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Direct Stain Diagnosis
CSF Bacteria, gram stain
Urine Bacteria
Vagina Yeast, Trichomonas
Aspirate, abscess Bacteria, ? Rx
Urethritis (male) Gm negative diplococci
Blood smear Malaria, Borrelia
Sputum AFB
Special Media
Organism Special Medium
B. pertussis Charcoal
N. gonorrhoeae Thayer Martin, CO2
Arcanobacterium Rabbit or Human Blood
H. influenzae Chocolate, CO2
E. coli 0157 Sorbitol
Campylobacter Selective, CO2, decreased 02
C. diphtheriae Loeffier's
Legionella Buffered charcoal yeast extract
Special Media (Major Categories)
Organism Special Medium
Antibiotic Mueller-Hinton Microbiology
Anaerobes Pre-reduced
Mycoplasma
Ureaplasma
Virus
The "HACEKS" Group
Fastidious, gm- coccobacilli - require CO2, heme, neg
growth on selective media.
Associated with oral-facial infections and SBE.
Haemophilus aphrophilus
Actinobacillus actinomycetemcomitans
Cardiobacterium hominis
Eikenella corrodens
Kingella kingae (arthritis, osteo)
Suttonella indologenes
Antigen Assays in Pediatric Patients
Useful Not Recommended
B. Pertussis FA H. influenzae*
C. difficile EIA N. meningitidis*
Cryptococcus S. pneumoniae*
Giardia/Cryptosporidium Gp. B Streptococcus*
Gp A Streptococcus
Measles
RSV EIA (limited use)
Varicella-zoster FA
* limited use impartially treated
Useful Applications for
Amplification Assays in Pediatrics
· Unculturable organisms
· Fastidious, slow-growing organisms
* Dangerous organisms which should not be grown in lab
· Few viable organisms in specimen
· Monitor or predict response to therapy
Amplification Assays in Pediatrics
(Unculturable Organisms)
Assay Indications
Parvovirus B I 9 Anemia in immunocompromised*
Hepatitis B
Hepatitis C Early hepatitis in seronegative
JC Virus PML in immunocompromised*
EBV Encephalitis in HIV
PTLD in transplant patients (quant)
Coxsackie A Aseptic meningitis/encephalitis
(summer)
*Becoming Standard of Care
Amplification Assays in Pediatrics
(Dangerous to try to Grow in Lab)
Assay Indications
HIV Newborns (transplacental Ab)*
Late AIDS (poor Ab response)
*Becoming Standard of Care
Amplification Assays in Pediatrics
(Monitor or Predict Outcome of Therapy)
Assay Indications
HIV Quantitative with CD4*
CMV Drug resistance genes
HIV Drug resistance genes
Hep B, C Monitor status
*Becoming Standard of Care
Amplification Assays in Pediatrics
(Slow Growing Organisms)
Assay Indications
M. tuberculosis Smear positive patients*
M. pneumoniae Atypical pneumonia
C. pneumoniae Atypical pneumonia > I year of age
B. pertussis Pertussis
CMV Viremia or encephalitis in
immunocompromised*
Cat Scratch lmmunocompromised*
Enterovirus Aseptic meningitis/encephalitis
(summer)
*Becoming Standard of Care
Amplification Assays in Pediatrics
(Few Viable Organisms)
Assay Indications
C. trachomatis STD in teens (not sexual abuse)
IV. gonorrhea STD in teens (not sexual abuse)
Herpesvirus Encephalitis*
*Becoming Standard of Care
If it looks like a duck ...........
and it flies like a duck .....
and it quacks like a duck .....
it's probably a duck!