Laboratory Diagnostic of

Special Senses Module

Ariyani Kiranasari ; Elisabeth D.H; Conny RT
Microbiology Department
Faculty of Medicine University of Indonesia
Important aspects of Microbiologic
Examination of specific Senses :

- Specimen collection and handling
- Specimen processing and culture
- Interpretation of microbiology
laboratory result
A. Selection

1. A swab is not recommended for collecting
specimens to diagnose otitis media infections.

When use a swab, external ear canal flora
contaminates the specimen, making
interpretation of clinically relevant growth
difficult and misleading
EAR (Otitis Media) SPECIMENS
2. The specimen of choice is an aspirate from
behind the tympanum (ear drum).

The fluid from
inner ear
represents the
infectious
process, not
external ear
canal flora.


Selection .

3. A small swab may used only when ear drum
has ruptured and fluid can be collected

4. Diagnosis is usually made clinically.
Tympanocentesis is painful and is done only in
young children and in patients with chronic
otitis media not responding to therapy
Selection .
B. Collection

1. Clean the external ear canal with antiseptic
solution. Antiseptic gauze can be packed into
the ear until the doctor is ready

2. The patient may be given a general anesthetic,
since the incision causes great pain

3. The physician surgically incises the ear drum
and collects as much fluids possible into a
syringe.
Collection .

Alternatively, material may be allowed to
collect on a sterile swab.

the ear speculum helps prevent contamination
by ear canal flora

4. Material in the syringe can be aspirated into
anaerobic transport vial or submitted directly in
the capped syringe
C. Labeling

1. Do not label the specimen as ear. If fluid has
been collected, it should be appropriately labeled
as tympanocentesis fluid

2. Provide Patient information

3. Indicate the age of the patient and any pertinent
history (chronic otitis, not responding to therapy)

4. Do not request anaerobic culture unless
anaerobic transport method is used.
D. Transport

1. Do not refrigerate the specimen

2. Transport the specimen to the laboratory
quickly. Hold it at room temperature

EYE SPECIMENS
A. Selection

1. Do not use the term Eye for identifying a
specimen. Specify what the specimen is, e.g.
lid margin sample, conjunctival sample,
corneal sample, aqueous or vitreous sample.

specify left or right eye.
Gambar mata dari depan ya?!..
Normal eye
conjuctiva
Excretory ducts
Lacrimal ducts
Lacrimal
sac
2. In serious eye infection such as suppurative
keratitis or endophthalmitis, media and transport
systems are made available.

for bacteria, chocolate agar is likely to be a good
universal medium

Selection .
Selection .
3. In bilateral conjunctivitis, culture of a specimen
from only one eye is necessary

4. For conjuctival specimens, the laboratory ideally
needs two swabs from the infected site;
one for culture and one for Gram.
B. Collection

Methods of collecting specimens from the eye
(refer to a guide to specimen management in clinical
microbiology.. Miller JM)

C. Labeling

1. Label the specimen with the actual diagnosis,
not eye
2. Label the specimen as being from the right or
the left eye
3. Label the specimen with patient information
Collection of conjunctival material
(conjunctival swab)
Collection of clinical samples of
corneal ulcers or keratitis
D. Transport

1. Many specimen should be plated at the
specimen collection site e.g the eye clinic.
The small amount of material collected tends
to dry quickly and this drying may contribute
to a loss of viability of agents

2. Use anaerobic transport where necessary but
not for conjuctival specimens

3. Chill the viral transport medium for transport
NASAL SPECIMENS
A. Selection

1. The specimen of choice is a swab specimen
taken at least 1 cm inside the nares

2. Lesions in the nose require samples from the
advancing margin of the lesions
B. Collection

1. Carefully insert the swabs at least 1 cm into the nares

2. Firmly sample the membrane by rotating the swab and leaving
it in place for 10 to 15 s

3. Withdraw the swabs, insert it into a transport container, and
crush the vial of transport medium in the container

C. Labeling
1. Label the swab container with patient information
2. Indicate whether or not a lesion is present


D. Transport

1. Transport the specimen to the laboratory as
soon as possible
2. Do not refrigerate the specimen
NASOPHARYNGEAL SPECIMENS
A. Selection

1. Specimens must be taken is any way that
avoids contamination with the nasal or oral
flora

2. The nasopharynx may be reached by a small
nasopharyngeal swab inserted through either
the nose or the throat
B. Collection

1. Remove excess secretions or exudate from the
anterior nares

2. Insert the nasal speculum if it used

3. Gently pass the swabs through the nose and
into the nasopharynx

4. Rotate the swabs on the nasopharyngeal
membrane, and allow the swab to remain in
place for 10 to 15 s to absorb organisms
Gambar mata dari depan ya?!..
Collection


5. Remove the swabs carefully,and place it in the
transport medium. Do not refrigerate it.

6. Remove the speculum

7. Alternatively, bend the wire at an angle and
insert it into the throat.

Then move the swabs upward into the
nasopharyngeal space
C. Labeling

1. Label the specimen with patient information

2. Include the suspected diagnosis where
possible


D. Transport

1. Transport the specimen to the laboratory as
soon as possible
2. Do not refrigerate the specimen
Microbiological Investigations
1. Microscopy
- Gram-stain is a frequently useful rapid indicator
of the causative organisms present and is
routinely performed
- Fluorescent stains are only performed when
clinically indicated

2. Culture and antibiotic sensitivities