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Conjunctival Discharge. Conjunctivitis  Inflammation  Erythema  Several causes: Bacterial Bacterial Viral Viral Allergic Allergic Chemical Chemical.

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Presentation on theme: "Conjunctival Discharge. Conjunctivitis  Inflammation  Erythema  Several causes: Bacterial Bacterial Viral Viral Allergic Allergic Chemical Chemical."— Presentation transcript:

1 Conjunctival Discharge

2 Conjunctivitis  Inflammation  Erythema  Several causes: Bacterial Bacterial Viral Viral Allergic Allergic Chemical Chemical

3 Conjunctivitis - Discharge DischargeCause DischargeCause PurulentBacteria ClearViral White, stringy mucousAllergies

4 Bacterial conjunctivitis Purulent discharge Conjunctival hyperemia

5 Viral Conjunctivitis  Adenovirus Systemic viral infections Systemic viral infections Painful Painful  Herpetic Discordant lack of pain Discordant lack of pain

6 Viral conjunctivitis Diffuse redness Watery discharge

7 Aim of the test  An etiological diagnosis of bacterial conjunctivitis by aerobic cultivation with identification and susceptibility test of the isolated bacteria.  Types of specimen Discharge from the eye(s).

8 Pathogen and commensals

9 Specimen collection  Pull down the lower eyelid so that the lower conjunctival fornix is exposed.  Swab the fornix without touching the rim of the eyelid with the sterile cotton swab.  Place the swab immediately in a bacterial transport medium or, the specimen is brought to the laboratory immediately, in a sterile test tube with 0.5 mL of buffered saline (pH 7).  Take Sufficient amount on the swab

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11 Time relapse before processing the sample  Eye specimen should be processed immediately because tears contains lysosomes which may kill the organism

12 Media  Blood Agar  Chocolate Agar  MacConkey Agar  Fluid Thioglycollat

13 Ear Discharge  Aim of the test Aetiological diagnosis of otitis external or otitis media by aerobic and anaerobic culture with identification and susceptibility test of the isolated organism (s).  Types of specimen Pus from the external or middle ear.

14 Pathogen and commensals

15 Specimen collection  Collect a specimen of the discharge on a thin, sterile cotton wool or Dacron swab.  Place the swab in a container with the transport medium, breaking off the swab stick to allow the stopper to be replaced tightly.  Label the specimen and send it to the laboratory.  Time relapse before processing the sample Not more than 2 hours

16 Media  Blood Agar,  Chocolate Agar,  MacConkey Aga  Fluid thioglycolla

17 Vaginal Discharge

18 Background & Terminology i.Vaginitis : significant inflammatory response in vaginal wall. Accompanied by high number of leukocytes in vaginal fluid. Found with candida and trichomonas infections. ii.Vaginosis : minimal inflammatory response with few leukocytes in vaginal wall. Associated with increase in bacterial concentrations. iii.Leukorrhoea : a non-infective, non- bloodstained physiological vaginal discharge.

19 Clinical Approach

20 Clinical approach II.Physical Exam : oAppearance of discharge. oErythema and edema of vaginal mucosa opH levels III.Diagnostic Tools: opH : Nitrazine paper oWet prep: microscopic examination of discharge oKOH prep: dissolves cellular debris leaving pseudohyphae of candida. oWhiff test: Fishy odor of BV oCulture

21 Common Causes

22 I.Normal discharge (30%) II.Bacterial Vaginosis (23-50%) III.Candida Vulvovaginitis (20-25%) IV.Trichomonas vaginitis (5-15%) V.Mixed infection or Sexually Transmitted Disease (20%)

23 The vaginal discharge of patients with BV has a characteristic fishy odor due to increased activity of anaerobic species. Addition of KOH will augment this odor.

24 Aim of the test  Isolate and identify potentially aerobic pathogenic organisms including  Gardnerella vaginalis and group B Streptococcus; establish the diagnosis of gonorrhea, medical/legal cases.

25 Types of specimen  Swab of vagina, cervix, discharge, aspirated endocervical, endometrial, prostatic fluid, or urethral discharge.  Use swab to inoculate Jembec for transport to the laboratory and recovery of Neisseria gonorrhoeae; swab  should also be sent in transport device.

26 Pathogen and commensals

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28 Specimen collection  Do not use lubricant on speculum.  Cervical mucous should be removed first before inserting swab into endocervical canal, move swab from side to side allowing several seconds for absorption of organisms by the swab.  Return swab to the transport tube and label.


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