The microbiology "unknown" misadventure.
A 19-year-old nursing student was hospitalized after several days of nausea, vomiting, diarrhea, and fevers. Salmonella paratyphi A was isolated from multiple blood cultures. Because this is an unlikely isolate in the United States, an investigation ensued. Two and a half weeks earlier, the student had been working on a microbiology laboratory exercise "unknown." Both the "unknown" organism and the patient's blood culture isolates were identified as S. paratyphi A, with the same biochemical reactions and antimicrobial susceptibility results. The patient's condition improved with antibiotic therapy, and she was discharged after 9 days in the hospital. Conclusions related to our investigation are as follows: (1) relatively virulent organisms were unnecessary to fulfill the laboratory objectives, (2) pipetting by mouth must never be allowed, (3) proper labeling of specimens is imperative, (4) instructors should have knowledge of laboratory safety regulations, and (5) it is the obligation of laboratory directors and administrators to provide a safe academic environment.