Basic Laboratory Procedures in Clinical Bacteriology

TMrg;karbec©keTs

mnÞIrBiesaFn¾CamUldæan

enAkñúgKøInik)ak;etrIsaRsþ

kare)aHBumÖpSayelIkTI2

GgÁkarsuxPaBBiPBelak

TIRkughSWENv

ii

TMrg;karbec©keTs mnÞIrBiesaFn¾CamUldæan enAkñúgKøInik)ak;etrIsaRsþ

iii

TMrg;karbec©keTs mnÞIrBiesaFn¾CamUldæan enAkñúgKøInik)ak;etrIsaRsþ kare)aHBumÖpSayelIkTI2 J. Vandepitte and J. Verhaegen Department of Microbiology St Rafaël Academic Hospital Leuven, Belgium K. Engbaek Department of Clinical Microbiology University of Copenhagen Herlev Hospital Herlev, Denmark P. Rohner Department of Clinical Microbiology Cantonal University Hospital Geneva, Switzerland P. Piot Join United Nations Programme on HIV/AIDS Geneva, Switzerland C. C. Heuck World Health Organization Geneva, Switzerland

World Health Organization

Geneva 2003

1

matika

GarmÖkfa 5 esckþIepþIm 6 karFanaKuNPaBenAkñúg)ak;etrIsa®sþ 7

esckþIepþIm 7 niymnn½y 7 kar®tYtBinitüKuNPaBépÞkñúg 13 karvaytMélKuNPaBBIxageRkA 29

PaK 1 karRsavRCav)ak;etrIsa®sþ 32 Qam 33

esckþIepþIm 33 etI Bacteraemia GacekIteLIgenAeBlNa nig TIkEnøgNa ? 33 karbUmykQam 34 fñalsRmab;bNþúHQam 36 dMeNIrkarénkarbNþúHQam 37

TwkxYrq¥wgxñg (Cerebrospinal fluid (CSF)) 40

esckþIepþIm 40 karbUmykvtßúviPaK nig karbBa¢Ún 40 karBinitüedayEPñkTeT 41 karBinitüedayeRbImIRkUTsSn_ 41 karviPaKCabzm 45 etsþedIm,Ivas;GMBIPaBsuaMnwgfñaM (Susceptibility testing) 46

Twkenam 47

esckþIepþIm 47 karykvtßúviPaK 48 karbNþúH nig karbkRsaylT§pl 50 karbkRsaylT§plkarbNþúH Quantitative rbs;Twkenam 54

2

karviPaK (Identification) 55 etsþrkPaBsuaMrbs;)ak;etrIeTAnwgfñaM (Susceptility Tests) 56

lamk 57

esckþIepþIm 57 Pñak;garbgáehtu nig sBaØaKøIniksMxan;² 58 kareRbIR)as;FnFanenAkñúgmnÞIrBiesaFn_RtwmRtUv 61 karyk nig kardwkCBa¢ÚnvtßúsMNaklamk 61 karBinitüsMNaklamkedayEPñkpÞal; 63 rebobbNþúHenAelIfñalbNþúHEdlsm,ÚredaycMNIGahar 64 fñalbNþúHsRmab;bNþúHBYk)ak;etrIbgáeraKkñúgeBaHevon 64 karbnSúT§bzm 66 karviPaKdMbUgénemeraKEdlbNþúH 68 karviPaKrkemeraKedaymIRkUTsSn¾CacugeRkay 77 karviPaKedayeRbIetsþesr:Umsa®sþ (Serological identification) 84

karlakpøÚvdegðImEpñkxagelI 92

esckþIepþIm 92 emeraKFm μtaenAkñúg Pharynx 92 )ak;etrIEdlbgá[rlak Pharynx 93 karyk nigkarbBa¢ÚnvtßúviPaK 96 karBinitüpÞal;edaymIRkUTsSn_ 96 karbNþúH nigkarviPaK 96 kareFIV Test Gg;TIb‘Íy:URkam 99

CMgWrlakpøÚvdegðImEpñkxageRkam (Lower Respiratory Tract Infection) 100

esckþIepþIm 100 karbgáeraKEdlCYbjwkjab;CageK 100 karykkMhak 102 dMeNIrkarénkarBinitükMhakenAkñúgmnÞIrBiesaFn_ ¬sMrab;karbgáeraKEdlminEmnCaeraKrebg¦ 103 karbNþúHrk Mycobacterium tuberculosis 108 karbkRsaylT§plénkarbNþúHrk M. tuberculosis 111 suvtßiPaBkñúgkarbMeBjkargar 112

3

Cm¶WkameraK 113

esckþIepIþm 113 rlakbgðÜrenamburs 114 vtßúviPaKykecjBIRbdab;ePTrbs;RsþI 118 vtßúviPaKEdlykecjBIdMe)ARbdab;bnþBUC 122

TwkrégmanxÞúH dMe)A nigbUs 127

esckþIepþIm 127 lkçN³KøIniksMxan;²EdlCYbRbTHjwkjab; nigPñak;garbgáeraKsMxan;² 128 karyk nigkardwkCBa¢ÚnvtßúviPaK 131 karviPaKelIsPaBxageRkA 133 karBinitüedaymIRkUTsSn_ 134 karbNþúH 136 karviPaK 138 etsþGg;TIb‘Íy:URkam 143

karsikSaBI)ak;etrIEdlminRtUvkarxül; (Anaerobic bacteriology) 144

esckþIepþIm 144 karBiBN’naBI)ak;etrI Tak;TgnwgtRmUvkarGuksIuEhSn 144 )ak;etrIsaRsþ 145

etsþGg;TIb‘Uy:URkam (Antimicrobial susceptibility testing) 152

esckþIepþIm 152 eKalkarN_TUeTAénetsþGg;TIb‘ÍyU:Rkam 153 niymn½yKøInikénBakü {Fn;} nig {sg;sIub{ ¬RbB½n§ 3-RbePT¦ 153 karENnaMGMBIkareRbIetsþGg;TIb‘Íy:URkamEdlGnuvtþRbcaMéf¶ 155 kareRCIserIsfñaMsMrab;kareFVIetsþGg;TIb‘Íy:URkamRbcaMéf¶enAkñúgmnÞIrBiesaFn_KøInik 157 bec©keTsEksMrYl Kirby-Bauer 161 etsþGg;TIb‘Íy:URkamedaypÞal; nigedayRbeyal 170 ktþabec©keTsEdlb:HBal;dl;TMhMtMbn;KμanemeraKduHkñúgviFI Disc-diffusion 170 karRtYtBinitüKuNPaB 173

4

etsþesr:UmsaRsþ 175

esckáIepþIm 175 karvas;EvgkarRtÜtBinitüKuNPaB 176 RbtikmμenAkñúgetsþesr:UmsaRsþ 179 etsþesr:UmsaRsþsMrab; Syphilis 181 etsþ Febrile agglutinins 191 etsþ Antistreptolysin O (ASO) 195 etsþGg;TIEhSn)ak;etrI 198

PaK 2 fñalbNúþHCasarvnþ½ nig Rbtikr 201 esckþIepþIm 202 emeraK fñalbNþúHnigRbtikrsMrab;rkeraKvinic½äy 203

Qam 204 TwkxYrq¥wgxñg 205 Twkenam 206 lamk 207 pøÚvdegðImxagelI 209 pøÚvdegðImxageRkam 210 vtßúviPaKykecjBIRbdab;bnþBUC nigRbB½n§Twkenam BiesssMrab;CMgWqøgtampøÚvePT (STDi) 211 taragénfñalbNþúHEdlRtÚveRbI nigRbtikrsMrab;rkeraKvinicä½y sMrab;mnÞIrBiesaFn_ Gtisuxum- CIvsaRsþfñak;kNþal 213

esovePACMerIsmYycMnYn sMrab;karGanbEnßmeTot 217

5

GarmÖkfa

CMgWqøgCamUlehtucMbgénmrN³PaBenAkñúgRbeTskMBugGPivDÆn¾ ehIykareFVIeraKvinicä½y nigkarBüa)alCMgW TaMg enHtMNageGaybBaðaRbQmnana cMeBaHesvasuxaPi)alenAkñúgtMbn;TaMgenH. GgÁkarsuxPaBBiPBelak)an nigkMBugBak;Bn§½ya:gskm μkñúgkarGPivDÆn¾ nigelIkkMBs;sþg;darbec©keTs sMrab;karRsavRCavmnÞIrBiesaFn¾én CMgWEbbenH karb:unb:g CabzmkñúgkareFVIeGayeTACasþg;darénkareFVIetsþrkemeraK)ak;etrIbgáCMgWRtUv)aneKeFVI eLIgkñúgqñaM19601. eFVIkarbnþelIbBaðaenHkñúgqñaM1970 KN³km μkarénGñkCMnajkarEpñksþg;darCIvsaRsþrbs; GgÁkarsuxPaBBiPBelak )aneRBognUvtMrUvkarnanasMrab;kareFVIetsþPaBkbnwgGg;TIb‘ÍyUTIkedayeRbIR)as; viFIsaRsþ Disc

2. kñúgeBldMNalKñaenaHEdr kic©RbwgERbgRtUv)aneKeFVIeLIgkñúgkarbBa©ÚlkarRtYtBinitüeTAkñúgkarGnuvtþrbs;mnÞIr-BiesaFn¾ enAkñúgqñaM 1981 GgÁkarsuxPaBBiPBelak)anbegáItnUvviFIvaytMélKuNPaBBIxageRkACalkçN³ GnþrCatisMrab;GtisuxumsaRsþ. mnÞIrBiesaFn¾EdlTak;TgnwgviFIenHGacnwgedIrtYQanmuxkñúgkarGnuvtþviFIsaRsþ vaytMélKuNPaBfñak;Cati enARKb;fñak;TaMgGs;énRbBn§½EfTaMsuxPaB. kare)aHBumÖpSaybc©úb,nñenH RbEmRbmUl nigeFVIeGaymanbc©úb,nñPaBnUvmKÁúeTsn¾ENnaMepSg² EdlpliteLIg edayGgÁkarsuxPaBBiPBelakkñúgb:unμanqñaMknøgmkenH eTAelIviFIeRCIserIsvtßúviPaKsMrab;karRsavRCavmnÞIr-BiesaFn¾ kMnt;GtþsBaØaNemeraK nigetsþPaBsuaMrbs;emeraKeTAnwgfñaMRbqaMgnwgemeraK. Bt’mannanaEdl manenATIenHKWcg;naMeTArkPaBsuxdmrmniykm μénkarRsavRCavGtisuxumsaRsþ nigetsþrkemeraK nigedIm,IelIk kMBs;KuNPaBmnÞIrBiesaFn¾nana TaMgenAfñak;mCÄwmnigfñak;mFüm. vaepþateTAelITMrg;EdleKRtUveFVItamCaCag eTAelIbec©keTsmUldæanén mIRkUTsSn¾ nigkarbMBak;BN’Edl)anBiBN’nalMGitrYcmkehIyenAkñúgkare)aHBumÖ déTeTotrbs;GgÁkarsuxPaBBiPBelak 3.

1

The public health aspects of antibiotics in feedstuffs. Report on a Working Group, Bremen, 1-5 October 1973. Copenhagen, WHO

Regional Office for Europ, 1973 (document no. EURO 3604 (2). 2

WHO Expert Committee on Biological Standardization. Twenty-eighth report. Geneva, World Health Organization, 1977 (WHO

Technical Report Series, N.610). 3

Manual of basic techniques for a health laboratory, 2nd ed. Geneva, World Health Organization, 2003

6

esckþIepþIm

CMgWqøg enAEtTajuyksmamaRtd¾x<s;hYsehtuénfvikasMrab;suxaPi)al enAkñúgRbeTskMBugGPivDÆn¾. eyag eTAtamr)aykarN_suxPaBBiPBelak ( World health report

1 ) )an bgðajfa enAkñúgmYyqñaM² manGñksøab;

RbmaN 2/2 lannak;edaysarCm¶WraKRsYcRsav. cMENkÉCm¶WrlakpøÚvdegðIm ( Primarily pneumonia ) KWCamUlehtusMxan;mYy epSgeTotEdlbNþal[mancMnYnGñksøab;Cag 4 lannak;enAkñúgmYyqñaM². eyagtam karviPaKTinñn½yCMgWsYt)anbgðaj[eXIjfa enAkñúgRbeTskMBugGPivDÆn¾BBYk)ak;etrI Haemophilus influ-

enzae nig Streptococcus pneu-moniae KWCaemeraKbgáCMgWeRcInCagbNþalmkBIBBYk Virus cMeBaHCm¶W pøÚvdegðImEdlekItenAelIkumar. cMeBaHBBYk H.influenzae nig S.pneumoniaeEdlbegáIt β-Lactamase edaybnßynUvPaBkbCamYy Benzylpenicillin )anelcmuxenAEpñkxøHkñúgBiPBelakeFVIeGaykarXøaMemIl emeraKbgáCMgWTaMgenHmansar³sMxan;ya:gxøaMg. cMeBaHCm¶WkameraKk¾kMBugEtmansPaBekIneLIg. bBaðaTaMgGs;enH)anKMramKMEhgdl;karratt,at nigkarrat t,atCasklénCMgWEdlmanRbPBCa)ak;etrI b¤vIrusEdlhak;dUcCaekIteLIgedayRbBn§½XøaMemIl eGBIedmIsaRsþ min smRsb nigviFankarkarBarminRKb;RKan;. edIm,IkarBar nigTb;sáat;nUvCm¶W)ak;etrIsMxan;² KWcaM)ac;RtUvman ]bkrN_samBaØ² eRbIR)as;enAkñúgkarXøaMemIleGBIedmIsaRsþnigkartamemIlCm¶WCaRbcaMnigk¾dUcCaRtUvman bec©keTsénkareFVIeraKvinicä½ygayRsYl nigGaceCOCak;)an . edIm,sMerc)annUvbBaðaRbQmEdlmannabc©úb,nñenH esvamnÞIrBiesaFn_suxaPi)al RtUvEtBwgEp¥keTAelIbNþaj mnÞIrBiesaFn_EdleFVIeraKvinicä½yGtisuxumsaRsþsMrab;mNÐlsuxPaB evC¢bNÐitenAtammnÞIreBTü nigGñkCMnaj xageGBIedmIsa®sþnana. PaBsμ úRKsμajénkargarenHnwgekIneLIgtaMgBImnÞIrBiesaFn¾fañk;eRkameTAdl;mnÞIrBiesaFn¾fñak;kNþal nigfñak; mCÄwm. enHKWCameFüa)ayEtmYyKt;EdlnwgGacRbmUl)anya:gelOnnUvBt’manEdlTak;TgRKb;RKan;edIm,IeFIV eGayRbesIreLIgnUvkarXøaMemIl nigGaceGayeKdwgTan;eBlevlanUvkarratt,at b¤karqøgeraKEdlminFm μta nigkar erobcMGnuvtþ nigvaytMélnUvviFankarGnþraKmn¾Cak;lak;nana. 1 r)aykarN_suxPaBBiPBelakqñaM2000 hSWENv GgÁkarsuxPaBBiPBelak 2000

7

karFanaKuNPaBenAkñúg)ak;etrIsa®sþ esckþIepþIm km μviFIFanaKuNPaBCameFüa)ayd¾manRbsiT§BlmYykñúgkarrkSasþg;darénkareFVIeraKvinicä½yedaymnÞIrBiesaFn_ nigkarGPivDÆn¾eGaykan;EtRbesIrnUvsþg;darTaMgenaH enATINaEdlcaM)ac;. enAkñúgGtisuxumCIvsaRsþKuNPaB minRtwmEtGaRs½yeTAelIbec©keTsb:ueNÑaHeT EteKRtUvKiteTAelIel,Óntémø ehIynwgsar³sMxan;énPaB Tak;TgetsþKøInik. CaTUeTAkareFVIetsþmnÞIrBiesaFn_vamantémøéføCamYynwgkarvivDÆn¾énevC¢saRsþ eKmanbMNg nwgbegáIn smmaRtfvikasMrab;suxaPi)al.

niymnn½y edIm,I[manKuNPaBl¥ etsþeraKvinicä½ymYyRtUvTak;TgnwgsBaØaKøInik KWfavaRtUvEtCYykñúgkarkarBar nigBüa)al Cm¶WTaMgGs;enaH. karvas;KuNPaBetsþeraKvinicä½yepSgeTotman ³

• kareCOCak;)an ( Reliability ) ³ etIlT§plRtwmRtUvb¤eT ? • karGaceFVIbBa¢ak;eLIgvij)an (Reproducibility)³ etIlT§pldUcKñab¤eT

enAeBlEdleyIgeFVIetsþ sareLIgvij ? • el,Ón ( Speed ) ³ etIel,ÓnénkareFVIetsþvaTan;eBlevla tamkartRmUvrbs;evC¢bNÐitb¤eT ? • témøtbsñg ( Cost-benefit ratio ) ³

etItémøénkareFVIetsþvasmRsbCamYyplRbeyaCn_Edlcg; )anrbs;GñkCm¶W b¤ shKmn_b¤eT ?

ktþaEdlTak;TgCamYyPaBGaceCOCak;)an nigkarGaceFVIbBa¢ak;eLIgvij)an énlT§plrbs;mnÞIrBiesaFn_ RbPBénkarxusqÁgGacbNþalmkBI ³

buKÁlik³ karRbtibtþirbs;km μkrmnÞIrBiesaFn¾ b¤ Gñkbec©keTsénmnÞIrBiesaFn_ KWvaBak;B½n§eday pÞal;eTAelIKuNPaBénkarGb;rM nigkarbNþúHbNþalEdlBYkeK)anTTYlbTBiesaFn¾ niglkçxNÐ½ kargar.

ktþabrisßan³ TIkEnøgeFVIkarminsmRsbBnøW b¤xül;ecjcUl sItuNðPaBTabb¤x<s;eBk semøgxøaMg eBk b¤lkçxNÐ½kargarminmansuvtßiPaBEdlGacb:HBal;dl;lT§pl .

vtßúviPaK³ bec©keTs nigeBlevlaénkarykvtßúviPaK nigRbPBvtßúviPaKCaerOy² vasßitenAeRkA karRtYtRtapÞal;rbs;mnÞIrBiesaFn_ b:uEnþvaCar)aMgmYypÞal;eTAelIlT§PaBrbs;mnÞIrBiesaFn¾

8

kñúgkareFVIeGaysMerc)annUvlT§plEdlKYreGayeCOCak;)an. ktþadéTeTotEdlmnÞIrBiesaFn_ Gac®tYtRta)an ehIyEdlvab:HBal;dl;KuNPaBlT§plenaHKWkardwkCBa¢ÚnkarkMNt;GtþsBaØaN karrkSaTuk nigkarerobcMvtßúviPaK. dUcenHehIymnÞIrBiesaFn_mantYnaTIkñúgkarbNþúHbNþaldl; GñkEdlyk nigdwkCBa¢ÚnvtßúviPaKesckþIENnaMCalaylkç½GkSr KYrEtmannigBinitüeLIgvijCa eTogTat;CamYynwgbuKÁlikKøIniknigbuKÁlikEfTaMevC¢sa®sþ.

smÖar³mnÞIrBiesaFn_³ KuNPaBRbtikr smÖar³KImI Ekv BN’sMrab;bMBak; fñalbNþúHemeraK nigstV mnÞIrBiesaFn¾TaMgGs;enHman\T§iBleTAelIPaBGaceCOCak;)anrbs;lT§pletsþ.

viFIsa®sþeFVIetsþ³ viFIsa®sþxøHmanPaBeCOCak;CagviFIsa®sþmYycMnYneTot. ]bkrN_³ kgVH]bkrN_ b¤]bkrN_EdlBMuRtUvsþg;dar b¤]bkrN¾EdlEfTaMmin)anl¥ nwgpþl;

lT§plEdlminGaceCOCak;)an. karBinitü nigkarGan³ karGand¾Rbjab;Rbjal;nUvlT§pl b¤k¾karmin)anBinitücMnYnRbLg;

mIRkUTsSn¾ eGay)anRKb;RKan; GacnaM[mankarPan;RcLM. r)aykarN_³ karcMlgkarPan;RcLM b¤ r)aykarN¾mineBjelj bgáCabBaða.

KuNPaBénkarbkRsaylT§pletsþ karbkRsayKWCaEpñkmYyd¾sMxan;enAkñúgGtisuxumCIvsa®sþ. enAdMNak;kalnimYy²énkarBinitüvtßúviPaKmYy eK KYrbkRsaylT§pledIm,IeRCIsyketsþEdll¥bMput edayEp¥kelIel,Ón nigPaBeCOCak;)ansMrab;tMNak;kal bnþbnÞab;eToténkarBinitü. karFanaKuNPaBenAkñúgmnÞIBiesaFn_GtisuxumCIvsaRsþ karFanaKuNPaPaB KWCakarrYmbBa©ÚlnUvskmμPaBTaMgLayEdlmnÞIrBiesaFn_RtUveFVIedIm,IFanafalT§pletsþ manKuNPaBl¥ . vaRtUvEt ³

- RKb;RCugeRCay³ RKbdNþb;RKb;dMNak;kalnimYy² taMgBIkarRbmUlvtßúviPaK rhUtdl;karbBa¢Ún r)aykarN¾eGayeTAevC¢bNÐit ¬ rUbTI1 ¦

- manehtupl³ epþatkarykcitþTukdak;eTAelIdMNak;kalEdlsMxan;bMputenAkñúgvdþ - eTogTat;³ pþl;kartamdanCaRbcaM énrebobeFVIetsþ - sgVak;³ EsVgrk nigEktRmUvPaBxusqÁgkñúgkrNIEdlekItman.

esvamnÞIrBiesaFn_manKuNPaBl¥ mann½yfa Ca»sfEdlmanKuNPaBl¥

9

karFanaKuNPaBCYykñúgkarFanafa etsþEdlmantémøx<s;eKRtUveRbIya:gsnSMsMécEdlGaceFVIeTA)an. vak¾CYy pgEdrkñúgkarkMNt;fa etIetsþfμ I²manRbsiT§PaB b¤k¾Kμan)ankar. CYyeFVIeGaykan;EtRbesIreLIgnUvkarRbtibtþi mnÞIrBiesaFn¾KøInik nigsuxPaBsaFarN³. RbePTénkarFanaKuNPaB RbePTénkarFanaKuNPaBman2 KWkarFanaKuNPaBépÞkñúg (Internal) nig karFanaKuNPaBBIxageRkA (External)

Internal³ enHRtUv)aneKeehAfa karRtYtBinitüKuNPaB Quality control EdlmnÞIrBiesaFn_ nImYy² mankm μviFIBinitüKuNPaBkareFVIetsþrbs;xøÜnpÞal;.

rUbPaBTI1 ³ dMNak;kalkñúgkarRsavRCavrbs;mnÞIrBiesaFn_énGñkCm¶Wqøgmñak; karykvtßúviPaK kardwkCBa¢Ún karbiTpøak karTukdak; karvaytMéledayEPñkpÞal; køin mIRkUTsSn¾ bkRsay bNþúH ³ eRCIsfñalbNþúH sItuNðPaB briyakas bnSúT§karbNþúH Antibiogram kMNt;GtþsBaØaN karbkRsay (vtßúqøgeraK, vtßúEdlb:HnwgemeraK b¤ emeraK )

GñkCm¶WCamYyCm¶Wqøg

vtßúviPaK Bt’manKøInik

r)aykarN_bzmdl;RKUeBTü

r)aykarN_cugeRkaydl;RKUeBTü

10

Internal Quality Control Bak;B½n§CamYy ³

- kartamdanCaRbcaMénKuNPaBetsþ - kar®tYtBinitüRKb;RCugeRCayenARKb;dMNak;kal cab;taMgBIkarRbmUl Specimen ¬RKb;eBl

EdlGaceFVI)an ¦ rhUtdl;karbBa¢Únr)aykarN¾cugeRkay mnÞIrBiesaFn_mankarTTYlxusRtUvRkmsIlFm’cMeBaHGñkCm¶W kñúgkarplitnUvlT§plRtwmRtUv mann½y.

External³ enHRtUveKehAfa QUALITY ASSESSMENT EdllT§plrbs;mnÞIrBiesaFn_ nwgRtUv)an®tYtBinitüedayPñak;garxageRkA . enAtambNþaRbeTsmYycMnYn Gñkshkarkargar enHKWeFVItamGaNtþi ¬Edl dwknaMedayrdæaPi)al¦ ehIytRmUv[manGaCJab½NÑRtwmRtUv.

External Quality assessment Bak;B½n§CamYy ³

- kartamdanCatMNak;kalénKuNPaBrbs;etsþ - kartamdanedaymineGaydwgmunénetsþkMNt;GtþsBaØaN

ehIymaneBlxøHeTAelIbec©keTsbnSúT§ rkemeraK.

lkçxNÐ½KuNPaBenAkñúgGtisuxumCIvsa®sþ RtUvnwglkçN³KøInik Clinical relevance lkçxNÐ½d¾sMxan;mYyénKuNPaBsRmab;etsþGtisuxumCIvsa®sþ KWsMedAfaetIvapþl;sm,TankMritNakñúgkarbgáar b¤Büa)alCm¶WqøgEdlenHeKehAfa Clinical relevance rbs;va. Clinical relevance GacFana)anEtenA eBlNa EdlmanTMnak;TMngl¥rvagRKUeBTüBüa)al nwgmnÞIrBiesaFn_ . edIm,IbBa¢ak;BI Clinical relevance eyIgman]TahrN_mYycMnYn ³

1> RbsinebImankBa©MúemeraK Gram-negative bnþicbnþÜcRtUveKbnSúT§ecjBIkMhakb¤tM)arBIbMBg;krbs; GñkCm¶WsRmakenAmnÞIreBTüenaH karkMNt;GtþsBaØaNbEnßmbnþeTot nigkareFVI Antibiogram KW minEmnCa Clinical relevance eT edayehtufaminmanrebobNamYyEdlnwgmanRbsiT§PaBeTAelI karBüa)alGñkCm¶WeLIy.

kar®tYtBinitüKuNPaBépÞkñúg KWmansar³sMxan;Nas;sRmab;rebobRbtibtþiEdll¥

11

2> RbsinebI Streptococcus pyogenes RtUveKrkeXIj enaHkareFIV Antibiogram eBjeljmYynwg

Kμan Clinical relevance eT edayehtufa Benzylpenicillin KWCafñaMsRmab;kareRCIserIs ehIy EdlEtgEtskm μenAkñúg Vitro .

