Question

A 17-year old girl was admitted to the hospital with a 1-week history of fever, chills, malaise, sore throat, skin rash, and polyarthralgia. She reported being sexually active and has a 5-week history of a profuse yellowish vaginal discharge, which was untreated. Upon presentation, she had erythematosus maculopapular skin lesions over her forearm, thigh and ankle, and her metacarpophalangeal joint, wrist, knee, ankle, and midtarsal joints were acutely inflamed. She had an elevated leukocyte count and sedimentation rate. Cultures of her cervix were positive for N. gonorrhoeae, but blood specimens, exudates for the skin lesions, and synovial fluid were all sterile.
Why were the synovial fluid cultures negative?

a. This organism cannot be cultured on artificial media

b. The arthritis is a non-suppurative sequala

c. The organism is difficult to recover from synovial fluid beyond the first few days of inflammation.

d. It should have grown. The lab made a critical mistake.

e. It should have grown. The nurse mislabeled the sample.

Answer 1

Answer:

C. The organism is difficult to recover from synovial fluid beyond the first few days of inflammation.

Explanation:

why not A

The organism N. gonorrhoeae can be cultured on Thayer Martin Agar( a selective medium used for the isolation of gonococci (Neisseria gonorrheae) from specimen containing a mixed flora of bacteria and/or fungi), from  following

I.urine samples,

II. urethral swab

III.orcervical swab.

therefore A is wrong

Why not B

Arthritis is both suppurative (infectious) as well as non- suppurative.

Why C

The organism is very difficult to recover from synovial fluid, but the presence of immune cells confirms the gonococci in the fluid.