Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days.
Microscopic Examination of Vaginal Discharge
(-) yeast or hyphae
(-) flagellated microbes
(+) white blood cells
(+) gram-negative intracellular diplococci
Case Study Questions
- According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probably diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis.
- Based on the vaginal discharged described and the microscopic examination of the sample could you suggest which would be the microorganism involved?
- Name the criteria you would use to recommend hospitalization for this patient
- Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources.
Based on the information provided in the case study, the most probable diagnosis for Ms. P.C. is pelvic inflammatory disease (PID). PID is an infection of the upper reproductive organs in women, including the uterus, fallopian tubes, and ovaries. It is often caused by sexually transmitted infections (STIs) such as chlamydia or gonorrhea.
Several factors in the case study point towards PID as the likely diagnosis. First, Ms. P.C. presents with lower abdominal pain, nausea, emesis, and a heavy, malodorous vaginal discharge. These are common symptoms of PID. The abnormal vaginal discharge described as “thick, greenish-yellow in color, and very smelly” is consistent with the characteristic discharge seen in PID.
Additionally, the history of unprotected sexual intercourse and the presence of gram-negative intracellular diplococci on microscopic examination of the vaginal discharge further support the diagnosis of PID. Gram-negative intracellular diplococci are suggestive of Neisseria gonorrhoeae, which is a common causative organism of PID. The presence of white blood cells in the vaginal discharge indicates an inflammatory response, which is also consistent with PID.
It is important to note that a definitive diagnosis of PID typically requires further evaluation, including additional laboratory tests and imaging studies. However, based on the clinical presentation and the microscopic findings, PID is the most probable diagnosis in this case.
The microorganism involved in this case is likely Neisseria gonorrhoeae, which is a gram-negative bacterium responsible for the sexually transmitted infection gonorrhea. The presence of gram-negative intracellular diplococci on the microscopic examination of the vaginal discharge suggests the presence of Neisseria gonorrhoeae. However, further laboratory testing, such as culture or nucleic acid amplification tests (NAATs), would be needed to confirm the presence of this specific organism.
Based on the information provided, there are several criteria that could be used to recommend hospitalization for this patient:
- Severe symptoms and signs: If the patient is experiencing severe abdominal pain, high fever, signs of systemic illness, or other severe complications, hospitalization may be warranted. These symptoms could indicate a more severe case of PID requiring close monitoring and possible intravenous antibiotic therapy.
- Inability to tolerate oral antibiotics: If the patient is unable to tolerate oral antibiotics due to severe nausea, vomiting, or other gastrointestinal symptoms, hospitalization may be necessary to administer intravenous antibiotics.
- Pregnancy: If the patient is pregnant, hospitalization is often recommended for the treatment of PID. Pregnant women with PID have an increased risk of complications, including preterm labor and delivery.
- Surgical emergencies: In some cases, PID can lead to the formation of an abscess or a tubo-ovarian complex. If the patient develops a surgical emergency such as a ruptured abscess or a tubo-ovarian abscess, immediate hospitalization and surgical intervention may be necessary.
- Immunocompromised status: If the patient has a compromised immune system, such as in the case of HIV infection or immunosuppressive therapy, hospitalization may be recommended to closely monitor and manage the PID infection.
In summary, based on the clinical manifestations and microscopic examination of the vaginal discharge, the most probable diagnosis for Ms. P.C. is pelvic inflammatory disease (PID) caused by Neisseria gonorrhoeae. Hospitalization may be considered based on the severity of symptoms, inability to tolerate oral antibiotics, pregnancy, surgical emergencies, or immunocompromised status. It is important for Ms. P.C. to receive appropriate medical care to prevent complications and to treat the underlying infection.