Jayachandran Nair
The objective of this case study was to highlight the role played by our regional laboratory in identifying N. gonorrhoeae bacteraemia infection in an otherwise un-suspecting patient who presented to Emergency department with fever. Using blood culture technique with BACTEC 9240, plate culture, catalase test, oxidase test and Gram’s stain, preliminary diagnosis was made at the regional laboratory. Blood culture became positive on day 3 and Gram’s stain from culture day 4 identified intracellular Gram-negative diplococci. The blood picture showed neutrophilia and a raised CRP indicating an underlying bacterial infection. This helped the physicians in starting prompt treatment with Ceftriaxone 500 mg and Azithromycin 1 g. The culture plates and blood culture bottles were then sent to the referral laboratory where confirmatory diagnosis was made using MALDI TOF (Matrix Assisted Laser Desorption Ionisation- Time of Flight), that gave a reading of 2.2 and a VITEK 2 system that gave a 99% probability. The timely detection of Neisseria by the regional laboratory helped the local health authorities to isolate the patient and treat him promptly, thereby preventing the spread of this infection to other parts of his body.