A patient appears in the emergency room with a submandibular mass. A smear is made of the drainage and a bewildering variety of bacteria are seen, including branched, gram-positive rods. Which of the following is the most clinically appropriate action?
The patient probably has actinomycosis. These laboratory data are not uncommon. There is no reason to work up all the contaminating bacteria. A fluorescent microscopy test for A. israelii is available. If positive, the FA provides a rapid diagnosis. In any event, it may be impossible to recover A. israelii from such a specimen. High-dose penicillin has been used to treat actinomycosis. One of the options suggests no further clinical work-up on the patients be done. Clearly, laboratory results may help the clinician make patient management decisions but each of these three cases show that physicians need to have a good understanding that laboratory tests may give conflicting information for the patient being treated. The physician must help the laboratory to understand how to use the data produced to give the patient the best possible medical care. Antibiotic sensitivity tests today are mostly automated and reliable. If a repeat is needed, a new blood sample should be drawn for the new test.
Consider vancomycin as an alternative drug
Determine if fluorescent microscopy is available for the diagnosis of actinomycosis
Do no further clinical workup
Suggest to the laboratory that low colony counts may reflect infection
Bacteria