Case 22

1. Presented by Cherub Kim, MD and reviewed by Sean Zhang MD, PhD

Clinical Vignette

A newborn baby is born premature via vaginal delivery, complicated by sepsis with disseminated intravascular coagulation and respiratory failure. After extensive critical care, the patient begins to improve. A few days later, the patient develops hypotension requiring vasopressors and increased need for ventilator support. The patient's white blood cell count is 43 K/cu mm (reference range, 9.0 - 30.0 K/cu mm). Urine culture grows Candida glabrata. Culture of endotracheal aspirate grows the following colonies on Sheep Blood Agar (SBA) (Figure 1). Its morphology on the Sabouraud Dextrose Agar (SDA) is show in Figure 2. The organism is smeared onto a slide and stained with methylene blue (Figure 3).

Figure 1 - Colonies on SBA.

Figure 2 - Colonies on SDA.

Figure 3 - Organism with methylene blue stain, 600x magnification.

Question: Which is the most likely organism isolated from the endotracheal aspirate?