3> RbsinebI Escherichia coli RtUveKrkeXIjBIkrNICm¶WraKEdlKμanQammþgmáal karkMNt;BIRbePT Serotype nwgK μan Clinical relevance eT edayehtufavaKμanTMnak;TMngc,as;las;rvag Serotype nigPaBbgáCaCMgWenaHeT.

4> RbsinebIkarbMBak;BN’ Gram enAelIvtßúviPaK bgðajfaman { Anaerobic flora cRmuH } enaH karkMNt;rkBYk Anaerobes CaTUeTA KWKμan Clinical relevance eT. vanwgcMNayeBlevla nig smÖar³ ehIynwgKμan b:HBal;dl;karBüa)alrbs;GñkCm¶WeLIy .

5> RbsinebIBYkpSit ( Yeast ) RtUveKrkeXIjBIvtßúviPaKBIRbB½n§pøÚvdegðImenaH etsþkMNt;rk Cryptoco-

ccus KYrEteFVI. etsþbnþeTot K μan Clinical relevance eT edayehtufa vanigKμankarb:HBal;dl; karRKb;RKgGñkCm¶WeT .

Casegçb etsþEdlmanKuNPaBl¥mYyKWCaetsþEdlRtwmRtUv nigpþl;nUvlT§plEdlmansar³RbeyaCn_dl; karbgáar b¤karBüa)alCm¶Wqøg. vaBuMmankarcaM)ac;eTkñúgkarrkemeraK nigkMNt;nUvral;RbePTepSg²rbs;emeraK enAkñúgvtßúviPaK. PaBeCOCak;)an sRmab;etsþEdlpþl;lT§plCatYelx PaBeCOCak;)an RtUveKvas;EvgedayemIlfa etIlT§plenaHvaenAekok b:uNÑaeTAnwgtYelxBitR)akd. ]TahrN_mYycMnYnénkareFVIetsþrebobenH KW ³

- [sakl,g Antibiotic énesr:UmQam - karvas;nUvtMélkMhab;Gb,brmarbs; Inhibitory ( MIC ) én Antibiotic kñúg Vitro - esrU:m Antibody titrations

sRmab;kareFVIetsþEdlpþl;nUvlT§plCatYelx PaBeCOCak;)an KWvas;edayemIlfaetIlT§plRtwmRtUvEdrb¤eT. ]TahrN_mYycMnYnénkareFVIetsþrebobenH KW ³

- karkMNt;GtþsBaØaNemeraK ( Pathogens ) - kareFVIetsþBIRbsiT§PaBén Antibiotic eday Disc method

12

vaküsBÞ½nanaCasþg;darsRmab;BBYkGtisuxumR)aN KWmansar³sMxan;dl;kareCOCak;. eQμaHTaMgLayEdlFøab; )ansÁal;CaGnþrCatiKYrRtUv)anykmkeRbI ]TahrN_dUcCa Staphylococcus aureus EdlBuMEmneRbIfa “Pathogenic staphylococci” eT . RtUveRbIBakü “Streptococcus pyogenes” BuMEmn “ Haemolytic

streptococci “ enaH eT . kareRbIviFIsa®sþ CaÉkPaB EdleKGnumtþi mansar³sMxan;Nas;. ]TahrN_ etsþPaBrYsrbs;emeraK edayeRbI Disc KYreFVIeLIgCamYynwgbec©keTsEdleKTTYlsÁal;CaGnþrCati dUcCa Kirby-Bauer test ¦. PaBEdlGacbBa¢ak;eLIgvij)an PaBEdlGacbBa¢ak;eLIgvij)an b¤k¾PaBCak;lak;énetsþGtisuxumCIvsaRsþ RtUvkat;bnßyedayrbs;BIr³

- kgVHPaBdUcKña vtßúviPaKEtmYyBIGñkCMgWmñak;GacpÞúknUvemeraKelIsBImYy. dUecñHkarbNþúHsar eLIgvijGacnwgrkeXIjemeraKepSg.

- kgVHesßrPaB³ enAeBlEdleBlevlaknøgeTA GtisuxumR)aNenAkñúgvtßúviPaKkrekItkan;EteRcIn b¤k¾søab;enAkñúgGRtaxus²Kña. dUcenHkarbNþúHsareLIgvij GacnwgrkeXIjemeraKepSg. dUecñH ehIyedIm,IbegáIn PaBCak;lak; eKRtUveFVIetsþvtßúviPaKya:gqab;EdlGaceFIVeTA)aneRkayBIeFVIkar RbmUl.

RbsiT§Bl ( Efficiency ) RbsiT§BlénkareFVIetsþGtisuxumR)aNmYy KWCalT§PaBrbs;vaEdlpþl;nUveraKvinicä½yRtwmRtUvénemeraKbgámYy b¤ CMgWmYy. karenHRtUv)anvas;EvgedaylkçN³BIry:ag ³ lT§PaBbBa¢ak;eraKvinicä½yviC¢man ( Diagnostic sensitivity ) cMnYnsrubénlT§plviC¢man Sensitivity = cMnYnsrubénGñkCm¶W QW ebI sensitivity rbs;etsþkan;Etx<s; cMnYnlT§plGviC¢-xus kan;Ettic . ]TahrN_ sensitivity én MacConkey agar minl¥eTsRmab;karEjkrkemeraK Slamonella typhi BI lamk. emeraKbgáCMgWeBaHevond¾sMxan;enH CaerOy²eKminGacrkeXIjeT edaysarEtkarduHdalya:geRcInelIslubénBBYk)ak;etrIEdlminbgáCMgWenAkñúgeBaHevon.

13

lT§PaBbBa¢ak;eraKvinicä½yGviC¢man (Diagnostic specificity)

cMnYnsrubénlT§plGviC¢man Specificity = cMnYnsrubénGñkCm¶W minQW Specificity rbs;etsþkan;Etx<s; cMnYnlT§plviC¢man-xuskan;Ettic . ]TahrN_ ³

• karbMBak;BN’ Ziehl-Neelsen énkMhakKWman Specificity x<s;sMrab;kareFVIeraKvinicä½y Tuber-culosis BIeRBaHvapþl;nUvcMnYnlT§plviC¢man-xustictYcb:ueNÑaH . • karbMBak;BN’ Ziehl-Neelsen énTwkenam KWman Specificity ticbMput eRBaHvapþl;nUv lT§plviC¢man-xuseRcIn ¬dUcCaeGaylT§plCaBBYk Mycobacteria EdlminR)akdRbCa¦. • etsþ Widal KWman Specificity TabEmnETn sRmab;eraKvinicä½yCm¶WRKuneBaHevon BIeRBaH Cross-agglutinating antibodies EdlenAesssl;taMgBIeBlqøgCMgWCamYynwg Salmonella

Serotype )an pþl;nUvlT§plviC¢man-xus. Sensitivity nig Specificity rbs;etsþmYyvamankarTak;TgrvagKña. edaybBa©úHkMritEbgEck Sensitivity énetsþ mYyGacRtUvbegáInenAkñúgtémøfycuHén Specificity rbs;va ehIybRBa©asmkvij. Diagnostic

sensitivity nig Specificity énetsþmYyk¾Tak;TgpgEdreTAnwgeRbva:Lg;Cm¶W enAkñúgcMeNamRbCaCnEdlsßit kñúgkarRsavRCav.

kar®tYtBinitüKuNPaBépÞkñúg lkçxNÐ½tRmUv km μviFI®tYtBinitüKuNPaNépÞkñúgRtUvEtCakarmYyEdlGacGnuvtþn_)anCak;lak; nigsnSMsMéc. km μviFI®tYtBinitüKuNPaBépÞkñúgminRtUvmaneKaledAvaytémøRKb;viFIsa®sþ Rbtikr nigkarbNþúHemraK enAral;éf¶ eFVIkar enaHeT. vaKYrEtvaytMélviFIsa®sþnImYy² Rbtikr nigfñalbNþúHemeraKTaMgLayeTAtamkalviPaKEdl GacGnuvtþ)an edayEp¥keTAelIsar³sMxan;énvtßúnImYy² cMeBaHKuNPaBénkareFVIetsþTaMgmUl .

viFIsa®sþ ( Procedures ) kar®tYtBinitüKuNPaBépÞkñúgepþImeLIgCamYyRbtibtþikarRtwmRtUvrbs;mnÞIrBiesaFn_ .

14

esovePARbtibtþirbs;mnÞIrBiesaFn_ enARKb;mnÞIrBiesaFn_KYrmanesovePARbtibtþimYyEdlrYmmanRbFanbTdUcxageRkam ³

- karsm¥atkEnøgeFVIkar - Gnam½ypÞal;xøÜnrbs;buKÁlbMeBjkargar - karRbytñ½RbEygGMBIsuvtßiPaB - karerobcMkEnøgjúaMnigCk;[enAeRkAmnÞIrBiesaFn_ - karerobcMTukdak; nige)aHecalsmÖar³qøgeraK - cak;va:k;saMgsmRsbkarBarGñkRbtibtþikr ]TahrN_ va:k;saMgkarBarCMgWeføImRbePT B

- EfrkSa]bkrN_ - karRbmUlvtßúviPaK - cuHbBa¢IvtßúviPaK - kMeTcecalvtßúviPaKEdlBuM)ankar ( Unsuitable specimen ) - karcat;EcgvtßúviPaK - kt;RtalT§pl - raykarN_lT§pl

eKRtUvGnuvtþtamesovePARbtibtþiedayRby½tñRbEyg nigEksMrYl nigeFVIVIbc©úb,nñPaBya:geTogTat; . karEfTaM]bkrN_ vaCakarmYyd¾sMxan;kñúgkarykcitþTukdak;EfTaM]bkrN_eRbIR)as;TaMgLayenAkñúgmnÞIrBiesaFn¾. etsþEdl RbkbedayKuNPaB nwgminGaceFVIeTA)aneLIy RbsinNaebI]bkrN_EdleKeRbIR)as;manKuNPaBGn; nigkgVH karEfTaM. fñalbNþúH fñalbNþúHmYyGacRtUv)anerobcMenAkñúgmnÞIrBiesaFn¾ edayeRbIeRKOgpSMCamUldæannanab¤edayeRbIemS:AedGuIRdat Edlmanlk;enAelITIpSar b¤k¾vaRtUvTijRsab;edIm,IykmkeRbI. emSAedGuIRdatEdllk;enAtam»fsßannana RtUv )anENnaM[eRbI BIeRBaHvaRtUv)andwkCBa¢Ún nigsþúkTukRbkbedayKuNPaBmYyx<s;EdleKeCOCak;fa vaman lkçN³l¥RbesIrCag karerobcMedaymnÞIrBiesaFn_pÞal;. edIm,ITTYl)annUvlT§pll¥mYy eKRtUveFVIkarcab; Garm μN_eTAelIcMNucdUcxageRkam

15

kareRCIserIsfñalbNþúH mnÞIrBiesaFn_EdlRbkbedayRbsiT§Bl)anrkSaTuknUvcMnYnfñalkñúgbrimaNmYyticbMput eGayRtUvnwgRbePT etsþEdlRtUveFVI. ]TahrN_fñalcahYymYy Edll¥GacRtUveKeRbICafñalsMrab;RKb;eKalbMNgTaMgGs; sRmab;erobcMfñal bNþúHQam fñaleRbIsUkULa ehIynigfñalepSgeTotmYycMnYn. fñalCMerI zsd¾x<s;mYy (Salmonella-Shigella agar or deoxycholate citrate agar) nigfñalCMerIsd¾Tab mYyeTot ( Mac Conkey agar ) vamansar³sMxan;Nas;sRmab;rkemeraKbgáCMgWecjBIlamk. fñalbNþúHBiessmYyeTotKYrRtUveKbEnßmedImI,TajykBYk Campylobacter spp .

karbBa¢aTij nigkarTukdak;fñaledGIuRdaet

1- bBa¢aTijfñalkñúgcMnYnEdleRKageRbIR)as;sRmab;ry³eBl 6 Ex b¤eRcInbMputsRmab;ry³eBl 1 qñaM 2- cMnYnfñalTaMgGs;enHRtUverobcMTukdak;enAkñúgkBa©b;EdlsRmab;eRbIry³eBl 1-2 Ex 3- enAeBlTTYlykRtUvmYlKMrbkBa©b;TaMgGs;eGaytwgENnRbkbedaysuvtßiPaB. enAkñúgbriyakas

esIm cUrP¢itkBa©b;fñaledGIuRdaetTaMgenH edayRkmYn)a:ra:hVIn ¬ bitcenøaHTaMgLay Edlman nigTuk vaeGayrwg¦.

taragTI1> karRtYtBinitüKuNPaBbrikçar

brikçar karEfrkSaCaRbcaM karRtYtBinitü bec©keTsEfTaM nigGFikarkic©

Ekv Anaerobic

>Autoclave

>

sm¥atEpñkxagkñúgEkvral;s)aþh_ eFVIeGaykatalIkrskmμeLIgvijeRkayBIdMeNIrkarmþg² ¬160oC, 2em:ag¦ bþÚrkatalIkrerogral; 3Exmþg

sm¥at nig bþÚrTwkral;Ex

eRbIbnÞHGaMgDIkaT½remTIELnexov kñúgeBldMeNIrkar nImYy² kt;smÁal; nigkt;RtaTuk ry³eBl )at;BN’rbs;GaMgDIkaT½rral;s)aþh_

Binitü nig él[RtUvnUvcMNuH TwkmundMeNIrkarnImYy² kt;Rtary³eBl nig sItuNðPaB b¤ sm<aFsRmab;dMeNIrkarnImYy² kt;RtakarRbtibtþi enAelIbnÞHs<½r ral;s)aþh_

BinitüemIlRTnab; biTenAkñúg KRmb ral;s)aþh_

erogral; 6Ex

16

Centrifuge

>Hot-air oven

sRmab;karsmøab; emeraKeRKOgEkv

>Incubator

>Microscope

>Refrigerator

>Water-bath

CUtépÞxagkñúgCamYyl,ayEdlsmøab;em eraKral;s)aþh_ b¤ bnÞab;BIkarEbkbMBg;Ekv b¤kMBb;

sm¥atEpñkxagkñúgral;Ex

sm¥atépÞxagkñúg nig eFñIr ral;Ex

CUtEPñkCamYyRkdasTn; b¤ Lens paper

bnÞab;BIéf¶ eFVIkarnImYy² sm¥at nig dak;eRbg fasTMrral;s)aþh_ RKbKRmbkarBarFUlIenAeBlmineRbIR)as; sm¥at nigeFVI[rlayerogral; 2Ex nigbnÞab;BIkar Føak;zamBl

CUtépÞxagkñúg nig bþÚrTwkral;Ex

kt;Rtary³eBl nig sItuNðPaB sRmab;deMeNIrkar nImYy²

kt;RtasItuNðPaBenAeBl cab;epþIménéf¶eFVIkarnImYy² ¬sßitkñúg 35±1oC¦

BinitüCYrkg;dg;ral;Ex dak;canénsuIlIkaexovCamYyMicro

scope enAeRkamKRmb karBarFUlI edIm,IkarBarkar krekItpSitenAkñúg sItuNðPaBesIm

kt;RtasItuNðPaBral;RBwk ¬sßitkñúg 2-8oC¦

BinitüemIlkMritTwkral;éf¶ kt;RtasItuNðPaBenAéf¶dMbUgéns)aþh_nImYy² ¬sßitkñúg 55-57oC¦

bþÚrRcas;ral;qñaM

erogral; 6Ex

erogral; 6Ex

edayRbcaMqñaM erogral; 6Ex

erogral; 6Ex

4- sresréf¶ExqñaMénkarTTYlenAelIRbGb;nImYy² 5- rkSaTukenAkEnøgggwt RtCak; nig manxül;ecj-cUll¥ 6- bgVil Stock edIm,IeRbIsmÖar³cas;mun 7- enAeBlebIkRbGb; RtUvsresréf¶ExqñaMénkarebIkva 8- e)aHecalral;fñal Dehydrated EdleLIgdMurwg b¤ eLIgexμA 9- rkSakMNt;Rtalaylkç½GkSrénfñalbNþúH enAkñúg Stock

karerobcMfñalbNþúH

1- Gnuvtþ[)anhμt;ct;tamesckþIENnaMrbs;plitkrsRmab;karerobcM 2- erobcMcMnYnEdlnwgRtUveRbIGs;munéf¶hYskMNt;eRbIR)as;xøÜnva ¬sUmemIlxageRkam¦

17

taragTI2> kMNt;Rta]bkrN¾RbtibtþisItuNðPaB

Temperature ____________ Instrument ________________________________ Room _________________ Read daily. Check it temperature indication is acceptable. If aberrant, record temperature in space

Date Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date

1 1

2 2

3 3

4 4

5 5

6 6

7 7

8 8

9 9

10 10

11 11

12 12

13 13

14 14

15 15

16 16

17 17

18 18

19 19

20 20

21 21

22 22

23 23

24 24

25 25

26 26

27 27

28 28

29 29

30 30

31 31

18

karTukdak;fñalEdlerobcMrYcehIy

1- karBarTl;nwgkMedARBHGaTitü 2- karBarTl;nwgkMedA . fñalbNþúHpÞúknUvQam sirIr³epSgeTot b¤k¾Gg;TIb‘Íy:UTik KYEtTukenAkñúgTUTwkkk 3- GayukaleRbIR)as;rbs;fñalbNþúHEdlerobcMrYcehIy enAeBlTukenAkEnøgRtCak;-ggwt vanwgGaRs½y

eTAelIRbePTRbGb;EdleKeRbI. GayukaleRbIR)as;CaTUeTAKW ³

- bMBg;EdlmanqñúksMLI 3s)aþh_ - bMBg;EdlmanKRmbrlug 2s)aþh_ - RbGb;EdlmanKRmbmYl 3s)aþh_ - can Petri RbsinebIbiTenAkñúges,ag)aøsÞik 4s)aþh_

karRtYtBinitüKuNPaBfñalbNþúHEdlerobcMrYcehIy

1- kareFVIetsþ pH. pH rbs;fñalbNþúHEdlerobcMrYcehIy mincaM)ac;BinitüeTogTat;CaFm μtaenaHeT

enAeBlEdleK)anerobcMvaRtwmRtUvBIemS:A Dehydrated. RbsinebIfñalbNþúH RtUveKerobcMeLIgBI eRKOgpSMmUldæan eKKYrEtTukva[RtCak;sinmunnwgeFVIetsþ pH. cMeBaHfñalbNþúHrwg eKKYrEtetsþ CamYynwgépÞeGLicRtUc b¤ bnÞab;BIRtaMenAkñúgTwkbit. RbsinebI ph xusKña eRcInCag 0/2 Ékta BI kRmitbBa¢ak; cUrtMrUvvaCamYynwgGasIut b¤Gal;kaLaMg b¤erobcMLÚmYyfμ I.

2- etsþGMBIPaBs¥atK μanemeraK. Gnuvtþn_etsþBIPaBs¥atK μanemeraK CaTUeTAFm μta enAelIfñalbNþúHEdl eK)anbEnßmQam b¤smasPaKdéTeTot eRkayBIsMlab;emeraKedayGUtUkøav. cUryk 3-5° BILÚ nImYy² nigTukecalenAsItuNðPaB 35 oC ry³eBl 2éf¶. ehIyTukrbs;EdlenAsl; enAkñúgTU Twkkk. RbsinebIeXIjman kBa©úMemeraKduHRcInCagBIrkñúgmYycan cUre)aHecalLÚTaMgmUl.

3- etsþelIlT§pl. mnÞIrBiesaFn_KYrEtrkSaTuk ememeraKenAkñúgsþúkmYyQut sRmab;eFVIkarRtYtBinitü lT§plrbs;fñalbNþúH. bBa¢IememeraKEdlKYrsþúkRtUv)anpþl;enAkñúgtarag2. Strains TaMgenHGac TTYl)anBIkargarRbcaMéf¶ b¤BITIpSar b¤BIRbPBpøÚvkar. karENnaMsRmab;karEfTaMnigeRbIR)as;em emeraKEdlsþúkTukmanpþl;CUnenA.

bBa¢IetsþelIlT§pl sRmab;fñalbNþúHEdleKeRbICaTUeTA manpþl;CUnenAkñúgtarag.

19

taragTI 2> Suggested stock strains for quality control 1

1 The strains most relevant to the needs of the laboratory should be selected.

Gram-possitive cocci Enterobacteriaceae

Enterococcus faecalis (ATTC 29212 Citrobacter freundii

or 33186) Enterobacter cloacae

Staphylococcus aureus (ATCC 25923 Escherichia coli (ATTC 25922)

Staphylococcus epidermidis Klebsiella pneumoniae

Streptococcus agalactiae Proteus mirabilis

Steptococcus mitis Salmonella typhimurium

Streptococcus pneumoniae Serratia marcescens

Streptococcus pyogenses Shigella flexneri

Gram-negative fastidious organisms Yersinia enterocolitica

Moraxella catarrhalis Other Gram-negative rods

Haemophilus influenzae type b Acinetobacter Iwoffi

β-lactamase-negative Pseudomonas aeruginosa (ATCC 27853)

β-lactamase-positive Vibrio cholerae (non-01)

Mhaemophilus parainfluenzae Fungi

Neisseria gonorrhoeae Candida albicans

Neisseria meningitidis

Anaerobes

Bacteroides fragilis

Clostridium perfringens

20

taragTI3 ³ etsþelIlT§plenAelIfñalbNþúHEdleKeRbICajwkjab;

Medium Incubation Control organism Expected result

Bile-aesculin agar 24h Enterococcus faecalis Growth and blackening

a-Haemolytic No growth, with haemolysis

Streptococcus

Blood agar 24h, CO2 Streptococcus Growth and B-Haemolysis

pyogenes

S. pneumoniae Growth and a-haemolysis

Chocolate agar 24h, CO2 Haemophilus influenzae Growth

Decarboxylase (cover with sterile oil)

lysine 48h Shigella typhimurium Positive

Shigella flexneri Negative

ornithine 48h S. typhimurium Positive

Klebsiella pneumoniae Negative

Dyhydrolase

arginine 48h S. typhimurium Positive

Proteus mirabilis Negative

Gelatinase (rapid tests) 24h Escherichia coli Negative

Serratia marcescens Positive

Kligler iron agar (see triple sugar iron agar)

MacConkey agar with crystal violet 24h E. coli Red colonies

P. mirabilis Colourless colonies (no swarming)

E. faecalis No growth

Malonate broth 24h E. coli Negative (green)

K. pneumoniae Positive (blue)

Mannitol salt agar 24h Staphylococcus aureus Yellow colonies

Staphylococcus aureus Rose colonies

epidermidis

E. coli No growth

21

taragTI3 ³ etsþelIlT§plenAelIfñalbNþúHEdleKeRbICajwkjab; ¬t¦

Medium Incubation Control organism Expected result Methyl red/Voges-Proskauer 48h E. coli Positive/negative

K. pneumoniae Negative/positive

Mueller-Hinton agar 24h E. coli ATCC 25922

S. aureus ATCC 25923 Acceptable zone sizes

Pseudomonas (Table 24, p. 110)

aeruginosa ATCC 27853

Nitrate broth 24h E. coli Positive

Acinetobacter Iwoffi Negative

Oxidation/fermentation 24h P. aeruginosa Oxidation at the surface

dextrose (without oil) A. Iwoffi No change

Peptone water (indole) 24h E. coli Positive

K. pneumoniae Negative

Phenylalanine deaminase. 24h E. coli Negative

ferrichloride P. mirabilis Positive

Salmonella-Shingella agar or 24h E. coli No growth

deoxycholate citrate agar S. typhimurium Colourless colonies

Yersina enterocolitica Colourless colonies

S. flexneri Colourless colonies

Selenite broth 24h S. typhimurium Growth after subculture

E. coli No growth after subculture Simmons citrate agar (incubate 48h E. coli No growth

with loose screw-cap) K. pneumoniae Growth, blue colour

Thiosulfate citrate bile salts 24h Vibrio spp. (non-agglutinating) Yellow colonies

agar

Thayer-Martin agar 24h, CO2 Neisseria meningitidis Growth

Neisseria gonorrhoeae Growth

Staphylococcus spp. No growth

E. coli No growth

C. albicans No growth

22

taragTI3 ³ etsþelIlT§plenAelIfñalbNþúHEdleKeRbICajwkjab; ¬t¦

Medium Incubation Control organism Expected result

Thioglycollate broth 24h Bacteroides fragilis Growth Triple sugar iron agar (depth of 24h Citrobacter freundii A/A gasa + H2S

butt should be at least 2.5cm; S. typhimurium K/A gasa + H2S

incubate with loose screw-cap) S. flexneri K/A gasa

A. Iwoffi No change

Urea medium 24h E. coli Negative

P. mirabilis Positive (pink) Voges-Proskauer (see methyl

red/Voges-Proskauer)

a A/A : Acide slant; K/A : Alkaline slant.

rebobEdleKRtUvGnuvtþtamenAeBleFVIetsþelIlT§pl enAelILÚfμ I²énfñalbNþúH KW ³

1- erobcM Suspension én stock strain CamYynwgPaBl¥k; EdlswgEtemIlGVImineXIjEdlsmmUl eTAnwg Barium sulfate standard EdleRbIenAkñúgviFIsa®sþ Modified Kirby-Bauer (McFarland

0.5) nigeRbIvamYyRkv:g;sMrab;Cakarcak;ePJac. 2- Tukecalkñúgry³eBldUcEdleKeRbICaFm μta. Gan caneTAtamviFIFmμta. 3- rkSaÉksarlT§pl[)ansmrmü.

