The clinical history of this patient is provided below: A previously healthy five your old girl presented with a recent history of sickness, vomiting, and diarrhoea. The symptoms had begun with general abdominal pain followed by episodes of diarrhoea and vomiting without blood contamination. No other close family members reported similar symptoms and on questioning there had been no unusual travel, camping, all consumption of unfamiliar food. On the first day of symptoms, her GP diagnosed viral gastroenteritis and stool cultures were sent to a local hospital. The following day, her vomiting increased in frequency, the patient continued to experience diarrhoea and her parents noted there was evidence of blood and mucus in the diarrhoea. The patient was admitted to the local hospital where a complete blood count revealed a white cell count of 22.5 x 109 cells/L with 89% neutrophils and 7% bands. A urine analysis revealed positive ketones of 150mg/ml and a specific gravity of 1.030 (reference interval 1.005 – 1.030). The patient was transferred to a general hospital for management of neutrophilia and dehydration. On admission, despite the symptoms described and a temperature of 38.7°C, other vital signs and physical exams were unremarkable. She was treated with intravenous fluids. Stool cultures for bacteria, shiga toxin, ova and parasites were obtained. Urinalysis showed positive protein of 300mg/dl and 4 red blood cells per high power field. On day two of admission, the patient passed cranberry coloured urine. Repeat laboratory tests were performed at this time for renal function and haematology including plasma creatinine, blood urea and full blood count as well as coagulation tests. Type of tests were performed as the follows: *Microbiology testing: – gram stain: Gram-negative bacterium. -OF test: Fermentative result which Acid production on both (open and covered) tubes. The acid produced changes the pH indicator, bromthymol blue, from green to yellow. (Escherichia coli) -oxidase test: negative -serotyping: O157: H7 *Haematology testing: -Abnormal RBC morphology and number. Schistocytes – fragmented part of a red cell. Spherocytes – lack central pallor and may appear smaller. Reticulocytes – Immature red cells, larger, contain RNA. Echinocytes – RBCs covered in spicules. Reduction or absence of platelets. May or may not present with leucocytosis *Biochemistry testing: -Plasma urea: 16umol/L (high). Total bilirubin: 55μmol/L (high). Prothrombin Time: 26 sec (why?). What I expect in the First paragraph:

1. Introduction: (500 words) Introduce the case history with the main symptoms that related to the diagnosis. The method that used for diagnosing this patient such as microbiology, biochemistry and haematology test and why we used each test for this patient. Following by some overall result and type of organism that was determined at the end of testing (E. coli O157: H7 ). Provide some information about this organism. Discussing the results as related to the diagnosis (haemolytic uremic syndrome). End with some treatment for this disease type of antibiotic or may be further test for direct diagnosis of this disease also some recommendation. 2. Discussion: (500 words): More deep information about each type of test and why is necessary to be performed in this diagnosis and how its related to the disease and the clinical history. 3. Conclusion and recommendation: Some type of treatment for the (haemolytic uremic syndrome disease and any further test might be performed and names some antibiotics of medications.

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