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Chapter 13 Outline
Introduction Clinical Specimens Types of Clinical Specimens Usually Required to Diagnose Infectious Diseases The Pathology Department (The Lab) Anatomical Pathology Clinical Pathology
Introduction
The proper diagnosis of an infectious disease requires: 1. Taking a complete patient history 2. Conducting a thorough physical examination of the patient 3. Carefully evaluating the patients signs and symptoms 4. Implementing the proper selection, collection, transport, and processing of appropriate clinical specimens
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Clinical Specimens
Specimens collected from patients such as blood, urine, feces, and cerebrospinal fluid (CSF), are known as clinical specimens.
Specimens commonly submitted to the hospitals Clinical Microbiology Laboratory (CML) include: blood, bone marrow, bronchial washings, sputum, CSF, cervical and vaginal swabs, feces, hair and nail clippings, pus, skin scrapings, sputum, synovial fluid, throat swabs, tissue specimens, urethral discharge material, urine, and urogenital secretions.
All specimens should be of the highest possible quality!
Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
The laboratory must provide written guidelines (Laboratory Policies and Procedures Manual).
The person who collects the specimen is ultimately responsible for its quality.
Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
A sufficient quantity of the specimen must be obtained to provide enough material for all required diagnostic tests.
Hazardous specimens must be handled with even greater care to avoid contamination of couriers, patients, and healthcare professionals.
Specimens should be collected and delivered to the lab as early in the day as possible to allow sufficient processing time.
Proper Method of Preparing the Venipuncture Site When Obtaining Blood for Culture
Ideally, fecal (stool) specimens should be collected at the laboratory and processed immediately to prevent a decrease in temperature, which would allow the pH to drop and cause the death of many Shigella and Salmonella species. Bacteria in fecal flora are obligate-, aerotolerant-, and facultative anaerobes.
A combination of direct microscopic examination, culture, biochemical tests, and immunologic tests may be performed to identify Gram-negative and Gram-positive bacteria, fungi, intestinal protozoa, and intestinal helminths isolated from fecal specimens.
Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Pathology Department (often referred to as the Lab) is under the direction of a pathologist (a physician who has specialized training in pathology).
The pathology department is divided into 2 major divisions: Anatomical Pathology Clinical Pathology
Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
In addition, autopsies are performed in the morgue and some Pathology Departments have an Electron Microscopy Laboratory.
The CML may be under the direction of a pathologist, a microbiologist, or a senior clinical laboratory scientist.
Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
CML professionals are very much like detectives and crime scene investigators -- gathering clues about a pathogen until they have enough information to identify it.
Diagram Ilustrating the 3 types of Hemolysis That Can be Observed on a Blood Agar Plate
The specimens processed here are the same as those that are processed in the Bacteriology Section, with the addition of hair and nail clippings and skin scrapings. A variety of procedures are used to identify fungal pathogens including special media, KOH preps, tease mounts, biochemical tests (for yeasts), and a combination of microscopic and macroscopic observations (for moulds).
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A Colony (Mycelium) of the Mould Aspergillus fumigatus, a Common Cause of Pulmonary Infections in Immunosuppressed Patients
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Various types of specimens are submitted, but sputum is the most common type
Mycobacterium spp. are identified by the acid-fast staining procedure and by using a combination of growth characteristics (e.g., growth rate, colony pigmentation, photoreactivity, and morphology) and a variety of biochemical tests