BN’sMrab;bMBak; nigRbtikr karENnaMsRmab;etsþ RbtikrmYycMnYn manpþl;CUnkñúgtarag4. etsþEdlKYreFVI KW³

- enAral;eBlEdleKerobcMLÚénl,aysRmab;eRbIkarf μ InImYy² - erogral;s)þah_¬enHsMxan;Nas;sRmab;kBN’RtCak; Ziehl-Neelsen³ BN’EdleKeRbItaMgBI

bUrmburaNmkmanGayukaleRbIR)as; 3 b¤ 4 Ex ¦. BN’ nigRbtikrKYrEtRtUv)ane)aHecalenAeBl Edl³

- dl;éf¶ Ex qñaM énkarhYskMNt;eRbI - elceLIgnUvsBaØaEdlGacemIleXIjBIkarxUcxat ¬l¥k; kkr ehIrBN’¦

23

Antigen nig Antisera sMrab;eFVIeraKvinicä½y

edIm,ITTYl)annUvlT§pll¥BI antigens nig Antisera ³

- Canic©CakalRtUvGnuvtþeTAtamkarENnaMrbs;Gñkplit - rkSavaTukenAsItuNðPaBEdleKENnaM . Rbtikr Serological xøH minRTaMnwgkMNkeT.

taragTI4 ³ karRbtibtþietsþenAelIRbtikrEdleKeRbICaTUeTA

Reagent or stain Species suitable for testing

Medium Positive Negative

Bacitracin disc S. pyogenes (zone) E. faecalis Blood agar

Catalase S. aureus E. faecalis Tryptic soy agar

Coagulase plasma S. aureus S. epidermidis Tryptic soy agar

B-Glucuronidase (PGUA)a E. coli K. pneumoniae Tryptic soy agar

Gram stain Staphylococcus spp E. coli Mixed in smear

ONPGb E. coli S. typhimurium Triple sugar iron agar or Kligler iron

agar

Optochin disc S. pneumoniae (zone) Streptococcus mitis Blood agar

Oxidase Pseudomonas aeruginosa E. coli Tryptic soy agar

Tellurite disc E. faecalis (no zone) Streptococcus Blood agar

agalactiae (zone)

V-factor (disc or strips) Haemophilus parainfluenzae

Haemophilus influenzae Tryptic soy agar

XV-factor (disc or strips) H. influenzae Tryptic soy agar

Ziehl-Neelsen stain Mycobacterium tuberculosis

Mixed non-acide-fast flora Sputum smear c

a 4- Nitrophenyl-β-D-glucopyranosiduronic acid. (PGUA) b o-Nitrophenyl-β-D-galactopyranoside. c Prepare a number of smears from known positive and negative patients. Fix by heat, wrap individually in paper, and store in the refrigerator

24

• eCosvagkarkk nigrlaysarcuHsaeLIg. munnwgbgák cUrEbgEck Antiserum CaPaKKuN[)an

RKb;RKan; sRmab;etsþ 2 b¤ 3 . • e)aHecalenAeBl dl;éf¶ Ex qñaM énkarhYskMNt;rbs;plitpl. • edIm,Ietsþ Agglutinating antisera Canic©kalRtUveRbIkarbNþúHEdlsuT§nwgf μIénRbtikmμEdlsÁal; • Canic©kalRtUvbBa¢Úl Serum Control énRbtikmμEdlsÁal;eTAkñúgLÚnImYy²rbs;etsþ. eKGacyk

Serum GñkCm¶W b¤ BIRbPBTIpSar.

• RbsinebIGaceFVI)ankmøaMgrbs; Control Serum KYrEtbgðajCa International Units kñúg mYymIlIlIRt • KUrbs; Sera EdlykBIGñkCMgWEtmYy EdleKykkñúgkMLúgeBléndMNak;kalRsYcRsav nigeTIbeRkakBIQW

KYrRtUveFVIetsþCamYynwgRbtikrkñúgLÚEtmYy. • sRmab;eraKvinicä½y Serological énCMgWsVayKWRtUveRbIEtviFIEdlfñak;Cati b¤GnþrCatiTTYlsÁal;b:ueNÑaH • LÚetsþ serological nImYy² KYrrYmman ³

- Serum GviC¢man ¬Specificity control¦ - Rbtikr Serum exSay ¬Senitivity control¦ - Rbtikr Serum xøaMg ¬Titration control¦ EdleKKYrEtGanvaenAkñúgBRgavNamYy én Titre rbs;

vaenAeBlEdl Titre cugeRkayRtUveKeFVIetsþ. - Canic©kalRtUvkt;RtanUvral; Control Serum Titres .

kareFVIetsþPaBkbrbs; Antibiotic eKENnaMeGayeRbIR)as;CaFm μtaTUeTAénviFIsa®sþ Kirby-bauer. edIm,IeCosvagnUvkMhus karENnaMxageRkam KYrRtUv)aneRbI ³ • DiscsKYrEtmanmuxkat;RtwmRtUv ¬6/35 mm ¦ • Discs KYrEtmankmøaMgRtwmRtUv ¬tarag24 ¦ • karrkSaTukKYrEtrkSaenAkEnøgRtCak; ¬-20 GgSares ¦ • sMPar³kargarKYrEtrkSaTukmin[yUrCag 1Ex enAkñúgTUrTwkkk ¬2-8 GgSares¦ • KWmanEt Mueller-Hinton agar etsþRbtibtþiKuNPaBb:ueNÑaHEdlKYreRbI .

• kRmwtpH RtwmRtUv ¬7>2-7>4¦ énfñalbNþúHbBa©b;KWsMxan;Nas;sRmab; antibiotic mYycMnYn . • Inoculum KYrRtUveFVIeGaysþg;dareFobnwgsþg;darPaBl¥k;EdleKsresr • brievNTMhMKYrEtvas;[)anRtwmRtUvBitR)akd.

25

• brievNTMhMKYrEtRtUvbkRsayedayeyageTAtamtarag Critical Diameters . brievNbnÞat;p©itsRmab;

sirIr³nImYy² KYrsßitenAkñúgcenøaHEdlmanenAkñúgtarag24. • Standard control strains TaMg3 man³

- Staphylococcus aureus(ATCC 25923; NCTC 6571); - Escherichia (ATCC 25922; NCTC 10418); - Pseudomonas aeruginosa(ATCC 27853; NCTC 10622);

• etsþKYrEtGnuvtþCamYynwg Standard strain TaMg3 ³ - enAeBlEdlLÚfμ Ién Disc RtUveKdak;eGayeRbIR)as; - enAeBlEdlLÚfμ IénfñalbNþúH RtUveKdak;eGayeRbIR)as; - mþgkñúgmYys)aþh_ edayeFVIRsbKñaCamYynwg AntibiogramEdleKeFVICaFm μtaTUeTAral;éf¶

• eRbItaragRtYtBinitüKuNPaBEdlmanbgðajenAkñúgrUbPaBTW 16 sRmab;eFVIkarkt;Rta nigvaytémø Performance Tests enH.

karEfTaM nigkareRbIR)as; Stock culture kareRCIserIs nigRbPB cUreRCIserIs Strain edIm,I[cMnYnGtibrmaénlkçN³ Morphological metabolic nig Serological Gac eGayeKykmkeFVIetsþCamYynwgcMnYnGb,rmaénkarbNþúHemeraK. manbBa¢Ipþl;CUnenAkñúgtarag2 eKGacTTYl )an Strain TaMgenHBIkarrYmbBa©ÚlKñaénRbPBdUcteTA ³

- BIvtßúviPaKKøInikEdleK)ancgRkgCaÉksarTukya:gRtwmRtUv - karRbmUlpþúMkarbNþúHemeraKCapøÚvkarnana - GñkplitsMrab;CMnYj - karGegátvaytMélKuNPaBBIGñkxageRkA - mnÞIrBiesaFn_bEg¥knana

karrkSaTuk karrkSaTukry³eBlEvg viFIsa®sþkñúgkarrkSaTukry³eBlEvgGnuBaØati[manry³eBlcenøaHrab;Ex b¤ qñaM rvagkarbNþúHemeraKbnþ²eTot nana. viFIsa®sþEdll¥bMputKW Lyophilization ¬RtCak;-s¶Üt¦ b¤rkSaTukenAsuItuNðPaB-70oC b¤TabCagenH enAkñúgm:asuInRtCak;GKÁIsnI b¤enAkñúgTwknIRtUEsn. viFIsa®sþepSgeTotEdlCMnYs)an manerobrab;dUcxageRkam³

26

Glycerol enA -20 oC

1- cUrbNþúHemeraKd¾suT§l¥enAelIfñalrwgsmRsbmYy

2- enAeBlkarbNþúHemeraKvivtþn_eBjelj cUrekasvaecjCamYynwgEdksMrab;ekas 3- dak;BMnUktUc²énemeraKbNþúHenAkñúg Sterile Neutral Glycerol.

4- EbgEckkñúgbrimaNBI 1-2 m>l eTAkñúgbMBg;EdlmanKMrbmYlbiT b¤ kUndbtUc² . 5- rkSaTukenAsItuNðPaB -20 oC . eCosvageFVI[kk b¤ rlay mþgeTot. epÞrvabnÞab;BI 12-18 Ex .

eRbgFmμCati enAsItuNðPaBkñúgbnÞb; 1

1- erobcMbMBg;rbs; Heart infusion agar edaydak;eGayeRTtbnþic. cMeBaHsirIr³EdlBi)akTukdak;

cUrbEnßmQamRss; b¤QamEdlkMedA. 2- rMgab;emeraKkñúgeRbgFm μCatienaH (Liquide petrolatum) enAkñúgxül;ekþA ¬sItuNðPaB 170 oC

ry³eBl 1 em:ag¦. 3- bNþúHvtßúEdlRtUvbNþúHsuT§enAelIkEnøgCMral. 4- enAeBleXIjfavalUtlas;l¥ehIy bEnßmeRbgFmμCatiEdlsMlab;emeraKehIyenARtg;RbEhl 1

sg;TIEm:Rtxag 5- elIkEnøgCMral. 6- eFVIkarbNþúHbnþ²eTotenAeBlmantRmUvkar edaylagduHsm¥atGVIEdllUtlas;BIxageRkameRbg. 7- rkSaTukenAsItuNðPaBkñúgbnÞb;. epÞrvabnÞab;BI 6-12 Ex .

karbNþúHkñúgCMerA enAsItuNðPaBkñúgbnÞb; ¬eRbIsRmab;Et Non- fastidious organism b:ueNÑaH dUcCa Staphylococci nig Enterobacteriaceae¦

1- erobcMbMBg; EdlmanKUTeRCAdak;cahYyEdlminmanCati Carbohydrate. eKpþl;Gnusasn¾eGayeRbI Tryptic soy agar (Soybean casein digest agar).

2- cak;sirIr³sMrab;bNþúH cUleTAkñúgfñalcahYy. 3- bNþúHvaeBjmYyyb;enAsItuNðPaB 35 oC. 4- biTbMBg;edayqñúkmYlb¤qñúkcuk. RCmuCKMrbeTAkñúgRkmYnEdlrlayedIm,IbiTP¢it. 5- rkSaTukenAsItuNðPaBkñúgbnÞb; ehIyepÞrvabnÞab;BI1qñaM .

27

karbNþúHedaycak;cUleTAkñúg Cystine Trypticase Agar (CTA)

¬sRmab; Neisseria nig Streptococci¦

1- erobcMbMBg;fñal CTA . 2- cak; sirIr³sMrab;bNþúH cUleTAkñúgfñal. 3- bNþúHvaeBjmYyyb;enAsItuNðPaB 35 oC . 4- biTbMBg;edayqñúkmYlb¤qñúkcuk . RCmuCKMrbeTAkñúgRkmYnEdlrlayedIm,IbiTP¢it. 5- sRmab; Neissei rkSaTukenAsItuNðPaB35oC ehIyepÞrerogral;2GaTitümþg. sRmab; Steptococci

rkSaTukenAsItuNðPaBkñúgbnÞb; nigepÞrvaerogral;Ex . fñalbNþúHBIsac;q¥insMrab;BYkemeraKEdlminRtUvkarxül; (Anaerobes)

1- cak;bBa©ÚlemeraKeTAkñúgbMBg;. 2- bNþúHvaeBjmYyyb;enAsItuNðPaB 35 oC . 3- biTbMBg;edayqñúkmYlb¤qñúkcuk . 4- rkSaTukenAsItuNðPaBkñúgbnÞb;. epÞrvaerogral;2Ex .

karrkSaTukry³eBlxøI karbNþúHsRmab;kareFVIkarviPaKCaFm μtaRbcaMéf¶GacRtUv)anerobcMkñúgviFIdUcteTA . sirIr³EdllUtlas;elOn

1- cak;bBa©ÚlemeraKeTAelIépÞCMralrbs; Tryptic soy agar enAkñúg bMBg;EdlmanqñúkmYlbiT. 2- bNþúHvaeBjmYyyb;enAsItuNðPaB 35 oC . 3- rkSaTukenAkñúgTUrTwkkk . epÞrvaerogral; 2Ex .

Streptococci

1- cak;emeraKeTAelI épÞCMralrbs;fñalEdleFIVIQam enAkñúgbMBg;EdlmanqñúkmYlbiT. 2- bNþúHvaeBjmYyyb;enAsItuNðPaB 35 oC . 3- rkSaTukenAkñúgTUrTwkkk . epÞrvaerogral;2Ex .

28

Meninggococci nig Haemophilus

1- cak;emeraKeTAelIépÞCMralrbs;fñal Chocolate b¤ can. 2- bNþúHvaeBjmYyyb;enAsItuNðPaB 35 oC . 3- rkSaTukenAkñúgsItuNðPaBkñúgbnÞb; . epÞrvaBIrdgkñúg1s)aþh_ .

Gonococci

1- cak;emeraKeTAelI Chocolate agar . 2- bNþúHva nigrkSaTukenAsItuNðPaB 35 oC . epÞrvaerogral;2éf¶ . 3- pøas;bþÚr Strain EdlsMrab;karRtYtBinitüKuNPaB enAerogral;eBlmaneraKfI μ²BIKøInIk.

kareRbIR)as;mnÞIrBiesaFn_bEg¥k RbePTénvtßúviPaKdUcxageRkamenH KYrEtbBa¢ÚneTAmnÞIrBiesaFn¾fñak;tMbn; b¤ mnÞIrBiesaFn_bEg¥kfñak;mCÄwm ³

- vtßúviPaKsRmab;RtUvkaryUr²mþg b¤etsþEdlRtUvkarCMnajx<s;(]TarhN_ Virology, Serodiagnosis of parasitic infections)

- vtßúviPaKcmøg dUcCasMrab;BinitüeTAelIlT§plrbs;mnÞIrBiesaFn_xøÜnpÞal;Edl)anbBa¢ÚneTA - vtßúviPaKEdleKRtUvkarsMrab;eFVIkarbBa¢ak;eTAelIlkçN³Cak;lak;Rkum b¤RbePTénemeraKbgáCm¶WEdl

Casar³sMxan;cMeBaHsuxPaBsaFarN³ ¬]TarhN_ Salmonella, Shigella, Vibrio cholerae,

Brucella, Meningococci,nig Pneumococci). mnÞIrBiesaFn_bEg¥kKYrEtmanlT§PaBpÁt;pÁg;nUvkarbNþúHsMrab;CabEg¥ksRmab;karRtYtBinitüKuNPaBnwgtRmUvkar karbNþúHbNþal nigesr:UmnigRbtikrsþg;dar sRmab;kareRbóbeFobCamYynwgGVIEdlkMBugeRbIR)as;enAkñúgmnÞIr BiesaFn_bEg¥k. RbsinebIminmankm μviFIvaytMélKuNPaBBIxageRkAeTenaH eKKYrEtsMueGaymnÞIrBiesaFn_bEg¥kpÁt;pÁg;vtßúviPaK nigfñalbNþúHEdldak;kUdmineGaynrNadwg. dUcenHmnÞIrBiesaFn_bEg¥kGaceFVIetsþeTAtamRbeyaCn¾rbs;;xøÜn kñúgkarrk nigkMNt;GtþsBaØaNrbs;emeraK .

29

karvaytMélKuNPaBBIxageRkA EpñkenH pþl;nUvBt’man eTAelIGVIEdlRtUvTak;Tg kñúgkarcUlrYmenAkñúgkm μviFIvaytMélKuNPaBBIxageRkA ¬eBl xøHeyIgsÁal;CakmμviFIetsþCMnaj { Proficiency Testing Scheme } ¦. eKalbMNg eKalbMNgénkmμviFIvaytMélKuNPaBBIxageRkAKW ³

- pþl;nUvkarFanaGHGag cMeBaHTaMgRKUeBTü nigsaFarN³ CnTUeTAfa kareFVIeraKvinicä½yenAmnÞIrBiesaFn_ enHKWRbkbedayKuNPaBl¥

- eFVIkarvaytMél nigeRbóbeFobPaBTukcitþ)anrbs;lT§plmnÞIrBiesaFn_eTAelIrgVas;smehtupl

- eFVIkarkMNt;BIkMhusqÁgrYmCaTUeTA - elIkTwkcitþkareRbIR)as;viFIsaRsþCaÉkPaB - elIkTwkcitþkareRbIR)as;nUvRbtikrsþg;dar - Rbkan;yknUvviFankarrdæ)al ¬EdlGacrYmman kardkhUtGaCJab½NÑkargar¦ tTl;nwgmnÞIrBiesaFn_

EdlminRKb;sþg;dar.

- CMrujeGaymankarRbtibtþiénkm μviFIRtYtBinitüKuNPaBépÞkñúg . karerobcM km μviFIvaytMélKuNPaBBIxageRkA mankarGegátmYycMnYn EdlkñúgenaH vtßúviPaKEdleKdak;elxkUdehIy RtUv eKEckcay tamry³karepJItaméRbsNIy¾ eTAkan;mnÞIrBiesaFn_nanaEdlcUlrYmkñúgkm μviFI. vtßúviPaKTaMgenH KYrEtRtUvdak;bBa©ÚleTAkñúgvtßúviPaKCaTUeTAFm μtarbs;mnÞIrBiesaFn_ ehIycat;Ecg nigeFVIetsþeday eRbIrebob dUcKñaEtmYynwg vtßúviPaKEdl)anmkBIKøInik. karGegátKYrEtRtUveFVIeLIg[RsbtamGnusasn¾dUcxageRkam ³

- karGegátKYrEtRtUv)aneFVIy:agtic4dgkñúg1qñaM - vtßúviPaK Gb,rma 3 EdlRtUvbBa©ÚleTAkñúgkarGegátnImYy² - ry³eBleFVIr)aykarN_KYrEtxøI ]TarhN_ 2 s)þah_ bnÞab;BITTYlvtßúviPaK - eKKYrrYmbBa©Úl karENnaM nigTRmg;r)aykarN_ eTAkñúgkarGegátnImYy² ehIy taragr)aykarN_RtUv

EtmanBIrc,ab;CamYynwgkarkMNt;eBlRbKl;c,as;las;.

30

karbNþúH karbNþúHKYrEtRtUvdak;bBa¢ÚlsRmab;karbBa¢ak;GtþsBaØaN nigsRmab;karetsþPaBkbTl;nwgGg;TIb‘Íy:UTik Ca kMNt;mYycMnYn. vaGacCakarbNþúHsuT§ b¤karlayKñaénkarbNþúHemeraKBIr b¤eRcIn. karbNþúHKYrEttMNagy:agticnUvlkçN³3dMbUg énlkçN³TaMg6dUcxageRkam ³

1- Rkum)ak;etrIEdlmanskþanuBlcMeBaHsuxPaBsaFarN³ b:uEnþEdlminEmnEtgEteXIj Cajwkjab;enA kñúgkarGnuvtþCaTUeTAFm μtaral;éf¶enaHeT ]TarhN_ Corynebacterium diphtheriae, Salmo-nella paratyphi A.

kMNt;smÁal; ³ Brucella nig Salmonella paratyphi minKYrRtUveKeRbIsRmab;kmμviFIvaytMélKuNPaBeT BIeRBaHfa vaGaceGayelceLIgnUvkarqøgeraKF¶n;F¶redayécdnü.

2- RbePTCIvsaRsþEdlminFmμta ehIyEdlCaerOy²mankarkMNt;GtþsBaØaNxus ]TarhN_ H2S-positive Eschrichia coli, Lactose-negative E.coli , Urease-negative Proteus.

3- emeraKbgáCMgWEdleKsÁal;fμ I² b¤ emeraK»kasniym ]TahrN_ Yersinia enterocolitica, Vibrio

parahaemolyticus, Burkholderia, Pseudomonas cepacia. 4- karRcbl;Kñaén Shigella, Citrobacter, E. coli nig Klebsiella GacRtUveRbIedIm,IviPaKCMnajrbs;

mnÞIrBiesaFn_ mYykñúgkarrkGtisuxumR)aNbgáCMgWBIkñúgcMnYnGtisuxumR)aNTUeTAmYycMnYn.

5- karRcbl;KñaénGtisuxumR)aNminbgáCMgW GacnwgRtUveKeRbI edIm,IeFVIkarviPaKlT§PaBkñúgkarsÁal; vtßúviPaKGviC¢man.

6- )ak;etrIEdlmanrUbragFn;RTaMBiess ]TahrN_ meticillin-resistance S. aureus ¬MRSA¦. Sera karviPaKelIesr:UmQam sRmab;karbgáeraKdUcteTAenH KYEtCaEpñkénkmμviFIvaytMélKuNPaBBIxageRkA enAkñúg)ak;etrIsaRsþ ³

- CMgWsVay Syphilis - CMgWs¥Úc Rubella

- CMgWGutkþam Brucellosis - CMgWedayBYk RsÞibtUkUk (Streptococcal infection)

- CMgWRKuneBaHevon

31

kardak;BinÞú nigr)aykarN_lT§pl qab;² bnÞab;BI)anTTYlr)aykarN¾BIRKb;GñkcUlrYm cemøIyRtwmRtUvKYrEtepJIeTAeGay mnÞIrBiesaFn_nana. kñúg GMLúgeBlmYyExbnÞab;BIenaH r)aykarN_cugeRkayKYrEtepJIeTAmnÞIrBiesaFn_ CamYynwgkarviPaK énlT§pl. BinÞúeTAelIkarRbtibtþi RtUv)anpþl;eTAeGaymnÞIrBiesaFn_nImYy². mnÞIrBiesaFn_nImYy²KYrEtmanelxsm¶at; EdldwgEtmñak;ÉgKt;. dUcenHvaGacdwgnUvkarRbtibtþipÞal;rbs;va edayeFobeTAnwgrbs;Gñkd¾éTeTot b:uEnþmnÞIr BiesaFn_déTeTotKWsßitenACaGnamik.

32

PaK 1 karRsavRCav)ak;etrIsa®sþ

33

Qam esckþIepþIm QamRtUv)aneKbNþúHeLIgedIm,IviPaKrk)ak;etrI b¤ GtisuxumR)aNdéTeTotEdleKGacbNþúH)an dUcCaBYk empSit b¤BYkpSitEdlmansrés. vtþmanénBBYk)ak;etrI b¤ pSitTaMgenaHenAkñúgQamRtUv)aneKehAfa Bacte-

raemia b¤ Fungaemia. CaFm μtaQamKWCavtßús¥atKμanemeraK EtmankrNIelIkElgmYycMnYn EdlbNþal eGayman Bacteraemia CabeNþaHGasnñEdlGacbNþalmkBIkardkeFμj karvHkat;kñúgmat; Broncho-

scopy b¤ karjat;bMBg;eTAkñúgepøak b¤bMBg;Twkenam . b:uEnþ Bacteraemia RbePTenHeRcInEtekIteLIgeday sarEt)ak;etrIEdlminbgáCm¶W nigCaTUeTACasHes,IyeTAvijedayÉkÉg edaysarEt Phagocytosis )ak;etrI TaMgenHenAkñúgeføIm nigkñúgpal . Septicaemia KWCaBaküKøInikEdl)aneKykmkeRbIedIm,IbriyayGMBI Bacteraemia EdlbeBa©jCaeraKsBaØa edaymankarbgáeraKF¶n;F¶r rYmbBa©ÚlTaMgRKunrgar Gs;kmøaMg Bul nigsMBaFQamFøak;cuH nwgGaceGaysuk :Shock :. Shock GacbNþalmkBICatiBulrbs;emeraK ( Toxins ) EdlbeBa©jeday)ak;etrI)asuI Gram

negative nigkuksuI Gram positive . etI Bacteraemia GacekIteLIgenAeBlNa nigTIkEnøgNa ? Bacteraemia KWCacMNucsMxan;rbs;CMgWqøgmYycMnYn ]TahrN_ Brucellosis leptospirosis nigRKuneBaH-evon . Bacteraemia sßitenAyUrKWCalkçN³énkarqøgeraKEpñkxagkñúgRbB½n§srésQam dUcCakarrlak sac;ebHdUg e)a:gdac;srésQamEdlqøgeraK nigsÞHsrésQamedaydMuQamkk. Bacteraemia beNþaHGasnñ Cajwkjab;eRcInEtmankarkreraKenAnwgkEnøgmYycMnYndUcCa ³ rlaksnøak; karQWcab; edayedkenAelIERKyUr rlakfg;Rbmat; rlakkñúgeBaHevonFM rlakeRsamxYr rlakxYrq¥wg rlaksYt rlaktRmgenam nigkarb:HTgÁic b¤ dMe)AenARtg;kEnøgvHkat; b¤ rbYs. bacteraemia GacekIteLIgeRkaykar vHkat; EtvaEtgEt)at;eTAvijedayÉkÉg cMeBaHGñkmansuxPaBFm μta . BBYk Acteraemia nig Fungaemia GacbNþalmkBIkarRCatcUlrbs;GtisuxumR)aNmYycMnYneTAkñúgsrés Qamtamry³karcak;fñaMtamsrésEv:n Catheters Rtg;muxm¢úlcak;fñaM. karbgáeraKTaMgBIrenHk¾GacbNþalmk BIGñkEdleRbIR)as;fñaMejóntamkarcak;srés nigGñkEdlmanRbB½n§karBarcuHexSaydUcCaGñkEdlpÞúkemeraK HIV nigekItCm¶W AIDS . karbgáeraKTaMgBIrEbbenHCajwkjab;eRcInEtbNþalmkBIGtisuxumR)aN»kasniym (Oppor-Tunistic Microorganism ) ehIyGacQaneTArkkarbgáeraKF¶n;F¶r. taragTI5 bgðajGMBImUlehtu cm,g²én Bacteraemia b¤ Fungaemia .

