COLOUR

SECTION

2
Indole
test
(tryptone
water
culture) Right: A positive test. Left: A
negative lest. See 7.5.6

1 Indole
and urease
tests.
Right:
A positive
indole strip tesl. Left: A
posttlve urease tesl.

4
Urease
test
(Christensen's
urea broth). Right:
A positive
lest
Left: A neqatlve test. See 7.5.9

6 Right: Methylene
blue stained pus cells in faeces
as seen with 40x objective.
A mononuclear
cell can be
seen upper left. Left: The unstained
yellow cells are
red cells. see7.18.11.

Yellow, sucrose
fermenting
Vibrio
colonies
on
tnlosutphate
bile-salt sucrose (TCBs) agar.

choterae
citrate

5 Lilmus
milk
decolorization
test, Right:
A posttlve
test. Left: A
negative lest. See 7.5.7

7 Gram stained smear (using 1 in 10 carbol fuchsin as counterstain)

of alkaline
peptone
water culture
of faeces
showing
Vibrio cholerae,
as seen wilh the 100x objective.
See 7.18.19

9
Mixed
culture
(36
cholerae
and enterococci
colonies)
on TeBS agar.

Plates 1-10

h) of
(very

Vibrio
small

10
Blue-green,
non-sucrose
fermenting colonies
of Vibrio parahaemolyticus
on TCBS agar.

DISTRICT

11

Xylose

lysine

deoxycholate

(XLD) cultures.

Escherichia
coli
colonies.
Right:
colonies
(some Proteus
species
look

Red-pink
identical).

Left:

LABORATORY

PRACTICE

IN TROPICAL

COUNTRIES

Yellow

Salmonella
See 7.11.

13
Kligler iron agar cultures
of salmonellae
and shigellae
showing
a pink-red
slope (alkaline
reaction)
and yellow
butt (acid reaction).
A
Shigella
species.
B: S. Paratyphi A, note the cracks in the agar due
to gas production.
C: $. Typhi, note the small amount
of blackening

14
Deoxycholate
citrate
agar (DCA} cultures.
Left: Nonlactose
fermenting
Shigella
colonies.
Right"
Lactose
fermenting
Escherichia
coli colonies.
See 7.11.

,?: S.

due to H2S production.

agar due 10 gas production

15

Basic

/abacter

fuchsin

Typhimurium,
rote the break up of the
and large amount
of H2S produced

stained

Gampy-

species
as seen with the 100X
oil objective.
Note,
small
spiral
curved
'gull' forms and older spirochaetal
forms

16

Campy/obacter jejuni

tive medium
See 7.18.21.

cultured

on

at 37C

Butzler

selec-

in a candle

jar.

17
Close-up
like spreading

lobacterjejuni.

Plates 11- 17

of typical
droplelcolonies
of CampySee 7.18.21.

COLOUR

SECTION

18
Urine cultures on CLED agar. Upper left: Enterococcus
faecalis.
Upper
right:
Proteus
species.
Lower
left:
Escherichia
coli. Lower righf: Klebsiella
species. See 7.12.

19
Urine cultures on CLED agar using filter paper
lation technique.
Left, top downwards:
E. faecalis,
growth,
no significant
growth,
no growth. Right, top
wards: Klebsella
species, E. coli

species,

Proteus

species,

inocumixed
down-

Staphylococcus

20
Wagtech
portable
water testing kit being used in the
field. The operator
is shown filtering the water through
the
membrane.
Note the turbidity
tubes on the right. See 7.17

21
Membrane
culture of water sample after incubation
44C
for 24 h. There
are approx.
40 colonies
on
membrane,
corresponding
to a faecal coliform
count
100 ml of 800 (5 ml of water filtered). See 7.17

22
Blood agar culture
showing
Staphylococcus
aureus
(large colonies)
and small
beta-haemolytic
colonies
of
Streptococcus
pyogenes.
See 7.18.1, 7.18.2.

23
Pure growth
See 7.18.1.

Plates 18-23

of Staphylococcus

aureus

on blood

at
the
per

agar.

