Microbiology Case Studies: Applying Laboratory Data to Patient Care

Clinical microbiology case studies bridge the gap between laboratory results and patient management. For laboratory students, technicians, researchers, and diagnostic professionals, the ability to interpret culture findings, Gram stain morphology, and antimicrobial susceptibility patterns in the context of a specific patient presentation is a core professional skill. This article presents a structured approach to learning from case studies, with emphasis on how laboratory data informs diagnosis, treatment selection, and infection control decisions. The content is designed for self-assessment and teaching purposes, with each case illustrating distinct principles of clinical microbiology practice.

At a Glance: Case Study Learning Framework

The table below summarizes the key elements that learners should extract from each microbiology case study encountered in training or practice.

The Role of Case Studies in Microbiology Education

Case-based learning has become a standard method for teaching clinical microbiology to medical and laboratory science students. A pilot study examining case-based learning in medical microbiology from the student perspective found that this approach helps learners connect foundational microbiological concepts to clinical scenarios (Case-based learning in medical microbiology, students perspective). Similarly, a study on case-based learning with practical exercises in a hygiene and microbiology course demonstrated the utility of this model for implementing new medical licensing regulations (Case-based learning with practical exercises in hygiene and microbiology).

The educational value of case studies extends beyond simple knowledge recall. A study evaluating e-learning in clinical microbiology found that students engaged most with pathogen-focused clinical cases and that engagement with these materials was associated with improved examination performance (Can e-learning improve performance in Clinical Microbiology examinations). This finding supports the use of case-based approaches for developing clinical reasoning skills in microbiology.

Core Principles of Laboratory Data Interpretation

Gram Stain as a Rapid Diagnostic Tool

The Gram stain remains one of the most valuable rapid diagnostic tests in clinical microbiology. When performed on properly collected specimens, it provides immediate information about the presence of bacteria, their Gram reaction, and their morphology. This information guides initial antimicrobial therapy before culture results become available.

For cerebrospinal fluid specimens, the Gram stain is particularly critical. In primary amoebic meningoencephalitis, a rare but highly fatal condition caused by free-living amoebae, the diagnosis requires a high index of suspicion and specific laboratory techniques (Primary amoebic meningoencephalitis). The transnasal portal of entry and the rapidly progressive clinical course make early laboratory recognition essential for any chance of successful management.

Culture and Identification Workflow

The culture workflow begins with specimen inoculation onto appropriate media and proceeds through colony morphology assessment, biochemical testing, and ultimately species identification. The choice of media and incubation conditions depends on the suspected pathogen and the specimen source.

Whole genome sequencing has emerged as a powerful tool for bacterial identification in clinical laboratories. A validation study of whole genome sequencing for pan-bacterial identification demonstrated that this approach identified 100% of isolates to the genus level and 89% to the species level in a diverse set of 125 bacterial isolates (Validation and clinical utility of whole genome sequence-based bacterial identification). The study also found that improved identification by whole genome sequencing had a positive impact on patient care, including cases where unclear identification led to ineffective antibiotic use.

Antimicrobial Susceptibility Testing

Susceptibility testing determines whether an organism is likely to respond to specific antimicrobial agents. The interpretation of susceptibility results requires understanding of minimum inhibitory concentrations, breakpoints, and the difference between in vitro activity and in vivo efficacy.

A case of Brevibacillus brevis peritonitis in a patient with hepatocellular carcinoma illustrated this principle. The case demonstrated a pattern of antibiotic susceptibility with differing in vitro and in vivo bactericidal efficacy (Brevibacillus brevis peritonitis). This highlights the importance of correlating laboratory susceptibility data with clinical response.

Case Study 1: Methicillin-Resistant Staphylococcus aureus Infection

Clinical Presentation and Laboratory Findings

Staphylococcus aureus is a versatile pathogen associated with diverse clinical presentations. Methicillin-resistant Staphylococcus aureus strains have been important nosocomial pathogens in healthcare facilities for more than three decades, and community-associated MRSA strains have emerged as a public health problem of global proportions (MRSA case studies).

