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Blood culture bottle should have 18 ml and 90 ml of broth for a child and an adult respectively buy cheap malegra dxt plus 160 mg online. Time of incubation of blood culture is 7 days and subculture is done in first generic malegra dxt plus 160 mg fast delivery, third and seventh day of incubation. If the appearance of blood culture is changed to cloudy, it indicates bacterial growth. Interpretation of results • Positive bacterial growth in three of blood culture broth ----- Definitive diagnosis • Positive bacterial growth in two of blood culture broth----- Probable diagnosis • Positive bacterial growth in one of blood culture broth----- Contamination Common contaminants of blood culture S. In children ----------- Haemophilus influenzae Streptococcus pneumoniae Neisseria meningitidis. In adults ------ Streptococcus pneumoniae Neisseria meningitidis Haemophilus influenzae Clinical features:. Sudden onset of head ache, fever, malaise, vomiting associated with neckand back stiffness, behavioral changes like irritability and drowsiness, convulsions and coma. Partially treated acute pyogenic meningitis 328 It manifests with unexplained head ache of weeks to months duration associated with fever, weakness, neck and back stiffness, and behavioral changes. Viral meningitis The clinical features of viral meningitis are milder than bacterial meningitis. Viruses causing viral meningitis are mumps virus, measles virus, coxsackie A and B virus, Entero viruses and echo virus. Cryptococcal meningitis The clinical features of fungal meningitis is similar to that of chronic bacterial meningitis. Chronic osteomyelitis Acute osteomyelitis Infection of bone which occurs commonly under ten years old. Treatment: Antibiotics alone are usually effective if started early and continued for several weeks. Chronic osteomyelitis It manifests with bone pain, bone destruction with formation of sequestra and discharging sinuses. Septic arthritis It is usually seen as a complication of septicemia or an extension of osteomyelitis. Laboratory diagnosis: Specimen: Blood culture, joint aspirate Gram reaction, culture, biochemical tests and serology for microbe identification. Treatment: Antibiotic therapy based on “best-guess” basis, should be started as soon as diagnostic specimens have been taken. Perform bacteriological analysis of water sample Bacteriology of water Good quality of water is odorless, colorless, tasteless and free from fecal pollution and harmful chemicals. Human illness is caused by water supplies becoming contaminated from feces being passed or washed into rivers, streams, or being allowed to seep into wells. Feces contain microorganisms like Escherichia coli, Streptococcus faecalis and Clostridium perfringenes, which contaminate safe water. Determining whether a water supply is fecally polluted is to test for the presence of normal fecal organism. Testing for normal fecal organisms as indicators of fecal pollution is a reliable way of determining whether water is bacteriologically safe to drink. A single laboratory examination of any water does not justify the conclusion that the supply is safe for drinking so bacteriologic analysis of water should be performed at regular intervals. Organisms used as indicators of fecal pollution are the coliform group particularly E. Hold the base of sterile bottle in one hand, remove the stopper and cover together with the other hand. Sterilize the tap using the flame by igniting a piece of cotton wool soaked in alcohol holding with a pair of tongs. Tie a sterile sample bottle on to a weighted length of rope; attach ½ Kg weighing stone as a weight below the bottle. Remove the cap from the bottle septically and lower the bottle into the well to a depth of one meter. Transport of water sample Water sample should be placed in an insulated cold box immediately after collection, and should be processed with in six hours of collection. Frequency of sampling Population served Sampling interval < 20,000 Four weeks 20,000-50,000 Two weeks 50,000-100,000 Four days Multiple tube technique for counting fecal coliforms A 100 ml water sample is distributed (five 10 ml amounts and one 50 ml amount) in bottles of sterile selective culture broth containing lactose and an indicator. After incubation, count the number of bottles in which lactose fermentation with acid and gas production has occurred. Estimate the most probable number of coliforms in the 100 ml water by referring to probability tables. Sources of food contamination Food may acquire their micro-organism from various sources and the following are the important sources.