34

karbUmykQam eBlevlaEdlRtUvbUmQam eKGacbUmykQamenAeBlNak¾)an EtCeRmIsd¾l¥bMput KWKYrEtbUmykQamenAmuneBlGñkCm¶WeRbIR)as; fñaM Gg;TIb‘Íy:UTik ( Antibiotics ) . eBlevlaEdll¥ nigsmRsbbMputkñúgkarbUmykQam KWenAeBlGñkCm¶Wman eraKsBaØamYycMnYn dUcCaRKun b¤ RKunrgar. edIm,I[manPaBsuRkitükñúgkarbNþúHemeraKkñúgQam. QamKYrRtUv )aneKykdac;²BIKñadak;kñúgfñalbNþúH nig[manKmøatBIKñaRbEhl 1 em:ag ¬b¤k¾GacticCag 1 em:ag ebIkar Büa)alminGacBnüareBl)an¦. kareFVIkarbNþúHQamedIm,IrkemeraK elIsBI 3dg KWeKkRmnwgeFVINas;. GtßRbeyaCn_ énkarbNþúHsaeLIgvijeRcIndg KW³

- kat;bnßy»kas)at;bg; én Bacteraemia beNþaHGasnñ - epÞógpÞat;lT§PaBénkarbgáeraK EdlbNþalmkBIemeraK»kasniymmYycMnYn dUcCa Staphylococcus

epidermidis CaedIm ebIsinvaRtUv)aneKrkeXIjdUcKña²BIkarcak;srésEv:neRcIndg.

taragTI5 ³ mUlehturYmén Bacteraemia b¤ Fungaemia

emeraK Gram-negative emeraK Gram-positive Escherichia coli Staphylococcus aureus Klebsiella spp S.epidermidis Enterobacter spp. α-Haemolytic ( viridans ) streptococci Proteus spp. Streptococcus pneumoniae Salmonella typhi E. faecalis ( group D ) Salmonella spp. other than S. typhi S.pyogenes ( group A ) Pseudomonas aeruginosa S. agalactiae ( group B ) Neisseria meningitides Listeria monocytogenes Haemophilus influenzae Clostridium perfringens Bacteroides fragilis ( anaerobe ) Peptostreptococcus spp. ( anaerobes ) Brucella spp. Candida albicans nigBBYkpSitepSg²eTot Burkholderia ( Pseudomonas ) pseudomallei ( ]TahrN_ Cryptococcus neoformans )

¬ kñúgtMbn;mYycMnYn ¦

vaCabBaðasMxan;bMputEdlfasMNakQamsMrab;ykeTAbNþúH KYrEtRtUvbUm muneBlGñkCm¶WeFVIkarBüa)al edayfñaM RbqaMgnwgemeraKNamYy. ebIsinCamankarcaM)ac; CMerIsfñaMsmøab;emeraK edIm,IykmkBüa)al GacnwgEktMrUv enA eBlEdleKTTYl)anlT§pletsþPaBkbCamYynwgemeraK.

35

brimaNQam edaysarEtbrimaNrbs; )ak;etrIkñúgmYymIlIlIRtQamCaTUeTAmancMnYntic dUcenHCakarcaM)ac;nigsmehtupl bMputEdlRtUvbUmyk 10 mIlIlIRt cMeBaHmnusSeBjv½y 2-5 mIlIlIRt cMeBaHkumar nig 1-2 mIlIlIRt cMeBaH kUn ekμgtUc b¤TarkeTIbnwgekIt . brimaNQam 2-5 mIlIlIRt GacCabrimaNRKb;RKan; cMeBaHkumarEdlman Bacteriaemia x<s; . karsmøab;emeraKelIEs,k Es,kenARtg;kEnøgEdlbUmykQam RtUvEteFVIkarsmøab;emeraKedayRbugRby½tñbMput edayeRbIsarFatusmøab; emeraKmYycMnYndUcCa Tincture of iodine2°, Polyvidone iodine10°, Gal;kul70° b¤l,ayGal;kul

70° CamYynwg Chlorhexidine 0>5°. muneBlbUmQamKYrEtTuk[sarFatusmøab;emeraKhYt[Gs;. RbsinebIeKeRbI Tincture of iodine eKKYrEteKCUtnwgGal;kul 70° Camunsin muneBleFVIkarbUmQam edIm,I kuM[mankarrlakEs,kekIteLIg . eTaHbICamankarsmøab;emeraKelIEs,kedayhμt;ct;y:agNak¾eday k¾Gacman)ak;etrImYy enAkñúgRsTab;eRkam Es,kqøgeTAkñúgQamEdr . ]TahrN_dUcCa S. epidermidis Propionibacterium acnes nigGacCa Spores rbs; Clostridium CaedIm. Pseudobacteraemia¬lT§pl Positive xuskñúgkarbNþúHQam¦Gac ekItmaneLIgEdr edaykareRbIR)as;sarFatusmøab;emeraKm¢úl nigsarauMgEdlqøgemeraK. karEjkrkemeraK EdlminFmμtasarcuHsareLIgeRcIndg ¬]Ta> Burkholderia (Pseudomonas) cepacia, Pantoea

(Entero- bacter) agglomerans b¤ Serratia spp.¦ enAkñúgmnÞIreBTüEtmYy eKRtUvEtsgS½yeTAelI karbgáeraK Noso-comial nigCMrujeGaymankaresIubGegát. karcmøgeraKmYyeTotEdlGacekItman CayfaehtuKWkarb:HBal; m¢úlEdlykeTAbUmQamCamYysmÖar³ b¤ sarFatuEdlmin)anrm¶ab;emeraKmYycMnYn ]TahrN_³ kñúgkrNIEdlswruaMgEtmYy eKeRbIR)as;edIm,Ipþl;QamsMrab;eFVIetsþrksarCatiKImIkñúgQam b¤edIm,I vas;rkel,ÓnQamkk ( Erythrocyte sedimentation rate ) CaedIm . sarFatuEdleFVImin[Qamkk (Anticoagulant) eKpþl;Gnusasn¾eGayeRbIR)as; Sodium Polyanethol Sulfonate ( SPS ) CasarFatusRmab;kuM[Qamkk BIeRBaHsarFatuTaMgenH k¾Tb;sáat;tYnaTIsmøab;emeraKrbs;esr:Um (Serum) nig BYkeKalikas (Phagocytes)

pgEdr. eKmincaM)ac;eRbIsarFatukuM[Qamkk (Anticoagulant) eTRbsinebIeK ykQameTAbNþúHkñúgfñal bNþúHrav (Broth) cMnYn 50 mIlIlIRt eRkayeBlbUmrYcPøam² nigRcbl;y:agxøaMgedIm,IkarBarkMNk. vaCa karcaM)ac;EdlRKb;mnÞIreBTü b¤mNÐlsuxPaBRtUvmanfñalbNþúH . kñúgkrNIEdlBuMmanfñalbNþúHenATIenaHeT

36

QamKYrRtUv)aneK bBa¢ÚneTAkan;mnÞIrBiesaFn_edaydak;enAkñúgbMBg;EkvEdlmanpÞúksarFatukuM[Qamkk (Citrate heparin b¤ SPS). bnÞab;BIQamRtUv)anbBa¢ÚneTAdl;mnÞIrBiesaFn_ehIy eKRtUvepÞrQam ¬vtßúviPaK¦ enH eTAkñúgdbEdlmandak;fñalbNþúHCabnÞan; edayeKarBtambec©keTsénkarsmøab;emeraK (Asceptic

technique) [)an hμt;ct; . kñúgkrNIEdlQamEdlbBa¢ÚneTAmnÞIrBiesaFn_edayBuMmaneRbIsarFatukarBarkuM [QamkkeT duMkMNkQamRtUvepÞrcUleTAkñúgdbfñalbNþúHedayRbugRby½tñ nigkuM[qøgemeraKcUl rIÉesr:Um ( Serum ) eKGacykeTAeFVIetsþesr:Umsa®sþmYycMnYn ¬]TahrN_ ³ Widal ¦ .

fñalsRmab;bNþúHQam kareRCIserIsfñalbNþúH fñalsMrab;bNþúHQam Broth nig Tryptic soy broth (TSB) KYrEtGaceGayRKb;)ak;etrIEdlmansBaØaKøInik Cak;lak; duHlUtlas;)an. brimaNénfñalbNþúH karRbesIrbMput QamKYrRtUv)aneKlayCamYynwgfñalbNþúHkñúgbrimaN 10 dg ticCagbrimaNrbs;fñalbNþúH ¬eKdak;brimaN 5 mIlIlIRt eTAkñúg 50 mIlIlIRténbrimaNfñalbNþúHrav¦ edIm,IBRgavbrimaNfñaMGg:TIb‘Íy:UTik nigkat;bnßy\T§iBlrbs;emeraKeTAelIesr:Umrbs;mnusS . dbfñalbNþúHQam eKRtUveRbIdbfñalbNþúHQam¬125 mIlIlIRt¦ Edl manecaHKMrbk,almYlrYcCaeRsc GacmYlecjcUl)an nigmanqñúkeFVIGMBIekAs‘U. cUrbMeBjeTAkñúgdbnUvbrimaNfñal 50 mIlIlIRt rYcbn§Úr KRmbknøHCuM . eRbIRkdas GaluymIj:ÚmesþIgbYnRCugRKbBIelIKRmbfñalbNþúHenaH rYcykvaeTAsmøab;emeraKedayeRbIGUtUkøav ( Auto-

clave ) enAkMedA 120GgSa cMnYn 20naTI . bnÞab;BIdkecjBIGUtUkøavPøam² kñúgeBlEdldb fñalbNþúHenAekþA enAeLIy mYlKRmbqñúk[ENnedayminRtUvdkykRkdasGaluymIj:ÚmecjeT ¬ebImineFVIdUecñHeT KRmbfñal bNþúHmins¥at K μanemeraKeT¦ . enAeBlEdldbfñalbNþúHcuHRtCak; kñúgdbfñalbNþúHnwgbegáIteLIgnUv)atuPUt Kμanxül;mYycMnYn ehIy)atuPUtenHnwgeFVI[eyIggay®sYlkñúgkarcak;bBa©ÚlQameTAkñúgdb ¬bWtQamcUl edayÉkÉg ¦ . RtUveFVIkarsmøab;emeraK[)anhμt;ct;bMputeTAelIqñúkdbenAmuneBlcak;bBa©ÚlQameTAkñúgdbfñalbNþúH. RtUv BinitüBicä½y[)anhμt;ct;eTAelIdbfñalbNþúHmuneBleFVIkarEbgEck b¤ykmkeRbIR)as;. RtUvcgcaMfafñal bNþúHEdlykmkeRbIRtUvEtCafñalbNþúHEdlføa minkkr . ebIsinCaeXIjfa fñalNþúHmankkr eyIgminRtUv yk vamkeRbIR)as;eT .

37

kñúgkrNImankarsgS½yelI)ak;etrI RtUvkarxül;dac;xat ( Strictly aerobic bacteria ) dUcCaBBYk Pseudo-

monas Neisseria b¤ BBYkpSitmYycMnYn dbfñalbNþúHKYrRtUv)aneKecaHTmøúHbBa©Úlxül;enAeBlmkdl; mnÞIrBiesaFn_Pøam² edayykm¢úlEdlmancuksMLIs¥atKμanemeraKecaHelIKRmbC½rdbfñalbNþúHEdl)ansmøab; emeraKrYcCaeRsc. eKGacdkm¢úlecj)an enAeBlEdlsMBaFenAkñúgdbfñalbNþúH mansMBaFdUcKñanwgsMBaF enAkñúgbriyakasxageRkAEdr. dbfñalbNþúHEdleKplitecjBIeragcRk Cajwkjab;eKEtgbBa©Úl]sμ ½nkabUnik (Carbon Dioxide ) EdlCa]sμ ½nmanRbeyaCn_kñúgkarCYy[ Bacteria b¤ pSitlUtlas;)anl¥ . enAkñúgRbeTsCm¶W Brucellosis maneRbv:aLg;x<s; dbfñalbNþúHQam 2 Can; (Dysphasic blood culture

bottle) EdlmYyCan;fñalbNþúHrav nigmYyCan;eTotCafñalbNþúHrwgEdldak;epþkenAelIépÞrabesμ Irbs;db (Castaneda bottle ) RtUveKpþl;Gnusasn¾[eRbIedIm,IeFVIkarbNþúHrkBBYk Brucella spp. caM)ac;RtUvman vtþmanrbs;]sμ ½nkabUnikedIm,IeFVIkarbNþúH nigEjkBYkGm,Úr B.abortus .

dMeNIrkarénkarbNþúHQam ry³eBlTukbNþúH dbénfñalbNþúHKYrRtUv)aneKdak;kñúgkMedA 35-370

C ehIyeFVIkarBinitüCab;CaRbcaMBIrdgkñúgmYyéf¶ ¬y:ag ehacNas;k¾RtUvtamdan)an 3éf¶ dMbUgEdr ¦ edIm,IrkemIlsBaØaKYr[sgS½yfa manemeraKduH . fñalbNþúH EdlGviC¢man Canic©kalEtgbgðaj[eXIjCaRsTab;kkrénekasikarQamRkhm EdlRKbBIelIedayTwkrbs; fñalbNþúH ragBN’cMebIgføa . eKdwgfamankarduH eday ³

- manduMkkenABIxagelIRsTab;Qam - épÞfñalbNþúHeLIgl¥k;esμ Isac; - mankarEbkRKab;QamRkhm - fñalbNþúHeLIgxab; b¤ kk - maneLIgCaRsTab;mYyesþIg - mankarbgábegáItCa Gas

- maneLIgRKab;l¥itenAelIépÞ b¤ enA)aténRsTab;RKab;Qam enAeBlNaEdleyIgemIleXIjfamanemeraKduHenAkñúgfñalbNþúHehIy cUrebIkKRmbdbfñalbNþúHedayRbug- Rby½tñnigkuM[qøgemeraKepSgcUl bUmykTwkfñalbNþúHedayeRbIEdkrgVg;KμanemeraK (Sterile Loop) b¤ BIEb:t )a:sÞ½r (Pasteur pipette) rYcdak;elIbnÞHkBa©k; edIm,IeFVIkarbMBak;BN’ Gram . kareFVIkarbNþúHbnþ²eTAeTot KWeFVIeLIgedayqUtenAelIfñalbNþúH nUvemeraKeBjmYy Loop ² eTAelIfñal ³

38

- cMeBaH)asuI Gram ³ eRbIR)as;fñalbNþúH MacConkey, Kligler iron, Motility-Indole

Urease ( MIU ), Simmons citrate - cMeBaHBBYk)asuI Gram- tUc² ³ eKeRbIR)as;fñalbNþúHrwgEdlmanQam ( Blood agar ) - cMeBaHBBYk Staphyloccci : eKeRbIfñalQam fñalGMbil Mannitol

- cMeBaHBBYk Streptococci ³ eKeRbIR)as;fñalbNþúHEdlmanQamedaymandak; Discs Edlman pÞúk Optochin Bacitracin nig Tellurite. eRbIR)as;fñalbNþúHEdlmanQamecomsRmab;eFVI etsþ CAMP nig eRbIR)as;fñalbNþúH Bile-Aesculin pgEdr.

sRmab;kargarBinitüCaFm μtanigRbcaMéf¶ vaKμankarcaM)ac;EdlRtUvTukfñalbNþúHQam[elIsBI 7 éf¶eLIy. kñúg krNIxøH fñalbNþúHRtUv)aneKBnüarTuk[elIsBI 7 éf¶ edIm,IbNþúHrkBBYk Brucella krNIsgS½yelIBYkemeraK EdlBi)akduHdéTeTot nig krNIGñkCm¶WmanCm¶W Endocarditis b¤ )anBüa)aleday Antimicrobials . karbNþúHbnþedaysμan² nigdMeNIrkarcugeRkay manGtisuxumR)aNmYycMnYnduHlUtlas;edaymin)anbegáItCakkr b¤ eFVI[eyIgemIleXIjeLIy . rIÉemeraKxøH eTot ]TahrN_dUcCa ³ BBYk Pneumococci eRcInEtxUcxatedayÉkÉg nig søab;Pøam²mYyrMeBc. edaysar EtehtuplenHehIy eTIbmnÞIrBiesaFn_mYycMnYnGnuvtþkareFVIkarbNþúHbnþmYyeTotelIfñalbNþúH Chocolate enAeRkayeBlTuk)an 18-24 em:ag . kareFVIkarbNþúHbnþedaysμan GacRtUv)aneKeFVIeLIgeRkayeBleKrkSa TukfñalbNþúH 7 éf¶ edayepÞrykl,aybNþúHEdlRcbl;cUlKñaya:gl¥ 2-3 tMNk; GMBIfñalbNþúHdMbUgeTAdak; kñúgbMBg;TIbEdlCafñalbNþúH Thioglycollate. bMBg;TIbenHRtUv)aneKrkSaTukkñúgkMedA 35-370

C nigBinitü [)an 3 éf¶ . kareFVIGg;TIb‘Íy:URkam ( Antibiogram ) enAeBlEdlrkeXIjmanvtþmanBBYk)asuI Gram-negative b¤BBYk Staphylococci duH ehIyeyIgGacsnSM eBlevlaedayGnuvtþeFVIetsþGg;TIb‘Íy:URkam minsþg;dar edaypÞal;mYy edayeRbIR)as;emeraKecjBIfñalbNþúH dMbUgEtmþg. ykGMe)assMLIEdls¥atK μanemeraKeTARClk;kñúgfñalbNþúHEdll¥k; rYcsgát;[GMe)assMLI[ s¶Ütbnþic edIm,Iykecj[Gs;nUvbrimaNEdlelIs . yksMLIeTA)a:telIfñalbNþúH Mueller-Hinton tam bec©keTs. sþg;darmYy. karBinitüemIllT§plbeNþaHGasnñRtUv)aneKeFVIeLIgenA 6-8 em:ag eRkayeBleKkMedAkñúg kMedA 370

C. 95° énkareFVIetsþrebobenHEtgTTYl)annUvlT§plEdlRtwmRtUvdUcKñanwgbec©keTssþg;darEdr

39

karcmøgemeraKBIeRkA karcmøgemeraKcUleTAkñúgfñalbNþúHQam GaceCosvag)antamry³eFVIkarsmøab;emeraK[)anl¥itl¥n;TaMgenA elIEs,k TaMgenAeBlbBa©ÚlQamkñúgdbfñalbNþúH nigTaMgeFVIkarbNþúHmþgeTotenAelIfñalbNþúHf μ I . EteTaHCa eyIgeFVIkarRbugRby½tñy:agNak¾eday k¾eKeXIjmanmankarbNþúHEdlqøg edaymankarcmøgemeraKBIeRkA EdlmanRbPBBIEs,k (S. epidermidis, P. acnes, Clostridium, Diphtheroids) b¤BImCÄdæanxageRkA (Acinetobacter spp. Bacillus spp.) dUcenHehIy)anCaemeraKmYycMnYnCYnkalvamanlkçN³dUcCaemeraK EdlbgáCm¶W nigGacbgá[ekItCaCm¶W endocarditis CaedIm. karbgáeraKBitR)akdEsþg eLIgdUcxageRkamenH ³

- ebIsinCaemeraKdUcKñaduHenAkñúgdbfñalbNþúHBIrepSgKñaedayeRbIvtßúviPaKCaQamEtmYy . - ebIsinCaemeraKdUcKñaenAkñúgdbfñalbNþúH edaysarQamGñkCm¶WEtmñak;elIsBIBIrdg . - ebIsinCakarduHlUtlas;elOn ¬ enA 48 em:ag ¦ - ebIsinCaemeraKEdleKEjk)anmkBIfñalbNþúHepSgKña EtCaRbePTemeraKEtmYy nigmanlT§pl

Gg;TIb‘Íy:URkamdUcKña . RKb;lT§plénkarbNþúH KYrRtUv)aneKpþl;dl;RKUeBTü b¤ evC¢bNÐit edayrYmbBa©ÚlTaMglT§pl mankarcmøg emeraKBIeRkAeTAkñúgfñalbNþúHpg . EteTaHCay:agNak¾eday cMeBaHlT§plEdlminRKb;RCugeRCayedaykgVH lT§plénkareFVIetsþGg;TIb‘Íy:URkamKYrEtRtUv)anbBa¢ak;enAelIRkdaslT§pl]TahrN_ Propionibacterium

acnes ¬emeraK»kasniymmanenAEs,k¦ Staphylococcus epidermidis ¬Probable contaminant¦. vaCaKuNsm,tþimYyEdlRtUv[manTMnak;TMngl¥rvagRKUeBTü b¤evC¢bNÐit CamYynwgbuKÁlikenAkñúgmnÞIrBiesaFn_ edIm,Ipþl;Bt’manCUnKñaeTAvijeTAmk . karviPaKrkeXIjemeraKBIr b¤eRcInRbePT RtUv)aneKcat;TukfaCa Bacteraemia edayemeraKeRcInRbePT Edl GacekIteLIgcMeBaHGñkCm¶WEdlmanRbB½n§karBarcuHexSay. EtkrNIenHk¾GacekItmanpgEdr kñúgkrNIEdlman karcmøgemeraKBIeRkAcUleTAkñúgfñalbNþúH. cMeBaH Bacteraemia EdlbegáIteLIgedaysarEtBYk)ak;etrIEdl minRtUvkarxül;GaclayLMKñaCamYynwgemraKEdlRtUvkarxül; (Aerobes) mYy b¤eRcInepSgeTot kñúgkrNI Bacteraemia F¶n;F¶rbUkpSMCamYynwgkarb:HTgÁicF¶n;F¶r b¤ k¾karvH kat;Rtg;eBaHevonFM .

40

TwkxYrq¥wgxñg (Cerebrospinal fluid (CSF))

esckþIepþIm karBinitüTwkxYrq¥wgxñg (CSF) KWCadMNak;kalsMxan;mYykñúgkarrkeraKvinicä½yrbs;Cm¶WrlakeRsamxYr edaysar )ak;etrI b¤BBYkpSit. vtßúviPaKenHRtUv)aneKcat;TukfaCavtßúviPaKEdlsMxan;bMput nigTamTar[mankarBinitü edayRbugRby½tñbMputBIGñkbec©keTsmnÞIrBiesaFn_ . TwkxYrq¥wgxñgFm μtaCaTwkEdlKμanemeraKføa CaTUeTAmanvtþmaneKalika sEt 3eKalikaskñúg 1 mm3 b¤ticCag enH ehIyKμaneKalikaRkhmeT . eKalika b¤ekasika nigsarFatuKImIpSMkñúgTwkxYrq¥wgxñgERb®bYleTAtamkRmit énkarbgáCm¶W . ]TahrN_dUcCaeTAtamCm¶WrlakeRsamxYr (Meningeal) b¤rlakxYrk,al (Encephalitis). eTaHbIkarrab;cMnYneKalikasenAkñúgTwkxYrq¥wgxñgenHmansar³sMxan;y:agNak¾eday EtmankarBinitürkemeraK enAkñúgxYrq¥wgxñgb:ueNÑaH RtUv)aneKelIkykmkBiPakSakñúgCMBUkenH . Pñak;garEdlbgá[manCaCm¶WrlakeRsamxYr (Meningitis) RtUv)anerobrab;enAkñúgtaragTI6 edayeyageTA tamGayurbs;GñkCm¶W. b:uEnþKYrEtcgcaMfa eKGaceXIjmankrNICan;;KñaekItmaneLIg . karbUmykvtßúviPaK nig karbBa¢Ún TwkxYrq¥wgxñgRbEhl 5-10 mIlIlIRt KYrRtUv)aneKbUmykedayevC¢bNÐit b¤RKUeBTü nigdak;bBa©ÚleTAkñúgbMBg; Ekvs¥at KμanemeraKcMnYnBIr. RtUvRbugRby½tñbMputkuM[mankarcmøgemeraKBIxageRkAeTAkñúgTwkxYrq¥wgxñg b¤begáIt [manCaCm¶WrlakeRsamxYr. TwkxYrq¥wgxñgmYyEpñknwgRtUv)aneKykeTAeRbIR)as;kñúgkarrab;rkcMnYneKalika nig ekasikamYyEpñkeTot RtUv)aneKykeTABinitüemIlsarFatupSMKImIdéTeTot nigEpñkEdlenAesssl;RtUv)aneK ykeTAeRbIR)as;kñúgkarBinitürkemeraK. vtßúviPaKKYrEtRtUv)aneKbBa¢ÚneTAkan;mnÞIrBiesaFn_Pøam² rIÉGñkbec©k- eTsBiesaFn_RtUvcab;epþImBinitüPøam²Edr eRBaHekasika nigeKalikaEdlmanenAkñúgvtßúviPaKenHGacxUcxateTA vijy:agelOn. ral;karyWty:avTaMgLayGacbNþal[lT§plénkarrab;cMnYnekasika minqøúHbBa©aMgsßanPaB KøInikrbs;GñkCm¶WeT .