Four case histories involving MRSA and methicillin-sensitive Staphylococcus aureus highlight the diversity of clinical presentations and relative virulence of these infections. The molecular characterization of clonality and virulence gene profiles among these cases demonstrated significant genetic diversity among MRSA and sensitive strains. Various combinations of virulence factors contribute to disease manifestations in infected patients (MRSA case studies).

Laboratory Workup

For suspected staphylococcal infections, the laboratory workup includes:

1. Gram stain of the clinical specimen showing gram-positive cocci in clusters
2. Culture on blood agar with colony morphology assessment
3. Catalase and coagulase testing for species identification
4. Susceptibility testing including oxacillin or cefoxitin for MRSA detection
5. Molecular testing for mecA gene or PBP2a detection when indicated

Management Implications

The distinction between MRSA and methicillin-sensitive Staphylococcus aureus has significant therapeutic implications. MRSA infections require treatment with agents active against resistant strains, while methicillin-sensitive infections can be treated with narrower-spectrum agents. The changing epidemiology of MRSA has spurred renewed interest in translating knowledge of molecular determinants of virulence into rational prevention and control strategies (MRSA case studies).

Case Study 2: Post-Travel Recurrent Furunculosis

Clinical Scenario

Dermatological conditions are frequent during travel to tropical regions, with skin and soft tissue infections caused by Staphylococcus species being the most common. Post-travel recurrent furunculosis is a clinical entity defined in 2015, characterized by recurrent, painful, purulent nodular lesions following travel to tropical destinations (Post-travel recurrent furunculosis).

Two cases illustrate this condition: an adolescent aged 12 and a young adult aged 34 who developed recurrent lesions in the axillary and dorsal regions following travel to Thailand. Both patients received surgical drainage along with systemic and topical antibiotic therapy. The symptoms manifested in progressively milder forms, resolved intermittently, and achieved complete resolution within 3 to 6 weeks (Post-travel recurrent furunculosis).

Laboratory Considerations

The laboratory workup for recurrent furunculosis includes:

1. Gram stain and culture of purulent material from drained lesions
2. Susceptibility testing of isolated Staphylococcus species
3. Consideration of MRSA, particularly in patients with healthcare exposure
4. Assessment for underlying host factors that may predispose to recurrent infection

Clinical Correlation

Accurate knowledge of this condition is vital for selecting adequate therapy and providing credible information to patients. A detailed travel history significantly improves therapeutic adherence during recurrent episodes (Post-travel recurrent furunculosis). This case emphasizes the importance of incorporating epidemiological information into laboratory test interpretation.

Case Study 3: Cutaneous Botryomycosis

Clinical Presentation

Cutaneous botryomycosis is a rare chronic suppurative infection that can mimic other conditions. Four cases reported in the dermatology literature had predisposing factors including alcoholism, diabetes, and trauma. Clinically, patients presented with nodules, suppurative plaques, or ulcers (Cutaneous botryomycosis).

Laboratory Findings

In two cases, Staphylococcus aureus was cultured. One case yielded Neisseria species, and another grew a coagulase-negative Staphylococcus and Corynebacterium species as the only organisms cultured. All patients responded to systemic antibiotic therapy (Cutaneous botryomycosis).

Diagnostic Challenges

Botryomycosis presents diagnostic challenges because the clinical appearance can resemble other granulomatous or suppurative conditions. The laboratory plays a critical role in establishing the diagnosis through:

1. Deep tissue biopsy for histopathology
2. Gram stain of tissue sections showing gram-positive cocci in tissue grains
3. Aerobic and anaerobic culture of biopsy material
4. Special stains to differentiate from fungal infections

Case Study 4: Melioidosis

Clinical Presentation and Risk Factors

Melioidosis is an emerging infectious disease acquired through percutaneous inoculation or contaminated water. Known risk factors include diabetes mellitus, renal failure, cirrhosis, and malignancy. The disease presents with a febrile illness with protean manifestations ranging from septicemia to localized abscess formation (Melioidosis).

