A 37-year-old male was admitted to a hospital complaining of abdominal pain, difficulty in swallowing and breathing, constipation, and nausea. He developed respiratory failure and required endotracheal intubation and ventilation. Two days before, the patient consumed dried salted fish bought from an artisanal producer. Laboratory investigation for infectious pathogen was performed using Kitt-Tarozzi's method. Observation under a bright field microscopy revealed the presence of typical microorganisms with tennis racket appearance. Which of the following is the most likely diagnosis?

Correct Answer: A

Rationale: The correct answer is A: Botulism. Botulism is caused by the toxin produced by Clostridium botulinum bacteria found in improperly preserved or canned foods. The symptoms described align with botulism, such as difficulty swallowing and breathing due to muscle paralysis. The tennis racket appearance seen under microscopy corresponds to the characteristic appearance of Clostridium botulinum spores. The other choices can be ruled out based on the clinical presentation and microscopy findings. Cholera typically presents with severe watery diarrhea, Nontyphoidal Salmonella infection with fever and gastrointestinal symptoms, and Typhoid fever with high fever and abdominal pain. Therefore, the most likely diagnosis in this case is botulism.

Correct Answer: A

Rationale: The correct answer is A: Sabouraud's peptone agar. This agar is specifically designed for the isolation of yeast and molds due to its low pH and high sugar content, creating an environment conducive for their growth. Yeast-like fungi thrive in this selective medium, while inhibiting the growth of bacteria and other contaminants. Summary: - Sabouraud's peptone agar is ideal for cultivating yeast-like fungi. - Endo agar is used for isolation of gram-negative bacteria, not fungi. - Milk-salt agar is used for lactobacilli and streptococci, not fungi. - Meat infusion agar is a general-purpose medium for cultivation of a wide range of microorganisms, not specifically for yeast-like fungi.

Correct Answer: B

Rationale: The correct answer is B: Gram-negative bacteria. Gram-negative bacteria have an outer membrane containing lipopolysaccharides (LPS). In the Gram staining technique, these bacteria appear pink/red due to the thin peptidoglycan layer, which allows the crystal violet stain to be washed out, revealing the safranin counterstain. Gram-positive bacteria (choice A) have a thick peptidoglycan layer but lack an outer membrane with LPS. Choice C is incorrect since only Gram-negative bacteria possess LPS in their outer membrane. Choice D is incorrect as all bacteria can be classified as either Gram-positive or Gram-negative based on their cell wall structure.

Correct Answer: A

Rationale: The correct answer is A: Clostridium perfringens. This bacterium is an anaerobic, Gram-positive rod that forms terminal spores and produces gas. It is commonly associated with wound infections and gas gangrene. Clostridium botulinum causes botulism and does not typically present with gas production. Bacillus anthracis is an aerobic, Gram-positive spore-forming bacterium causing anthrax. Clostridium tetani causes tetanus and does not produce gas. Thus, based on the characteristics described in the question, Clostridium perfringens is the most likely causative agent.

Correct Answer: D

Rationale: The correct answer is D, Shiga anatoxin. This is because the Salk and Sabin vaccines are actually for polio, not chemical vaccines. HPV vaccine is a biological vaccine, not a chemical one. Shiga anatoxin is a chemical vaccine used against Shigella bacteria, making it the only correct choice for chemical vaccines in this question.

Correct Answer: B

Rationale: Step-by-step rationale: 1. Filamentous spiral nucleocapsid is characteristic of Filoviridae, such as Ebola virus. 2. Linear unsegmented single strand (-) RNA is a key feature of Filoviridae genomes. 3. The lipid bilayer membrane of cellular origin is found in Filoviridae viruses. 4. Therefore, the correct answer is B (Filoviridae) due to the alignment of all three morphological features. Summary: - A (Picornaviridae): Has an icosahedral capsid, not filamentous spiral. - C (Orthomyxoviridae): Has a segmented genome, not linear unsegmented. - D (Togaviridae): Has a spherical capsid, not filamentous spiral.

Correct Answer: C

Rationale: Toxoplasma gondii is a protozoan parasite known to cause toxoplasmosis. It belongs to the group of eukaryotic organisms called protozoans because it is a single-celled organism with complex cellular structures. Protozoans are characterized by their ability to move and perform essential functions independently. Algae (choice A) are photosynthetic eukaryotic organisms, fungi (choice B) are non-photosynthetic eukaryotes that include molds and yeasts, and helminths (choice D) are multicellular parasitic worms. Therefore, the correct answer is C because Toxoplasma gondii is a protozoan parasite.

Correct Answer: A

Rationale: Step-by-step rationale: 1. Blue-green pigment + fruity odor are characteristic of Pseudomonas aeruginosa. 2. P. aeruginosa is a Gram-negative bacterium commonly associated with wound infections. 3. P. aeruginosa is known for its ability to produce pyocyanin (blue-green pigment) and a sweet, fruity odor. 4. Other choices like E. coli, K. pneumoniae, and P. mirabilis do not typically produce blue-green pigment or fruity odor. 5. Therefore, based on the characteristics observed, the likely causative agent is Pseudomonas aeruginosa. Summary of other choices: - Escherichia coli: Does not produce blue-green pigment or fruity odor. - Klebsiella pneumoniae: Does not typically produce blue-green pigment or fruity odor. - Proteus mirabilis: Does not produce blue-green pigment or fruity odor.

Correct Answer: A

Rationale: Rationale for correct answer (A: Escherichia coli): 1. Endo agar selects for Gram-negative bacteria. 2. Red colonies on Endo agar indicate lactose fermentation, characteristic of E. coli. 3. E. coli is a common cause of pneumonia, especially in immunocompromised patients. Summary of why other choices are incorrect: - B: Klebsiella pneumoniae: Typically forms mucoid colonies on agar. - C: Pseudomonas aeruginosa: Produces characteristic greenish-blue colonies on agar. - D: Proteus mirabilis: Does not typically ferment lactose, so would not produce red colonies on Endo agar.