streptococcus pneumoniae lp utm
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Streptococcus pneumoniae
Fac parte din flora normal a tractului respirator superior , frecventa portajului oro-
faringian fiind estimat la 30-70%.
Poate coloniza si mucoasa genito-urinar sau intestinul.
n raport cu localizarea infectie pneumococii pot cauza:
infectii acute ale tractului respirator inferior:
ronsit
!ronsita cronica - Procesul inflamator cronic determin leziuni ireversi!ile ale mucoasei "i
glandelor su!mucoase, precum "i ale aparatului mioelastic
Pneumonie
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infectii ale cavittilor conecte ale tractului respirator
sinusit
otit medie acut
mastoidit
alte infectii
peritonit
meningit
endocardit
conjunctivit etc.
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Diagnosticul de laborator in infectiile cuStreptococcus pneumoniae
Produse patologice
sputa,&', secretii etc
Recoltare produs patologic
PRODUS RECOLTREa!C"T#TTEb!TR"SPORT
O$SER%T##RESPECTA
PRECAUTIUNILE
UNIVERSALE
SPUTPeria&ul dintilor , clatireaenergica a gurii si gargara cuapa'
Tuseste si e(pectoreaza intr)un recipient steril *cu gatullarg cu capac care se inc+ideermetic!
a! - mlb! . / +
Se recolteaza sputa subdirecta indrumare aasistentei'
Se e(plica pacientuluidiferenta dintre ae(pectora si a scuipa'Sputa se recolteazadimineata cand pacientulface 00toaleta bronc+iilor1'
E(amenulmacroscopic: sputa ruginie, muco-purulenta
E(amenul microscopic direct(frotiu din produsului patologic *pp!
colora)ia *ram: coci lanceolati, dispusi +n diplo cu capetele ascutite spre eterior
si +nconjurati de o capsula proprie
coci dunt localizati intra si perileucocitar prezenta celulelor inflamatorii, care este
dovada ca s-a recoltat un produs patologic real sputa, nu saliva/, rare cellule
epiteliale
Sputum Gram stain from a patient with a pneumococcal pneumonia. Note the numerous
polymorphonuclear neutrophils and gram-positive, lancet-shaped diplococci. Courtesy of C. Sinave,
MD, personal collection
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&riterii de respingere a sputei
mai mult de $1 celule epiteliale pe campul microscopic
#nsamantarea pp
se insamanteaza in poligon desc2is fara o latura/ pe medii solide, in scopulo!tinerii coloniilor micro!iene izolate: &olum!ia sange
#ncubare la 374&, #5 $ ore, in prezenta 1% &6$
#dentificarea bacteriei
Caractere morfotinctoriale2 frotiu din cultur3 pur3: coci lanceolati, dispusi +n
diplo cu capetele ascutite spre eterior
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Caractere de cultur32 colonii 89, cu 2emoliza partiala viridans
;up #5-$ de ore coloniile mucoide vor prezenta +n centru o deprimare ceea ce confer
aspect crateriform coloniei, datorit fenomenului de autoliz.
Caractere bioc+imice:
4ermentarea inulinei
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Produce enzime autolitice fenomen indus si accelerat de !il, sruri !iliare,
acizi !iliari.
Testul bilolizeieste util +n diferentierea pneumococilor
de alti streptococi alfa-2emolitici care nu sunt lizati +n prezenta !ilei.
S.pneumoniaesunt sensi!ili la optoc2in etil-2idrocuprein/, sensi!ilitatea la aceast
su!stant fiind de asemenea util +n identificarea si +n diferentierea
pneumococului de alti streptococi viridans.
Testul de sensibilitate la optoc+in
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Reactia de umflare a capsulei
>ntigenul capsular poliza2aridic are si el specificitate de tip, +mprtind pneumococii +n
aproimativ ?0 de serotipuri capsulare diferite care pot fi identificate prin reactia de
umflare a capsulei cu seruri specifice anticapsulare polivalente si monovalente,
@eufeld/.
ntibiograma
9treptococcus pneumoniae prezenta o foarte mare sensi!ilitate la penicilin
pAn +n anul #?7.
Bulpinile rezistente la penicilin pot prezenta rezistent si la alte anti!iotice,
incluzAnd macrolide, rifampicina, cefalosporine, cloramfenicol,
sulfametoazoltrimetoprim, clindamicin, tetraciclin, etc.
>nti!iograma este astzi strict necesar +n infectiile pneumococice,
testarea sensi!ilittii fat de penicilin fiind realizat cu microcomprimate de
oacilin de # CgDml.
Eediul Euller inton cu 1% sange , inocul 0.1 EFarland, temp 31 &, incu!are #5 panala $ ore, 1 % &6$
>legerea discurilor pentru testarea sensi!ilitatii prin metoda difuzimetrica, interpretarea
rezultatelor conform Performance standards for antimicrobial susceptibility
testing;
&9G D$0#0 anterior numit @&&9/
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Kirby-Bauer sensitivity plate to test the effectiveness of various antibiotics on the bacterial culture.
Modul de desfasurare a lucrarii practice
studentii primesc manuscrisul cu etapele diagnosticului de laborator in
infectia cu Streptococcus pneumoniae.
1. Lp se desfasoara interactiv- se discuta pe marginea manuscrisului primit
anterior LP-ului
2. material demonstrativ-medii de cultura-Columbia-sange -colonii de
S. pneumoniae,studentii recunosc coloniile, recunosc hemoliza viridans
3. antibiograma S .pneumoniaestudentii masoara diametrele si noteaza in
caiet, interpretare conform CLSI/2010,.S. pneumoniae
4. Fiecare student prinde imaginea la microscop si examineaza frotiuri
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Bibliografie
Bacteriologie Medicala, Olga Dorobat, editura UTM, 2006
Clinical Microbiology Procedures Handbook, Henry D. Isenberg, editata
American Society for Microbiology,2004
Koneman's Color Atlas and Textbook of Diagnostic Microbiology,Washington
C Winn, Stephen D. Allen, Gail L. Woods, William M. Janda, Paul C.
Schreckenberger, editura Lippincott Williams & Wilkins, 2005
Manual of Clinical Microbiology , Patrick R. Murray,
Visit Amazon's Patrick R. Murray Page
search results
Learn about Author Central
Ellen Jo Baron, Michael A. Pfaller, Fred C. Tenover, Robert H. Yolken, editura
ASM, 2007
Performance Standards for Antimicrobial Susceptibility Testing.M 100, S19
CLSI /2010
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