laboratory diagnosis€¦laboratory diagnosis stool re macroscopic examination color, form and...
TRANSCRIPT
![Page 1: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/1.jpg)
![Page 2: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/2.jpg)
Laboratory diagnosis
Specimens
Fresh stool, mucus flecks and rectal swabs for culture
Serum specimens, if desired, must be taken 10 days apart to demonstrate a rise in titer of agglutinating antibodies
8/12/2016 2Prof WWM
![Page 3: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/3.jpg)
Laboratory diagnosis
Stool RE
Macroscopic examination
color, form and consistency
only blood and mucous present
no faecal matter (red currant jelly stool)
odour odourless 8/12/2016 3Prof WWM
![Page 4: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/4.jpg)
Laboratory diagnosis
Stool RE
Microscopic examination
Large numbers of fecal leukocytes and somered blood cells often are seen microscopically
8/12/2016 4Prof WWM
![Page 5: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/5.jpg)
Culture
Specimens are inoculated onto
nutrient agar,
blood agar
8/12/2016 5Prof WWM
Laboratory diagnosis
![Page 6: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/6.jpg)
Culture
Differential media
MacConkey agar
EMB agar
8/12/2016 6Prof WWM
Laboratory diagnosis
![Page 7: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/7.jpg)
Culture
Selective media
Hektoen enteric agar or SalmonellaShigella agar), which suppress other Enterobacteriaceae and gram positive organisms
8/12/2016 7Prof WWM
Laboratory diagnosis
![Page 8: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/8.jpg)
Culture
Colourless (lactosenegative) colonies are inoculated into TSI agar
Organisms that fail to produce H2S, that produce acid but not gas in the butt and an alkaline slant in TSI agar medium
8/12/2016 8Prof WWM
Laboratory diagnosis
![Page 9: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/9.jpg)
Culture
Colonies that are nonmotile should be subjected to slide agglutination by specific Shigella antisera
8/12/2016 9Prof WWM
Laboratory diagnosis
![Page 10: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/10.jpg)
Identification
Gram stain smear shows gram negative bacilli
Motility test shows nonmotile bacilli
8/12/2016 1 0Prof WWM
Laboratory diagnosis
![Page 11: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/11.jpg)
Sugar fermentation test
Lactose, Glucose, Mannitol, Sucrose
Other biochemical tests
IMViC U
8/12/2016 1 1Prof WWM
Laboratory diagnosis
![Page 12: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/12.jpg)
1 2
![Page 13: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/13.jpg)
K
N
K
Agas
H2S
A
A
K
A
Triple Sugar Iron agar slant (TSI slant)
Shigella A = acidicK = alkalineN = neutral
![Page 14: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/14.jpg)
Voges-Proskauer testpositivenegative
Voges-Proskauer test negative
![Page 15: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/15.jpg)
Urease test
positivenegative
urease test negative
![Page 16: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/16.jpg)
Citrate utilization test
positivenegative
no citrate utilization
![Page 17: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/17.jpg)
Serological identification
Slide agglutination by specific shigella antisera (against S. dysenteriae, S. flexneri, S. boydii, S. sonnei)
8/12/2016 1 7Prof WWM
Laboratory diagnosis
![Page 18: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/18.jpg)
Serology (Antibody detection)
Serology is not used to diagnose shigella infections
Shiga toxin can be tested for by Vera and HeLa cell tests
8/12/2016 1 8Prof WWM
Laboratory diagnosis
![Page 19: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/19.jpg)
Molecular methods
PCR targeting
1 . Invasion plasmid antigen H (ipaH)
2 .Gene for Shigella enterotoxin 2 (ShET2 )
3 .Gene encoding aerobactinmediated iron uptake system
8/12/2016 1 9Prof WWM
Laboratory diagnosis
![Page 20: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/20.jpg)
Molecular methods
Typing
Plasmid profile
Colicine typing
8/12/2016 2 0Prof WWM
Laboratory diagnosis
![Page 21: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/21.jpg)
Character Bacillary dysentery
Amoebic dysentery
Incubation period
Short (<7 days) Long
Onset Acute Insidious
8/12/2016 Prof WWM 2 1
Laboratory diagnosis
![Page 22: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/22.jpg)
• Symptoms
• Bacillary dysentery
• Amoebic dysentery
• Tenesmus
• Generalized abdominal tenderness
Severe
• Localized over sigmoid,
caecum, colon).
