Case of the Married Minister: Francisella tularensis by CHLOE BAYNE https://padlet.com/cmb017/qx6u0udlgrmo4ro5 BYN 230 S1 Project #1 en-us 2021-09-16 15:04:43 UTC 2025-03-09 15:46:59 UTC hello@padlet.com Under Light Microscopy cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746269980
  • Gram stain showing gram-negative bacteria
  • Holds onto the Safranin (gram-negative) better than crystal violet (gram-positive) 


    • ]]>     2021-09-16 15:07:07 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746269980     Shape, Arrangement, & Unique Features cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746280610
  • 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.

    • ]]>     2021-09-16 15:10:38 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746280610     Staining Technique Used to Characterize the Bacteria in the Case cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746290984
  • 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)

    • ]]>     2021-09-16 15:14:11 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746290984     Patient's Signs & Symptoms cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746304923
  • 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

    • ]]>     2021-09-16 15:18:49 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746304923     Microbiology Tests Order for the Case cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746329104
  • 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).


    • ]]>     2021-09-16 15:27:07 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746329104     Test Results to Make a Diagnosis cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746336091 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! 


    ]]>     2021-09-16 15:29:13 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746336091     Treatments Prescribed for Patient cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746346099
  • 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).

    ]]>     2021-09-16 15:32:26 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746346099     Patient Outcome cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746360471
  • 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 


    • ]]>     2021-09-16 15:37:19 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746360471     What I'm Looking Forward to Learning More About cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746427351 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! :)]]>     2021-09-16 16:01:55 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746427351     Citations cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746481964 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


    ]]>     2021-09-16 16:24:40 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746481964     Happy Ending Celebration :) cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746486235 2021-09-16 16:26:26 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746486235 Case of the Married Minister: Francisella tularensis cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746663599 2021-09-16 17:46:40 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1746663599 A Little Concept Map :) cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1747064619 There were so many names, right?! Here is a little concept map that helped me! ]]> 2021-09-16 22:04:57 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1747064619 IMPORTANT MESSAGE cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1747068846 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! ]]> 2021-09-16 22:09:36 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1747068846 Wait a hoppin' minute?! cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1747071783 Yes, a sick little rabbit can also get you sick! I know... super sad :(]]> 2021-09-16 22:12:49 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1747071783 What's the difference in route? cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1747077103 Doxycycline is given orally while gentamicin is injected!]]> 2021-09-16 22:17:58 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1747077103 Chlamydia Gram-Positive Stain for Further Comparison cmb017 https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1747080800 The purple is cool, but the minister has a gram-negative bacteria causing his symptoms!]]> 2021-09-16 22:21:57 UTC https://padlet.com/cmb017/qx6u0udlgrmo4ro5/wish/1747080800