Conjunctival Discharge

Conjunctivitis

InflammationInflammation ErythemaErythema Several causes:Several causes:

Bacterial Bacterial ViralViral AllergicAllergic ChemicalChemical

Conjunctivitis - Discharge

DischargeDischarge CauseCausePurulentPurulent BacteriaBacteria

ClearClear ViralViral

White, stringy mucousWhite, stringy mucous AllergiesAllergies

Bacterial conjunctivitis

Purulent dischargeConjunctival hyperemia

Viral Conjunctivitis

AdenovirusAdenovirus Systemic viral infectionsSystemic viral infections PainfulPainful

HerpeticHerpetic Discordant lack of painDiscordant lack of pain

Viral conjunctivitis

Diffuse rednessWatery discharge

Aim of the test

An etiological diagnosis of bacterial conjunctivitis by aerobic cultivation with identification and susceptibility test of the isolated bacteria .

Types of specimen Discharge from the eye(s).

Pathogen and commensals

Specimen collection Pull down the lower eyelid so that the lower

conjunctival fornix is exposed. Swab the fornix without touching the rim of

the eyelid with the sterile cotton swab. Place the swab immediately in a bacterial

transport medium or, the specimen is brought to the laboratory immediately, in a sterile test tube with 0.5 mL of buffered saline (pH 7).

Take Sufficient amount on the swab

Time relapse before processing the sample

Eye specimen should be processed immediately because tears contains lysosomes which may kill the organism

Media

Blood Agar Chocolate Agar MacConkey Agar Fluid Thioglycollat

Ear Discharge

Aim of the test Aetiological diagnosis of otitis external or

otitis media by aerobic and anaerobic culture with identification and susceptibility test of the isolated organism (s).

Types of specimen Pus from the external or middle ear.

Pathogen and commensals

Specimen collection

Collect a specimen of the discharge on a thin, sterile cotton wool or Dacron swab.

Place the swab in a container with the transport medium, breaking off the swab stick to allow the stopper to be replaced tightly.

Label the specimen and send it to the laboratory.

Time relapse before processing the sample Not more than 2 hours

Media

Blood Agar, Chocolate Agar, MacConkey Aga Fluid thioglycolla

Vaginal Discharge

Background & Terminologyi. Vaginitis : significant inflammatory

response in vaginal wall. Accompanied by high number of leukocytes in vaginal fluid. Found with candida and trichomonas infections.

ii. Vaginosis : minimal inflammatory response with few leukocytes in vaginal wall. Associated with increase in bacterial concentrations.

iii. Leukorrhoea : a non-infective, non-bloodstained physiological vaginal discharge.

Clinical Approach

Clinical approachII. Physical Exam :

o Appearance of discharge.o Erythema and edema of vaginal mucosao pH levels

III. Diagnostic Tools:o pH : Nitrazine papero Wet prep: microscopic examination of

dischargeo KOH prep: dissolves cellular debris leaving

pseudohyphae of candida.o Whiff test: Fishy odor of BVo Culture

Common Causes

Common Causes

I. Normal discharge (30%) II. Bacterial Vaginosis (23-50%) III. Candida Vulvovaginitis (20-25%) IV. Trichomonas vaginitis (5-15%) V. Mixed infection or Sexually

Transmitted Disease (20%)

Whiff TestWhiff Test

The vaginal discharge of patients with BV has a characteristic fishy odor due to increased

activity of anaerobic species. Addition of KOH will augment this odor.

Aim of the test

Isolate and identify potentially aerobic pathogenic organisms including

Gardnerella vaginalis and group B Streptococcus; establish the diagnosis of gonorrhea, medical/legal cases.

Types of specimen Swab of vagina, cervix, discharge,

aspirated endocervical, endometrial, prostatic fluid, or urethral discharge.

Use swab to inoculate Jembec for transport to the laboratory and recovery of Neisseria gonorrhoeae; swab

should also be sent in transport device.

Pathogen and commensals

Specimen collection Do not use lubricant on speculum. Cervical mucous should be removed

first before inserting swab into endocervical canal, move swab from side to side allowing several seconds for absorption of organisms by the swab.

Return swab to the transport tube and label.