Laboratory Diagnostic of Special Senses Module 2013

8/12/2019 Laboratory Diagnostic of Special Senses Module 2013

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Laboratory Diagnostic of

Special Senses Module

Ariyani Kiranasari ; Elisabeth D.H; Conny RT

Microbiology Department

Faculty of Medicine University of Indonesia


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Important aspects of MicrobiologicExamination of specific Senses :

- Specimen collection and handling- Specimen processing and culture

- Interpretation of microbiology

laboratory result


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A. Selection

1. A swab is no trecommended for collecting

specimens to diagnose otitis media infections.

When use a swab, external ear canal flora

contaminates the specimen, making

interpretation of clinically relevant growth

difficult and misleading

EAR (Otitis Media) SPECIMENS


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2. The specimen of choice is an aspirate from

behind the tympanum (ear drum).

The fluid from

inner ear

represents the

infectious

process, not

external earcanal flora.

election.


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3. A small swab may used only when ear drum

has ruptured and fluid can be collected

4. Diagnosis is usually made clinically.

Tympanocentesis is painful and is done only in

young children and in patients with chronic

otitis media not responding to therapy

election.


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B. Collection

1. Clean the external ear canal with antiseptic

solution. Antiseptic gauze can be packed into

the ear until the doctor is ready

2. The patient may be given a general anesthetic,

since the incision causes great pain

3. The physician surgically incises the ear drum

and collects as much fluids possible into a

syringe.


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Collection .Alternatively, material may be allowed to

collect on a sterile swab.

the ear speculum helps prevent contaminationby ear canal flora

4. Material in the syringe can be aspirated into

anaerobic transport vial or submitted directly inthe capped syringe


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C. Labeling

1. Do not label the specimen as ear. If fluid hasbeen collected, it should be appropriately labeled

as tympanocentesis fluid

2. Provide Patient information

3. Indicate the age of the patient and any pertinent

history (chronic otitis, not responding to therapy)

4. Do not request anaerobic cultureunless

anaerobic transport method is used.


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D. Transport

1. Do not refrigerate the specimen

2. Transport the specimen to the laboratory

quickly. Hold it at room temperature


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EYE SPECIMENS

A. Selection

1. Do no tuse the term Eyefor identifying a

specimen. Specify what the specimen is, e.g.

lid margin sample, conjunctival sample,

corneal sample, aqueous or vitreous sample.

specify left or right eye.


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Gambar mata dari depan ya?!..Normal eye


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conjuctiva

Excretory ducts

Lacrimal ducts

Lacrimal

sac


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2. In serious eye infection such as suppurative

keratitis or endophthalmitis, media and transport

systems are made available.

for bacteria, chocolate agar is likely to be a good

universal medium

election.


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election.

3. In bilateral conjunctivitis, culture of a specimen

from only one eye is necessary

4. For conjuctival specimens, the laboratory ideally

needs two swabs from the infected site;

one for cultureand one for Gram.


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B. Collection

Methods of collecting specimens from the eye(refer to a guide to specimen management in clinical

microbiology.. Miller JM)

C. Labeling

1. Label the specimen with the actual diagnosis,

no t eye2. Label the specimen as being from the rightor

the lefteye

3. Label the specimen with patient information


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Collection of conjunctival material(conjunctival swab)


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Collection of clinical samples of

corneal ulcers or keratitis


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D. Transport

1. Many specimen should be plated at the

specimen collection site e.g the eye clinic.

The small amount of material collected tends

to dry quickly and this drying may contributeto a loss of viability of agents

2. Use anaerobic transport where necessary but

not for conjuctival specimens

3. Chill the viral transport medium for transport


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NASAL SPECIMENS

A. Selection

1. The specimen of choice is a swab specimen

taken at least 1 cm inside the nares

2. Lesions in the nose require samples from theadvancing margin of the lesions


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B. Collection

1. Carefully insert the swabs at least 1 cm into the nares

2. Firmly sample the membrane by rotating the swab and leavingit in place for 10 to 15 s

3. Withdraw the swabs, insert it into a transport container, and

crush the vial of transport medium in the container


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C. Labeling

1. Label the swab container with patient information

2. Indicate whether or not a lesion is present

D. Transport

1. Transport the specimen to the laboratory as

soon as possible

2. Do not refrigerate the specimen


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NASOPHARYNGEAL SPECIMENS

A. Selection

1. Specimens must be taken is any way that

avoids contamination with the nasal or oral

flora

2. The nasopharynx may be reached by a small

nasopharyngeal swab inserted through either

the nose or the throat


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B. Collection

1. Remove excess secretions or exudate from theanterior nares

2. Insert the nasal speculum if it used

3. Gently pass the swabs through the nose and

into the nasopharynx

4. Rotate the swabs on the nasopharyngeal

membrane, and allow the swab to remain in

place for 10 to 15 s to absorb organisms


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Gambar mata dari depan ya?!..


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ollection

5. Remove the swabs carefully,and place it in the

transport medium. Do not refrigerate it .

6. Remove the speculum

7. Alternatively, bend the wire at an angle and

insert it into the throat.

Then move the swabs upward into the

nasopharyngeal space


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C. Labeling

1. Label the specimen with patient information

2. Include the suspected diagnosis where

possible

D. Transport

1. Transport the specimen to the laboratory as

soon as possible

2. Do no trefrigerate the specimen


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Microbiological Investigations

1. Microscopy

- Gram-stain is a frequently useful rapid indicator

of the causative organisms present and is

routinely performed

- Fluorescent stains are only performed when

clinically indicated

2. Culture and antibiotic sensitivities


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Documents

Laboratory Diagnostic of Special Senses Module 2013