DISTRICT

24

Gram

smear

positive

of pus,

cocci

as seen

using

of

Staphylococcus aureus
the

100X

oil objective.

in

See

LABORATORY

PRACTICE

IN TROPICAL

COUNTRIES

25
Gram positive
Streptococcus
pyogenes
in smear
pus, as seen using the 100x oil objective. See 7.18.2.

of

7.18.1.

r ...
(.,"~.~

(
26

Blood

agar

Streptococcus

cultures.
Upper.
Culture
of
showing
sensitivity
to baciaround
the
disc).
Lower.
resistant
streptococci
(typed

pyogenes

,t~

27 Throat
Streptococcus

swab
culture
pyogenes.
See

showing

beta-haemolytic

7.18.2.

tracin
(no haemolysis
Beta-haemolytic
bacitracin
as Group

28
smear.

F). See

7.18.2.

Streptococcus
The organisms

a capsule

(seen

pneumoniae

in Gram stained

are diplococci

and

as a pink

area

around

surrounded
the

organisms).

by

29

Culture of Streptococcus pneumoniae on blood agar

showing

alpha-haemolytic

disc. See 7.18.4.

8ee7.18.4.

Plates 24-29

colonies

sensitive

to

optochin

COLOUR

SECTION

30
Corynebacterium
blood agar. See 7.18.7.

diphtheriae

growing

on

32
Albert stained
smear of Corynebacterium
riae rods showing
dark-staining
volutin granules
with the 100x objective.
See 7.18.7.

34
Clostridium
perlringens
seen with the 100X objective.

in Gram stained
See 7.18.9.

tellurite

diphtheas seen

smear

as

31 Corynebacterium
diphtheriae
Tinsdale
medium.
Colonies
are
brown discoloration.
See 7.18.7.

cultured
surrounded

on
by

33
Gram positive
(easily decolorized)
pleomorphic
Corynebacterium
diphtheriae
joined
together
at
angles, as seen with the 100x objective.
see 7.18.7.

modified
zones
of

rods of
various

35
Lactose
egg-yolk
milk agar cultures
with antitoxin
applied
to left half of plate. Upper.
Clostridium
perfingens
showing
opacity
due to lecithinase
activity (Inhibited
on left
by antitoxin)
and reddening
in medium
due to lactose
fermentation.
Lower.
Clostridium
species
showing
lecithinase
activity
(partially
inhibited)
and clearing
in medium
due to
proteolysis.
See 7.18.9

Plates 30-35

DISTRICT

LABORATORY

PRACTICE

36

Clostridium

perfringens

showing

marked

haemoly-

IN TROPICAL

,/

See 7.18.9

37 Gram stained smear

showing
terminal
spores

38
Gram stained smear of cerebrospinal
Iluid showing
pus cells and Neisseria
meningitidis
(small intracellular
Gram negative diplococci).
See 7.18.12

39
Neisseria
meningitidis
after overnight
incubation
atmosphere.
See 7.18.12.

sis on blood

4()

Cervical

agar after anaerobic

swab

culture

(smallest
colonies)
on
medium
is non-selective
flora. See 7.18.13.

of

incubation.

Neisseria

agar.

gonorrhoeae

chocolate
Because
the
there is no inhibition
of vaginal

41
Pure growth
Martin agar, made
See 7.18.13.

Plates 36-41

COUNTRIES

of culture

in

of Clostridium

fetani

colonies
on chocolate
agar
a carbon
dioxide
enriched

of Neisseria
gonorrhoeae
on Thayer
selective
by the addition
of antibiotics.

COLOUR

42
New

SECTION

Pure growth
of Neisseria
gonorrhoeae
on modified
York City selective
medium.
See 7.18.13.

43
Gram stained urethral
smear
Neisseria
gonorrl1oeae (intracellular
cocci)

as seen

with

~~!a.~~On1Joeae

44
Acridine
orange
fluorescent
stained
vaginal smear
showing
Tn'chomonas
vagina/is
(red-brown)
and pus cells
(yellow-green),
as seen with the 40X objective.
See 7.10.

46
Romanowsky
stained
urethral
smear
showing
Klebsiella
granulomafis
(Donovan
bodies)
in
a
macrophage
cell as seen with the 100x
objective.
The
organisms
show bi-polar
staining.
See 7.10

the

100X

looks

the

showing
pus cells and
Gram
negative
diplo-

objective.
same

as

See
N.

45
Clue cell in Gram stained
vaginal
Gram negative
bacilli and Gram variable
seen with the 100X objective.
See 7.10

47

Pseumomonas

pigment

Plates 42-47

in the medium.

aeruginosa
on
See 7.18.20

7.18.13.
meningitidis

Note:
in

smear showing
coccobacilli
as

blood

agar.

