CHAPTER 13

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DIAGNOSING INFECTIOUS DISEASES
 The proper diagnosis of an infectious disease
requires
(a) taking a complete patient history,
(b) conducting a thorough physical
examination of the patient,
(c) carefully evaluating the patient’s signs and
symptoms, and
(d) implementing the proper selection,
collection, transport, and processing of
appropriate clinical specimens.
CLINICAL SPECIMENS
 are types of specimens, such as blood, urine,
feces, and CSF, that are collected from
patients and used to diagnose or follow the
progress of infectious diseases.

 The clinical specimens that are used to

diagnose infectious diseases must be of the
highest possible quality.
 Three Components of Specimen Quality

1. Proper selection of the specimen (i.e., to

select the appropriate type of specimen for
diagnosis of the suspected infectious
disease)
2. Proper collection of the specimen
3. Proper transport of the specimen to the
laboratory
BLOOD
 Bacteremia is the presence of bacteria in the bloodstream—
may or may not be a sign of disease.
 Septicemia is a disease. Septicemiais a serious disease

characterized by chills, fever, prostration, and the presence

of bacteria or their toxins in the bloodstream.
 Toxemia refers to the presence of toxins in the

bloodstream.
 Fungemia is the presence of fungi.
 Viremia is the presence of viruses.
 Parasitemia is the presence of parasites.
 Meningococcemia is a specific type of septicemia, in which

the bloodstream contains Neisseria meningitidis(also known

as meningococci).
 Leukemia is also a disease where there is a proliferation of

abnormal WBCs (leukocytes) in the blood.

Urine
 Urine is ordinarily sterile while it is in the
urinary bladder.
 The ideal specimen for a urine culture is a
clean-catch, midstream urine specimen. (CCMS)
 “Clean-catch” refers to the fact that the area
around the external opening of the urethra is
cleansed by washing with soap and rinsing with
water before urinating.
 “Midstream” refers to the fact that the initial
portion of the urine stream is directed into a
toilet or bedpan, and then the urine stream is
directed into a sterile container.
 To prevent continued bacterial growth, all urine
specimens must be processed within 30 minutes of
collection, or refrigerated at 4°C until they can be
analyzed. Refrigerated urine specimens should be
cultured within 24 hours.

 A COMPLETE URINE CULTURE consists of a colony

count, isolation and identification of the pathogen,
and antimicrobial susceptibility testing.

 A CFU count that is 100,000 (1 ×10⁵) CFU/mL or

higher is indicative of a UTI
 The presence of two or more bacteria per ×1,000
microscopic field of a Gram stained urine smear is
indicative of a UTI with 100,000 (1 ×10⁵) or more
CFU per milliliter.
CerebroSpinal Fluid
 Meningitis, encephalitis, and
meningoencephalitis are rapidly fatal diseases
that can be caused by various microbes,
including bacteria, fungi, protozoa, and viruses.
 CSF specimens are treated as STAT) emergency)
specimens in the CML, where workup of the
specimens is initiated immediately upon
receipt.
 Diagnostic Procedure: Lumbar Tap / Lumbar
Puncture
SPUTUM
 Sputum is pus that accumulates deep within the lungs of
a patient with pneumonia, tuberculosis, or other lower
respiratory infection.
 Laboratory workup of a good-quality sputum specimen
can provide important information about a patient’s lower
respiratory infection, whereas workup of a patient’s saliva
cannot.
 The clinician may wish to obtain a better quality specimen
by bronchial aspiration through a bronchoscope or by a
process known as transtracheal aspiration.
 Needle biopsy of the lungs may be necessary for
diagnosis of Pneumocystis jirovecii pneumonia (as in
patients with acquired immunodeficiency syndrome
[AIDS] and for certain other pathogens).
THROAT SWABS

 Routine throat swabs are collected to determine

whether a patient has strep throat
(Streptococcus pyogenes pharyngitis).

 If any other pathogen (e.g., Neisseria

gonorrhoeae or Corynebacterium diphtheriae) is
suspected by the clinician to be causing the
patient’s pharyngitis, a specific culture for that
pathogen must be noted on the laboratory test
requisition, so that the appropriate culture
media will be inoculated.
WOUND SPECIMENS

 Whenever possible, a wound specimen should be

an aspirate (i.e., pus that has be collected using a
small needle and syringe assembly), rather than a
swab specimen.
 Specimens collected by swab are frequently
contaminated.
 The person collecting the specimen should always
indicate the type of wound infection (e.g., dog
bite, surgical site, or burn wound infection) on the
laboratory test requisition and the anatomical site
from which the specimen was obtained.
GC Cultures
 The initials GC represent an abbreviation for
gonococci, a term referring to N.gonorrhoeae.
 N. gonorrhoeaeis a fastidious bacterium that is
microaerophilic and capnophilic.
 Only Dacron, calcium alginate, or nontoxic
cotton swabs should be used to collect GC
specimens. Ordinary cotton swabs contain fatty
acids which can be toxic to N. gonorrhoeae.
 When attempting to diagnose gonorrhea, swabs
(vaginal, cervical, urethral, throat, and rectal)
should be inoculated immediately onto Thayer–
Martin or Martin-Lewis medium and incubated in
a carbon dioxide (CO2) environment.
 Alternatively, they should be inoculated into a
tube or bottle (e.g., Transgrow) that contains an
appropriate culture medium and an atmosphere
containing 5% to 10% CO2(Fig. 13-8).
 To prevent loss of the CO2, the bottle should
be held in an upright position while inoculating.
Otherwise, the CO2spills out and is displaced by
room air.
 These cultures should be incubated at 37°C
overnight and then shipped to a microbiology
laboratory for positive identification of N.
gonorrhoeae.
 Never refrigerate GC swabs because the low
temperature might kill the N. gonorrhoeae.
FECAL SPECIMENS
 Ideally, fecal specimens (stool specimens
should be collected at the laboratory and
processed immediately to prevent a decrease
in temperature, which allows the pH to drop,
causing the death of many Shigella and
Salmonella species.
 Alternatively, the specimen may be placed in

a container with a preservative that maintains

a pH of 7.0.
Acombination of direct microscopic
examination, culture, biochemical
tests, and immunologic tests may be
performed to identify Gramnegative
and Gram-positive bacteria (e.g.,
enteropathogenic Escherichia coli,
Salmonellaspp., Shigellaspp.,
Clostridium perfringens, C. difficile,
Vibrio cholerae, Campylobacterspp.,
and Staphylococcusspp.), fungi
(Candida), intestinal protozoa (Giardia,
Entamoeba), and intestinal helminths
Organization of a typical Clinical
Microbiology Laboratory.
Mycology Section
Virology Section
Figure 13-20.
Cytopathic effect
(CPE). A. Normal
appearance of
human diploid
fibroblasts. B. The
appearance of
the same cells, 48
hours after being
inoculated with
herpes
simplex type 2 virus.
END of CHAPTER 13