41

taragTI6> mUlehtuCaTUeTAénCm¶WrlakeRsamxYredayBYkBBYk)ak;etrI b¤BBYkpSit

cMeBaHTark ¬cab;BIeTIbnwgekItrhUtdl;Gayu 2 Ex ¦ Escherichia coli

Listeria monocytogenes BBYk Enterobacteriaceae epSgeTot dUcCa Salmonella ssp., Citrobacter spp. Streptococcus agalactiae ( group B ) cMeBaHRkumGayuepSg²eTot Haemophilus influenzae ¬ RbePTEdlman capsular RbePT b ¦1

( a )

Neisseria menningitidis

Streptococcus pneumoniae

Mycobacterium tuberculosis Listeria monocytogenes

2 ( b )

Cryptococcus neoformans3 ( b )

Staphylococci3 ( c )

karBinitüedayEPñkTeT sPaBxageRkArbs;TwkxYrq¥wgxñg (CSF) KYrEtRtUv)aneKkt;RtaTukdUcCa mansPaBføa l¥k; kkr xÞúH b¤ elOg ¬edaysarEtkarEbkRKab;QamRkhm b¤ekItelOg¦ b¤ edaysarmanQamlayLMKñaCamYynwgsrés Fibrin

b¤ Pellicle.

karBinitüedayeRbImIRkUTsSn_ karerobcMvtßúviPaK enAkñúgkrNIEdlTwkxYrq¥wgxñgmansPaBF¶n;F¶r eBalKWmanxÞúH vaRtUv)anBinitüPøam² edaymincaM)ac;eFVIkarbgVil eLIy. b:uEnþkñúgkrNITaMgLayepSgeTot TwkxYrq¥wgxñgKYrRtUv)anbgVilenAkñúgbMBg;Ekvs¥atK μanemeraKCamunsin munnwgeFVIkarviPaK ¬ eKcUlcitþeRbIbMBg;EkvEdlman)atragCasaCIcMNuH 15 mIlIlIRt EdlmanKRmbbiTCit ¦ edayeRbIel,Ón 10000Rkam kñúgry³eBl 5-10 naTI . ykTwkxYrq¥wgxñgEpñkelIecj edayeRbIbMBg;bWt Pasteur EdlP¢ab;CaeRcIneTAnwgC½rbWt rYcepÞrvaeTAdak;kñúgbMBg;EkvepSgeTot TukeRbIR)as;sRmab;eFVIetsþrk sarFatuKImI nigesr:Umsa®sþepSgeTot ( Chemical and b¤ Serological tests ) . eRbIR)as;kMNkrgEdl nUv)atbMBg;EkvEdlenAsl;sRmab;eFVIetsþrkemeraKepSg²eTot . 1 ( a ) minsUvCYbjwkjab;eRkayBIGayuBI 5 qñaM 2 ( b ) eRcInCYbRbTHcMeBaHGñkCm¶WEdlmanPaBsuaMfycuH ¬ rab;bBa©ÚlTaMgGñkCm¶WeGdsn_ 3( c ) eRcInekItlayLMCamYynwgGñkvHkat;RbB½n§srésRbsaT

42

karBinitüpÞal;edaymIRkUTsSn¾ bWtykkMNkBI)atbMBg;EkvmYytMNk;dak;enAcenøaHbnÞHEkv nig bnÞHEkvesþIg rYcykeTAeFVIkarBinitüeday mIRkUTsSn_ ( x 400 ) sRmab;rk ³

- Leukocytes ( Polymorphonuclear neutrophils b¤ Lymphocytes ) - RKab;QamRkhm - )ak;etrI - BBYkpSit

ebIsinCakarBinitüeXIjmankarsgS½yelIvtþmanrbs;BBYkpSitdUcCa Cryptococcus neoformans cUrdak; laymYytMNk;énTwkkMNkTwkxYrq¥wgxñgeTAnwgmYytMNk;énTwkex μA\NÐa (India ink) enAelIbnÞHkBa©k;rYc RKb bnÞHkBa©k;esþIgBIelI ehIyykeTABinitüemIlnigmIRkUTsSn_ edIm,IrkemIllkçN³Biessrbs;pSitenaH. lkçN³ Biessrbs; Cryptococcus neoformans KWvamaneRsamragmUlb¤GacmanCaExñgtamlkçN³rbs;BYkpSit ehIybgðaj[eXIjCalkçN³rgVg; nig BnøWdUcRBHc½nÞeBjbUrmI . enAkñúgtMbn;Edlmankarratt,atedaysarCm¶W African trypanosomiasis EdlbgáeLIgedayBBYk Trypa-

nosoma RtUvBinitüedayRbugRby½tñkñúgkarEsVgrkkareFVIclna nigBBYk Trypanosomes EdlmanRbemay. mankrNICm¶WrlakeRsamxYredaykRmmYyeTot ehIyCaTUeTAnaMeGaysøab; KWbgáeLIgedayBBYkGamIb Edlrs; enAedayesrIenAkñúgTwkeRbIR)as; (Naegleria fowleri) ehIyEdlcUlkñúgxøÜnmnusStamry³rn§RcmuHrYceRCot cUleTAkñúgRbB½n§srésRbsaT. eKGacrkeXIjenAkñúgkarBinitüedaysPaBRss;kñúglkçN³CaTRmg;manclna rbs;GamIbEdlmanTMhMRbhak;RbEhlnwgTMhMRKab;QamsRbePT Neutrophilic leukocytes . BinitüPñasEdlbMBak;BN’ Gram )ak;etrIEdlbgá[manCm¶WrlakeRsamxYrGacRtUv)aneKBinitüeXIjenAeBleFVIkarbMBak;BN’ Gram eTAelIPñas enAelILam karBinitüenHKWsMxan;xøaMgNas;. sm¶ÜtPñasedayxül; rYcP¢ab;edayeRbIkMedAfñm² nigcugeRkay eFVIkarbMBak;BN’edaybec©keTsbMBak;BN’ Gram. BinitüedaymIRkUTsSn_BRgIk X1000dg ¬eRbIeRbgBRgIk CMnYy¦ [)any:agtic 10naTI b¤rhUtTal;EtrkeXIj)ak;etrI. taragTI7 rayGMBIKMehIyeraKvinicä½ysMxan;² EdlTak;TgCamYynwgTRmg;epSg²énCm¶WrlakeRsamxYr .

43

taragTI7 KMehIyBITwkxYrq¥wgEdlTak;TgCamYyCm¶WrlakeRsamxYr

karBinitü RbePTénCm¶WrlakeRsamxYr

)ak;etrIepSg² rebg pSit vIrus

karvaytémøelIkar BBYkmanéNVy:U BBYkmanéNVy:UmYy BYkmanéNVy:UmYy BYkmanéNVy:UmYy

rab;eKalika s eRcInkMNat; ( young neutrophils

polymorphonuclear enAek μgx©I )

neutrophilis ( PN )

KøúykUs kRmitTabxøaMg kRmitTab kRmitTab Fmμta

0>28 - 11>1 mIlIm:Ul¼lIRt 1>1-2>2 mIlIm:Ul¼lIRt 1>1-2>2 mIlIm:Ul¼lIRt 3>6-3>9 mIlIm:Ul¼lIRt

RbUetGuIn eLIgx<s; eLIgx<s; eLIgx<s; eLIgx<s;bnþickñúgdMNak;

kalbgáeraKdMbUg

karbMBak;BN’ Canic©kalrkeXIj)ak;etrI rkeXIjedaykRm Canic©kalrkeXIj GviC©man

( Gram ) ( acid-fast ) ( India ink )

taragTI8 kareRCIserIsfñalsRmab;bNþúHTwkxYrq¥wgxñg GaRs½yelIlT§plénkarbMBak;BN’ Grama

karBinitü )asuI Gram-negative kuksuI Gram-positive kuksuI )asuI mineXIjman

cMeBaHTark

cMeBaHepSgeTot cMeBaHTark cMeBaHGayuepSg²eTo

t Gram-

negative Gram-positive vtþmanemeraK

fñalbNþúHmanQamRss;b + + + + edayeRbI optochin + + + disc fñalbNþúHmanQamRss; + + + manqñÚt S. aureusb fñalbNþúHQamq¥in ( Chocolate agar ) (+) (+) (+) fñalbNþúH MacConkey + + + + + + + fñalbNþúHrav Tryptic soy + + + + + + +

a+ = eRbI nig ( + ) = eRbIk¾)anmineRbIk¾)an

b bNþúHenAkñúgmCÄdæanEdlsm,ÚreTAeday CO2 ¬ eCIgEdlmanduteTonenAxagkñúg ¦

44

karbMBak;BN’ (Ziehl-Neelsen) eTaHbICaRbsiT§PaBénkarviPaKrkemeraKrebgEdlbgá[manCm¶WrlakeRsamxYr edaysaremeraKenHmantictYc k¾eday k¾karBinitüedaykarbMBak;BN’ Ziehl-Neelsen elIkMNkTwkxYrq¥wgxñg b¤ TwkxYrq¥wgxñgEdlmanlay srés Fibrin RtUv)aneKBinitü ebIsinCamankarsgS½yfamanCm¶WenHBIsMNak;RKUeBTü b¤ evC¢bNÐit . cUrBinitü bnÞHkBa©k;EdlmanbMBak;BN’ Ziehl-Neelsen [)an 15 naTI y:agtic. ebIsinCalT§plBinitüedaymIRkU-TsSn_ GviC¢manRtUveFVIkarBinitümþgeTotenAéf¶bnÞab; . karbNþúH ebIsinCa)ak;etrIRtUv)aneKrkeXIjenAkñúgbnÞHkBa©k;EdlbMBak;BN’ Gram cUreRCIsykfñalbNþúHEdlsmRsb bMputedIm,IeFVIkarbNþúH ¬emIltaragTI8¦. b:uEnþebIeKBuMmaneXIjemeraKNamYyenAbnÞHkBa©k;EdlbMBak;BN’ Gram b¤k¾lT§plminc,as;las;eT RtUveFVIkarbNþúHTwkxYrq¥wgxñgenHenAelIfñalbNþúHsþg;daredayrYmbBa©ÚlTaMg fñalbNþúHEdlmanQam edayeFVICasñamqñÚtedayeRbI Staphylococcus aureus edIm,I[mankarduHlUtlas; H. Influenzae )angay®sYl. fñalbNþúHEdlmanQamRss;nigfñalbNþúHEdlmanQamq¥in ( Chocolate

agar ) KYrEtRtUv)aneKbNþúHkñúgkMedA 350C kñúgmCÄdæanEdlsm,ÚreTAeday]sμ ½nkabUnik. RKb;fñalbNþúH

TaMgGs;KYrRtUv)antamdanCaRbcaMkñúgry³eBl 3éf¶ . enAeBlEdlmankarsgS½yfamanCm¶WrlakeRsamxYredaysarEtemeraKrebg eKRtUveFVIkarbNþúHrkemeraKrebg edayeRbIfñalbNþúH Löwenstein Jensen [)an 3 TIb y:agtic. dak;kñúgfñalbNþúHnImYy² mYytMNk;én kMNkkkrrbs;TwkxYrq¥wgxñgEdl)anbgVilrYcehIybNþúH[)an6s)aþh¾. enAkñúgry³eBl 2-3éf¶dMbUgbMBg;TIb KYrRtUv)aneKbNþúHkñúgsßanPaBepþk ehIyedaybn§ÚrKRmbTIbknøHCuM . bMBg;TIbKYrRtUv)aneKBinitütamdankarduH lUtlas;énemeraKrebgerogral;s)aþh_. PñasEdlsgS½yfamanemeraKduH eKRtUverobcMvaenAkñúgbnÞb;suvtßiPaB )ak;etrIsa®sþmYy ehIysMgYtvaedayxül; P¢ab;vaedaykMedA nigbMBak;BN’edayviFI Ziehl-Neelsen. vtþman rbs;)asuIEdlcab;ykBN’ Ziehl Gac[eyIgeFVIeraKvinicä½yfaCaCm¶WrlakeRsamxYredayemeraKrebg. ral; emeraKEdlbNþúHeXIj KYrRtUvbBa¢ÚnvabnþeTAmnÞIrBiesaFn_mCÄwmmYy edIm,IeFVIkarepÞógpÞat;lT§pl nigeFVIetsþ Gg;TIb‘Íy:URkam (Susceptibility testing) . ebIsinCasgS½yfamanvtþmanrbs; Cryptococcus neoformans tamry³karBinitüedayTwkexμA\NÐa b¤k¾ BwgEp¥kelImUlehtusBaØaKøInikNamYy kMNkkkrrbs;TwkxYrq¥wgxñgKYrRtUveKbNþúHkñúgfñalbNþúH Sabouraud

dextrose cMnYn 2 bMBg; dak;bNþúHenAkñúgkMedA 350C rhUtdl;ry³eBlmYyEx . Cryptococcus neofor-

mans duHpgEdrenAelIfñalbNþúHEdlmanQamRss;. dUcenHfñalbNþúHenHKYrEtRtUv)aneKbNþúHenAkMedA 350

C cMnYnmYys)aþh_ ebIsinCacaM)ac;.

45

karviPaKCabzm ebIsinCaeXIjmankarduHenAelIfñalbNþúH MacConkey enaH eKRtUvsgS½yfaCaBBYk)ak;etrIkñúgeBaHevon (Enterobacriaceae) ehIyKYrEtRtUv)aneKviPaKbnþeTot edayeRbIbec©keTsnigfñalbNþúHepSg²eTot EdleKeRbIsRmab;viPaKrk)ak;etrIEdlbgáCm¶WkñúgeBaHevon . kñúgkrNIreXIjmankBa©úMBYkkuksIu Gram-positive duH edaymantMbn; β-haemolysis tUcenACMuvijnaH eKsgS½yfaCaBYk S. agalactiae (Group B streptococci). ebIeXIjdUecñHeyIgRtUveFVIetsþ CAMP edIm,I epÞógpÞat;. ebIeXIjmankBa©úMemeraKEdlduHragptcUlkñúgRtg;épÞkNþal nigmanBN’ébtgeRBOg²én α-haemolysis enaH eKGacsnñidæanfa RbEhlCaBBYk S.pneumoniae. edIm,IepÞógpÞat;emIlfaetICa S.pneumoniae b¤Gt;eKRtUv eFVIetsþedayeRbI Optochin disc viC¢man 6 mm dak;enAelIfñalbNþúHEdlmanQamRss; EdlbBa©ÚlBBYk )ak;etrIEdlsuT§nigsgS½yenaH. bnÞab;GMBIdak;bNþúHry³eBlmYyyb;mk BBYk Pneumococci nigbegáItCa tMbn;EckxNÐ½mYy (Inhibition zone) EdlmanviC¢maRt 14 mm b¤ k¾FMCagenHenACuMvij Optochin disc. lT§plviPaKEdleKTTYl)anl¥CageKbMputKWkareFVIetsþedayeRbIR)as;fñalbNþúHEdlmanQam nigbNþúHenA kñúgmCÄdæanEdlsm,ÚreTAeday]sμ ½nkabUnik. ebIsinCalT§plénkareFVIetsþ enAelIfñalbNþúHEdlmanQam enHBuMGaceFVIkarsnñidæan)an eKKYrEteFVImþgeTotenAfñalbNþúHfμ I . BBYk H. influenzae duHlUtlas;EtenAelIfñalbNþúHEdlmanQamq¥in (Chocolate agar) Etb:ueNÑaHehIy vaduHkñúglkçN³CabNþúMemeraK (Colonies) EdlmanragsMEb:tdUcpáayrNbenACit²ExSrbs;BYk Staphylo-

cocci enA elIfñalbNþúHEdlmanQam. eKGaceFVIetsþbnþBIenHeTotedayeRbI H. influenzae type b anti-

serum enAelILam Agglutination test. cMeBaHBYk Diplococci Gram-negative EdlduHenAelIfñalbNþúHEdlmanQamRss; nigQamq¥in ehIypþl; [nUvetsþ Oxydase viC¢many:agelOnbMputenaH GacRtUv)aneKsnñidæanfaCaBBYk Meningococci ehIyetsþ edIm,IepÞógpÞat;bnþeTotenaH KWeKeFVIenAelILam Agglutination test edayeRbIR)as; Antiserum RbePT (A,

B, C) rbs; N. meninggitidis. Agglutination test GviC¢man eKminRtUvTat;ecalnUvkarsnñidæanfaCaBBYk Meningococci eT eRBaHvamany:agticbYnRkumtUc²bEnßmeTot. ebIsinCa Agglutination testGviC¢man eKKYreFVIetsþmYyeTotedayeRbI Carbohydarte nig bBa¢ÚnfñalbNþúH b¤emeraKeTAkan;mnÞIrBiesaFn_bEg¥kfñak; mCÄwm. lT§plviPaKdMbUg² nigtamdMNak;kalnImYy² KYrEtRtUv)aneKpþl;CUnevC¢bNÐit b¤RKUeBTü ¬dUcCa Gram-negative duHlUtlas; niglT§pl Agglutination test CaedIm¦. RtUveFVIkMNt;cMNaMbnþeTotfa lT§plcugeRkaynwgpþl;CUnCabnþbnÞab;eTot.

46

kBa©úMénemeraK)asuI Gram-negative EdlduHelIfñalbNþúHQam CatMbn;tUcmYyén β-haemolysis RtUveK snñidæanfa GacCa Listeria monocytogenes. etsþEdlRtUveFVIbnÞab;mkeTot edIm,IbBa¢ak;[kan;Etc,as;enaH KWPaBviC¢manenAelIetsþRbtikmμ Catalase PaB rs;rbs;emeraKenAkñúgfñalbNþúHrav b¤ MIU nigduH ehIyehIrBN’exμAGs;enAelIfñalbNþúH Bile-aesculin . etsþedIm,Ivas;GMBIPaBsuaMnwgfñaM (Susceptibility testing) cMeBaHBBYk)asuI Gram-negative nigBYk Staphylococci kareFVIetsþQameRbIbec©keTsDIs (Disc) sþg;dar KYrEt)aneKykmkeRbIR)as; . eKmincaM)ac;eFVIetsþPaBsuaMnigfñaM ( Antibiogram ) cMeBaH Listeria monocytogenes, S. agalactiae b¤ N. meningitidis eT eRBaHeKdwgfa PaBsuaMénemeraKenHCamYynwgfñaMBBYk Ampicillin nig Benzylpenici-

llinKWmanedaykRmCaTIbMput . RKb;BBYk Pnemococci TaMgGs;KYrEt)aneKeFVIetsþPaBsuaMnwgfñaMenAelIfñalbNþúHEdlmanQam edIm,IrkPaB suMarbs;emeraKeTAnwgfñaMRbePT Chloramphenicol nig Benzylpenicillin. nigcugeRkayeTIbeKeFVIetsþCa mYyDIs Oxacillin (1µg) karrlakpøÚvdegðIm ¦. cMeBaHBBYk H. influenzae vijkareFVIetsþrkPaBsuaMnwgfñaM Chloramphenicol KYrEtRtUv)aneFVIeFVIeLIgenAelI fñalbNþúHEdlmanQamq¥in b¤fñalbNþúHEdlmanQamedaybEnßmsarFatuciBa©wmdéTeTot. cMeBaHBBYkEdl suMaCamYy Ampicillin esÞIrEtTaMgGs;begáItGg;suImRbePT β-lactamase EdleKGacbBa¢ak;)antamry³kar eFIVetsþelOn (Rapid tests) mYy EdleKENnaMsMrab;rkemIlBYkemeraK Gonococci Edlplit β-lacta-

mase .

47

Twkenam esckþIepþIm Twkenam KWCavtßúviPaKmYyEdlCajwkjyRtUv)aneKsuMeFVIkarbNþúH . vak¾Gacpþl;nUvbBaðacm,gCaeRcInEdl GaRs½yeTAelIsuRkwtüPaBkarykvtßúviPaK karbBa¢ÚnvtßúviPaKeTAkan;mnÞIrBiesaFn_ bec©keTsénkarbNþúH nig karbkRsaylT§pl . dUcCavtßúviPaKdéTeTotEdlRtUv)anbBa¢ÚneTAkan;mnÞIrBiesaFn_Edr Bt’manEdlpþl; edayRKUeBTü b¤ evC¢bNÐiteTAkan;mnÞIrBiesaFn_kan;EteRcIn kan;Etpþl;lT§PaBénkarRbmUlTinñn½yGMBIkarbNþúH kan;EtsuRkwtü . TItaMgEdlbgáeraKrlakelIRbB½n§bgðÚrTwkenam (UTI) jwkjab;CageKbMput KWeRcInekItenAelIe)aøkenam (Cystitis) nigbgðÜrenam (Urethra). epþImecjGMBITItaMgTaMgGs;enH karbgáCm¶WnwgGacbnþeLIgeTAkan;bMBg; bgðÚrTwkenam (Ureters) edaybegáIt[manCarlakbMBg;bgðÚrTwkenam (Ureteritis) ehIybnþeTAkan;tMrgenam EdlGacbNþal[rlaknigmanxÞúH (Pyelonephritis). cMeBaHkarrlakelIRbB½n§Twkenam eKsegáteXIjeRcIn ekItenAelI®sþICagburs ehIykarykvtßúviPaKeGay)anRtwmRtUvk¾manbBaðaeRcInNas;EdrsMrab;RsþI. TaMgburs nig ®sþI karrlaknUvRbB½n§TwkenamGacBuMbgðaj[manCaeraKsBaØa b¤RsYcRsav b¤rauMér:. cMeBaHkarrlak EdlminbgðajCaeraKsBaØaeRcIneKrkeXIjtamry³karbNþúHTwkenam. karrlak RbB½n§TwkenamRsYcRsav (Acute UTI) eKeRcInCYbRbTHelI®sþIEdlmanv½ycMNas; ehIyGñkCm¶WTaMgGs;enaHRtUv)aneK Büa)alenApÞH nigdak;eGayedkeBTüedaykRm. TaMgburs nig®sþIRKb;v½yEdlmankarrlakRbB½n§TwkenamrauMér: CaTUeTAeRcIn EtbUkpSMCamYyCm¶WepSgeTot ¬]> Pyelonephritis, Prostatic disease, b¤ Congenital anormaly of the

genitourinary tract) ehIyCaTUeTAGñkCm¶WTaMgenHRtUv)aneKGnuBaØat[ sRmakBüa)alenAkñúgmnÞIreBTü. Cm¶WrlakRbB½n§Twkenam UTI minbgðajCaeraKsBaØaRsYcRsav nigrauMér:CaCm¶W3RbePTxusKña ehIylT§plrbs; mnÞIrBiesaFn_CaerOy²tRmUv[mankarbkRsayepSg²Kña . Pyelonephritis EdlKμanbeBa©jCaeraKsBaØaenAelI®sþI CYnkalenAEtminGacrkmUlehtuBitR)akdeXIj b:uEnþ CaerOyeKGacrkeraKvinicä½y)antamry³kareFVIkarbNþúHTwkenamtambec©keTs Quantitative y:aghμt;ct; bMput . cMeBaHkarrlakRkeBjRbUsþatrauMér: eKeRcInCYbjwkjab;nigBi)akkñúgkarBüa)al nigCaerOy²eRcInEt bNþal[mankarekIteLIgvijénCm¶WrlakRbB½n§Twkenam (UTI). esÞIrEtRKb;krNIénCm¶WrlakRbB½n§Twkenam TaMgGs;PaKeRcInbNþalmkBI)ak;etrIkñúgeBaHevon CaBiess Escherichia coli RtUv)aneKrkeXIjeRcInCag )ak;etrIdéTeTot. RbEhl10°énGñkCm¶WrlakRbB½n§TwkenamGacbNþalmkBI)ak;etrIBIrRbePT ehIy)ak;etrI TaMgBIrRbePTenHGacbNþal[sPaBénCm¶Wkan;Etvivtþn_F¶n;F¶r. vtþmanrbs;)ak;etrIbIRbePT b¤eRcInCagenH enAkñúgkarbNþúHTwkenam vaCaPsþútagEsþg[eXIjBIkarykvtßúviPaKmin)anRtwmRtUv b¤min)anRbugRby½tñ.

48

eTaHCay:agNak¾eday Cajwkjab;eKEtgeXIjmanemeraKeeRcInRbePTenAkñúg UTI enAelIGñkCMgWEdleKeFVI sugTwkenam. karykvtßúviPaK eKminGacemIlrMlgbec©keTsénkarykvtßúviPaK kardwkCBa¢ÚnvtßúviPaKeTAkan;mnÞIrBiesaFn_ ehIynigkaryk citþTukdak;rbs;buKÁlikmnÞIrBiesaFn_ edIm,IbNþúHnigtamdankarbNþúHTwkenam)aneT. kic©karTaMgGs;enHKWCakar TTYlxusRtUvrbs;mnÞIrBiesaFn_kñúgkarpþl;dl;RKUeBTünUvbMBg;Ekv b¤ db)aøsÞik b¤ EkvmanCMBYyEdls¥atK μan emeraK nigmanmat;FM b¤k¾smÖar³epSgeTotEdlGacdak;vtßúviPaK)an. smÖar³sRmab;dak;vtßúviPaKTaMgGs;enH KYrEtCasmÖar³EdlmanKRmbbiTCit twgENnl¥ b¤RKbedayRkdasGaluymIj:ÚmesþIgedIm,ICaRbeyaCn_rkSa smÖar³TaMgGs;enaHsßitkñúgsPaBs¥at KμanemeraKeRkayeBleFIVkarsmøab;emeraKedayeRbIkMedAs¶Üt b¤GUtUkøav . vtßúviPaKEdlCaTwkenam eKGacykvatamkarvHkat; ]TahrN_ karbWtykenAxagelIf¶aseRkameBaH (Supra-

pubic) edaykareRbI Cystoscopy b¤ karbUmykTwkenamedayeRbI Catheterization CaedIm. RbsinebI bec©keTsxagelIBuMRtUv)aneKykmkeRbIeT mnÞIrBiesaFn_KYrEtykTwkenamTwkkNþalTIEdls¥atRtwmRtUv CaBiesscMeBaHkUnek μg nig®sþI . edayehtufaTwkenamxøÜnÉgGaceRbob)annwgfñalbNþúHmYyenaH dUcenHRKb; vtßúviPaKCaTwkenam KYrEtRtUv)aneKcab;epþImdMeNIrkarbNþúH nigBinitü 2em:ag eRkayeBlvtßúviPaKRtUv)aneKyk b¤k¾rkSaTukenAkñúgTUrTwkkkenAsItuNðPaB 40

C rhUtdl;vaRtUv)anbBa¢ÚneTAdl;mnÞIrBiesaFn_ nigRtUveKcat;Ecg min[elIsBI 18em:ag eRkayeBlvtßúviPaKRtUv)anyk . ebIGaceKKYrEtykTwkenamenAeBlRBwkeTAbNþúH. eKKYrEtR)ab;GñkCm¶W[Tb;Twkenam enAyb;EdlmunnwgeK RbmUlTwkenam. GñkCm¶WeRkAEdlCaRsþI KYrEt ³

1> lagéd[)ans¥atCamYynwgsab‘U nigTwk rYcCUtédCamYynwgkEnSgs¥at . 2> EjkbbUrTaMgBIr rYclagsMGateyanI nigbbUrTaMgenaHfñm²CamYynwgTwksab‘UekþA]NÐ²eday

eRbIR)as;rmUrsMLIs¥atK μanemeraK. CUttaMgBImuxrhUtdl;xageRkayéneyanI. RtUvcgcaMfa minRtUveRbIR)as;Twksmøab;emeraKedIm,IsMGateyanIeT .