Note

,
-(!,

DISTRICT

LABORATORY

PRACTICE

IN TROPICAL

COUNTRIES

'<', .

,\

'\'"

...

..

"'

....

-- ,
I

.."

48
Gram negative
pleomorphic
rods of HaemophiJus
influenzas
in cerebrospinal
fluid, as seen with the 100X oil
objective.

Note

the thread-like

forms.

See

49 Haemophilus influenzae
after
overnight
incubation
atmosphere.
See 7.18.24.

7.18.24.

in

colonies
on chocolate
agar
a carbon
dioxide
enriched

50 Beta-Iaclamase acidimetric filler paper test.

Yellow

reaction

of oera-tactamase

producing

strain.

Right:

Left:

No

colour change of a non-beta-Iactamase producing strain. See

7.16.

..

51
ing

Oxoid
strains.

positive

52 Positive sateutnsm test to identify

Haemophilus
The Haemophilus
colonies are growing only
central
Staphylococcus
aureus line 01 growth

influenzae.
near the

test.

nitrocefin
test to detect
beta-Iactamase
Left:
Strongly
positive
test.
Centre:
Right:

53
Identification
of
Growth
is seen around

See 7.18.24.

Plates 48-53

Negative

eera-tactamass

H. influenzae
XV disc.

using
See 7.18.24.

producWeakly

strain.

X, V, XV

See

discs

COLOUR

SECTION

\"' "

54
Yersinia pestis in Giemsa
lOOX objective.
The organism

stained
shows

smear as seen with the

bi-polar
staining.
See

7.18.22.

56
Mycobacterium
tuberculosis
acid fast bacilli (AFB) in
Zlehl-Neelsen
stained
sputum
smears
counterstained
with
malachite
green. Left: Many AFB. Right:
Scanty
AFB (100x
objective).
See 7.18.28

55
Loeffler
polychrome
methylene
blue
stained
blood
smear showing
anthrax
bacilli surrounded
by
mauve-red
capsules
(McFadyean's
reaction),
as seen
with the lOOX oil objective.
See 7.18.6.

57
Many
bacilli (AFB)
couoterstaoeo

Mycobactenum
in Ziebt-Neelsen
with methylene

tuberculosis
acid
tast
stained
sputum
smear
blue (100x
objective).

See 7.18.28.

J
58
Mycobacterium
leproe
smear as seen with the lOOx

in Ziehl-Neelsen
stained
objective.
See 7.18.29.

skin

59
Gram positive
branching
intertwining
threads of
actinomycetes
as seen with the 100x objective.
See

7.18.31.

Plates 54-59

DISTRICT

LABORATORY

60 Treponema
pallidum
in chancre fluid as seen by darkfield microscopy using the 40X objective. See 7.18.32.

'fIi,H,e'

'fIi,H,cf

Syphilis

Syphilis

PRACTICE

IN TROPICAL

COUNTRIES

61
Leptospira
interrogans
as seen by dark-field
microscopy using the 40x objective. See 7.18.33.

Control~

Test area

Sample
well

Positive

Negative
Negative test

Positive test
62

Visitect

Syphilis

test

results.

See

63

7.18.32

LeptoTek

specific

64 Borreliae in Romanowsky stained blood films from

patient with relapsing fever as seen with 1OOx objective. Left:
Bcrreliae in thin blood film (Giemsastained). Right: Borreliae
in thick

film

(Field

stained).

See

65

Ori-Dot

Leptospira

Borrelia

latex

agglutination

test

to detect

antibodies. See 7.18.33

vincenti

and

Gram

negative

anaerobes

in

Gram stained smear from a patient with acute ulcerative

gingivitis. as seen with 100x objective. See 7.18.34.

7.18.34.

Plates 60-65

COLOUR

SECTION

66
Giemsa stained blood film showing
Bartonella
bacil/iformis
organisms
inside
red cells from a patient with Oroya fever.
See 7.18.36

68
Potassium
hydroxide
preparation
ringworm
fungi with branching
septate
conidia.
See 7.18.38.

67
Left:
Giernsa
stained
smear
showing
inclusion
bodies
in epithelial
cell, as seen
nucleus
of the cell (centre)
is surrounded
bodies (above and to lower right of nucleus).
cell are pus cells. Right: Chiamydia
trachoma
of conjunctival
scraping.
The inclusion
body

of a
hyphae

skin
scale,
showing
and spherical
arthro-

Chlamydia
trachoma tis
with 100x
objective.
The
by blue-mauve
reticulate
Surrounding
the epithelial
tis in an iodine preparation
stains brown. See 7.18.37

69
Blue ink stained potassium
hydroxide
preparation showing
Malassezia
furfur with yeast cells
and short hyphae as seen with the 40X objective.