A case of a 42-year-old male from a non-endemic region presented with fever of 2 months duration, sepsis, persistent pneumonia, right hip joint pain, and hepatic and splenic abscesses. Aspiration of the joint and soft tissue fluid collection yielded gram-negative bacilli identified as Burkholderia pseudomallei (Melioidosis).

Laboratory Diagnosis

The laboratory diagnosis of melioidosis requires:

1. Culture of blood, sputum, urine, or abscess material on appropriate media
2. Recognition of the characteristic safety pin appearance on Gram stain
3. Biochemical identification of Burkholderia pseudomallei
4. Distinction from other gram-negative bacilli, particularly Pseudomonas species

Neuroinvasive Disease

Neuromelioidosis is a rare but severe complication of melioidosis associated with high mortality. Cases have exhibited diverse neurological manifestations including quadriparesis, hemiparesis, encephalopathy, and abscess formation. All cases were confirmed through culture and received appropriate antibiotic therapy (Unmasking neuroinvasive melioidosis).

India is considered to have significant underreporting of melioidosis, leading to delayed diagnosis and treatment challenges. Early identification and initiation of antimicrobial therapy are crucial to improve patient outcomes. Clinicians should maintain a high index of suspicion for Burkholderia pseudomallei in neurological infections to minimize diagnostic delays (Unmasking neuroinvasive melioidosis).

Case Study 5: Fungal Infections in Atypical Settings

Isolated Iliac Bone Cryptococcosis

A rare case of isolated iliac bone cryptococcosis in an immunocompetent patient from India presented with severe, persistent back pain significantly impacting daily activities. Comprehensive evaluation led to the diagnosis of iliac bone osteomyelitis caused by Cryptococcus neoformans. The patient was successfully treated with a prolonged one-year course of fluconazole therapy, resulting in complete resolution of symptoms without recurrence (Isolated iliac bone cryptococcosis).

This case highlights the importance of considering fungal osteomyelitis in atypical bone infections, even in immunocompetent individuals. The laboratory diagnosis requires:

1. Culture of bone biopsy material on fungal media
2. Histopathological examination with special fungal stains
3. Antigen testing when appropriate
4. Susceptibility testing to guide prolonged therapy

Podospora bulbillosa Keratitis

A case series reported three patients aged 56 to 62 years with rare fungal keratitis caused by Podospora bulbillosa presenting as unilateral severe non-pigmented keratitis. All cases were culture positive, and species identification was confirmed by ITS rDNA region sequencing. Antifungal susceptibility testing showed lower minimum inhibitory concentrations for voriconazole, amphotericin B, and anidulafungin than for natamycin (Podospora bulbillosa keratitis).

Treatment with topical and systemic antifungal agents and surgical interventions resulted in healing with improved vision in one patient only. These were the first reported cases of Podospora bulbillosa keratitis from Northeast India (Podospora bulbillosa keratitis).

Phaeohyphomycosis in an Immunocompromised Host

A Canadian renal transplant recipient was treated for chronic hepatitis E virus infection and subcutaneous phaeohyphomycosis due to Medicopsis romeroi with complete recovery. This case highlights the diagnostic and treatment challenges encountered in managing atypical infections in a high-resource but low-endemicity setting (Chronic hepatitis E and Medicopsis romeroi coinfection).

Case Study 6: Bacterial Keratitis

Clinical Context

Bacterial keratitis presentations are often treated using commercially available second-generation fluoroquinolones, ciprofloxacin 0.3% and ofloxacin 0.3%, as monotherapy. The guidelines available for instillation regimes are often not supported by data from clinical studies (The clinical treatment of bacterial keratitis).

Laboratory Role

The laboratory contributes to bacterial keratitis management through:

1. Corneal scrapings for Gram stain and culture
2. Culture on blood agar, chocolate agar, and Sabouraud dextrose agar
3. Identification of bacterial or fungal pathogens
4. Susceptibility testing to guide topical therapy

Treatment Considerations

A review of peer-reviewed clinical studies compared treatment failure rates for ciprofloxacin and ofloxacin for bacterial keratitis in relation to Day-1 drop regimes. Lower numbers of drops of ciprofloxacin on Day-1 were significantly associated with increased treatment failure rates. The derived minimum number of drops on Day-1 was 47 drops for ciprofloxacin and 24 drops for ofloxacin (The clinical treatment of bacterial keratitis).

