The patient: A 3-year-old boy in San Antonio, Texas
What happened: The patient's mother worked as a microbiology lab technician, and part of her job involved visiting physicians' offices to gather lab dishes of clinical samples that had been collected from patients. One day, she had her son in the car while she was making these rounds, according to a report of the case, which was published in 1984.
While en route, she stopped at a grocery store and then drove home to drop off her purchases. Once home, she briefly left her son in the parked car as she brought the groceries inside. When she returned, she found that her son had crawled into the backseat where she'd placed the clinical cultures — and that he'd eaten most of the contents of one lab dish.
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That dish contained "chocolate agar," a brownish medium used to grow bacteria that's made of split-open red blood cells. It's named for its color and contains no actual chocolate but nonetheless may have looked appetizing to the child, the report noted.
The diagnosis: The mother immediately brought her child to their family doctor, who found that the remaining material from the lab dish contained Neisseria gonorrhoeae, the bacteria that causes gonorrhea. Doctors decided to monitor the boy for signs of bacterial infection in his throat. Up to six days after he ate the agar, the boy's throat swabs tested negative for N. gonorrhoeae. No test was taken on the seventh day, but on the eighth day, he tested positive.
(The report didn't note whether the boy experienced any symptoms of the infection, and often, gonorrhea infections of the mouth and throat cause no symptoms. Possible symptoms include swollen lymph nodes and throat redness and soreness. Untreated gonorrhea can sometimes lead to dangerous complications, such as bloodstream infections or harmful immune system changes.)
The treatment: The doctors treated the infection following the Centers for Disease Control and Prevention's (CDC) guidelines at the time. This involved giving the patient intermuscular injections of an antibiotic called procaine penicillin G. (Nowadays, penicillin G is not recommended as a therapy for gonorrhea, in part because many strains of N. gonorrhoea circulating in the U.S. are now resistant to the drug's effects.)
The boy was also given probenecid mixed into ice cream. Probenecid helps boost the effect of some antibiotics by slowing the rate at which they're cleared from the body. This course of treatment "produced a prompt cure" and the boy tested negative for the bacteria on tests given afterward, the report said.
What makes the case unique: Gonorrhea most often spreads via sexual contact, through exposure to semen or vaginal fluid carrying the bacteria. As such, evidence of the infection in children can often point to sexual abuse taking place. In this case, however, doctors observed a very unusual instance of non-sexually transmitted gonorrhea related to exposure to laboratory cultures.
Cases of gonorrhea had been tied to laboratory exposures before — for example, a lab technician was once infected in the eye with N. gonorrhoeae while running experiments with the bacteria. When it comes to pediatric cases, though, this route of transmission is odd because children are not typically in environments where they could be inadvertently exposed to N. gonorrhoeae cultures.
Besides underscoring the importance of safety protocols in research, this case "reminds us of the risks involved in leaving children unattended in automobiles," the report authors added.
For more intriguing medical cases, check out our Diagnostic Dilemma archives.
This article is for informational purposes only and is not meant to offer medical advice.
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