edgardny
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This bug causes pneumonia but it is detected in urine culture, so it gets to cause uti and pneumonia, then why it is not detected in sputun? This question is for bactitech
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| ssk
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why this question is for bactitech ?
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| edgardny
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I asked bactitech because I wanted to know the detection wise of this bacteria and his experience. But anyone can contribute with answers. From what I read in this forum bactitech has good experience in the lab.
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| bactitech
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I have seen Klebsiella in urines, respiratory specimens, blood cultures, wounds - it is quite ubiquitous. I'm not quite sure what you are asking me - I think you are asking that, if KLPN is in a urine culture, why is it not always found in a sputum?
I'm not really sure. Sputum specimens are notoriously lousy specimens, which could have something to do with it. We reject any sputum with >25 epis/LPF. This dumps about 25% of our specimens right from the outset.
Many times respiratory pathogens show up in blood cultures and urine cultures. For example, Staph. aureus in a urine culture almost always indicates a respiratory origin, as it is an uncommon pathogen of the urinary tract. Many times these patients are septic (i.e. positive blood cultures) as well. Whenever I get a urine with >100,000 SAUR, I always look to see if they have a positive blood culture. Many times, they do. As far as a correlation with the respiratory specimen, I don't know.
Blood travels through the lungs and the causative agents of pneumonia can get into the blood there and travel into the urine. KLPN can also cause UTI's without respiratory involvement, I think.
Good question for your local infectious disease resident.....
Although I'm extremely flattered that you asked me, I'm not a doctor. Also, I'm female :-). Anyone else can readily chime in on this thread. Perhaps someone else will have insight into this question.
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| bactitech
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Duplicate removed - having problems posting this.
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| edgardny
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Thank u for ur answer, u actually did answer my question and got to the point because I did n't know about the best technique to isolate, identify, and correlate due that u explained that most sputum are lousy especimens. We physicians know about the clinical and from what the books highlight, but we don't have the lab experience. I asked this question to u because I like to read ur input in the forum because u have a great experience and I do like the way u explain in detail the answers. Thank u. But one thing I understand is that you're not a doctor, but what does the female has to do with this question. When we think about Klebsiella, we think about old people and history of alcoholism, but that is not always the case. I saw in people without alcoholism, adult and female.
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| bactitech
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You referred to me as a male, i.e. "his experience" and I thought I'd clarify that. Nothing more than that :-).
Yes, I always thought that primary infection with KLPN usually indicated someone with COPD, etc.
Kleb is an extremely mucoid organism on the plate, sometimes sliming all over, depending upon the strain, so that you can't even open the lid without some sticking to it. I can't imagine how nasty that must be inside your lungs. Sometimes if you pick a colony it trails a long trail of mucoid capsule with it. Ugh. Some of them can be really resistant also, especially in patients that have been treated with antibiotics over a long period of time.
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| edgardny
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Sorry I didn't remember I referred to you as a male. But overall thank u for ur explanation. Another question, is it difficult to identify TB in the lab, and if labwise is other way to identify other than sputum. I know I have to correlate with X rays and clinical symptoms. In other words is any othery way than acid fast staining?
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| bactitech
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When a sputum or other specimen that is considered "contaminated" with many types of bacteria comes in ordered for acid fast culture, the specimen is "concentrated" first. This consists of mixing the specimen with a diluted NaOH solution and NALC (n-acetyl-L-cysteine) to break down mucus that can trap AFB. The NaOH/NALC solution (commercially available) is added in equal amounts to the specimen, vortexed thoroughly, and then allowed to sit, or "digest" for 15 minutes. Then a buffer is added to equal a volume of 50 ml (done in a conical tube). This is then centrifuged at 3000 rpm for 15 minutes. The buffer is decanted, and then the button that is left is stained (a drop is put on a microscope slide) and also inoculated onto culture media. Currently we use the MGIT liquid system and a Lowenstein-Jensen slant for backup. These are observed weekly for 6-8 weeks before calling negative. If the smear is positive for AFB (we use a fluorescent method - auramine/rhodamine that is a lot more sensitive than ZN) we call the physician immediately. There is no way one can speciate from the smear. I think our lab uses probe testing for early detection once growth appears in the MGIT tube. I haven't performed AFB cultures in many years, but I think that's faster than traditional culture methods. The probes are for specific AFB organisms, i.e. M. kansasii, M. tuberculosis, and possibly MAI (not sure about the last one).
http://www.microbio.uab.edu/Dental-Opt/Lectures/b...
This page gives a lot of information. They spin for 30 minutes, however. I've only ever spun it for 15.
http://www.labcorp.com/datasets/labcorp/html/chap...
This page, from a large US reference lab, gives a lot of information also.
Many labs do not have the technical people or facilities to work up AFB cultures, so they go directly to a reference laboratory. You need a bio-safety hood, and techs who know what they're doing. Other labs just process the specimens, incubate them, and if they grow anything that's acid fast, they send the organism out for identification to a reference lab.
There's always a PPD test, but that can only tell you if the patient has been exposed. I have converted to a positive PPD (long story with a stupid colleague, who also converted) but my chest xray remained negative. I was put on 6 months of INH prophylaxis. This was not at my current job.
I can tell you from experience that a positive PPD is extremely painful. Mine indurated to 18 mm and was present for about a month. My arm swelled up around it and the lesion itself looked like it might ulcerate. Nasty!
TB is nothing to fool around with - I know from experience. One hundred years ago ONE THIRD of people from age 15-45 were infected with the organism and I believe it was in the top 4 causes of death in the US. We are extremely lucky that researchers persevered to find antibiotics that would work against this dreaded bug. Sadly, in the world of MDR TB, this handful of drugs might not work in the future.
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| edgardny
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Thank u, it is a good explanation. I really appreciate the details.
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| mjl1717
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I wont say much with bactitech here.
But sometimes you will hear an attending say"currant jelly sputum"
which describes the viscous mucoid features of this bug as bactitech already mentioned.
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| bactitech
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Believe me, I have seen every type of nasty sputum specimen known to man over thirty years in the lab biz. Something has to be pretty darned gross to attract our attention any more. I work in a high volume micro lab that gets specimens from four hospitals, so we see it all!
The "currant jelly" description is a textbook phenomena. Most sputum specimens are mixed with saliva to some degree. We screen all of them by Gram stain. The ones with >25 epis/LPF are not cultured, and the floor is instructed to have the patient recollect. You can tell the "good" ones from their appearance most of the time, but sometimes the Gram stains force us to cancel the cultures.
I was working as a contingent for a short time at our local medical school. The infectious disease doc came in with his students one day to look at someone's sputum or tracheal aspirate Gram stain. There were epithelials in it, although apparently not enough of them to formally cancel the specimen. I remember him telling them that the culture was worthless, and to ignore any culture results on this specimen. You of course will want to check with your local ID doc about his/her opinion of this, but it makes sense. Many people have gram negatives as colonizers only, especially after they've been moved to an ICU unit. These bugs are not necessarily the cause of anything, but they latch onto people in critical care units amazingly quickly. Our patients are cultured immediately upon ICU entry to see if they are already colonized with Acinetobacter baumanii, which our hospital has been tracking quite closely. It is a very resistant gram negative rod at some hospitals, and quite sensitive at other places. Believe me, you will probably see more of this bug than Klebsiella.
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