The mean number of drops used in the clinical studies was significantly lower than the manufacturers' recommended Day-1 regimes for both ciprofloxacin and ofloxacin. Many published guidelines suggested the same drop regime for both fluoroquinolones despite significant differences in the manufacturers' suggested minimum drop regimes (The clinical treatment of bacterial keratitis).

Case Study 7: Chorioamnionitis

Clinical Syndrome

Clinical chorioamnionitis is the most common infection-related diagnosis in labor and delivery units and is an antecedent of puerperal infection and neonatal sepsis. The condition is suspected when intrapartum fever is associated with two other maternal and fetal signs of local or systemic inflammation, including maternal tachycardia, uterine tenderness, maternal leukocytosis, malodorous vaginal discharge or amniotic fluid, and fetal tachycardia (Clinical chorioamnionitis at term).

Microbiology

Clinical chorioamnionitis is a syndrome caused by intraamniotic infection, sterile intraamniotic inflammation, or systemic maternal inflammation induced by epidural analgesia. The most common microorganisms are Ureaplasma species, and polymicrobial infections occur in 70% of cases (Clinical chorioamnionitis at term).

Laboratory Diagnosis

In cases of uncertainty, a definitive diagnosis can be made by analyzing amniotic fluid with methods to detect bacteria, including Gram stain, culture, or microbial nucleic acid detection, and inflammation markers including white blood cell count, glucose concentration, and interleukin-6 (Clinical chorioamnionitis at term).

The fetal attack rate is low, with the rate of positive neonatal blood cultures ranging between 0.2% and 4%. Intrapartum antibiotic administration is the standard treatment to reduce neonatal sepsis (Clinical chorioamnionitis at term).

Case Study 8: Infant Infections Associated with Expressed Breast Milk

Clinical Context

Human breast milk is widely recognized as optimal infant nutrition, and expressed breast milk is increasingly used in both home and neonatal intensive care unit settings. However, milk expression introduces opportunities for microbial contamination and growth not present during direct breastfeeding (Infant infections associated with expressed breast milk).

Laboratory Findings

A scoping review identified 48 case reports across 43 studies involving 142 infants and 15 pathogen species. Infections predominantly affected very preterm, very low birthweight infants in neonatal intensive care units. Among infected infants with reported outcomes, 23% died during the reported clinical course (Infant infections associated with expressed breast milk).

The most frequently implicated pathogens were Streptococcus agalactiae, Cronobacter sakazakii, Staphylococcus aureus, Serratia marcescens, Klebsiella pneumoniae, and Bacillus cereus. Epidemiological evidence linking expressed breast milk to infection was frequently limited by inconsistent sampling timing (Infant infections associated with expressed breast milk).

Laboratory Considerations

When investigating suspected infections associated with expressed breast milk, the laboratory should:

1. Culture the expressed breast milk specimen using appropriate quantitative methods
2. Compare organisms isolated from the milk with those isolated from the infant
3. Consider molecular typing to establish epidemiological relatedness
4. Document collection and storage practices that may have contributed to contamination

Laboratory Quality Management

Quality Control Principles

The World Health Organization Laboratory Quality Management System Handbook provides guidance for establishing and maintaining quality in laboratory testing (WHO Laboratory Quality Management System Handbook). Key elements include:

1. Pre-analytical quality: specimen collection, transport, and processing
2. Analytical quality: test performance, controls, and calibration
3. Post-analytical quality: result reporting, interpretation, and communication

Biosafety Considerations

The World Health Organization Laboratory Biosafety Manual provides guidance for safe handling of infectious materials (WHO Laboratory Biosafety Manual). When working with clinical specimens, laboratory professionals must:

1. Follow standard precautions for all specimens
2. Use biological safety cabinets for procedures that generate aerosols
3. Implement appropriate containment for risk group 3 organisms such as Burkholderia pseudomallei
4. Maintain documentation of biosafety training and incidents

Assay Validation

The National Center for Advancing Translational Sciences Assay Guidance Manual provides comprehensive guidance for assay development and validation (NCATS Assay Guidance Manual). The U.S. Food and Drug Administration Bioanalytical Method Validation Guidance outlines expectations for method validation in regulated settings (FDA Bioanalytical Method Validation Guidance).