5007.16.39

70
Aspergillus
positive hyphae

in Gram
stained
sputum
smear
showing
as seen with the l00x
objective.
See 7.18.49

Gram

Plates 66-71

71
Intracellular
yeast
celis
of
Peniciilium
mameffei
in a Giemsa
stained
preparation
as
seen with the 100x
objective.
See 7.16.50.

D,STRla

72 Gram stained vaginal smear

Candida
albicans
yeast
cells and
with

100x

objective.

See

showing
Gram
pseudohyphae

positive
as seen

LABORATORY

73
single

74

76

Yeast
c.s.f

Toluidine

ical cysts
objective.

cells
of Cryptococcus neoformans in Gram
as seen with the tuox
objective.
See 7.18.48.

blue

0 (TBO)

of Pneumocystis
T80
does not

cysts. See 7.18.52.

stained

jiroveci,
stain the

India ink
and

smear

showing

spher-

as seen with the 40x

internal
structure
of the

75
stained

77
tures

with

surrounding

COUNTRIES

drawing ink) preparation showing

cells of Cryptococcus
reotomans
the 40x objective. Note the large

the

yeast

cells.

See

7.18.48.

Encapsulated Cryptococcus neoformans in Giemsa

c.s.t as seen with the 100X objective.
See 7.18.48

Giemsa

stained

of Pneumocystis

the 100x
objective.
cysts.
See 7.18.52.

Plates 72-77

IN TROPICAL

(Pelikan
budding
yeast

in c.s.! as seen

7.18.47

capsule

stained

PRACTICE

smear

showing

jiroveci
Giemsa

cysts

does

small
(centre)

not stain

internal
as seen

the outline

strucwith
of the

COLOUR

SECTION

HIVTESTS

Positive

Negative

Positive

Negative

reaction

reaction

reaction

reaction

using

using

using

using

serum

serum

whole

blood.

whole

blood . ....-

78
Capillus HIV-1/HIV-2
assay to detect
antibody
to HIV-1/-2.
See 7.18.55.

I
___

Control

Control
----Tcstlinc

\~\
HIV-I

Sample

line

well

HIY-112

HlV2

/\ \

Control

HIV-2

Sample

line

well

r:

HIY-112

Control

UnlGold

HIV 1 and 2 test

results.

See 7.18.55

80

SO Bioline

Plates 78-80

HIV U 3.0 test

test

HIV

Sample
wcll

79

Positive

II

Posttlve Htvtest

Negative Hrvtcsr

HIV

Positive
test

results.

See 7.18.55

1,2

Negative
test

DISTRICT

81
cyte,

Normal blood
and neutrophil.

film showing
See 8.7.

from

left to right

83
Normal
blood
film showing
from
monocyte,
and two neutrophils.
See 8.7.

left

to

a monocyte,

right,

a small

INFECTION

65
band

Infection
blood picture showing
left shift
cells and metamyelocytes.
See 8.7.

LABORATORY

large

PRACTICE

IN TROPICAL

COUNTRIES

lympho-

lymphocyte,

64
Basophil
in a normal
(not often seen).

blood

BLOOD PICTURE

of neutrophils

with

86

Blood

film

from

patient

with infection
showing
left shift of
neutrophils
with toxic granulation.

Plates 81-86

film

COLOUR

SECTION

87
BI?Od film from
a patient
with
chronic
lymphocytic
leukaemia.
Note the smear cells, l.e. damaged
lymphocytes.

88
Blood film from a patient with acute lymphoblastic leukaemia.
The cells are blast cells. See 8.2.

89
Blood film from
showing
early myeloid

90
Myeloblasts
showing
Auer
and also in nucleus.
See 8.2.

91

Blast

cell showing

a patient with
cells. See 8.2.

clear

nucleoli.

chronic

myeloid

leukaemia

See 8.2

92
Imprint
(touch)
smear
lymphoma
cells. See 8,2.

Plates 87-92

rods

in cytoplasm

showing

Burkitt's

DISTRICT

93
Blood
myelomatosis
rouleaux
ground

film
from
patient
showing
a plasma

of red cells
protein

staining.

and

some

with
cell,
back-

LABORATORY

PRACTICE

94
Normal large lymphocyte,
lower light
and reactive (atypical) lymphocytes
to left
See 8.7.

IN TROPICAL

COUNTRIES

95
Copack
Haemoglobin
Colour
Scale showing haemoglobin
value close
to 6g1dl. See 8.4.

See 8.2.