3> lagsMGateyanInigbbUrf μm²CamYynwgTwkekþA]NÐ² rYcsm¶ÜtCamYynwgrmUrsMLI Edls¥at KμanemeraK. kñúgkMLúgeBlGnuvtþkargar GñkCm¶WKYrEtEjkbbUr[dac;ecjBIKña ehIyminRtUv ykRmamédeTAb:HRtg;tMbn;Edl)ansMGatrYcral;eT .

49

4> enamecalbnþic. GñkCm¶WKYrEtRtgykTwkenambnþmkeTotdak;kñúgkMb:ugTwkenamEdls¥atK μan

emeraKmYyrYcRKbKRmb[)anelOnbMput enAeRkayeBlTwkenamRtUv)aneKykrYcmk. enHKW CaTwkenamTwkkNþal.

5> RbKl;kMb:ugTwkenameTA[Kilanubdæak b¤Kilanubdæakyikar edIm,IbBa¢ÚnvaeTAkan;mnÞIrBiesaFn_ CabnÞan; .

GñkCm¶WeRkAEdlCabursKYrEt³

1> lagsMGatédnwgsab‘U nig Twk rYcCUtsm¶ÜtédCamYynwgkEnSgs¥at 2> cab;Bnøat;Es,kligÁeTAeRkayrYclagsMGatk,alligÁedayTwksab‘UekþA]NÐ² ehIyCUtsm¶Üt

CamYynwgrmUrsMLIEdls¥atKμanemeraK. minRtUveRbIR)as;Twksmøab;emeraKedIm,IlagsMGat ligÁeLIy .

3> lagCRmHk,alligÁCamYynwgTwkekþA]NÐ² fñm² ehIysm¶ÜtedayeRbIrmUrsMLIs¥atK μan emeraK kñúgkMLúgeBlGnuvtþkargarminRtUvykRmamédeTAb:HBal;tMbn;Edl)ansMGatenaHeT

4> TajEs,kligÁmkeRkay rYcenamecalbnþic. TajEs,kligÁ[Cab; ehIyGñkCm¶WbeBa©jTwk enamEdlenAsl;dak;kñúgkMb:ugpÞúkTwkenams¥atK μanemeraKmYy . mYlKRmbkMb:ug[)anCitl¥ eRkayeBlRbmUl)anTwkenamPøam² . enHKWCaTwkenamTwkkNþal.

5> RbKl;kMb:ugTwkenameTA[Kilanubdæak b¤KilanubdæakyikaredIm,IbBa¢ÚnvaeTAkan;mnÞIrBiesaFn_ CabnÞan;

cMeBaHGñkCm¶WEdledkCab;nwgERKminGaceRkak)an eRbIR)as;viFIxagelIedIm,IykvtßúviPaKEtKilanubdæak b¤ Kilanubdæakyika RtUvCYyGñkCm¶W b¤ebIcaM)ac;Kilanubdæak b¤Kilanubdæakyikar KYrEtCYysMGatmuneBlEdl GñkCm¶Wenamecjmk . cMeBaHkrNITaMgBIr eKRtUvyk[)anTwkenammYyEdlRtwmRtUvrkSaTukkñúgkMb:ugs¥atK μanemeraK nig[ c,as;fa TwkenamTaMgenaHRtUv)aneKbBa¢ÚneTAkan;mnÞIrBiesaFn_CamYynwgBt’manrbs;GñkCm¶WeraKvinicä½y nig sMeNIsuMBinitü cMeBaHTark nigkUnek μg CabBaðacm,gmYykñúgkarykTwkenamEdlRtwmRtUvrbs;Tark nigkUnek μgEdlsRmakenAnwgERK b¤ek μg Edlminshkar. [Twk b¤ePC¢³epSgeTot[ek μgpwk. lagsMGatRbdab;ePTrbs;ek μg nigTarkenaH. ekμgGac RtUv)aneKdak;[GgÁúyelIePøArbs;mþay Kilanubdæak b¤ Kilanubdæayikar b¤GñkemIlek μg ehIyEdlGacelIkTwk

50

citþ[ek μgenaHenam nigGacRtgykTwkenam[)aneRcInbMputtamEtGaceFVIeTA)andak;kñúgkMb:ugs¥atK μanemeraK. kMb:ugpÞúkTwkenamenHKYrEtRKbbiTCit nigbBa¢ÚneTAkan;mnÞIrBiesaFn_edIm,IeFVIkarBinitü nigbNþúHPøam² . karbNþúH nigkarbkRsaylT§pl RKb;TwkenamEdl)anepJIeTAkan;mnÞIrBiesaFn_Epñk)ak;etrIsa®sþ KYrEtRtUv)aneKBinitünigeFVIkarbNþúH Pøam² ebImindUecñHeTeKRtUvrkSaTukvaenAkñúgTUrTwkkkeRkamsItuNðPaB4GgSa rhUtdl;eBleKGacmaneBledIm,I Binitü. dMeNIrkarénkarBinitüRtUvRbRBwtþeTAtamdMNak;kaldUcxageRkam ³

1> eFVIkarBinitüPñasEdlbMBak;BN’ Gram

2> eFVIetsþErgedIm,Irk)ak;etrIsMxan;Cak;lak;enAkñúgTwkenam 3> karbNþúHnwgRbRBwtþeLIgeBlEdleKBinitüfa etsþBinitüemIl)ak;etrIxagelIviC¢man nigeFVI

eLIgRKb;TwkenamEdlTTYl)an edaykareFVI Cystoscopy, Suprapubic Bladder

Puncture (SBP) b¤ edayeRbI Catheters bgðÚrecjmk . 4> eFVIetsþrkPaBsuaMrbs;emeraKcMeBaHfñaM (Antibiogram) cMeBaHemeraKEdlrkeXIjRtUvnwg

KøInik. karerobcM nigBinitüPñasEdlbMBak;BN’ Gram KWCaEpñksMxan;mYyéndMeNIrkarenAkñúgmnÞIrBiesaFn_. eRbIR)as; bMBg;bWt)a:sÞ½r ¬Pipette mYysMrab;vtßúviPaKmYy¦ bWtykTwkenamEdl)anRkLúk[es μ Isac; nigminbgVilmYy dMNk;dak;elIbnÞHkBa©k;. Tuk[dMNk;TwkenamenHs¶ÜtedayÉkÉg rYcP¢ab;PñasenHedayeRbIkMedA nigbMBak;BN’ Gram enATIbBa©b;. eFVIkarBinitüedaymIRkUTsSn_edayeRbIeRbgBRgIkeRkamEkvBRgIk ¬ x 600dg b¤eRcInCag enH ¦ edIm,IrkemIlvtþmanrbs;)ak;etrI RKab;QamsRbePT Polymorphonuclear nig ekasikaEs,k. kñúgmYyrgVg;énEkvBRgIkrbs;mIRkUTsSn_ ( One oil-immersion field ) Canic©kaleKsnñidæanfaman 105 b¤ eRcInCagenH enAkñúgmYymIlIlIRtrbs;Twkenam. vtþmanrbs;RKab;QamsmYyb¤eRcInenAkñúgmYyrgVg;énEkv BRgIkrbs;mIRkUTsSn_bgðaj[kan;Etc,as;EfmeTotGMBIlT§PaBrlakRbB½n§Twkenam ( UTI ). TwkenamEdl bgðajGñkCm¶WBuMmanCm¶W UTI eTenaH vanwgbgðaj[ eXIjfa manEt)ak;etrInigRKab;QamBIrb¤bIb:ueNÑaH b¤k¾K μan esaHenAkñúgbnÞHkBa©k;TaMgmUl. cMeBaHvtßúviPaKrbs;GñkCm¶WCa®sþI vtþmanénekasikaEs,kedaylayLM b¤min layLMnig)ak;etrIbgðaj[kan;Etc,as;fa vtßúviPaKenHRtUv)aneKeFVI[ mankarqøgCamYy)ak;etrIEdlmanenA karBarRbB½n§eyanIrbs;®sþI ehIycaM)ac;RtUvEtykvtßúviPaKmþgeTot edayminKitGMBIcMnYnén)ak;etrIenAkñúgmYy rgVg;EkvBRgIkrbs;mIRkUTsSn_eT. ebIsinRKUeBTüRtUvkarlT§plBinitüTwkenamCabnÞan;enH lT§plénkareFVIkar BinitüvaytémøelIkarbMBak;BN’ Gram KYrEtRtUv)anepJIeTAkan;RKUeBTüCabnÞan;nigmanbBa¢ak;bEnßmenAnwg lT§plenaHfa lT§plénkarbNþúHnigCUnenAeBleRkayCabnþbnÞab; .

51

viFIBinitüErg Gvtþmanénekasikas nig )ak;etrI eRkayBIeFVIkarBinitübnÞHkBa©k;EdlbMBak;BN’ Gram elITwkenam Edlyk )antambec©keTsRtwmRtUvdUc)anerobrab;xagedIm vaCaGMeNHGMNagd¾suRkwtümYyGac[eKsnñidæanfa BuMman karrlakenARbB½n§TwkenamenH. mincaM)ac;bNþúHTwkenamEdlBinitüeXIjGviC¢manenAelILam EdlbMBak;BN’ Gram eLIy . etsþBinitüEdlsamBaØ nig manRbsiT§PaBmYyeTot KWCabnÞHetsþ Test strip EdleRbIsMrab; kat;bnßy Leukocytes Esterase/Nitrate. eKRClk;bnÞHetsþenHeTAkñúgsMNakTwkenam dUcEdlkarENnaM enAkñúgkBa©b;. kalNavamanBN’páaQUk KWCaRbtikmμviC¢man EdlR)ab;famanvtþman Leukocytes Esterase nig¼b¤)ak;etrIEdlmanelIsBI 105 enAkñúgmYymIlIlIRtTwkenam. sMNakTwkenamEdleKBinitüeXIjviC¢manenA etsþErgenH KYrEtRtUv)aneKeFVIkarbNþúHCabnÞan;edIm,IkarBakarduHlUtlas;én)ak;etrIEdlminbgáCm¶W. ebIsinNa etsþErgenHminbgðaj[eXIjCaBN’páaQUkNamYyeT eKGaceFVIkarsnñidæan nigbkRsaylT§plfa etsþErg GviC¢man ehIyraykarN¾GBa©wg nigmincaM)ac;eFVIkarbNþúHTwkenamenaHeT. bnÞHsnøwketsþenHGacnwgmin Sen-

sitive RKb;RKan;kñúgkarrkeXIj)ak;etrIkñúgTwkenam enAeBlEdl)ak;etrITaMgenaHmanbrimaNticCag 105 kñúg TwkenammYymIlIlIRt . karbNþúH Quantitative nigkarkMNt;GtþsBaØaNedaysnμt; manbec©keTsBIry:agkñúgesovePAenH EdleKpþl;Gnusasn¾eGayeRbI KWkarbNþúH Quantitative nig karkMNt; GtþsBaØaNedaysn μt³ bec©keTsEdleRbIR)as;rgVg; EdlmanRkwt ( Calibrated Loop Technique ) nig bec©keTsRClk;RkdaseRcaH ( Filter-paper dip strip method ) . bec©keTseRbIrgVg;manRkwt (Calibrated loop technique) dMeNIrkarénkarbNþúHtamviFIenH KWeKeRbIrgVg;eFVIGMBIC½r)aøsÞik b¤elah³edIm,IepÞrTwkenamcMnYn 1mIRkUlIRteTAdak; bNþúHenAelIfñalbNþúH ¬fñalbNþúH MacConkey EdllayCamYynwg Crystal BN’sVay nig fñalbNþúHman QamminCMerIs¦ .

1> RkLúkTwkenamfñm²[esμ Isac; ep¥ógkMb:ugTwkenambnþic. CamYynwgrgVg;C½r)aøsÞik b¤elah³ cMNuH 1mIRkUlIRtykrgVg;C½r b¤elah³enaHeTAb:HelIépÞkMb:ugenaH edIm,I[TwkenambWtcUleTA kñúgrgVg;edayÉkÉg . minRtUvRClk;rgVg;C½r b¤elah³enaHkñúgTwkenameT .

2> dak;Twkenam 1mIRkUlIRtenaH bNþúHenAelIfñalbNþúHEdlmanQamedayqUtCabnÞat;Rtg;mYy tRmg;eTAkan;cMNuckNþalp©itfñalbNþúH ¬1¦ rYcbnþeFVIqñÚtmYyeTot[qøgkat;qñÚtedImmþgeTA sþaMmþgeTAeqVg ( Original ) ¬2¦ cugeRkaybBa©b;edaysñamqñÚtfμ IeTot edayqøgkat;sñam qñÚtTaMgBIrxagelI ¬3¦ ¬ emIlkñúgrUbTI3 ¦ .

52

3> eFVIkarbnþbNþúH nig GnuvtþdUcKñaenAelIfñalbNþúH MacConkey . 4> rkSafñalbNþúHenaHeRkamkMedA 350

C cMnYnmYyyb; . fñalbNþúH MacConkey nig fñalbNþúHmanQamenH GacRtUv)aneKCMnYsedayfñalbNþúHminCeRmIsmYyepSg eTot ¬]Ta>fñalbNþúH CLED

1 / fñalbNþúH lactose BN’sVay¦. bec©keTsRClk;bnÞHRkdaseRcaH ( Filter-paper dip-strip method ) bec©keTsRClk;bnÞHRkdaseRcaHrbs; Leigh & Williams

2 KWBwgEp¥keTAelIkarbWt nig karepÞrCabnþbnÞab; nUvbrimaNTwkenamkMNt;mYyeTAkan;canfñalbNþúH. mnÞIrBiesaFn¾GaceFVIbnÞHRkdasedayxøÜnÉg edayeRbIR)as;Rkdaspþit b¤eRcaHBiessmYy Edlkat;[)an beNþay 7/5sg;TIEm:Rt nigTTwg0/6sg;TIEm:Rt ¬emIlrUbPaBTI4¦. RkitRkdasenHRtg;kEnøgEdlmanRbEvg 1/2sg;TI Em:Rt BIcugNamYyk¾)an edayeRbIexμAéd. bec©keTsbnÞHRkdas KYrEtRtUveRbobeFobCamYynwg bec©keTsrgVg;manRkwtümunnwgsMrbykbec©keTsenHmkeRbIkñúgkarRsavRCavRbcaMéf¶TUeTAFm μta. bnÞHRkdas RtUv)aneKplit kñúgbrimaNNamYy rYcdak;enAkñúgRbGb;smRsbNamYy nigsmøab;emeraKedayeRbIGUtUkøav. bnÞHRkdasEdleKrMgab;emeraKehIyeRsc k¾mandak;EdrenATIpSar. eRbIR)as;bnÞHRkdasmYysRmab;vtßúviPaK mYy ehIybnÞHRkdasenHRtUvykBIkñúgRbGb;Edl)anerobcMsmøab;emeraKrYcehIy. cugbnÞHRkdasEdl)anRkit rYcRtUv)aneKRClk;kñúgTwkenamEdl)anRkLúk[es μ Isac;l¥. bnÞab;mkbnÞHRkdasRtUv)aneKdkecjCabnÞan; ehIyTwkenamEdlelIsRtUv)aneKTuk[RsUbcUleTAkñúgRkdas .

rUbPaBTI3 ³ karbNþúH)ak;etrIenAelIfñalbNþúH

1 CLED : Cystine-Lactose-Electrolyte-Deficient 2 Leigh DA & Williams JD. bec©keTskñúgkarRsavRCavrk)ak;etrIsMxan;eRbIR)as;enAkñúgkarviPaKEdlmanbrimaNGñkCm¶WeRcIn . TsSnavdþI Journal of Clinical Pathology, 1964, 17: 498-503

53

rUbPaBTI4 ³ düaRkaménbnÞHRkdasRClk;

rUbPaBTI5 ³ bnÞHRkdasEdldak;enAelIfñalbNþúH bgðajGMBIkarepÞrcMnYnrbs;bNþúM emeraKeTACacMnYn)ak;etrIenAkñúgmYymIlIlIRtrbs;Twkenam

épÞEdlsßitenABIeRkamRkitEdlRtUveKbt;epþkCaeCIgrbs;BüBa¢n³ { L } ehIyeKKYrdak;va[b:HeTAnwgfñalbNþúH Brolacin agar

1 b¤ fñalbNþúHEdlmanpÞúk Lactose BN’sVaycMnYn 2-3naTI. bnÞHRkdasmYycMnYnGacRtUv eKbNþúHenAfñalbNþúHEtmYyedayRKan;EtEbgEckfñalbNþúHenaH. eKGaceFVIkarEbgEckfñalbNþúHmYyCa 16 ctuekaNEkg¬emIlrUbPaBTI5¦. viPaKelIctuekaNEkgTaMgenaHCamYynwgelxsmÁal; b¤eQμaHrbs;GñkCm¶W mñak;². ykbnÞHRkdasTIBIrecjGMBIRbGb; ehIyGnuvtþtamviFIsa®sþeGaydUcelIkTI1Edr nigbegáIt)anCasñam pþitdUcelIkTI1. enAeBlEdlfñalbNþúHRtUv)aneKbNþúHeBjeTAedaysñampþitdUc²KñaehIyenaH eKRtUvykva eTATukenAkñúgkMedA 35-370

C ehIykBa©úMemeraKEdl)anmkBIbnÞHnImYy² nwgRtUv)aneKrab; . edaymanCMnYy GMBIrUbPaBTI5eKGacbMElgcMnYnmFümrbs;kBa©úMemeraKEdlduHenAelIKUnImYy²rbs;bnÞHRkdaseTACacMnYn)ak;etrIenAkñúgTwkenam 1mIlIlIRt . 1 Bromothymol-blue lactose agar

> 25 >100 000

25 100 000

5-24 10 000-100 0000-4 < 10 000

emeraK Gram-negativecMnYnrbs; cMnYnrbs; bNþúMemeraK¼1mIlIlIRt )ak;etrI¼1mIlIlIRt

cMnYnrbs; cMnYnrbs; )ak;etrI¼1mIlIlIRt bNþúMemeraK¼1mIlIlIRt

> 100 000 > 30

100 000 30

10 000-100 000 10-29 < 10 000 0-9

emeraK Gram-positive

54

edayGnuvtþPøam²bnÞab;BIviFIsa®sþxagelI eKcak;TwkenamcUlBak;kNþalénfñalbNþúH MacConkey ¬CamYy Crystral BN’sVay¦ edayeFVIeRbIrgVg;RkwtüEdlrMgab;emeraK. karbNþúHbEnßmenAelIfñalbNþúHEdlmanQam Gac[eKeFVIkarviPaK)anelOncMeBaHBBYkkuksuI Gram-positive. fñalbNþúHKYrRtUv)aneKbNþúHkñúgsItuNðPaB 35-370

C cMnYnmYyyb; ehIyeFVIkarviPaKenAéf¶bnÞab;edIm,IrkemIlkarduHdal. viFIsa®sþénkarviPaKGacRtUv eKcab;epþImecjGMBIkBa©úMemeraKTaMgLayEdlEjkecjdac;l¥ BIbNþakBa©úMEdlemIleTARbhak;RbEhlKña. ebIsinNa CamantRmUvkarcaM)ac;kareFVIetsþedIm,IrkPaBsuaMrbs;emeraKnwgfñaM b¤etsþGg;TIb‘Íy:URkamtamry³ bec©keTseRbI Disc GacRtUv)aneKerobcMpgEdr edayykecjGMBIfñalbNþúHdMbUg. GnuvtþtamviFIenH enaHlT§plénkareFVIviPaK nigetsþGg;TIb‘Íy:URkamnwgRtUveKTTYl)anenAéf¶bnÞab;mkeTotdMNalKña karbkRsaylT§plkarbNþúH Quantitative rbs;Twkenam

Gs;ry³kalCaeRcInqñaMmkehIyEdleKKitfa manEtvtþmanbNþúM)ak;etrIelIsBI 105 CFU (Colony

Forming Units) enAkñúgTwkenamEdlyk)anRtwmRtUvb:ueNÑaH EdlRtUv)aneKKitfa Clinically Relevant

sMrab;eraKvinicä½yénkarrlakRbB½n§Twkenam. karsnñidæanEbbenHRtUv)aneKeFVIkartva:. GñkCMnajxøHKitfa³ eTaH bICabrimaN 104 CFU b¤ k¾ticCagenHk¾eday k¾GacbBa¢ak;famanbgáCm¶WEdr . GñkCMnajxøHeToteCOCak;fa vtþmanrbs;eKalikasRbePT Polymorphonuclear EdlCaGñkTTYlxusRtUvFMbMput kñúgeBlmankarbgáeraK enaHs[eXIjfamankarrlakRbB½n§Twkenam (UTI). karENnaMCaTUeTAkñúgkarbkRsaymandUcxageRkam ³

RbeTTI1 ³ ebIticCag 104 CFU kñúg 1 mIlIlIRtTwkenam . eKRtUvbkRsayfa ³ GacnwgKμanCm¶Wrlak RbB½n§Twkenam. krNIelIkElgKWebIsinNaCabNþúMemeraKticCag 104

CFU enAkñúg1mIlIlIRt Twkenam edayeRbIR)as;TwkenamEdlbUmecj b¤bWtedayeRbIR)as; Cystoscopy b¤)anmkBI ®sþIEdlmaneraKsBaØarlakRbB½n§Twkenamb¤eKeXIjmanvtþmanrbs;eKalikasenAkñúgTwkenam dUcenHRtUveFVIkarviPaKelI)ak;etrIEdl)anrkeXIj nig eFVIetsþPaBsuaMrbs;)ak;etrIeTAnwgfñaM (Susceptibility).

RbePTTI2 ³ ebIenAcenøH 104-105 CFU kñúg 1 mIlIlIRt. ebIsinCaGñkCm¶WBuMmaneraKsBaØaGVIKYr[kt;

smÁal;eT eFVIkaresñIsuMTwkenamCaelIkTI2 ¬f μ I ¦ nigrab;mþgeTot. ebIsinCaGñkCm¶WmaneraK sBaØaEdlbgðajfamanCm¶WrlakRbB½n§Twkenamvij bnþeFVIkarviPaK nigeFVIetsþGg;TIb‘Íy:URkam edayeRbIR)as;bNþúMemeraKmYy b¤BIrRbePTEdl)anrkeXIj. karrab;cMnYn)ak;etrIKYrEtRtUv )aneKeFVIkñúgkrNIGñkCm¶WrlakRbB½n§Twkenam nigmanbeBa©jeraKsBaØa b¤CYnkalmanvtþman eKalikasenAkñúgTwkenam . kñúgkrNImanPaBminc,as;las;elIkarrab; b¤brimaNTwkenam

55

minRKb;RKan; b¤mankarmnÞilsgS½yeTAelIeraKsBaØa KYrEtykTwkenamCaelIkTI2 edIm,IeFVI etsþmþgeTot. cUrraykarN¾cMnYnrbs; CFU .

RbePTTI3 ³ kñúgkrNIeRcInCag 105 CFU kñúg 1 mIlIlIRtTwkenam. pþl;Bt’manGMBIlT§plénkarrab;

eTAkan;RKUeBTünigbnþeFVIkarviPaKnigeFVIetsþGg;TIb‘Íy:URkameTAelI)ak;etrImYy b¤BIrRbePT epSgKñaEdleKrkeXIj. cMnYn)ak;etrIenHpþl;nUvKMnitya:gxøaMgfaCaCm¶WrlakRbB½n§Twkenam enARKb;GñkCMgWTaMgGs; edayrab;bBa©ÚlTaMgGñkCm¶WEdlCa®sþI nig BuMmaneraKsBaØa .

ebIsinCamanvtþman)ak;etrIeRcInCagBIrRbePTenAkñúgTwkenam ehIysßitenAkñúgRbePTTI2 b¤TI3 cUreFVIkarbk Rsayfa {RbEhlCamankarcmøgemeraKBIxageRkA. dUecñHsUmemtþaepJITwkenamEdlenamPøam² nigeRbIR)as; bec©keTskñúgkaryk[)anRtwmRtUv : . karviPaK (Identification) karviPaKKYrEtRtUv)aneKeFVI[)anelOnbMputtamEtGaceFVIeTA)an. edaysarEtesÞIrEtRKb;krNIénkarrlak RbB½n§Twkenam KWbgáeLIgeday E.coli dUcenHkareFVIetsþel,ÓnKYrEtRtUv)aneKeRbIR)as;edIm,IbBa¢ak;[c,as;GMBI kBa©úMeraKBN’RkhmEdleKykecjBIfñalbNþúH MacConkey . etsþ β-Glucuronidase sMrab;karviPaKrk E.coli

1 etsþenHbBa¢ak;nUvsmtßPaBénemeraKmYykñúgkarbegáItGg;suIm β-glucuronidase. Gg;suImenHCaGñkbMpøaj 4- nitrophenyl-β-D Glucopyranosidurinic acid ( PGUA ) [køayeTACa Glucuronic Acid nig p-

nitro- phenol . karelcecjnUvBN’elOgbBa¢ak;[dwgfaetsþenaHviC¢man . viFIsaRsþ (Procedure)

1> erobcMl,ayEdlRtUvviPaK[xab;dUcTwkedaHeKaenAkñúgbMBg;EkvEdlmanpÞúkesr:UméRb 0/25 mIlIlIRt . l,ayenH KYrEtRtUv)aneKerobcMedayykkBa©úMemeraKEdl duHenAelIfñalbNþúH MacConkey .