Advanced Diagnostic Technologies

Whole Genome Sequencing

Whole genome sequencing extends from microbial identification to epidemiological insight and antimicrobial resistance prediction. The roadblock for clinical laboratories lies in implementation and validation of such complex technology and data analysis (Validation and clinical utility of whole genome sequence-based bacterial identification).

A validation study using whole genome sequencing for pan-bacterial identification analyzed a diverse set of 125 bacterial isolates, including a subset of isolates without genus and species identifications. Using the 16S rRNA, rpoB, and groEL genes for identification, whole genome sequencing identified 100% of isolates to the genus level and 89% to the species level (Validation and clinical utility of whole genome sequence-based bacterial identification).

Chart review identified cases where improved genus and species level identification by whole genome sequencing may have had a positive impact on patient care. Reasons included the use of an ineffective antibiotic due to unclear identification, use of antibiotics when not clinically indicated, and help with an outbreak investigation (Validation and clinical utility of whole genome sequence-based bacterial identification).

Requirements for Whole Genome Sequencing Implementation

Whole genome sequencing analysis and interpretation in clinical and public health microbiology laboratories requires specific infrastructure and expertise (WGS analysis and interpretation in clinical and public health microbiology laboratories). Key requirements include:

1. Bioinformatics pipelines for sequence analysis
2. Reference databases for comparison
3. Validation data demonstrating accuracy and reproducibility
4. Standard operating procedures for interpretation and reporting
5. Integration with existing laboratory information systems

Phage Therapy Matching

Phage therapy is a promising solution for bacterial infections that are not eradicated by conventional antibiotics. A crucial element of this approach is appropriate matching of bacteriophages and antibiotics to the bacterial target according to the clinical setting (Clinical Phage Microbiology).

There is currently little consistency in the protocols used for the laboratory evaluation of bacteriophages intended for antibacterial treatment. A framework termed Clinical Phage Microbiology has been suggested to match appropriate bacteriophage-based treatments in clinical microbiology laboratories. Special cases that might require additional evaluation include bacteriophage interactions with the host immune response, biofilm-associated infections, and polymicrobial infections (Clinical Phage Microbiology).

Surveillance and Epidemiological Applications

Laboratory-Based Surveillance

Clinical microbiology laboratories serve as important data sources for disease surveillance. A study comparing surveillance of neuroborreliosis in Sweden through two different sources found that the hospital discharge register was unsuitable for surveillance, whereas laboratory-based reporting was a feasible alternative (Lyme neuroborreliosis epidemiology in Sweden).

Among 150 neuroborreliosis cases diagnosed at the largest clinical microbiology laboratory in Sweden, only 45% had received the recommended ICD-10 code combination. Based on laboratory reporting, the annual incidence of neuroborreliosis in Sweden was 6.3 cases per 100,000 in 2014 (Lyme neuroborreliosis epidemiology in Sweden).

Post-Mortem Microbiology

Fatal Streptococcus pyogenes infections have been studied through a comprehensive case series combining microbiology with autopsy findings. This study by the ESCMID study group for forensic and post-mortem microbiology examined cases in Spain, Turkey, the United Kingdom, and Belgium after pandemics (Fatal Streptococcus pyogenes infections).

Common Failure Patterns in Case Interpretation

Overreliance on Single Laboratory Results

Laboratory results must be interpreted in the context of the clinical presentation. A single positive culture does not always indicate infection, and a negative culture does not exclude infection. The laboratory professional should consider:

1. Specimen quality and collection technique
2. Prior antimicrobial therapy that may suppress growth
3. Fastidious organisms that may not grow on routine media
4. Contamination from skin flora or environmental sources

Failure to Correlate with Clinical Findings

The laboratory result should explain the patient presentation. When discrepancies exist, the laboratory professional should:

1. Review the specimen source and collection date
2. Consider repeating the test on a fresh specimen
3. Communicate with the clinical team about the discrepancy
4. Document the interpretation and any limitations

Misidentification of Organisms

Accurate species identification is essential for appropriate therapy. The case of Brevibacillus brevis peritonitis demonstrated that unusual organisms can be misidentified or dismissed as contaminants (Brevibacillus brevis peritonitis). Laboratory professionals should maintain a high index of suspicion when:

1. The organism does not fit the expected clinical picture
2. Biochemical results are atypical
3. The organism is rarely encountered in the laboratory
4. Molecular identification is available and should be considered

Professional Escalation Criteria

Laboratory professionals should escalate findings to the clinical team or public health authorities when:

1. A notifiable disease is identified
2. An organism with outbreak potential is isolated
3. A result suggests a public health threat
4. The laboratory finding requires urgent clinical action
5. A discrepancy between laboratory and clinical findings cannot be resolved

The National Center for Biotechnology Information provides literature resources for staying current with emerging pathogens and diagnostic methods (NCBI Literature Resources).

Frequently Asked Questions

How should a laboratory professional approach an unfamiliar organism isolated from a clinical specimen?

The approach should include repeating the Gram stain to confirm morphology, performing appropriate biochemical tests, considering molecular identification methods such as 16S rRNA gene sequencing or whole genome sequencing, and consulting reference materials or subject matter experts. The case of Brevibacillus brevis peritonitis demonstrates that unusual organisms require careful workup instead of dismissal as contaminants (Brevibacillus brevis peritonitis).

What is the role of the Gram stain in guiding initial antimicrobial therapy?

The Gram stain provides immediate information about the presence and morphology of bacteria in a clinical specimen. This information guides initial antimicrobial therapy before culture and susceptibility results become available. For cerebrospinal fluid specimens, the Gram stain is particularly critical for conditions such as primary amoebic meningoencephalitis where rapid diagnosis is essential (Primary amoebic meningoencephalitis).

How does whole genome sequencing compare to traditional methods for bacterial identification?

Whole genome sequencing identified 100% of isolates to the genus level and 89% to the species level in a validation study of 125 bacterial isolates. It also provided improved results for the majority of isolates that were originally reported with genus-only or descriptive identifications (Validation and clinical utility of whole genome sequence-based bacterial identification).

What are the key considerations for interpreting antimicrobial susceptibility results?

Susceptibility results must be interpreted in the context of the infection site, the pharmacokinetics of the antimicrobial agent, and the clinical response. The case of Brevibacillus brevis peritonitis demonstrated differing in vitro and in vivo bactericidal efficacy, highlighting the importance of correlating laboratory data with clinical outcomes (Brevibacillus brevis peritonitis).

How should travel history influence the laboratory workup?

Travel history is essential for considering pathogens that are uncommon in the local population. Post-travel recurrent furunculosis following travel to tropical regions requires consideration of Staphylococcus species and appropriate culture and susceptibility testing (Post-travel recurrent furunculosis). Similarly, melioidosis should be considered in patients with appropriate travel or residence history and compatible clinical findings (Melioidosis).

What is the role of the laboratory in outbreak investigations?

The laboratory supports outbreak investigations through accurate species identification, susceptibility testing, and molecular typing. Whole genome sequencing has been shown to help with outbreak investigations by providing improved genus and species level identification (Validation and clinical utility of whole genome sequence-based bacterial identification).

How should laboratory professionals handle discrepancies between laboratory results and clinical presentation?

Discrepancies should trigger a review of specimen quality, collection technique, and test performance. The laboratory professional should communicate with the clinical team, consider repeating the test on a fresh specimen, and document the interpretation and limitations. Laboratory-based surveillance data can provide context for expected findings in specific populations (Lyme neuroborreliosis epidemiology in Sweden).

What biosafety precautions are needed when handling specimens from patients with suspected melioidosis?

Burkholderia pseudomallei is a risk group 3 organism that requires appropriate containment. The World Health Organization Laboratory Biosafety Manual provides guidance for safe handling of infectious materials (WHO Laboratory Biosafety Manual). Laboratory professionals should follow standard precautions, use biological safety cabinets for procedures that generate aerosols, and implement appropriate containment measures.