REO CELLS

96

Normocytic

normochromic

red cells.

97
Blood film from a patient with macrocytic
anaemia (folate
deficiency),
showing oval macrocvtes.
poikilocytosis,
megaloblast
{right) and hypersegmented
neutrophil.
see 8.2, 8.4.

Plates 93-97

COLOUR

98
with

SECTION

Hypochromic
iron deficiency.

microcytic
red cells from a patient
Note, elongated
pencil cells. See

8.2,8.4.

99
Blood
sickle cells,
See8.1D.

film from
nucleated

a child with sickle cell anaemia,

showing
red cell, tarqet cells and polychromasia.

100
Positive sickle cell slide test. See 8.10. The sickle
cells may appear crescent
shaped with pointed
ends or
holly
leaf shaped,
especially
in sickle
cell frait.
A
positive
sickle
cell test indicates
that a person's
red
cells contain
HbS.

101
HbS solubility
filtration
test. Left: Result with normal adult
haemoglobin
(HbAA) showing
dark red filtrate and no insoluble
haemoglobin
on filter paper. Centre: Patient with sickle cell trait
(HbASj, showing
pink-red
filtrate and some red precipitate
(HbS)
on filter paper. Right: Patient
wifh sickle cell anaemia
showing
pale yellow filtrate and heavy red precipitate
on filter paper.

102
Thick film from a patient
wifh sickle cell anaemia
and talclparum
malaria.
Note the blue stippling
in the
background
(reticulin
of renculocytes).
P. falciparum
trophozoite
is shown in upper right of picture.
See 8.1 O.

103
cells

Haemoglobin
and occasional

Plates 98-103

C disease
cell with

blood film. Note the many

HbC crystals.
See 8.2.

target

DISTRICT

104 Blood
elliptocytes

film

showing

many

ovalocytes

and

a few

LABORATORY

PRACTICE

IN TROPICAL

105
Beta thalassaemia
major blood picture
showing
marked
poikilocytosis,
hypochromasia,
polychromasia,
nucleated
red
cell, and target cells. The well haemoglobinized
red cells are
transfused
red cells. See 8.2.

106
Red cells showing
pale staining
Hb H inclusions
as seen in a cresyl blue stained preparation.
Cells have
been likened to 'golf bails'. See 8.9.

107

108

109
Blood
film showing
small densely
and large polychromatic
cell (reticulocyte).

violet

Heinz bodies
in red
stained
preparation

reticulocyte

stained

cells as seen in a crystal

(can also be seen
in a

preparation).

COUNTRIES

Polychromasia
bitten out margins
haemolytic
anaemia

See 8.9.

Plates 104-109

with half-ghost
cells and red cells
as seen in a G6PD deficient
patient
due to oxidant
stress. See 8.2.

with
with

staining
spherocytes
See 8. 7.

COLOUR

SECTION

110
Reticulocytes
containing
dark
blue-purple
stained
granules
in New methylene
blue stained preparation
{similar
ance when stained with brilliant creevt blue}, See a.s

112
Blood film showing
(red cell fragments)
and

schtstocytes
polychroma-

reticulin
appear-

113
Small darkly stained
Howell Jolly body in a red
cell (centre). see 8.7

sia. See 8.7.

111
Blood film showing
polychromasia.
See 8.7.

many

114
Blood
film from
an infant
disease
of the newborn
(HDN)
nucleated
red cells. See 9.4

acanthccytes

and

with
haemolytic
showing
many

..

115

Fields'

stained

thick

Plasmodium tstcipsrum
pigment.

blood film showing

many
and monooytes
containing

trophozoites
of
black
malaria

See 8.7.

Plates 110-116

116
Red
cells
containing
trcphozoltes
of
Plasmodium
falciparum
and Maurers dots. (see also
Colour Plates pp. 252-253
in Part 1 of the book)