Pines City Colleges

COLLEGE OF NURSING
Magsaysay Rd., Baguio City

MICROBIOLOGY AND PARASITOLOGY LABORATORY

ACTIVITY 1: PROBLEM-BASED LEARNING CASES ON COMMON
MICROBIOLOGIC AGENTS CAUSING COUGH

Case No. 1:

CHIEF COMPLAINT: Cough and fever for four days

HISTORY: J.A., a 68 year old man, Filipino, who developed a harsh, productive cough four days
prior to being seen by a physician. The sputum is thick and yellow. He developed fever,
shaking, chills and malaise along with the cough. One day ago he developed pain in his right
chest that intensifies with inspiration. The patient lost 2 kgs over the past 6 months but claims
he did not lose his appetite. No report of Aspiration of oral intake were reported and no
medications and consult done. Past history reveals that he had a chronic smoker's cough for 10
which he describes as being mild, non-productive and occurring most often in the early morning.
He also had hypertension and is controlled well with medication. He smoked 2 packs of
cigarettes per day for the past 30 years.

PHYSICAL EXAMINATION: The patient is an elderly man who appears tired and underweight.
His complexion is fair. He coughs continuously. Vital signs are as follows: blood pressure
130/80, apical heart rate 99beats/minute and regular, respiratory rate 24/minute and
temperature 38.5OCelcius. Examination of the neck reveals no lymph node enlargement. Both
lungs are resonant except for dullness on the right mid-basal lung. Auscultation reveals bilateral
diminished breath sounds with crackles on the same right mid-basal lung field. The remainder of
the lung fields is clear. Percussion and auscultation of the heart reveals no significant
abnormality. Examination of the fingers was unremarkable.

LABORATORY: WBC 17,000/mm3 (Increased); neutrophils 80% (Increased), lymphocytes

15% (Decreased).

COURSE OF ILLNESS: Following a chest x-ray PA view and Lateral which revealed an acute
pneumonia in the right middle lobe.

Questions:
1) Is this an infectious process? If yes, what is the most likely etiologic agent? Give the
clinical basis of your answer.
2) Draw (or Copy Picture) and Label the expected Microscopic Findings of the Pathogen?
3) Discuss the Pathophysiologic Process of the infection? Why are the Lung Findings
consolidated in one area.
4) Discuss the virulent factors of the agent.
5) What pharmaceutical agents can be given in the patient? What pharmacologic agents
should not be given to the patient? Why?
6) Differentiate between Community-Acquired and Hospital-Acquired Type of this case?

A.B.C./2020
 Pines City Colleges
COLLEGE OF NURSING
Magsaysay Rd., Baguio City

Case No. 2:

CHIEF COMPLAINT: Cough and fever for 4 Weeks

HISTORY: J.B., a 29 year old man, American, who developed a productive cough for 4 weeks
prior to being seen by a physician. The sputum is thick and greenish. He noted undocumented
fever for the past month with associated weakness. One day ago he noted bloody streaks in his
sputum prompting consult. The patient lost 15 kgs over the past 3 months but claims he did not
lose his appetite. Review of recent travel revealed that patient travelled to the Philippines where
he noted one of the hotel attendants who attended them for 4 weeks having the same
symptoms. Patient is an occasional smoker and alcohol drinker.

PHYSICAL EXAMINATION: The patient is noted to be conscious, coherent, and ambulatory

and in slight respiratory distress with SPO2 of 89%. Vital signs are as follows: blood pressure
140/80, apical heart rate 101 beats/minute and regular, respiratory rate 25/minute and
temperature 37.9OCelcius. Examination of the neck reveals non-tender enlarged lymph nodes.
Lung Auscultation revealed decreased breath sounds on the apical area with diffuse crackles.
Percussion and auscultation of the heart reveals no significant abnormality. Examination of the
fingers was unremarkable.

LABORATORY: WBC 18,000/mm3 (Increased); neutrophils 80% (Increased), lymphocytes

15% (Decreased).

COURSE OF ILLNESS: Following a chest x-ray PA view and Lateral which revealed a Solitary
Pulmonary Nodule (SPN) on both lung apexes which is least likely malignant.

Questions:
1) Is this an infectious process? If yes, what is the most likely etiologic agent? Give the
clinical basis of your answer.
2) Draw (or Copy Picture) and Label the expected Microscopic Findings of the Pathogen?
3) Discuss the Pathophysiologic Process of the infection? Why is there a presence of SPN
on chest x-ray
4) Discuss the virulent factors of the agent.
5) What pharmaceutical agents can be given in the patient? Why is there a need for more
than types of antibiotics?
6) Determine other types of this Disease based on its organ affectation and discuss the
difference between the different types?

A.B.C./2020
 Pines City Colleges
COLLEGE OF NURSING
Magsaysay Rd., Baguio City

Case No. 3:

CHIEF COMPLAINT: Cough and fever for 2 Weeks

HISTORY: J.C., a 47 year-old woman presented with chief complaint of documented fever to
37.8-.39.0O Celcius, non-productive cough and dyspnea which has progressed over one week.
She was tested HIV-positive 5 years ago at which time her CD4 lymphocyte count was 583.
Zidovudine was started, but she stopped taking it after one month and did not return to her
doctor for follow-up. She has anorexia and lost 70 pounds over the last 3 months. She took
antibiotics for the past 7 days but symptoms were not relieved.

She used heroin and cocaine intravenously for a six month period 6 years ago. She does not
smoke or drink, has no past STD's and is not sexually active. She has no known drug allergies
(NKDA).

PHYSICAL EXAMINATION: She was pale, diaphoretic and in acute respiratory distress.
T=37.4o C, P 96/'min, R 30/min, BP 110/70. Oral thrush was present. Examination of the lungs
disclosed poor inspiratory effort and bibasilar crackles 2/3 of the way up the posterior lung field.
She had a tachycardia but no murmurs. Her abdomen was non-tender, and there was no
enlargement of the liver or spleen. Pelvic exam was normal except for vaginal candidiasis.
Neurologic examination was normal.

LABORATORY EVALUATIONS:
WBC: 7,500/mm3
Neutrophils: 43, Lymphocytes: 41, Monocytes: 9, Eosinophils: 6, Basophils: 1
CD4: 100/mm3
HIV RNA level: 250,000 copies/ml

Questions:
1) What is the main Diagnosis of the patient? Note: HIV infection have different types
2) Is the cough an infectious process? If yes, what is the most likely etiologic agent
assuming direct fluoroscopy of sputum will be performed?
3) Draw (or Copy Picture) and Label the expected Microscopic Findings of the Pathogen
from the sputum?
4) Discuss the Pathophysiologic Process of the infection?
5) Discuss the virulent factors of the agent.
6) What pharmaceutical agents can be given in the patient? Does an antibacterial agent
have a role in the patient’s cough?
7) What other opportunistic infections can be expected in these kinds of patients? How and
Why?

Prepared by: Allan B. Castro (Senior High School Department)

A.B.C./2020
 Pines City Colleges
COLLEGE OF NURSING
Magsaysay Rd., Baguio City

ACTIVITY 1: PROBLEM-BASED LEARNING CASES ON COMMON

MICROBIOLOGIC AGENTS CAUSING COUGH EVALUATION SHEET

NAME OF CONTENT PARTICIPATION PEER EVALUATION SCORE

MEMBER (35 pts.) (5 pts.) (10 pts.)
1)

2)

3)

4)

5)

6)

Evaluated by: Allan B. Castro

Date: ________________________

A.B.C./2020