1 Kilian M. Borrow P. Rapid diagnosis of Enterobacteriaceae. 1. Detection of bacterial glycosidases. Acta Pathologica et Microbiologica Scandinavica, Section B, 1976, 84:245-251.

56

2> rMlay 300 mIlIRkam én 4-Nitrophenyl-β-D Glucopyranosidurinic

Acid ( PGUA ) nig 100 mIlIRkaménpSitEdlcRmaj;ehIy (Oxoid L21)1

eTAkñúg 20 mIlIlIRt énsarFatu Phosphate buffer (Tris buffer, pH 8.5). EktRmUv pH [)an 8,5 ± 0,1. 0/25 mIlIlIRt l,ayenAkñúgbMBg;TIbs¥atK μan emeraKtamTIbEdlbg;elxcMNaMrYcCaeRsc. biTqñúkbMBg;TIbrYc biTpøakéf¶ExelI bMBg;TIbEdlpÞúkl,ay PGUA enH .

3> cak;bBa©Úll,ayxab;énemeraKEdlRtUveFVIetsþ eTAkñúgTIbmYyrbs;fñal PGUA. TukbMBg;TIbenHenAeRkamkMedA 25 GgSaes ry³eBl 4 em:ag. BN’elOgEdl EsþgeLIg bBa¢ak;GMBIvtþmanrbs; β-Glucuronidase ¬lT§plviC¢man¦. ebIsin CaBuMmaneLIgBN’GVIeT enaHbBa¢ak;falT§plGviC¢man. vtþmankMNkBN’elOg bBa¢ak;[eyIgeXIjfalT§plEdlTTYl)anminGaceCOCak;)an. kñúgkrNIenH eK RtUveFVIetsþ mYyepSgeTot .

GtisuxumR)aNRtYtBinitüKuNPaB³

- Escherichia coli lT§plviC¢manpþl;CaBN’elOg - Shigella flexneri lT§plGviC¢man manBN’føa

RKab; PGUA manlk;enAelITIpSar.

etsþrkPaBsuaMrbs;)ak;etrIeTAnwgfñaM (Susceptility Tests) etsþGg;TIb‘Íy:URkam KYrEtRtUv)aneKeFVIelIbNþúMemeraKEdleKbnSúT§rYcral;Etb:ueNÑaH . etsþenH CaTUeTArwtEt mansar³sMxan;EfmeToteTAelI)ak;etrIEdleKrkeXIjenAelIGñkCm¶WEdlsRmakenAkñúgmnÞIreBTü b¤k¾manRbvtþi mankarrlakRbB½n§TwkenamsarCaf μ I . )ak;etrIEdlykecjGMBIfñalbNþúHrbs;GñkCm¶WEdlmankarrlakRbB½n§ Twkenam (UTI) dMbUgGacmintRmUv[eFVIetsþenHeT .

1 Gacrk)anenA Oxoid Ltd, Wade Road, Basingstoke, Hampshire, RG24 8PW, England.

57

lamk esckþIepþIm karbgáeraKkñúgeBaHevoneday)ak;etrI bNþal[manCm¶WraKrUs raKmYl b¤ k¾cukeBaH KWCabBaðasuxPaBd¾sMxan; enATUTaMgBiPBelak. Cm¶WraKQrenAlMdab;fñak;TI2ebIeRbobeFobeTAnwgCm¶WebHdUgEdlCamUlehtueFVI[mnusS søab; b:uEnþvaKWCaCm¶WEdlnaMmuxeKkñúgkarsøab;rbs;kumar. enAkñúgRbeTsEdlkMBugGPivDÆn_ Cm¶WraKrYs)ansmøab; kumarEdlmanGayucenøaH 1-4 qñaM RbmaN 2/5 lannak;Caerogral;qñaM. RkumkumarEdlmanGayudUcxagelI kñúgRbeTsTn;exSay RbQmmuxnigkarsøab;edayCm¶WraKrUseRcInCag 600 dg ebIeRbobeFobeTAnwgRbeTs GPivDÆn_. enAkñúgRbeTskMBugGPivDÆn_mYycMnYn kumarmñak;²GacRbQmmuxnigkarraKrUs 10dg b¤eRcInCagenH enAkñúgmYYyqñaM . kUnek μgCajwkjybgáCm¶WedaysarEtPñak;garbgáeraKeRcInRbePT. CYnkaleTaHbICakUnek μgBuMmanekItCm¶WraKk¾ edayk¾eKeXIjkUnek μgenHpÞúkeTAedayemeraKEdlbgáCm¶WenAkñúglamkrbs;eKEdr. tamry³karsikSaGegát )anbgðaj[eXIjfa ek μgEdlRbQmmuxnwgemeraKTaMgenaHjwkjab; nige)AedaHyUr GacmanPaBsuaMskmμ nig GackarBarTb;Tl;nig\T§iBlénemeraKTaMgenaH)aneRcIn. eK)aneFVIkarkt;cMNaMpgEdrGMBIpllM)ak kñúgkar kMNt;rkmUlehtuénkarraKrUsedayRKan;EteFVIkarbNþúHlamkEtmþgKt;enaH. edaysarEtmankarekIneLIgénGRtaeRbva:Lg;rbs; HIV/AIDS nigGñkCm¶WEdlmanRbB½n§karBarTn;exSay edaysarkarBüa)aledayeRbIR)as;kaMrsμ IenaH Cm¶WraKrUsEdlekItenAelIGñkTaMgenaHkøayeTACakic©karEdl Bi)akedaHRsaymYy. GñkCm¶W HIV/AIDS EdlraKenAkñúgdMNak;eRkaymkeToténCm¶WeRcInEtBi)ak kñúgkar Büa)al nigyaryIdl;CIvit . Cm¶WEdlbNþalmkBI)ak;etrIkñúgeBaHevon (Enteric Bacterial) eTAelIGñkman HIV/AIDS eRcInEteRbIry³eBlyUredayrab;bBa©ÚlBBYk Campylobacter Salmonella Shigella nig Mycobacteria. Cm¶WRKuneBaHevonenAelIGñkCm¶W HIV/ADIS EdlbgáeLIgedayBYk Salmonella eRcIn bNþal[man Bacteraemic CaTUeTARbEhl 20dg nigjwkjab;RbEhl 5dgelIsGñkEdlKμanCm¶WenH . enAkñúgGtItRbeTs Zaire 84°énGñkCm¶WEdlmanCm¶WraKrUselIsBIrmYyExRtUv)aneKrkeXIjfa manesr:Um viC¢manén HIV (Seropositive for HIV) nig 40° énGñkCm¶W HIV/AIDS )ankMBugEtrs;enAnigTb;Tl; CamYynwgCm¶WraKrUsenH .

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Pñak;garbgáehtu nig sBaØaKøIniksMxan;² BBYk Salmonella EdlmanelIsBI 200 RbePTtUc²eTotenaH (Serotypes) CaGñkedIrtYsMxan;kñúgkarbgáCm¶W eTAelImnusS nigstVciBa©wm. enAelImnusSvaGacbNþal[manCaCm¶WenARkBHeBaHevon (Gastroenteritis) RKuneBaHevon nig Bacteraemia edayman b¤KμankarsayPayeTAkEnøgdéTeTot. SalmonellaEdlbNþal [manCm¶WrlakeBaHevon CaTUeTAcab;epþImedaykarvilmux k¥Üt cukeBaH raKrUs enAeRkayBI 8-48 em:ag bnÞab;BI briePaKGaharEdlmins¥at nigmanBBYk Salmonella enAkñúgenaH. eraKsBaØaKøInikCaerOy²bnþrhUtdl;eTA 3-5 éf¶munnwg)at;eTAvij edayKμankarBüa)al. fñaMGg;TIb‘ÍyUTik min)anCYyeGayeraKsBaØaKøInik)at;qab;enaH eT b:uEnþvaGacBnüareBlénkarCasHes,Iy nigCaGñkpÞúkemeraKedayBMumaneraKsBaØaeTAvijeT. kareFVIetsþ Gg;TIb‘Íy:URkam nigkarBüa)alGg;TIb‘Íy:UTik minRtUv)aneKeFVIeLIgenAkñúgkrNIminF¶n;F¶renaHeT. kareRbIR)as; Gg;TIb‘Íy:UTiklÁwkNaEtman Bacteraemia. manGñkCm¶WmYycMnYn CaCRmkén Salmonella spp EdleKeXIj manenAkñúglamk nigTwkenamry³eBlmYyqñaM b¤yUrCagenH b:uEnþenAEtminmaneraKsBaØa. RbEhl 3° énGñk Cm¶WRKuneBaHevon nig 0/2 dl; 0/6°énGñkEdlrlakRkBHeBaHevon edaysarBBYk Salmonella EdlminEmn Typhoid nwgmanlT§plénkarbNþúHlamk viC¢mankñúgry³eBlelIsBImYyqñaM . BYk Shigella spp bgá[manCm¶WKøInikCaeRcIn EdltaMgBICMgWEdlminmaneraKsBaØa eTAdl;CMgWeraKBMumanRKunekþA nigdl;CMgWraKmYlF¶n;F¶r. eraKsBaØarYmman cukeBaH QWeBaHcg;CuHEtCuHminecjcuk ehIyCajwkjab;eTAeTot eKeXIjmanecjQamecjBIkarrlak. Shigella spp KWCamUlehtucm,génCMgWrakmYledayBYk)ak;etrI mUlehtubnÞab;KW E.coli EdlsIunigbgáeGaymanQameBaHevon (Eteroinvasive nig Eterohaemorrhagic

E. coli). mankrNIbgá[QWcab;tictYcmYycMnYnmintRmUv[mankarBüa)aleT b:uEnþeTaHCay:agNak¾eday cMeBaHkrNIF¶n;F¶r b¤enAeBlsayPayelIkTIBIr kareFVIetsþGg;TIb‘Íy:URkambgðajnUvPaBsuMarbs;emeraKcMeBaHfñaM EdleKEtgeRbICaTUeTAx<s;enAkñúgRbeTsCaeRcIn. eKsÁal;nigdwgc,as;famanBYk Shigella bYnRkum ehIyRkum TaMgbYnenaHEbgEckCasrubman 39 Serotypes nig Subtyoes. eKeXIjmanRkum A (S. dysenteriae)

Rkum B (S.flexneri ) nigRkum C ( S. boydii ) EdlmanEckCa Serotypes CaeRcIn ehIyEdlman Serotype EtmYycMeBaHRkum D (S. sonnei). BBYk S. dysenteriae nig S. flexneri KWCaBYk Shigella EdleKCYbjwkjab;CageKenAkñúgRbeTs EdlkMBugGPivDÆn_ cMENkÉ S. sonnei KWCaRkumEdleKCYbjwkjab; enAkñúgRbeTslUtlas; . eKsegáteXIjman Escherichia coli y:agtic 6 Rkum EdlbNþal[manCaCm¶WraKrUs. BYk E. coli TaMgenH man enteropathogenic E. coli (EPEC) enterotoxigenic E. coli (ETEC) enterohaemorrhagic

E. coli b¤ E. coli EdlbegáIt verotoxin (EHEC b¤ VTEC), enteroinvasive E. coli (EIEC), enter-

oadhesive E. coli (EAEC) nig enteroaggregative E. coli (EAggEC) enteroadhesive.

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4 Rkum kñúgcMeNam6RkumxagelI )anbNþal[manCm¶WraKrUsjwkjab;CageKenAkñúgRbeTskMBugGPivDÆn_. eTaHCay:ag Nak¾eday karviPaKrkBBYk)ak;etrITaMgGs;enHtRmUv[mankarBinitüelIetsþesr:Usa®sþ etsþrk CatiBulGMBIkar bNþúHekasika karsikSarkPaBbgáeraKeTAelIstV nigbec©keTsBinitüEhSn (Geneprobe

Techniques) Edlkic©karTaMgGs;enHhYsBIsmtßPaBrbs;mnÞIrBiesaFn_KøInikfñak;mFüm. mnÞIrBiesaFn_nana KYrEtGacmanlT§PaBy:agehac k¾GaceFVIkarviPaKrkBYk VTEC CaBiessBYk Serotype 0157:H7 Edl manlkçN³Biessrbs;vaKWetsþ Sorbitol GviC¢man. EtBYk E. fergusonii nig E. hermaniik¾etsþ Sorbitol GviC¢manEdr. dUecñHBBYk E. coli Edlmanetsþ sorbitol GviC¢manRtUvkaretsþbEnßmeTotKWkar eRbIR)as;esr:UmRbqaMg (Antiserum) rbs; E. coli O157. lT§plEdlbgðajfamankarbegáIt Verotoxin eFVI[eKGacsnñidæan[ Cak;c,as;fa vaCaBBYk VTEC. Cm¶WGasnñeraK KWCaCm¶WmYyEdlbgáeLIgedaysarCatiBulrbs;emeraK. RKb;eraKsBaØaTaMgGs;GacbNþalmk EtBIkar)at;bg;nUvrsrbs;eBaHevon EdlbNþalmkBICatiBulEdlbeBa©jedaysar Vibrio Cholerae enAkñúg eBaHevon. karBinitülakmbgðaj[eXIjfa BuMmaneXIjekasikaEdlrlakNamYyeT EteKeXIjfamankarraK rUsy:agxøaMg ehIylamkCaTUeTAsuT§EtTwk . dUecñHdMeNIrkarénkarBüa)alEdlsMxan;bMputKWkarb®gÁb;eLIgvij nUvrs;rbs;eBaHevon rIÉkareRbIR)as;fñaMsmøab;emeraKKWCaCMh‘anTIBIrb:ueNÑaH . V.cholerae ratt,aty:agelOnbMput. eKeFVIkarEbgEckBYkenHCa Serotypes mYycMnYnedayBwgEp¥keTAelI CatiBulRbePT O EdlmanenAelIsMbkrbs;)ak;etrI (Somatic O antigen) ehIyenAkñúg Serotypes O1 eKeXIjmanBIrBYk KWBYk “Classical” nig “EI Tor” . rhUtdl;qñaM1992 manEtBBYk V.cholerae Rkumesr:U O1 (classical b¤ EI Tor) RtUv)aneKrkeXIjfaCaBYkEdlratt,atnigRkumesr:U Serogroups déTeTot RtUv)aneKKitfaCaRbePTGasnñeraKEdlekItyUr²mþgelImnusS nig bgáCm¶WenAeRkAeBaHevon. enAkñúgqñaM1992 eKeXIjmankarratt,atd¾sahavmYy enAtMbn;eqñrxagekIténRbeTs\NÐa ehIyva)anratt,aty:agqab;rh½s eTAdl;RbeTsCitxag. karqøgratt,atenHbNþalmkBIRkum V.cholerae O139 Bengal EdleKminsÁal; Serogroup. eKeXIjmankarbNþúHnigbnSúT§emeraK V.cholerae O139 enHGMBIbNþaRbeTsTaMg10enAkñúg tMbn;GasuIGaeKñy_ b:uEnþvahak;dUcCaminykCakar)an . V. parahaemolyticus nig BYk Vibrio déTeTot (V. fluvialis, V. hollisae, V. mimicus) nig Aero-

monas (A. hydrophila, A. sobria, A. caviae) CaGñkedIrtYsMxan;EdlbNþal[mankarBulcMNIGahar b¤ rlakRkBHeBaHevon CaBiessekItenAelImnusSEdlbriePaKGaharsmuRTEdleqA b¤cMGinmin)anl¥ . Campylobacter jejuni nig C. coli )anelceLIgnigedIrtYsMxan;bgáeraKkñúgeBaHevon ehIyEdleKrkeXIj jwkjab;dUcBBYk salmonella & Shigella EdlenAesÞIrEtTUTaMgBiPBelak . karGegátEdl)aneFVIeLIgenA TVIbGa®hVik nig GasuI )anbgðaj[eXIjmanGaMgsuIdg;RbmaNBI 19-38° nigminmaneraKsBaØamanRbmaNBI

60

9-40°enAelIkUnek μg . karbgáCm¶WenAkñúgeBaHevonmancab;GMBIry³eBlxøInigRsalrhUtdl;rlakeBaHevon F¶n;F¶r bUkpSMnigmankarraKrUsxøaMgkøa cukeBaH RKunekþA nigQWsac;duM. lamkCadMbUgmanlkçN³CasMe)arxab; ehIybnÞab;mkKWCalamkEdlraK nigrav ehIycugeRkayQaneTArkraKrUsxøaMgkøarhUtdl;eXIjmanQam nig xÞúH . eraKsBaØaCaTUeTAnig)at;eTAvijenAkñúgry³eBlmYys)aþh_. cMnYn 25°énGñkCm¶WRbePTenHGaclab;mk vij b:uEnþCaTUeTAmanPaBFUrRsalCagelIkdMbUg . CaTUeTAkarbgáCm¶WenAkñúgdMNak;kalenHminmanGVICaFMduMeT ehIyk¾mincaM)ac;Büa)aledayeRbIR)as;fñaM b¤k¾RtUveTAetsþGg;TIb‘Íy:URkamEdr . Arcobacter butzleri RtUv)aneKcat;TukfaCaBYk Campylobacter EdlduHenAsItuNðPaB ehIyk¾RtUv)aneK rkeXIjfa CamUlehtuEdleFVI[mankarraKrUsenAelICm¶WCaBiesskumarenAkñúgRbeTskMBugGPivDÆn_. karbgá Cm¶WenAelImnusSedayBYk Yersinia enterocolitica RtUv)aneKrkeXIjenAkñúgtMbn;mYycMnYndUcCa ³ PaKxageCIgGWr:ub Cb:un nigshrdæGaemrik . PaKeRcInén)ak;etrIRbePTenHRtUv)aneKrkeXIjenAelIGñkCMgW kumarEdlraKraKrUsyUr²mþg . Clostridium diffcile mUlehtucm,génCMgWeBaHevon EdlTak;TgnwgkareRbIR)as;fñaMGg;TIb‘Íy:UTIk. vabgáCm¶W mYycMnYnFMEdlGacmancab;BIkarraKrUsbnþicbnþÜcrhUt dl;eFVI[søab; edaykarrlakeBaHevonFM. tamry³kar BinitüRsTab;eBaHevonFM edaykarcak;qøúHemIlGac[eKeFVIeraKvinicä½yfaCakarrlakRsTab;eBaHevonFM kñúgkrNI enHeKBuMcaM)ac;eFVIetsþbBa¢ak;GMBImnÞIrBiesaFn_eLIy. eKeXIjmanetsþsRmab;BinitürkeraKvinicä½yenHmanlk;enATIpSarrYmman fñalbNþúHetsþsRmab;eFVI[kkr (Latex agglutination) edIm,Irk Cell-associated protein etsþ ELISA sRmab;rk Cytotoxin nig Enterotoxin nigetsþsMrab;bNþúHCatiBulekasikaedIm,Irk Cytotoxin. manGñkCm¶WsRmakenAkñúgmnÞIreBTü CaeRcIn køayeTACaCRmkpÞúkBBYk)ak;etrIRbePTenH EtBuMbeBa©jCaeraKsBaØaGVIeT CaBiessenAeBlEdleKTTYl karBüa)aledayfñaMsmøab;emeraK ¬Gg;TIb‘Íy:UTik¦ BBYk\T§iBlTUlMTUlay. dUecñHkarbNþúHemeraKRbePTenH CakarbNþúHedayminbgðajkarplitCatiBulenaH vamantémøkñúgkareFVIeraKvinicä½ytictYcbMput. Rotavirus KWCaPñak;garEdlbgá[manCm¶WraKrUsEdlminEmnCa)ak;etrIEtmYyKt;EdlRtUv)anelIkykmk BiPakSaenAeBlenH. manBBYkvIrusCaeRcIneTotEdlCamUlehtud¾sMxan;énCMgWraKEt RotavirusKWvamanCaTUeTA enARKb;TIkEnøgTaMgGs;eBjBiPBelak edaymanGRtaswgEtes μ IKñaTaMgenAkñúgRbeTskMBugGPivDÆn_ nigRbeTs GPivDÆn_. karbgáCm¶W KWeRcInekItenAelIkUnek μgEdlmanGayucab;BI 6-18 Ex edaymaneRbva:Lg;x<s;enArdUv RtCak;énqñaM. kareFVIeraKvinicä½yRtUv)aneKeFVIeLIgedayeRbIR)as; Enzyme Immunoassay (ELISA) b¤ CamYyetsþEdlsamBaØ nigniymykmkGnuvtþKWCaetsþeFVI[kkr (Latex Agglutination Assay). Rbtikr EdleKykmkeRbI sMrab;etsþTaMgBIrmanlk;enAkñúgTIpSarb:uEnþmantémøéfø.

61

kareRbIR)as;FnFanenAkñúgmnÞIrBiesaFn_RtwmRtUv mnÞIrBiesaFn_EdlsßitenAkñúgmnÞIreBTü b¤KøInikEdlmankic©karmmarjwkenAkñúgRbeTskMBugGPivDÆn_mYycMnYn)an køayeTACakEnøgkkkujeTAedayvtßúviPaK. karbNþúHemeraKminRtUv)aneKtRmUv[eFVIeTenAkñúgkrNIEdlmankar tamdan)anRtwmRtUv enAkñúgkrNIEdlmankarraKrUsEttRmUv[b®gÁb;EtCatiTwkEdl)an)at;bg;mkvijEtb:ueNÑaH ehIyk¾mintRmUv[eRbIR)as;fñaMsmøab;emeraKEdr. kñúgkrNImYYycMnYn ¬GñkCm¶WEdlmanCm¶WRKuneBaHevon¦ RtUveK tRmUv[eFVIkarbNþúHedIm,ICaRbeyaCn_kñúgkarBüa)al[)anRtwmRtUvmYy. bBaðaenARtg;fa etIeyIgRtUveFVIdUcemþ:c edIm,IeRbIR)as;vtßúFatuedImd¾kRm[)anRtwmRtUv . Cajwkjab;suxPaBsaFarN³KWCakic©karmYyEdlsMxan;bMput ehIymnÞIrBiesaFn_pÞal;RtUvEtpþl;nUvlT§pl GMBI Pñak;garbgáCm¶WkñúgeBaHevonEdlekItmanenAtamRsuknImYy² niglT§plGg;TIb‘Íy:URkamEdleqøIytbeTAnwg)ak;-etrIbgáeraKTaMgenaH nigeFVIkarRsavRCavkarqøgratt,atNamYy. dUecñHRKUeBTüBüa)alRtUvshkar[)ans¥it rmYtCamYynigmnÞIrBiesaFn_. viFImYyEdlGnuBaØat[mnÞIrBiesaFn_GPivDÆn¾CRgúkTinñn½yEdlKYr[eCOCak;)anenaH KWkarykvtßúviPaKrbs;Gñk Cm¶WraKrUstammnÞIreBTü b¤KøIniknanatamry³karRbmUlvtßúKMrUedayecaH²(Random Systematic Sample ). karbnßycMnYnvtßúviPaKeFVI[eKmaneBlevlaRKb;RKan;kñúgkartamdanelIvtßúnImYy². ebIsinNavtßúviPaKKMrUnImYy² KWCavtßúviPaKEdlGnuvtþtameKalkarN_RtwmRtUv¬]TahrN_ erogral; 25 GñkCm¶WerIsykmñak;¦ dUcenHlT§pl EdlTTYl)anGacRtUv)aneKTsSTay b¤RbmaNemIlGMBIkarbgáeraKcMeBaHRbCaCnTaMgGs;. ebIsinCaeK rkeXIjfamaneraKsBaØaCak;c,as;NamYyenAkñúgmnusSEdlsßitkñúgRkumGayuNamYy b¤ enAkñúgrdUvNamYy mnÞIrBiesaFn_GacepþatykcitþTukdak;eTAelIbBaðaCakMNt;enaH . mnÞIrBiesaFn_GacseRmckñúgkareFVIetsþcMeBaHEt)ak;etrI EdlbgáCm¶WkñúgeBaHevonmYycMnYnEtb:ueNÑaH. Yersinia

enterocolitica bgáCm¶WedaykRmenAkñúgRbeTssßitenAkñúgtMbn;RtUBic. ebIsinCa)ak;etrITaMgenHminbgáCMgW enA kñúgtMbn;EdlmnÞIrBiesaFn¾RKbdNþb;eTenaH kareFVIetsþrkvaGacRtUvlubecal. lT§plBImnÞIrBiesaFn_KYrEt bBa¢ak;[)anc,as;las;GMBIeQμaHrbs;emeraKEdl)anrkeXIjenaH. ebIsinNaCaBYk Salmonella nig Shige-

lla KWCaBBYkemeraKbgáCm¶WEdleKTat;ecal r)aykarN¾lT§pl Edlpþl;edaymnÞIrBiesaFn_minRtUvsresrfa : KμaneXIj emeraKbgá }enaHeT EteKKYrEtsresrfa{rkmineXIjmanvtþman Salmonella nig Shigella} eT. karyk nig kardwkCBa¢ÚnvtßúsMNaklamk eKKYrEtyksMNaklamkenAkñúgdMNak;kaldMbUgénCm¶WraKrUs KWCaeBlEdlemeraKbgákMBugEtmanbrimaNx<s; ehIyl¥bMput enAmuneBlcab;epþImeFVIkarBüa)aledayGg;TIbIy:UTik. eKKYrEtyklamkenAeBlRBwkRBlwm ehIybBa¢ÚneTAkan;mnÞIrBiesaFn_[)anmunéf¶Rtg;edIm,I[eKGaceFVIkarviPaKenAéf¶EtmYy. eKKYrbdiesdkMuTTYl

