Case #5:

An 82 year old woman with an history of HTN treated with Vasotec (enapril maleate), and of
NIDDM, was seen in the outpatient clinic complaining of a blister on her lower lip that she said
she had been developing slowly over a year. The blister was diagnosed as a mucocele (a
mucus cyst), and an appointment was made to have it biopsied and excised at a future date. In
the course of her examination, a routine urinalysis (without the microscopic) was requested and
the urine was found to be significant for nitrite positive; and leukocyte esterase moderate. The
results prompted the request for a urine C&S. The urine C&S subsequently indicated a colony
greater than 100,000 CFU/ml with an identification of E. coli.

• What aspect of the urine sediment do you find significant?

- Pus cells and bacteria (Caused the Nitrite and Leukocytes Esterase test in the urine to
be positive.)
• There are certain types of bacteria (e.g. E. coli) which have the ability to reduce
nitrate, a normal constituent of urine, to nitrite, which does not normally appear in
the urine. Therefore, Nitrites in the urine can be an early warning that a urinary
tract infection might exist.
• A positive LE test result is most frequently accompanied by the presence of
bacteria. The LE detects the presence of esterase in the granulocytic white
blood cells (neutrophils, eosinophils, and basophils) and monocytes. Neutrophils
are the leukocytes most frequently associated with bacterial infections.

• What diagnosis would you give this case?

- Urinary tract infection
• The presence of a single type of bacteria (E. coli) growing at high colony counts
(greater than 100,000 colony forming units (CFU)/ml) indicates a Urinary Tract
Infection.

• What type of treatment do you think this patient was given for the condition shown here
- Antibiotic therapy with the correct dosage relating to her age.

Antibiotic Age Route Dosage

Trimethoprim- Adult ORAL or IV 160 mg-800 mg/

Sulfamethoxazole (TMP-SMX 12 hours for 10 to 14 days
8 to 10 mg/kg/day

Nitrofurantoin (Furadantin, Adult ORAL 50 to 100 mg four times daily

Macrodantin for seven days

Amoxicillin Adult ORAL 250 mgs/ 8 hrs or 500 mgs/12

hours.

• What results will be expected upon performing the microscopic examination of the
patient's urine?
- Urine microscopic exam will be, pus cells ranging from many to TNTC (too numerous
to count) and bacteria.

References:
http://www.labtestsonline.org/understanding/analytes/urine_culture/test.html

http://www.testsymptomsathome.com/TEC06.asp

http://adam.about.com/reports/000036_7.htm

http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/
http://adam.about.com/reports/000036_7.htm

http://www.labtestsonline.org/understanding/analytes/urine_culture/test.html

http://www.testsymptomsathome.com/TEC06.asp

http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/

http://www.drugs.com/mtm/sulfamethoxazole-and-trimethoprim.html

http://en.wikipedia.org/wiki/Nitrofurantoin

http://www.drugs.com/pdr/amoxicillin.html

http://www.rxlist.com/vasotec-drug.htm

Angeles University Foundation

College of Allied Medical Professions
 Department of Medical Technology

In Partial Fulfillment of the requirement in

Clinical Microscopy
(Case Analysis)

Submitted by:

Group 5
Garcia, Vixienne Geia

Natividad, Justine Lorenz

Nicdao, Jan Kevin

BSMT III-A

Submitted to:
Ms. Crizelda Liwanag

Submitted on:
January 7, 2010

Sample Test Paper:

1. NIDDM stands for:

a. Non-Identifiable Diabetes Mellitus
 b. Non-Insulin Dependent Diabetes Mellitus
c. Non-Insulin Deficient Diabetes Mellitus
2. In the case, the old woman was complaining of a blister on her lower lip, which was later
diagnosed as a mucocele. A mucocele is a/an:
a. Allergy
b. Mucus cyst
c. Mole
3. An excision and a/an ____ were scheduled on a future date for the mucocele.
a. Chemotherapy
b. Biopsy
c. Aspiration
4. Which of the following was used to treat the patient’s history of HTN?
a. Vasotec
b. Amoxicillin
c. Nitrofurantoin
5. The significant results of the requested Routine Urinalysis is/are:
a. Leukocyte esterase (many); nitrite (+)
b. Leukocyte esterase (few); nitrite (-)
c. Leukocyte esterase (moderate); nitrite (+)
6. The results in #5 prompted for a/an:
a. C&S
b. Repeat test
c. None; the tests were sufficient in diagnosis
7. Women tend to have higher LE values due to:
a. Vaginal contamination
b. Difference in sexual activity
c. Men and women have same range values
8. In the nitrite reaction, which is normally found in the urine?
a. Nitrite
b. Nitrate
c. Both
9. The C&S results indicated:
a. >100,000 CFU/ml of E.coli
b. <100,000 CFU/ml of E.coli
c. 100,000 CFU/ml of E.coli
10. The diagnosis of the case was:
a. HTN
b. UTI
c. NIDDM

Answer Key:

