,growth%20and%20spread%20of%20bacteria

Tankeshwar, A. (2021, June 20). Chocolate agar: composition, preparation, uses. MICROBE ONLINE, https://microbeonline.com/chocolate-agar-composition-uses-colony-characteristics/

Tost, J., Gut, I. (2007, September 6).

DNA methylation analysis by pyrosequencing, Nature Protocols, https://www.nature.com/articles/nprot.2007.314#citeas