new_n_lost
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A sexually active 18-year-old woman presents with a fever of 102 F for the past 24 hours and lower abdominal pain and anorexia for the past 5 days. On physical examination, there is generalized tenderness of the abdomen, and the cervix is erythematous with motion tenderness. There is no rash nor any lesions on the external genitalia. A smear of the odorless cervical discharge contains sloughed epithelial cells and scant neutrophils.
Which of the following would likely be found in the exudate?
A. A naked, icosahedral double-stranded circular DNA virus
B. Iodine-staining intraepithelial inclusion bodies
C. Intraneutrophilic gram-negative diplococci
D. Intranuclear "owl's eye" inclusion bodies
E. Lactose-fermenting gram-negative bacilli
F. Pear-shaped flagellated protozoa
G. Pleomorphic, gram-negative rods
H. Spirochetes on dark-field microscopy
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| po
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C
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| usmlefever
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c n gonorrhea
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| SILVER
DoWhatYouGotToDo!
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C. Intraneutrophilic gram-negative diplococci
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| bactitech
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Please realize that we techs are taught in MT school that intracellular gram negative diplococci are not necessarily diagnostic in a female. There are organisms in the female genital tract that can mimic GC on a smear. At my current employer, we usually report out gram negative cocci in pairs, or intracellular gram negative cocci in pairs. I personally will usually call the ER doc and tell them that I'm suspicious of GC but I can't necessarily report on the "golden words." We are the ones reporting your results, so you might want to check with your local micro lab to see how they report these smears out on female patients.
Our ER "special" on females is a gram stain (usually badly made by ER staff - PLEASE roll the swab onto the slide - do NOT scrub or squiggle it on in a big glob), a saline wet prep for trichomonas, and a collection device for Chlamydia/GC DNA amplification (test code is CGUP at our place). Cultures are usually NOT performed on ER patients. Males just get a CGUP (see below).
On a male, intracellular GNDC ARE diagnostic and can be reported to a state lab. However, with the advent of DNA amplification testing, I have not seen a gram smear come down on a male with urethral discharge in at least five years.
DNA amplification testing specimens are collected on a special swab collection device that is only used for the test. Testing can also be done on a urine specimen, which is obviously less painful to collect than a urethral swab. They are usually ordered for both Chlamydia and GC. Chlamydia live in the columnar epis of the urethra so therefore you must get inside the male urethra far enough to get to where they live. A urine is easier for both male and female patients.
Hope this helps. Obviously physical findings will not change, but the testing that you will be ordering will depend on whether your hospital performs DNA amplification testing. It is expensive to do, but smaller labs send them out to larger ones like our lab. We perform them daily M-F.
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| monam84
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what about b. chalmydia was inclusion bodies, most common cause of PID? i dont remember if its stained with iodine or not though
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| drduck
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cud anyone plz tell me the answer,
i felt answer is either HPV or it may be Chlamydia.
i thought so cos there are only few neurophils
and no exudate or major discharge.
in infection with GNDC there must be profuse dischage???
its a case of PID and so I can easily rule out HPV.
so Chlamy is the choice
what do u people say???
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| drduck
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and yes clamy has iodine staining inclusions ....for sure
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| GoodGirl
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What I know Chlamydia has Iodine stained cytoplasmic inclusion, and is the most common bacterial STD.
So what is the answer NNL ?????
Thanks Bactitech.
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| new_n_lost
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| new_n_lost
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The correct answer is B.
The presentation is typical for pelvic inflammatory disease (PID). Chlamydia trachomata (serotypes D-K) is the most common bacterial cause of sexually transmitted disease (STD) in this country and is the most likely agent on the list to produce the symptoms described. It is an ATP-defective organism that must therefore live intracellularly in the human host and can be visualized inside epithelial cells with iodine, Giemsa, or fluorescent-antibody stains. The remainder of the answer choices refer to other agents that could be found in the female genital tract, either by sexual transmission or by contamination with fecal flora, but they are not the best choices.
A naked, icosahedral double-stranded circular DNA virus (choice A) refers to human papilloma virus, which is the most common cause of STDs in the U.S., but presents with anogenital warts.
Intraneutrophilic gram-negative diplococci (choice C) refers to Neisseria gonorrhoeae, which would be expected to present with dysuria and neutrophilic exudate.
Intranuclear "owl's eye" inclusion bodies (choice D) refers to cytomegalovirus, a common STD in the United States, but not a common agent of PID. Most cases in average adults are manifested by mononucleosis-like symptoms.
Lactose-fermenting gram-negative bacilli (choice E) would be consistent with Escherichia coli. Although this organism is the most common cause of urinary tract infections in women in the United States, it would not be expected to cause PID.
Pear-shaped flagellated protozoa (choice F) refers to the protozoan parasite Trichomonas vaginalis, the only protozoan STD in the world. Infection would be characterized by a malodorous, cheesy exudate, and there would be more erythema of the external genitalia than of the cervix.
Pleomorphic, gram-negative rods (choice G) are consistent with Hemophilus ducreyi, which causes chancroid, and presents in a different manner.
Spirochetes on dark-field microscopy (choice H) refers to Treponema pallidum, the causative agent of syphilis, which would produce rash and/or chancre, depending on the stage of the infection.
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| lq2006
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B. Chlamydia trachomata
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