1. NIDDM stands for:

a. Non-Identifiable Diabetes Mellitus
b. Non-Insulin Dependent Diabetes Mellitus
c. Non-Insulin Deficient Diabetes Mellitus
 2. In the case, the old woman was complaining of a blister on her lower lip, which was later
diagnosed as a mucocele. A mucocele is a/an:
a. Allergy
b. Mucus cyst
c. Mole
3. An excision and a/an ____ were scheduled on a future date for the mucocele.
a. Chemotherapy
b. Biopsy
c. Aspiration
4. Which of the following was used to treat the patient’s history of HTN?
a. Vasotec
b. Amoxicillin
c. Nitrofurantoin
5. The significant results of the requested Routine Urinalysis is/are:
a. Leukocyte esterase (many); nitrite (+)
b. Leukocyte esterase (few); nitrite (-)
c. Leukocyte esterase (moderate); nitrite (+)
6. The results in #5 prompted for a/an:
a. C&S
b. Repeat test
c. None; the tests were sufficient in diagnosis
7. Women tend to have higher LE values due to:
a. Vaginal contamination
b. Difference in sexual activity
c. Men and women have same range values
8. In the nitrite reaction, which is normally found in the urine?
a. Nitrite
b. Nitrate
c. Both
9. The C&S results indicated:
a. >100,000 CFU/ml of E.coli
b. <100,000 CFU/ml of E.coli
c. 100,000 CFU/ml of E.coli
10. The diagnosis of the case was:
a. HTN
b. UTI
c. NIDDM

Research Information:

Hypertension is a chronic medical condition in which the blood pressure is elevated. It

is also referred to as high blood pressure or shortened to HT, HTN or HPN. The word
"hypertension", by itself, normally refers to systemic, arterial hypertension. Hypertension can be
classified as either essential (primary) or secondary. Essential or primary hypertension means
that no medical cause can be found to explain the raised blood pressure. It is common. About
90-95% of hypertension is essential hypertension. Secondary hypertension indicates that the
high blood pressure is a result of (i.e., secondary to) another condition, such as kidney disease
or tumours (adrenal adenoma or pheochromocytoma). Persistent hypertension is one of the risk
factors for strokes, heart attacks, heart failure and arterial aneurysm, and is a leading cause of
chronic renal failure. Even moderate elevation of arterial blood pressure leads to shortened life
expectancy. At severely high pressures, defined as mean arterial pressures 50% or more above
average, a person can expect to live no more than a few years unless appropriately treated.
Beginning at a systolic pressure (which is peak pressure in the arteries, which occurs near the
end of the cardiac cycle when the ventricles are contracting) of 115 mmHg and diastolic
pressure (which is minimum pressure in the arteries, which occurs near the beginning of the
cardiac cycle when the ventricles are filled with blood) of 75 mmHg (commonly written as
115/75 mmHg), cardiovascular disease (CVD) risk doubles for each increment of 20/10 mmHg.
VASOTEC® (Enalapril Maleate) is the maleate salt of enalapril, the ethyl ester of a
long-acting angiotensin converting enzyme inhibitor, enalaprilat. Enalapril maleate is chemically
described as (S)-1-[N-[1-(ethoxycarbonyl)-3-phenylpropyl]-L-alanyl]-L-proline, (Z)-2-
butenedioate salt (1:1). Enalapril maleate is a white to off-white, crystalline powder with a
molecular weight of 492.53. It is sparingly soluble in water, soluble in ethanol, and freely soluble
in methanol. Enalapril is a pro-drug; following oral administration, it is bioactivated by hydrolysis
of the ethyl ester to enalaprilat, which is the active angiotensin converting enzyme inhibitor.
VASOTEC is indicated for the treatment of hypertension. It is effective alone or in combination
with other antihypertensive agents, especially thiazide-type diuretics. The blood pressure
lowering effects of VASOTEC and thiazides are approximately additive.
Diabetes mellitus type 2 or type 2 diabetes (formerly called non-insulin-dependent
diabetes mellitus (NIDDM), or adult-onset diabetes) is a disorder that is characterized by
high blood glucose in the context of insulin resistance and relative insulin deficiency.
Traditionally considered a disease of adults, type 2 diabetes is increasingly diagnosed in
children in parallel to rising obesity rates due to alterations in dietary patterns as well as in life
styles during childhood. Unlike type 1 diabetes, there is very little tendency toward ketoacidosis
in type 2 diabetes, though it is not unknown. One effect that can occur is nonketonic
hyperglycemia which also is quite dangerous, though it must be treated very differently.
Complex and multifactorial metabolic changes very often lead to damage and function
impairment of many organs, most importantly the cardiovascular system in both types. This
leads to substantially increased morbidity and mortality in both type 1 and type 2 patients, but
the two have quite different origins and treatments despite the similarity in complications.
An oral mucocele, is a clinical term that refers to two related phenomena: mucus
extravasation phenomenon, and mucus retention cyst. The former is a swelling of connective
tissue consisting of collected mucin due to a ruptured salivary gland duct usually caused by
local trauma, in the case of mucus extravasation phenomenon, and an obstructed salivary duct
in the case of a mucus retention cyst. The mucocele is a bluish translucent color, and is more
commonly found in children and young adults.
A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary
tract. The main causitive agent is Escherichia coli. Although urine contains a variety of fluids,
salts, and waste products, it usually does not have bacteria in it. When bacteria get into the
bladder or kidney and multiply in the urine, they cause a UTI. The most common type of UTI is a
bladder infection which is also often called cystitis. Another kind of UTI is a kidney infection,
known as pyelonephritis, and is much more serious. Although they cause discomfort, urinary
tract infections can usually be quickly and easily treated with a short course of antibiotics.