Bacteremia Diagnosed on Peripheral Blood Smear before Blood Cultures become Positive:A case report / 대한임상병리학회지

ABSTRACT

In a 49-year-old man admitted due to dyspnea, epistaxis and loss of consciousness, disseminated intravascular coagulation with petechiae and ecchymosis was presented. Bacteria within monocytes and neutrophils were observed in the peripheral blood smear of this patient, and, also, prominent toxic changes, such as marked granulation, vacuolation, and Dohle bodies, were noted in leukocytes. These bacteria could be confirmed by Gram stain of peripheral blood smear and blood cultures as Klebsiella pneumoniae, at 48 hours after bacteremia was diagnosed by the blood films. We believe that this report is the first case of bacteremia diagnosed by a Wright's stained peripheral blood smear in Korea. Despite intensive treatment with respiratory support, associated with broad spectrum antibiotherapy, he died on the second day of the admission and before getting the result of blood cultures. Therefore, direct examination of peripheral blood smears could be a valuable tool for the early diagnosis and management of high-level bacteremia.