Moderate
• Stool • mucus and blood
• Feces, mucusand blood
• Volume • small • Copious
Laboratory diagnosis
![Page 23: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/23.jpg)
• Microscopic examination
• Bacillary dysentery
• Amoebic dysentery
• RBC • discreate • clumps
• Pus cells • numerous • few
• Eosinophils • (-) • (+)• Charcott
leyden crystal • (-) • (+)
Laboratory diagnosis
![Page 24: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/24.jpg)
Character Bacillary Dysentery Amoebic Dysentery
incubation periodonset SymptomsTenesmus StoolVolume Microscopic examination: RBC pus cells, Eosinophils Charcott leyden crystal
Short (<7 days)Acute Generalized abdominal tenderness Severemucus and bloodsmall discreatenumerous()()
LongInsidious Localized over sigmoid, caecum, colon). ModerateFeces, mucus and bloodCopious ClumpsFew(+)(+)
8/12/2016 2 4Prof WWM
Laboratory diagnosis
![Page 25: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/25.jpg)
Infection is followed by a typespecific antibody response
Serum antibodies fails to protect against infection
8/12/2016 2 5Prof WWM
Immunity
![Page 26: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/26.jpg)
IgA antibodies in the gut may be important inlimiting reinfection
Live attenuated strains given orally as experimental vaccines
8/12/2016 2 6Prof WWM
Immunity
![Page 27: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/27.jpg)
Treatment
Ciprofloxacin, ampicillin, doxycycline, and trimethoprimsulfamethoxazole
suppress acute clinical attacks of
dysentery
shorten the duration of symptoms
fail to eradicate the organisms from
the intestinal tract8/12/2016 2 7Prof WWM
![Page 28: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/28.jpg)
Treatment
Multiple drug resistance can be transmitted by plasmids and resistant infections are widespread
Many cases are selflimited
Opioids should be avoided in Shigella dysentery
8/12/2016 2 8Prof WWM
![Page 29: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/29.jpg)
Epidemiology
Shigellae are transmitted persontoperson
Most cases of shigella infection (S. dysenteriae can spread widely
8/12/2016 2 9Prof WWM
![Page 30: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/30.jpg)
Epidemiology
Epidemic outbreaks of disease occur in daycare centers, nurseries and custodial institutions
Disease occurs worldwide with no seasonal incidence (consistent with persontoperson spread involving a low inoculum)
8/12/2016 3 0Prof WWM
![Page 31: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/31.jpg)
8/12/2016 Prof WWM 3 1
![Page 32: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/32.jpg)
Epidemiology
S. sonnei the U.S. infections
S. flexneri predominates in developing countries
Epidemics of S. dysenteriae occur in Africa and Central America, with case fatality rates of 5% to 15%
8/12/2016 3 2Prof WWM
![Page 33: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/33.jpg)
Epidemiology
Highest risk for disease
young children in daycare centers, nurseries and custodial institutions
siblings and parents of these children
male homosexuals
60% of all infections occur in children under 10 years of age
8/12/2016 3 3Prof WWM
![Page 34: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/34.jpg)
Prevention and control
Mass chemoprophylaxis for limited periods of time (e.g. in military personnel) has been tried
Resistant strains of shigellae tend to emerge rapidly
8/12/2016 3 4Prof WWM
![Page 35: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/35.jpg)
Prevention and control
General measures
Sanitary control of water, food and milk
sewage disposal
Fly control
Isolation of patients and disinfection of excreta
8/12/2016 3 5Prof WWM
![Page 36: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/36.jpg)
Prevention and control
General measures
Detection of subclinical cases and carriers, particularly food handlers
Antibiotic treatment of infected individuals
8/12/2016 3 6Prof WWM
![Page 37: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/37.jpg)
Prevention and control
Specific measures
Vaccines
Live attenuated strains rational attenuation
Oral route » mucosal vaccine »
One dose, Induction of antiLPS SIgA
8/12/2016 3 7Prof WWM
![Page 38: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/38.jpg)
Subunit vaccines
Based on the use of detoxified LPS
Systemic route (IM, SC)
Induction of anti LPS IgG
8/12/2016 3 8Prof WWM
Prevention and control
![Page 39: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/39.jpg)
Subunit vaccines
*Efficient in young children
*Pentavalent
S.dysenteriae 1, S.sonnei,
S.flexneri 2a, S.flexneri 3a, S.flexneri 6
8/12/2016 3 9Prof WWM
Prevention and control
![Page 40: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/40.jpg)
Vaccine: SC602
A Shigella flexneri 2a specifically attenuated specifically attenuated vaccine strain
8/12/2016 4 0Prof WWM
Prevention and control
![Page 41: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/41.jpg)
KLEBSIELLA PNEUMONIA
![Page 42: Laboratory diagnosis€¦Laboratory diagnosis Stool RE Macroscopic examination color, form and consistency only blood and mucous present no faecal matter (red currant jelly stool)](https://reader033.vdocuments.us/reader033/viewer/2022041419/5e1e217a71ad5d3358062704/html5/thumbnails/42.jpg)
RHINOSCLEROMA