laboratory diagnostic of special senses module

8/9/2019 Laboratory Diagnostic of Special Senses Module

1/51

Laboratory

Diagnostic of Special SensesModule

Ariyani Kiranasari ; Elisabeth D.H;Conny R

Microbiology Depart!ent

"aculty of Medicine #ni$ersity of


2/51

%!portant aspects ofMicrobiologicE&a!ination of speci'c Senses (

- Specimen collection andhandling

- Specimen processing andculture

- Interpretation of microbiology

laboratory result


3/51

A. Selection

1. A swab is not recommended forcollecting

specimens to diagnose otitis mediainfections.

When use a swab, external ear canal

fora

AR )*titis Media+ S,EC%ME-


4/51

2. The specimen of choice is an aspirate

from behind the tympanum (ear drum).

The fuid rominner earrepresents theinectious

process, not

external earcanal fora.

Selection .


5/51

. A small swab may used only when eardrum has ruptured and !uid can be

collected

". #iagnosis is usually made clinically. Tympanocentesis is painful and is done

only in young children and in patientswith chronic otitis media not respondingto therapy

Selection .


6/51

/. Collection

1. $lean the e%ternal ear canal withantiseptic solution. Antiseptic gau&e canbe pac'ed into the ear until the doctor isready

2. The patient may be gien a general

anesthetic since the incision causesgreat pain

. The physician surgically incises the ear

drum and collects as much !uids possible


7/51

$ollection ****.

Alternatiely material may be allowed tocollect on a sterile swab.

the ear speculum helps preentcontamination by ear canal !ora

". +aterial in the syringe can be aspirated

into anaerobic transport ial or submitteddirectly in the capped syringe


8/51

C. Labeling

1. #o not label the specimen as ear. If !uidhas been collected it should beappropriately labeled as tympanocentesisfuid

2. ,roide ,atient information

. Indicate the age of the patient and anypertinent history (chronic otitis notresponding to therapy)

". #o not request anaerobic culture unless


9/51

D. ransport

1. #o not refrigerate the specimen

2. Transport the specimen to thelaboratory uic'ly. old it at roomtemperature


10/51

E0E S,EC%ME-S

A. Selection

1. #o not use the term Eye for identifyinga specimen. Specify what the specimenis e.g. lid margin sample con/unctial

sample corneal sample aueous oritreous sample.

speciy let or right eye.


11/51

Gambar mata dari depan ya?!…………………..

Normal eye


12/51

conjuctiva

Excretory ducts

Lacrimal ducts

Lacrimal

sac

N a s

o

l a c r i m

a l

s a c

La c r i m a l g l a n d s


13/51

2. In serious eye infection such assuppuratie 'eratitis or endophthalmitis

media and transport systems are madeaailable.

or bacteria, chocolate agar is likely to be a

good universal medium

Selection .


14/51

Selection .

. In bilateral con/unctiitis culture of aspecimen from only one eye is necessary

". 0or con/uctial specimens the laboratoryideally needs two swabs from the infectedsite

one for culture and one for ram.


15/51

/. Collection

+ethods of collecting specimens from theeye

(reer to a guide to specimen management inclinical microbiology.. !iller "!)

C. Labeling

1. 3abel the specimen with the actualdiagnosis not eye2. 3abel the specimen as being from the

right or the let eye

. 3abel the specimen with patient


16/51

Collection of con1uncti$al !aterial)con1uncti$al s2ab+


17/51

Collection of clinical samples of

corneal ulcers or keratitis


18/51

D. ransport

1. +any specimen should be plated at thespecimen collection site e.g the eyeclinic. The small amount of material

collected tends to dry uic'ly and thisdrying may contribute to a loss ofiability of agents

2. 4se anaerobic transport wherenecessary but not for con/uctialspecimens

. $hill the iral transport medium for


19/51

-ASAL S,EC%ME-S

A. Selection

1. The specimen of choice is a swabspecimen ta'en at least 1 cm inside thenares

2. 3esions in the nose reuire samples fromthe adancing margin of the lesions


20/51

/. Collection

1. $arefully insert the swabs at least 1 cm into the nares

2. 0irmly sample the membrane by rotating the swab andleaing it in place for 15 to 16 s