Related Diagnostic Guides

• Laboratory Results Template: How to Present Data Clearly and Reproducibly
• How to Interpret Gram Stain Results: Morphology, Arrangement, and Color
• Quality Control in the Microbiology Laboratory: Key Practices for Reliable Results
• Bench Sheets and Raw Data Forms: Designing Laboratory Records That Preserve Traceability
• Antimicrobial Susceptibility Testing in Secondary Viral Co-infections

References and Further Reading

• Laboratory Quality Management System Handbook. World Health Organization.
• Laboratory Biosafety Manual. World Health Organization.
• Assay Guidance Manual. National Center for Advancing Translational Sciences.
• Bioanalytical Method Validation Guidance. U.S. Food and Drug Administration.
• NCBI Literature Resources. National Center for Biotechnology Information.
• MRSA case studies.. Methods in molecular biology (Clifton, N.J.), 2007.
• [Post-travel recurrent furunculosis].. Orvosi hetilap, 2026.
• Cutaneous botryomycosis.. Journal of the American Academy of Dermatology, 1991.
• Rabbit's revenge.. The Lancet. Infectious diseases, 2003.
• Primary amoebic meningoencephalitis.. The Laryngoscope, 1978.
• The clinical treatment of bacterial keratitis: A review of drop instillation regimes.. Contact lens & anterior eye : the journal of the British Contact Lens Association, 2022.
• Melioidosis.. The Journal of the Association of Physicians of India, 2008.
• Brevibacillus brevis peritonitis.. The American journal of the medical sciences, 2009.
• Infant infections associated with expressed breast milk: a scoping review.. 2026.
• Isolated iliac bone cryptococcosis in an immunocompetent patient successfully managed with prolonged antifungal therapy: A rare case report and literature review.. 2026.
• Unmasking neuroinvasive melioidosis: Insights from Burkholderia pseudomallei cases in an Indian neurocenter - A case series.. 2026.
• Chronic hepatitis E and Medicopsis romeroi coinfection in a Canadian renal transplant recipient: a case report.. 2026.
• Podospora bulbillosa keratitis: A case series with molecular confirmation from North-east India.. 2026.
• Validation, Implementation, and Clinical Utility of Whole Genome Sequence-Based Bacterial Identification in the Clinical Microbiology Laboratory.. Journal of Molecular Diagnostics, 2021.
• Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment. American Journal of Obstetrics and Gynecology, 2023.
• Can e-learning improve the performance of undergraduate medical students in Clinical Microbiology examinations?. BMC Medical Education, 2019.
• Lyme neuroborreliosis epidemiology in Sweden 2010 to 2014: clinical microbiology laboratories are a better data source than the hospital discharge diagnosis register. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, 2019.
• Executive summary of the diagnosis and treatment of urinary tract infection: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC).. Enfermedades Infecciosas y Microbiologia Clinica, 2017.
• Clinical Phage Microbiology: a suggested framework and recommendations for the in-vitro matching steps of phage therapy.. The Lancet Microbe, 2021.
• Fatal Streptococcus pyogenes infections in Spain, Turkey, UK and Belgium after pandemics: a comprehensive case series combining microbiology with autopsy findings. A study of the ESCMID study group for forensic and post-mortem microbiology (ESGFOR).. European Journal of Clinical Microbiology and Infectious Diseases, 2026.
• Case-based learning with practical exercises in the course hygiene and microbiology as a model for the implementation of the new medical licensing regulations. Deutsche Medizinische Wochenschrift, 2023.
• A pilot study on case-based learning (CBL) in medical microbiology, students perspective. Medical Journal Armed Forces India, 2021.
• Murray's Basic Medical Microbiology. Murray S Basic Medical Microbiology Foundations and Clinical Cases, 2023.
• WGS analysis and interpretation in clinical and public health microbiology laboratories: What are the requirements and how do existing tools compare?. Pathogens, 2014.

This article is educational and does not replace validated laboratory procedures, institutional biosafety review, manufacturer instructions, or professional interpretation.