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The best course of action is to wait an those results additional 24 hours and perform another L/S ratio on D order malegra dxt plus 160mg. Report results as invalid a fresh sample of amniotic fluid because an L/S ratio Body fluids/Correlate laboratory data to verify test of 3:1 would indicate a high probability of fetal lung results/L/S ratio/3 maturity purchase 160 mg malegra dxt plus fast delivery. Te 24-hour catecholamine excretion would be misinterpreted urine creatinine level is 0. Check the urine pH to verify that it is less under the age of 10, and peak blood levels occur than 2. A serum D-xylose level greater creatinine than 30 mg/dL at 1 hour is considered normal. Request a new 24-hour urine sample for anti-tissue transglutaminase and other antibodies D. Body fluids/Evaluate laboratory data to recognize problems/Catecholamines/3 378 Chapter 6 | Urinalysis and Body Fluids 28. Request that the order be cancelled trophoblastic origin, such as teratoma and seminoma, C. Perform the test and report the result if and is an important marker for nontrophoblastic negative tumors, as well. If the amniotic fluid sample is slightly pink in color within 1 hour of specimen contaminated with blood, platelets will falsely collection. A specimen is too dilute for testing if respiratory illness the creatinine is below 20 mg/dL and specific D. A sample is considered physiological and instrument variance substituted if the creatinine is below 5. Values error/Specimen collecting and handling/3 above for pH and temperature are within acceptable limits. When testing for drugs of abuse in urine, which of the following test results indicate dilution and would be cause for rejecting the sample? Te urine sample and peroxide in addition to pH, specific gravity, and was submitted as part of a preemployment creatinine. These substances are known to cause physical exam that also includes drug testing. A viral infection of the kidney high numbers of renal tubular epithelial cells and B. An adulterated urine specimen laboratory error is possible, a false positive caused by D. Error in reading the nitrite pad caused by poor reflectometer error would be suspected if the test reflectometer calibration pad were negative when reading it manually. While the sample is still suitable for microbiological analysis, it will not give reliable cell 32. Total hemolytic complement and glucose are common problem, and can be reduced by adding ordered on a synovial fluid sample that is too 22% bovine albumin or 10% dextran to the cytospin viscous to pipet. Add 1 mg/mL hyaluronidase to the sample and can be collected and counted without anticoagulant. Request a new specimen Body fluids/Apply knowledge to identify the best course of action/Synovial fluid/3 34. Improper alignment Body fluids/Apply knowledge to identify sources of error/Fluid cell counts/3 380 Chapter 6 | Urinalysis and Body Fluids 35. Semisolid transport media such as Amies, Stuart, that the skin be cleansed with: or Cary–Blair are suitable for the transport of A. Streptococcus pneumoniae Microbiology/Apply knowledge of standard operating Microbiology/Select methods/Reagents/Media/Specimen procedures/Specimen collection/1 collection and handling/2 2. When cleansing the skin with alcohol and then Answers to Questions 1–5 iodine for the collection of a blood culture, the iodine (or iodophor) should remain intact on 1. B In order to attain asepsis of the skin, 70% alcohol the skin for at least: followed by 2% iodine is used for obtaining blood A. Microbiology/Apply knowledge of standard operating procedures/Specimen collection and handling/1 3. It inhibits phagocytosis and complement Peptostreptococcus, but this can be reversed with B. A flexible calcium alginate nasopharyngeal swab is the best choice for collecting 4. A flexible calcium alginate nasopharyngeal swab a specimen from the posterior nares and pharynx. Bacteroides fragilis Microbiology/Apply knowledge of standard operating procedure/Specimen collection and handling/1 383 384 Chapter 7 | Microbiology 6. Select the method of choice for recovery of Answers to Questions 6–10 anaerobic bacteria from a deep abscess. Skin snip of the surface tissue organisms present on the skin or mucosal surfaces C. Swab of the scalpel used for débridement following surface decontamination provides the least exposure to ambient oxygen.