. 7ithdraw the swabs insert it into a transportcontainer and crush the ial of transport medium inthe container


21/51

C. Labeling

1. 3abel the swab container with patientinformation

2. Indicate whether or not a lesion is present

D. ransport

. Transport the specimen to the laboratoryas soon as possible

". #o not refrigerate the specimen


22/51

-AS*,HAR0-3EAL S,EC%ME-S

A. Selection

1. Specimens must be ta'en is any waythat aoids contamination with the nasalor oral !ora

2. The nasopharyn% may be reached by asmall nasopharyngeal swab insertedthrough either the nose or the throat


23/51

/. Collection

1. 8emoe e%cess secretions or e%udatefrom the anterior nares

2. Insert the nasal speculum if it used

. ently pass the swabs through the noseand into the nasopharyn%

". 8otate the swabs on the nasopharyngealmembrane and allow the swab to remainin place for 15 to 16 s to absorb

organisms


24/51

Gambar mata dari depan ya?!…………………..


25/51

Collection

6. 8emoe the swabs carefullyand place itin the transport medium. Do notrefrigerate it.

9. 8emoe the speculum

:. Alternatiely bend the wire at an angle

and insert it into the throat.

Then moe the swabs upward into thenasopharyngeal space


26/51

C. Labeling

1. 3abel the specimen with patientinformation

2. Include the suspected diagnosis where

possible

D. ransport

. Transport the specimen to the laboratoryas soon as possible

". #o not refrigerate the specimen


27/51

Microbiological Investigations

1. Microscopy

- Gram-stain is a frequently useful rapid indicator

of the causative organisms present and is

routinely performed

- Ziehl-Neelsen stain

- Fluorescent stains are only performed when

clinically indicated

. !ulture and anti"iotic sensitivities


28/51

ransport Media

7hen the patient is notclose to the bacteriologylaboratory there is a

ris' that the pathogen ina bacteriologicalspecimen may notsurie or may beoergrown bynon-pathogen during thetime it ta'es to transportthespecimen to thelaboratory.

A. $arry


29/51

Neisseria

gonorrhoeae

Gram-negative diplococci


30/51

Neisseria

gonorrhoeae


31/51

,lenty of 3ra! positi$e cocci in pairs!orphologically rese!bling Streptococcus

pneumoniae are seen


32/51


33/51

,lenty of 3ra! positi$e cocci in clusters!orphologically rese!bling Staphylococcus sp.

are seen


34/51

Staphylococcus sp.


35/51

Mycobacteriumtuberculosis


36/51

#seudomonas aeruginosa

on =utrient Agar

he organis! produce a di4usible yello25green pig!ent


37/51

Haemophilusinuenzae


38/51

Bacteroides fragillis

Plenty of Gram negativebacilli are seen


39/51


40/51

$andida albicans on Sabouraoudagar

Single egetatie cells that typically form smooth creamy bacterial-li'e colony


41/51

Gram of Candida albicans

Blastospora


42/51

Manny brancing septate fungal filament visuali!e

used "it Potassium ydroxide #$%&' () *


43/51

Aspergillus sp. With Conidia that are

produced by vaseshaped conidiogenous

cell termed a phialide


44/51

%spergillus sp. on Sabouraoud agar

ae a u&&y or woollyappearance that

is due to the

mycelium


45/51

Culture for $iruses

Con$entional tubeculture techni6ue


46/51


47/51

+mmunoflorescence staining so"ing te reticulate

bodies of Chlamydia trachomatis gro"n on Mc Coy

Cell line culture


48/51

+mmunoflorescence staining so"ing te

infected cell positive for ,denovirus in te

direct smear of conjuctival s"ab


49/51

+mmunoflorescence staining for detection of

&erpes simplex virus - positive


50/51


51/51

Th ank you

for

th att ntion

laboratory diagnostic of special senses module

Documents