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Specimen Considerations (Part 2) - Modified
Specimen Considerations (Part 2) - Modified
H. Incubation conditions
i. 28oC for fungi
ii. 35-37oC for most bacteria, virus and mycobacteria
iii. A number of different environmental conditions exist
→ Aerobes : grows in ambient air, which contains (21% oxygen and 0.03% carbon
dioxide)
- The fluorescein detection is considered to be a sensitive test for the detection of liquorrhea
Glucose
→ In order to rule out false positive results due to possible blood-admixture, a determination
of hemoglobin should be conducted (using test strips)
Tau Protein
→ Differentiates CSF leakage from nasal secretions?
→ Immunofixation electrophoresis
→ Migrates slow in the beta zone next to unmodified transferring
→ Migrates together with transferring
Cerebrospinal Fluid or Nasal Secretion Findings used in the differentiation between CSF and nasal secretion
- An abnormal connection between the spaces containing CSF and the exterior, usually
occurring in the region of the nose and less commonly in the ears is referred to as CSF Investigation Cerebrospinal Fluid Nasal Secretion
fistula
- Drainage of CSF is called liquorrhea Detectable
False negative result : 2 out of 88
Differentiation between CSF and Nasal secretion Β2-transferrin Not detectable
patients, possibly absence of liquorrhea
→ If liquorrhea is suspected, an immunochemical test for detection of β2-transferrin should be at the time of sampling
conducted
o The immunoblotting assay is well suited for this purpose Calcium 1.05-1.35 mmol/L 1.0-1.75 mmol/L
→ Total protein and glucose determinations are unreliable for the differentiation
→ Quantitative glucose determinations does not provide unequivocal result since glucose is Mainly: lymphocytes (adults) & Mainly neutrophils
Cells monocytes (children) Normally 6% eosinophils
detected in a large percentage of non-CSF containing nasal secretions from healthy people
Up to 6% neutrophils → >6% in allegic rhinitis
as well as in patients with allergic or infectious rhinitis
→ Glucose concentrations ≥ 30 mg/dL are considered to prove the presence of cerebrospinal Fluoresecin Positive → especially suited to detect
Negative
fluid detection subclinical liquorrhea
β2-transferrin Total protein 0.2-0.5 g/dL 3-40 g/L
- In the immunoblotting assay, CSF and serum from the patient are electrophoretically
separated on an agarose gel plate followed by detection using specific transferring 46-86 mg/dL (2.7-4.8 mmol/L)
Up to 10 mg/dL
antibodies Glucose Always > 30 mg/dL (1.7 mmol/L)
(0.6 mmol/L)
60-70% of the blood glucose conc.
- Serum shows a homogenous β1-transferrin band
- CSF shows β1 and β2-transferrin band Potassium 3 mmol/L 17 mmol/L
- Therefore, CSF is not only detectable but it can also be differentiated from nasal or wound
secretion, tear fluid or saliva Sodium 141 mmol/L 90-148 mmol/L
Fluorescein Detection
- Intrathecal injection of 2 mL of 5% sodium fluorescein into the lumbar region and placement Three important analytes to detect CSF
of three Merocel sponges into each nasal cavity for an overnight period → β2-transferrin
- The detection of Liquorrhea is accomplished in agarose gel electrophoresis, the detection → fluorescent detection
of fluorescein labelled proteins is subsequently performed by fluorometric scanning → Tau protein
Pancreatic products : fluid secretion, bicarbonate, a-amylase, lipase,
trypsin, and chymotrypsin
o As part of functional diagnostic test, duodenal juices is mostly employed in
secretin-pancreozymin test for the assessment of EXOCRINE pancreatic capacity
Tear Fluid
- It is collected by : Sweat
o Glass capillary from the lower lacrimal sac - It is a liquid secreted by the sweat glands of the skin
o Cellulose sponge which is placed into the lower conjuctival sac - Used for the determination of cystic fibrosis
- Investigations for the Characterization of Tear Fluid Quantities in the sweat
Duodenal Juice - The determination of serum trypsin for the detection of cystic fibrosis renders the
- Duodenal juice is obtained by means of a duodenal tube, in the secretin-pancreozymin test determination of electrolytes in the sweat, after pilocarpine stimulation, dispensable to a
- For example : a three line tube is used for separating collecting duodenal juice and gastric large extent
juice - Pilocarpine iontophoresis involves the investigation of 100 uL of sweat for its sodium and
- Diagnostic investigations chloride concentration after stimulation with pilocarpine
o Duodenal juice is examined for :
Pathogens : Giardia lamblia
Pilocarpine Normal Abnormal
Biliary components : bilirubin and cholesterol
iontophoresis
Chloride (mmol/L) <50 ≥70
Sodium (mmol/L) <40 ≥50
Investigations Assessment
Volume Normally about 0.5 mL during the middle of the cycle
Scores
0 = 0.0 mL ▪ 2 = 0.2 mL
1 = 0.1 mL ▪ 3 = ≥0.3 mL
Consistency Scores
0 : thick
1 : moderately cervical mucus
2 : slightly tenacious
3 : normal mucus (preovulatory)
Ferning Cervical mucus which has been air-dried on a slide : 100 fold
magnification (HPO)
0 : no crystallization
1 : atypical ferning
2 : main branch with side branches
3 : complete fern like pattern (3-4 fold branching)