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Successful estab- lishment of lymphocyte chimerism following liver transplants appears to based on the same principle discount malegra dxt plus 160mg with visa. Following sensitization of the skin flap with a contact antigen the animal reacted to a second antigenicexposureof the remaining(intact) skinwith accelerated kinetics purchase 160mg malegra dxt plus free shipping. When the lymph vessel leading from the prepared skin flap to the lymph node was interrupted, or the draining lymph node was destroyed prior to the initial sensitiza- tion, the typical secondary response was not observed—leading to the conclusion that no T cell response was induced. Following an initial sensitization at any other location on the skin the secondary response was observed, even on the skin flap regardless of interruption of the lymph vessel or destruction of the draining lymph node. This result indicated that the antigen-experienced effector lympho- cytes reached the site of antigen via the bloodstream. This artificially in- tegrated “self antigen” was ignored by the host’s immune system, as indicated by the absence of b cell destruction or autoimmunity (diabetes). This model demonstrated that many self-antigens are ignored by the immune sys- tem simply because they are only present outside of the lymphatic system. How- ever, should such antigens enter the immune system in a suitable form (in this case by viral infection) the host will produce an autoimmune T-cell response. Usage subject to terms and conditions of license Immunological Tolerance 93 In summary, the non-responsiveness of T-cells can be achieved by: negative selection in the thymus; by excessive induction in the periphery; or by seque- stration of the antigen outside the lymphoid organs. Persistence of the anti- gen within the lymphoid tissues is a prerequisite for the first two mechan- isms. For the third mechanism, it is the absence of antigen within lymphatic 2 organs which guarantees non-responsiveness. There is also a necessary role for ’second’- or ’costimulatory’-signals in the activation of T cells within lym- phoid tissues, however, their role in T-cell responsiveness within solid organs remains unclear. B-Cell Tolerance In contrast to classic central T-cell tolerance, B cells capable of recognizing self-antigens appear unlikely to be subjected to negative selection (Table 2. B-cell regeneration in the bone marrow is a very intensive process, dur- ing which antigen selection probably does not play an important role. As a general rule, these potentially self-reactive B cells are not stimulated to produce an immune response because the necessary T helper cells are not present as a result of having being subjected to negative selection in the thymus. B cell and antibody tolerance is therefore largely a result of T cell tolerance which results in the absence of T help. The finding that a certain antigenic structures and sequences can activate B cells in the absence of T help indicates that autoreactive B cells which are present could be prompted to produce an IgM autoantibody response via Ig cross-linking by paracrystalline multimeric antigens. However, since self- antigens are not normally accessible to B cells in such repetitive paracrystal- line patterns, the induction of IgM autoantibody responses is not normally observed. These structures become accessible to B cells within inflamed lesions, and may therefore induce autoantibody responses in certain circumstances. Ignored self-peptides, and in all likelihood infectious agents, may play a role in providing such T help. Usage subject to terms and conditions of license 94 2 Basic Principles of Immunology Table 2. Immunological Memory Immunological memory is usually defined by an earlier and better immune response, mediated by increased frequencies of specific B or T cells as deter- mined by in vitro or adoptive transfer experiments. B-cell immunological memory is more completely described as the ability to mediate protective immunity by means of increased antibody concentrations. Higher frequen- cies of specific B and T lymphocytes alone, appears to only provide limited Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Usage subject to terms and conditions of license Immunological Memory 95 or no protection. Instead, immunological protection requires antigen-depen- dent activation of B and Tcells, which thenproduce antibodies continuously or can rapidly mediate effector T functions and can rapidly migrate into per- ipheral tissues to control virus infections. Usually the second time a host encounters the same antigen its immune 2 response is both accelerated and augmented. This secondary immune re- sponse is certainly different from the primary response, however, it is still a matter of debate as to whether these parameters alone correlate with im- mune protection. It is not yet clear whether the difference between a primary and secondary immune response results solely from the increased numbers of antigen-specific B and T cells and their acquisition of “memory qualities”, or whether immune protection is simply due to continuous antigen-induced activation (Table 2. Usage subject to terms and conditions of license 96 2 Basic Principles of Immunology There is no surface marker which can unequivocally differentiate between memory T and B cells and “naive” (never before activated) cells. Instead, im- munological memory is normally taken to correlate with an increased num- ber of specific precursor Tand B cells. Following an initial immunization with antigen, this increased precursor frequency of specific cells is thought to be 2 maintained by an antigen-independent process. Yet the precursor cells can only be activated (or re-activated) by antigen, and only activated T cells can provide immediate protection against re-infection outside the lymphoid or- gans, e. Similarly, only antigen activated B cells can mature to become plasma cells which maintain the increased blood antibody titers responsible for mediating protection.

