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inoculation and transport of the swab to the laboratory. This is a firm coagulated serum medium containing
nutrient broth, prepared as a tubed slant. Many of the normal throat flora organisms do not grow on Loefflers
medium, so it is somewhat selective. In addition, when C. diphtheriae grows on this medium its microscopic
morphology is characteristic. A methylene-blue-stained smear reveals thin, club-shaped bacilli and reddishpurple metachromatic granules. This appearance can lead to a rapid presumptive diagnosis of diphtheria. Blood
agar to which potassium tellurite has been added constitutes a good selective and differential medium for
primary isolation of C. diphtheriae. The tellurite not only suppresses many other throat flora, but it is
metabolized by C. diphtheriae with resulting blackening of its colonial growth. Thus the organism is
differentiated from others that can grow on the agar medium. The use of blood agar in the initial battery assures
the recovery of corynebacteria, as well as other pathogenic bacteria species that might be present, and
differentiates those that are hemolytic. The biochemical differentiation of C. diphtheriae from other
corynebacteria is based on carbohydrate fermentations.
Demonstration of toxin production is essential in reporting identification of a strain of C. diphtheriae, for
not all strains are toxigenic. Tests for virulence, that is, toxigenicity, are made either in experimental animals
(rabbits or guinea pigs) or by an in vitro method (Elek test). In the Elek test, antitoxin strips are placed on agar
plates to detect toxin produced by strains of C. diphtheria growing on the medium.
Bordetella pertussis is the etiologic agent of whooping cough. This very fastidious organism grows best
on special media. The two most common are Bordet-Gengou (BG) agar, which is enriched with glycerin, potato,
and 30% defibrinated sheep blood, and Regan-Lowe (RL) agar, which consists of charcoal agar, defibrinated
horse blood, and an antimicrobial agent to inhibit growth of normal respiratory flora. The charcoal is present to
adsorb toxic substances that might be present in the agar. Visible colonies are produced only after three to five
days incubation in a microaerophilic atmosphere. On BG medium, the colonies are raised rounded, and
glistening (resembling mercury droplets or a bisected pearl), and usually have a hazy zone of hemolysis. On RL
medium, the colonies are round, domed, shiny, and may run together slightly. B. pertussis is a gram-negative
bacillus resembling Haemophilus species, with which it was once classified. When whooping cough is suspected,
the best specimen for laboratory diagnosis is a nasopharyngeal swab, but throat swabs may be used in addition.
Laboratory Exercise:
Haemophilus, Corynebacterium and Bordetella
A. Haemophilus
Purpose:
To identify Haemophilus species in culture
Materials:
Blood agar plates, chocolate agar plates, nutrient agar plates, X and V disks,
alcohol lamps, inoculating loops, forceps
Broth/ chocolate agar cultures of Haemophilus influenzae and Haemophilus parainfluenzae
Procedures:
1. Make a Gram stain of each species of Haemophilus.
2. Divide a BAP and a chocolate agar plate in half with your marking pen or pencil. Label one half H. influenzae
and the other half H. parainfluenzae.
3. Inoculate H. influenzae on the appropriate side of each plate and streak for isolation within this half. Repeat
with H. parainfluenzae on the other half of each plate.
4. Incubate these plates in a candle jar or CO2 incubator at 35C for 24 hours.
5. Repeat step 2 using the NA plate, but inoculate each strain heavily and streak for confluent growth within its
half of the plate.
6. Now, using heated, cooled forceps, place an X and a V disk on the agar surface streaked with H. influenzae
and repeat on the H. parainfluenzae side. The two disks on each side should be placed not more than 1 inch
apart, and centered in the area streaked.
7. Incubate this plate in a candle jar or a CO2 incubator at 35C for 24 hours.
8. Describe your observations and indicate your interpretation of the appearance of the blood and nutrient
agar plates.
B. Corynebacterium
Purpose:
To identify Corynebacterium in smears and culture
Materials:
Blood agar plates, blood tellurite plate, tubed phenol red glucose broth, tubed phenol red
maltose broth, tubed phenol red sucrose broth,
Prepared Gram- and methylene-blue-stained smears of C. diphtheria,
Loefflers slant cultures of C. xerosis and C. pseudodiphtheriticum, NA slant culture of E. coli
Procedures:
1. Prepare a Gram stain and a methylene blue stain from either one of the Corynebacterium cultures. Read and
compare these with the Gram- and methylene-blue-stained smear of C. diphtheriae.
2. Inoculate a BAP with either one of the Corynebacterium cultures. Streak for isolation.
3. Divide the blood tellurite plate into two parts with your marker. Inoculate one side of the plate with a
Corynebacterium species, the other side with E. coli.
4. Inoculate the Corynebacterium culture into each of the three carbohydrate broths.
5. Incubate all plate and tube cultures at 35C for 24 hours.
6. Examine your cultures and record your observations.
C. Bordetella
Purpose:
To observe Bordetella pertussis in demonstration and to examine a throat culture on BordetGengou (BG) and Regan-Lowe (RL) media
Materials:
Prepared Gram stains of B. pertussis, Bordet-Gengou and Regan-Lowe agar plates
Procedures:
1. Examine the prepared Gram stains and record your observations.
2. Observe colonial morphology as demonstrated.
3. Collect a throat specimen and inoculate the Bordet-Gengou and Regan-Lowe plates.
4. Incubate the plates at 35C in a candle jar or CO2 incubator for 24 hours.
Study Questions (Answer on a separate sheet of bond paper):
1. What is chocolate agar?
2. Define X and V factors.
3. Name three species of Haemophilus and indicate the types of infection with which each may be associated.
4. What is the satellite phenomenon?
5. Why is a direct smear of spinal fluid essential when bacterial meningitis is suspected?
6. Name the etiologic agent of diphtheria and describe the media used to isolate it from a clinical specimen.
7. What is a virulence test and how is it performed?
8. Can diphtheria be transmitted directly via the respiratory route? If so, how?
9. How is diphtheria prevented?
10. Why is early laboratory diagnosis of diphtheria important?
11. How can transmission of respiratory infections be prevented?