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The gas has a high penetration capacity and can even get through some plastic foils discount 160mg malegra dxt plus with mastercard. One drawback is that this gas cannot kill dried microorganisms and requires a relative humidity level of 40– 90% in the sterilizing chamber buy discount malegra dxt plus 160 mg online. Ethylene oxide goes into solution in plastics, rubber, and similar materials, therefore sterilized items must be allowed to stand for a longer period to ensure complete desorption. Formaldehyde irritates mucosa; skin contact may result in inflammations or allergic eczemas. In the past, it was commonly used in gaseous form to disinfect the air inside rooms (5 g/m3). The types of alcohol used in disinfection are ethanol (80%), propanol (60%), and isopropanol (70%). Due to their rapid action and good skin penetration, the main areas of application of al- cohols are surgical and hygienic disinfection of the skin and hands. Today, phenol derivatives substituted with organic groups and/or halo- gens (alkylated, arylated, and halogenated phenols), are widely used. One common feature of phenolic substances is their weak performance against spores and viruses. They bind to organic materials to a moderate degree only, making them suitable for disinfection of excreted materials. Chlorine, iodine, and derivatives of these halogens are suitable for use as disinfectants. Chlorine and iodine show a generalized microbicidal ef- fect and also kill spores. Calcium hypochlorite (chlorinated lime) can be used in nonspecific disinfec- tion of excretions. Chloramines are organic chlorine compounds that split off chlorine in aqueous solutions. The most important iodine preparations arethe solutions of iodine and potassium iodide in alcohol (tinc- ture of iodine) used to disinfect skin and small wounds. While iodo- phores are less irritant to the skin than pure iodine, they are also less effective as germicides. This group includes ozone, hydrogenperoxide, potassium perman- ganate, and peracetic acid. These substances (also known as surface-active agents, tensides, or detergents) include anionic, cationic, amphoteric, and nonionic detergent compounds, of which the cationic and amphoteric types are the most effec- tive (Fig. They have no effect at all on tuberculosis bacteria (with the exception of amphotensides), spores, or nonencapsulated viruses. Their efficacy is good against Gram-pos- itive bacteria, but less so against Gram-negative rods. Their advantages in- clude low toxicity levels, lack of odor, good skin tolerance, and a cleaning ef- fect. Practical Disinfection The objective of surgical hand disinfection is to render a surgeon’s hands as free of organisms as possible. Alcoholic preparations are best suited for this purpose, although they are not sporicidal and have only a brief duration of action. Principles of Sterilization and Disinfection 41 Alcohols are therefore often combined with other disinfectants (e. Alcohols and/or iodine compounds are suitable for disinfecting patient’s skin in preparation for surgery and injections. Strong-smelling agents are the logical choice for disinfection of ex- cretions (feces, sputum, urine, etc. Con- taminated hospital sewage can also be thermally disinfected (80–100 8C) if necessary. Suitable agents include aldehyde and phenol derivatives combined with surfactants. Instrument disinfection is used only for instruments that do not cause inju- ries to skin or mucosa (e. Laundry disinfection can be done by chemical means or in combination with heat treatment. The substances used include derivatives of phenols, alde- hydes and chlorine as well as surfactant compounds. Chlorine is the agent of choice for disinfection of drinking water and swimming-pool water. Final room disinfection is the procedure carried out after hospital care of an infection patient is completed and is applied to a room and all of its furnish- ings.

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