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lamkEdleKbegáIt. l¥bMputeKRtUvyklamkRss;² edayt,arrn§KUf b:uEnþeKTTYlykkart,arrn§KUTEtenAkñúg krNIEdllamkminRtUveK)aneKykPøam² b¤k¾karepJIlamkeTAkan;mnÞIrBiesaFn_RtUvBnüareBl. rebobyksMNaklamk pþl;[GñkCm¶WnUveQIqáwHlamkcMnYnBIr CamYynwgkMb:ugdak;lamk EdlmanKRmbbiTCitnigmin[elclamk b¤ ehorecj ¬]TahrN_kMb:ugEdls¥ateFVIGMBIEkv)aøsÞik b¤Rkdas b¤k¾RbGb;BiessNaepSgeTotEdlmansøabRBa EdlP¢ab;eTAnigKRmbrbs;kMb:ug¦. kareRbIR)as;dbsRmab;dak;fñaM Penicillin RbGb;dak;eQIKUsnigsøwkeck minKYrRtUv)anGnuBaØat[eRcIneT eRBaHvaGaccmøgeraKdl;buKÁlikmnÞIrBiesaFn_ . ENnaMGñkCm¶W[CuHdak;elIRkdasGnam½y b¤enAelIRkdasRkEst ehIy[GñkCm¶WqáwHvaepÞrdak;eTAkñúgkMb:ug eday eRbIeQITaMgBIr . lamkEdlqáwHykeTAdak;enAkñúgkMb:ugKYrEt[)anTm¶n;y:agtic 5 Rkam b¤ ebIGacqáHenARtg;kEnøgEdlmanQam rMGil b¤xÞúH EtminRtUvlayLMCamYynwgTwkenameT. eBlEdleKqáwHlamkdak;)anRKb;RKan; ehIyRKbKRmb kMb:ug[)anCit . R)ab;GñkCm¶W[bBa¢ÚnvtßúviPaKeTAkan;mnÞIrBiesaFn_Pøam²eRkayeBlykva)an ehIyebImindUecñaHeT cMeBaHvtßú viPaKEdlRtUvbBa¢ÚneTAkan;mnÞIrBiesaFn_mankaryWty:avcab;BI 2em:ageLIgeTA RtUvykeQIrmUrsMLI 2 b¤3 eTAqáwHyklamkbnþicRtg;kEnøgmanQamxÞúHrYcdak;eTAkñúgRbGb; b¤fñalbNþúHEdleRbIR)as;sRmab;dwkCBa¢Ún vtßúviPaK (Cary-Blair, Stuart b¤ Amies) b¤k¾dak;enAkñúg 33 mIlIm:Ul¼lIRt énTwk Glycerol-phosphate. cMeBaH Cholera nig BBYk Vibrio spp déTeTot Twk Peptone Gal;kaLaMg ( Alkaline peptone water ) KWCafñalbNþúHsRmab;dwkCBa¢Únd¾l¥bMput ¬fñaldwkCBa¢ÚnEdlsm,ÚreTAedaycMNIGaharciBa©wm¦. emeraKEdlbgá eraKGacrs;enAkñúgfñalrebobenHrhUtdl;eTAmYys)aþh_ ebIeTaHCaenAkñúgsItuNðPaBmnÞIrBiesaFn_ b¤k¾enAkñúg TUrTwkkk . rebobyklamkedayt,arrn§KUT

1> epSImrmUrsMLICamYyTwks¥atKμanemeraK rYcs‘UkeTAkñúgrn§KUf rYcbgVil ehIyTIbBa©b;dkecj mkvij . emIlvtþmanrbs;lamkEdlditCab;nwgsMLI ehIybnþeFVIrebobenHrhUtTal;Etman brimaNlamkRKb;RKan;Cab;eTAnwgrmUrsMLIenaH. cMnYnrmUrtM)arEdlRtUvykKWGaRs½yeTAelI etIeKykvaeTAeRbIR)as;eFVIkarGegátelIGVIxøH.

2> dak;rmUrsMLIenAkñúgbMBg;TIbs¥atK μanemeraKEdlmanqñúkCasMLI b¤CaKRmbbiTCit ebIsinCa eKmin)anykeTABinitü 1-2 em:ageRkayBIBIykvtßúviPaK)anPøam. ebIsinCaeQIrmUrsMLIRtUv )aneKTukyUrCag 2em:agdak;vaenAkñúgfñaldwkCBa¢Ún .

63

karBinitüsMNaklamkedayEPñkpÞal;

1> BinitüemIllamkedayEPñkpÞal; rYckt;RtadUcteTA ³

- PaBrwgrbs;lamk ¬ manrag K μanrag ¬Tn;¦ b¤ rav ¦ - BN’rbs;va ¬ BN’ s elOg etñat b¤ ex μA ¦ - vtþmanénrbs;minFm μtadéTeTotdUcCa ¬ ]TahrN_ esøs b¤ Qam ¦

2> dak;lamk b¤ k¾eQIrmUrsMLICamYynwgesøsebImanenAkñúg methylene blue 0,05% mYy

dMNk;enAbnÞHkBa©k; rYclay[sBV . 3> dak;bnÞHkBa©k;esþIgBIelI EtkuM[manBBuHxül; rg;caM 2-3 naTI. eFVIkarBinitübnÞHkBa©k;eday

mIRkUTsSn_ edayeRbIbMBg;EkvBRgIk ( x 100 ) . 4> kt;RtanUvekasikanana EdleyIgGacBinitüeXIjy:agc,as; dUcCaBBYkmanéNVy:UmYy b¤eRcIn

(Mono nuclear b¤ Polymorphonuclear ) EtminRtUvykcitþTukdak;eTAelIekasikaEdl xUcrUbrageT .

BinitüemIlekasikananaEdlmanenAkñúglamkraKGacbBa¢ak;GMBIemeraKEdlbgáCm¶W ³

- kBa©úMénBYk Polymorphonuclear ¬ > 50 ekasikakñúgmYyrgVg;kBa©k;EkvBRgIk mIRkUTsSn_¦ Macro-phages nigRKab;QamRkhmEdlbBa¢ak;GMBIbgáCm¶W eday sarBYk shigellosis (shigella) .

- cMnYnBYk Polymorphonuclear bnþicbnþÜc ¬< 20 ekasikakñúgmYyrgVg;kBa©k;Ekv BRgIkmIRkUTsSn_¦ RtUv)aneKrkeXIjenAkñúgkrNIEdlbgáeraKedayBYk (salmo-

nellosis nig invasive E. coli ). kñúgkrNICm¶WraKmYlbgáeLIgeday Amoe-

bic dysentery eKeXIjekasikaPaKeRcInxUcxat ¬exμacekasika¦. ekasikas nig ekasikaRkhmRtUv)aneKeXIjpgEdr enAkñúgkrNICMgWraKrUsEdlbgáeLIg edayBBYk Campylobacter spp .

- kñúgkrNIeKeXIjmanekasikasbnþicbnþÜc ¬2-5ekasikaenAkñúgmYyrgVg;énEkv BRgIkrbs;mIRkUTsSn_¦RtUv)aneKrkeXIjenAkñúgkrNICMgWGasnñeraK CMgW Entero-

toxigenic nig Entropathogenic E.coli nigCMgWraKedaysarvIrus.

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karbNþúH nigfñalbNþúHsMNaklamk karbNþúHemeraKRtUv)an eKeRbIR)as;CaTUeTAsRmab;rk Salmonella spp nig Vibro cholerae BIsMNak lamk. fñalbNþúHrav Selenite F b¤ Tetrathionate RtUv)aneKykmkeRbIR)as;edIm,IbNþúH Salmonella

spp nigTwk Alkaline peptone ( APW ) sRmab;bNþúH V. choplerae. karbNþúHmintMrUveGayeFIVeLIy cMeBaHBYk Salmonella spp, Campylobacter spp, Yersinia enterocolitica nig Clostridium

difficile. rebobbNþúHenAelIfñalbNþúHEdlsm,ÚredaycMNIGahar

1> erobcMl,aylamkedaylamkRbmaN 1 Rkam enAkñúgbMBg;EkvEdlmanpÞúkTwkesr:UméRb cMnYn 1 ml . ebIsinCavtßúEdlTTYl)anmkCalamkEdlrav esr:UméRbminRtUv)aneKyk eRbIeT. vtßúviPaKEdlsßitenA elIeQIrmUrsMLIEdleTIbEtyk)anPøam² b¤ EdlrkSaTukenAkñúg fñaldwkCBa¢Ún Cary-Blair RtUv)aneKykeTAlagenAkñúgesr:UméRbmYymIlIlIRt. muneBl EdldkeQIrmUrsMLIecj sgát;sMLIeTAnwgRCug bMBg;TIbxagkñúg[Gs;BIcugrmUrsMLI .

2> Efml,aylamk 3rgVg; )aøsÞik b¤elah³ b¤eRcInCagenHeTAkñúgfñalbNþúHEdlsm,ÚrcMNI Gahar.

3> cUrbNþúHenAelIfñalbNþúH Selenite F cMnYn 18 em:ag nig APW cMnYn 6-8 em:ag. enAkñúg mnÞIrBiesaFn_xøH eKykl,aylamk BIr b¤bI Loopful BIfñal APW dMbUgeTAdak;bNþúHbnþ enAelI APW fμ InigTukeGayvaduHkñúgry³ 6-8em:ag.

4> eFVIkarbNþúHbnþkBa©úMemeraKedayykmYy LoopfuleTACUtelIfñalbNþúHCeRmIsnigminCeRmIs V. cholerae duHy:agelOnenAkñúg APW ehIynwgduHelIslubBI)ak;etrIepSg²eTot kñúgry³ 6-9 em:ag. EteTaHCay:agNak¾eday bnÞab;BI 8 em:ageRkayBBYk)ak;etrIepSgGaceFVIkarduHlUtlas;y:agelIslubelI V.

cholerae. cMeBaHBYkminEmn O1 V. cholerae ( Non-O1 V. cholerae) duHlUtlas;y:agelOnCag V.

cholerae O1 ehIyGacduHlUtlas;eRcInCagBYk V. cholerae O1enAeBlEdlmanvtþmanemeraKTaMgBIr duHlUtlas;CamYyKña. fñalbNþúHsRmab;bNþúHBYk)ak;etrIbgáeraKkñúgeBaHevon fñalbNþúHsMrab;eKalbMNg CaTUeTAEdlmansarFatuCeRmIsmFüm b¤eRcInRtUveKENnaMeGayeRbIsRmab;rk Shigella spp., Salmonella spp nig Y.enterocolitica. fñalbNþúH MacConkey Edlman Crystal

BN’sVayKWCafñalbNþúHsMrab;eKalbMNgTUeTA. eKGacbNþúH Y.enterocolitic enAelIfñalbNþúH MacCon-

65

key enAkñúgsItuNðPaB 35oC cMnYnmYyéf¶ ehIybnÞab;mkrkSaenAsItuNðPaBkñúgmnÞIrBiesaFn_ ¬22-29 oC¦ cMnYnmYyéf¶eTot . fñalbNþúH Xylose-lysine-deoxycholate (XLD) RtUv)aneKeRbIR)as;CafñalbNþúHCeRmIsxøaMgsRmab;rk BYk Shigella nig Salmonella spp. fñalbNþúH Deoxycholate Citrate (DCA), Hektoen Enteric

Agar (HEA) b¤ Salmonella-Shigella (SS) k¾smRsbnwgykmkeRbIR)as;Edr. BBYk Shigella dysen-

teriae RbePT 1 S. sonnei nig enteroinvasive E. coli duHminl¥eTenAelIfñalbNþúH SS. EteTaHCay:ag Nak¾edayfñalbNþúH SS RtUv)aneKeRbIR)as;pgEdrsRmab;rk Y. enterocolitica enAeBlEdleKrkSaeRkam kMedAdUceFVIenAelIfñalbNþúH MacConkey Edr. manmnÞIrBiesaFn_mYycMnYneRbIR)as;fñalbNþúH Bismuth

sulfite edIm,I RsavRCavrk Salmnella typhi nig BBYk Salmonella déTeTot . manfñalbNþúHCMerIsmYycMnYn (Blaser, Butzler, Skirrow) EdlmanbEnßmfñaMsmøab;emeraKxøH RtUv)aneKeRbI R)as;sRmab;rkBBYk Campylobacter spp.. eTaHCay:agNak¾edayfñalbNþúHEdlmanQammFüm5-10° bEnßmBIelIeday Cephalosporin ¬15mIRkURkam¼1 mIlIlIRt¦ Vancomycin ¬10 mIRkURkam¼1mIlIlIRt¦

Amphotericin B ¬2 mIRkURkam¼1 mIlIlIRt¦ nig 0/5° én Ferrows sulfate-sodium metabisulfite-

sodium pyruvate (FBP) RtUv)aneKykeRbIR)as;edIm,Irk Campylobacter spp enHEdr . eTaHbICa)ak;etrIPaKeRcInduHenAelI MacConkey b:uEnþeKeRbIR)as;fñalbNþúHCeRmIsmYy edIm,IbNþúHrkBBYk Vibrio spp. fñalbNþúH Thiosulfate Citrate Bile salts Sucrose (TCBS) KWCafñalbNþúHEdleKeRbIs Rmab;rkBBYk V. cholerne O1 BBYkminEmn O1 nig V. parahaemolyticus EtfñalbNþúHTaMgenHmantémø éfø. rIÉfñalbNþúH Telluride Taurocholate Gelatine (TTG) KWCafñalbNþúHCeRmIsmYyeTotEdleKyk mkeRbI b:uEnþvaminmandak;lk;enATIpSareT. fñalbNþúH Alkaline Meat Extract (MEA) nig Alkaline

Bile Salt (BSA) KWCafñalbNþúHEdlmantémøefaksamBaØ ehIyeKGacerobcMeLIgedayxøÜnÉg ehIypþl; lT§pl)anl¥ . Clostridium difficile BImunmkKWCa)ak;etrIEdlBi)akbNþúHmYy muneBlEdlmankareRbIR)as;fñalbNþúH Cefoxitin-Cycloserine-Fructose (CCFA). karbegáItfñalbNþúHEdlpSMeLIgBIEtEpñkelOgrbs;s‘ut)an RtUveKeRbIR)as;sMrab;rk C.difficile EdlGviC¢mancMeBaH Lecithianse nig Lipase xN³EdlBBYk Clostri-

dia déTeTotRtUveKrkeXIjenAkñúgeBaHevondUcCa C.perfringens, C. bifermentans nig C. sordelli Edl man Lecithinase viC©man .

66

karbnSúT§bzm vtßúviPaKKYrEtRtUv)anBinitü nigbNþúH[)anelOnbMputenAeBlEdlvtßúviPaKRtUv)aneKbBa¢Únmkdl;mnÞIrBiesaFn_ karbNþúH[)anelOnenH CaRbeyaCn_EdlGac[eKTTYl)annUvlT§plx<s;kñúgkarbNþúHBYk Shigella nig Campylobacter spp.. ebIsinCaeKmin)aneFVIkarbNþúHPøam²eT vtßúviPaKKYrEtRtUv)aneKrkSaTukenAkñúgTUrTwk kkkñúgsItuNðPaB 4 GgSaes . l,aylamkxab;KYrRtYv)aneKeRbICamYynwgfñalbNþúHEdlCeRmIsxøaMg ehIyeRbIR)as;l,aylamkminsUvxab;Ca mYynwgfñalbNþúHminsUvCeRmIs. enAkñúgmnÞIrBiesaFn_mYycMnYn eKeFVIkarbNþúHedaypÞal; CamYYynwgtM)arrn§KUT b:uEnþeKRtUvEtRbugRby½tñnigykcitþTukdak;edayminRtUvdak;vtßúviPaK[eRcIneBkeT . rebobbNþúHénkarbnSúT§dMbUg

1- dak;l,aylamkcMnYn 3 loopful eTAbNþúHelIfñalbNþúHEdlCeRmIsx<s; nigdak;l,ayenH 1 Loopful sMrab;fñalCMerIsTab. dak;vaenAcMkNþalfñalbNþúH ehIyqUteLIgelIcuHeRkam ehIyqUtkat;tamkNþalfñalbNþúH dUc)anbgðajenAkñúgrUbPaBTI6. rebobenHnwgeFVIeGay kBa©úMemeraKduH)anCaGtibrima. kBa©úMemeraKtictYcmanduHenACayxag²rbs;fñal.

2- bnÞab;BIerobcMrYcral;ehIyykfñalbNþúHenaHeTAdak;bNþúH. dak;fñalbNþúHsRmab;rk Sal-

monella, Shigella Yersinia spp. nig V. cholerae enAkMedA 35GgSaes enAkñúgm:asuIn bNþúHmanGuksuIEsn ¬Kμan ]sμ ½nkabUnik¦ fñalbNþúHsRmab;bNþúHrk Campylobacter spp. RtUvdak;kñúgkMedA 42GgSaes enAkñúgmCÄdæan MicroaerophilicEdlman]sμ ½nkabUnik 10° ehIyfñalbNþúHsRmab;NþúHrk Clostridium difficile RtUvdak;kñúgmCÄdæanEdlKμanxül; nig rkSaenAkMedA 35GgSaes .

mCÄdæankñúgkarbNþúHrk Campylobacter fñalbNþúHEdleKeRbIR)as;sRmab;rk Campylobacter spp. KYrEtRtUv)aneKrkSaTukenAsItuNðPaB42-43 GgSaes enAkñúgmCÄdæanEdlman 5°énGuksuIEsn 10°én]sμ ½nkabUnik nig 85°énGas‘Ut . karduHlUtlas; énemeraKenAkñúgeBaHevonFm μtaRtUv)anhamXat;edaysarEtsItuNðPaBenH kñúgxN³EdlkMedAkñúgkRmitenH minmanb:HBal;dl;karduHlUtlas;rbs;BYk Campylobacter eT . EteTaHCay:agNak¾eday ebIsinNaeK RsavRCavrkBBYk)ak;etrIepSgeTotpgEdrenaH fñalbNþúHKYrEtRtUv)aneKdak;enAkñúgsItuNðPaBTabKWBI 35-37 GgSaes .

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mCÄdæanénkarduHlUtlas;EdlsmRsbbMputrbs;BYk Campylobacter spp.

RtUv)aneKbegáIteLIgtamviFI epSg². bec©keTsénkarbegáItCamCÄdæanenHGaRs½yeTAelITMhMkargarrbs;mnÞIrBiesaFn_ nig témøEdlRtUv cMNay .

RbGb;EkvEdlmanduteTonGacbegáItCamCÄdæanmYyEdlmanRbEhl 17-19°én]s μ ½nGuksuI-Esnnig 2-3° én]sμ ½nkabUnik . mCÄdæanenHminEmnCamCÄdæanBiesssRmab;karduHlUtlas; énBBYk Campylobacter spp. ehIyman)ak;etrIxøHminduHlUtlas;kñúgmCÄdæanenaHeT. tam karRsavRCavmYycMnYn)anbgðajfa karbNþúHkñúgsItuNðPaB 42GgSaes enAelIfñalbNþúHEdl bEnßm FBP nigCYy[mankarduHlUtlas;)anl¥. GaharbEnßm FBP )anCYy[ Campylo-

bacter spp. Fn;nwgkareRbIR)as;GuksuIEsn edayeFVImin[ Superoxides nig Hydrogen

Peroxide manskm μPaB. KuNvibtþiénRbB½n§EbbenHKWkarkMedA b¤ bNþúHkñúgry³eBlyUr ehIy Tb;sáat;GuksuIEsnmYycMnYnrbs; Campylobacter spp. .

rUbPaBTI6 ³ karbNþúH)ak;etrIenAelIfñalbNþúH

manRbB½n§bNþúHEdlsamBaØ nig Gs;fvikaticmYyeTotRtUv)aneKykmkeRbI KWkarbNþúHrYmKña . eKyk fñalbNþúHEdlman)ak;etrIEdlminRtUvkarxül;mindac;xat ( Facultative Anaerobic

Bacteria ) eTAdak;bNþúH kñúgRbGb;bitCitmYyEdlmandak;fñalbNþúHsRmab;bNþúHBBYk Cam-

pylobacter spp. edaysarCa)ak;etrIEdlminRtUvkarxül;mindac;xat)anduHenAkñúgmCÄdæan EdlmanGuksuIEsntic nig]sμ ½nkabUnikekIneLIg. KuNvibtþiénkareRbIR)as;bec©keTsenHKWkar bNþúHnwgTukkñúgry³eBlEvgcMeBaH Campylobacter spp. .

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eKGaceRbIR)as;kBa©k;EdlGacbegáItGuI®dUEsn nig]sμ ½nkabUnikedayÉkÉg)ansRmab;eFVIkar

bNþúHrk Campylobacter spp. ehIyEdlmandak;lk;enAkñúgTIpSar. eKykkBa©k;enHeTAdak; kñúgRbGb;EdlBuMmanGuksuIEsnedIm,IbegáItmCÄdæanenH eKRtUvdUrkBa©k;enHerogral;eBlebIkKRmb RbGb;. RtUvcgcaMfaeKminGacdak;elIs 6 fñalbNþúHenAkñúgRbGb;eT .

RbB½n§es,ag)aøsÞiksMrab;TukfñalbNþúH k¾manlk;EdrenAelITIpSar. es,agenHGacbt;)an edayéd b¤edaysuBaØakasBIBIreTAbIdg ehIyeKRtUvbMeBjvaeLIgvijCamYynwg 5°én]sμ ½nGuk suIEsn 10°én]sμ ½nkabUnik nig 85°én]s μ ½nGas‘Ut .

eKk¾GaceRbIR)as;pgEdr nUvRbB½n§bUmykecjdak;CMnYsmkvij edayeRbIR)as;RbGb;EdlKμan xül; nigBuMmankatalIkr. RbGb;enHRtUv)aneKbUmykxül;ecjcMnYnBIrdg[)ansMBaF 38 s>m ¬15 mIlIEm:Rt)art¦ ehIybMeBjmkvijeday 10°én]sμ ½nGuI®dUEsn 90°énGas‘Ut.

karviPaKdMbUgénemeraKEdlbNþúH karviPaKrk)ak;etrI eKeFVIeLIgTaMgtamry³etsþCIv-KImIsa®sþ nigesr:Umsa®sþ kñúgkMritNaenaH vaGaRs½yeTAelI smtßPaBénmnÞIrBiesaFn_nImYy². KMnUsbM®BYjEdleKeRbIR)as;sRmab;CamKÁúeTsn¾ kñúgkarviPaKrk)ak;etrIkñúg eBaHevonsMxan;²enH manbgðajenAkñúgrUbPaBTI7 a-c . cUrviPaKkBa©úMemeraKEdlduHrayl¥ enAkñúgrUbragCak;lak;enAelIcanbNþúHbzm edayeFVIsBaØasMKal;nUvnwg)at rbs;fas Petri. kBa©úMemeraKTaMgGs;enHnwgRtUveKepÞrsMrab;eTAeFVIetsþbnþbnÞab;eTot. ebIsinCamanemeraK elIsBImYyRbePTRtUv)aneKrkXIj cUrbNþúHy:agticmYykBa©úMemeraKén)ak;etrImYymux². Lactose-nonfermenting )ak;etrI dUcCaBBYk Salmonella nig Shigella spp. CaedIm )anduHeday[CakBa©úM emeraKtUc²nigmanBN’tictYcenAelIfñalbNþúH MacConkey fñalbNþúH SS nig DCA. cMENkÉkBa©úMemeraK BBYk Proteus spp. vij GacRcLMCamYynwgkBa©úMemeraKrbs;BYk Salmonella

nig Shigella spp. CaBiessenAelIfñalbNþúH MacConkey nig DCA edaysarEtlkçN³énkarmin eRbIR)as; lactose. emeraKEdl eRbIR)as; lactose dUcCaBBYk E. coli, Enterobacter/Klebsiella spp )anduHCakBa©úMemeraKEdlman cab;BIBN’páaQUkeTACaRkhmenAelIfñalbNþúH MacConkey DCA nig SS. rIÉenAelIfñalbNþúH XLD vij Shigella nig Salmonella spp )anduHeLIgCakBa©úMemeraKEdltUc²BN’Rkhm ehIyesÞIrEtRKb;BYk Salmonella TaMgGs;EtgEtbegáItCaBN’exμAenAcMkNþal. y:agNamijmanBBYk Proteus spp mYycMnYnk¾begáItCacMNucexμAenAcMkNþal kBa©úMemeraKEdrenAelIfñalbNþúH XLD. rIÉenAelI fñalbNþúH Bismuth sulfite vij Salmonella typhi duHCakBa©úMemeraKEdlmanBN’exμAnigcaMgepøkelah³. cMENk Yersinia enterocolitica EdlduHenAelIfñalbNþúH MacConkey nig SS vij )anbegáItCakBa©úM emeraK tUc²BN’Rsal ehIyEdlduHy:ag elOnelIsItuNðPaB 22-29 GgSaes.

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BYk Salmonella nig Shigella spp fñalbNþúHbIxusKñaEdleKeRbIR)as;sRmab;eFVIkarviPaKrkBYk Salmonella nig Shigella spp enAdMNak;- kaldMbUg ³

- fñalbNþúH UreaEdlmanlayTwkrkSalMnwgGasIutexSay (UREA) - fñalbNþúH Motility-indole-lysine (MIL) - fñalbNþúH Kligler’s iron (KIA)

rUbPaBTI7 a DIdüaRkamEdlbBa¢ak;GMBIkarviPaKdMbUgeTAelIemeraKkñúgeBaHevonEdlCYbRbTHjwkjab;

( Ente-robacteriaceae) rebobbNþúH nig karGanlT§plenAelI (UREA)

1- edayeRbI Loop cUkykkBa©úMemeraK Non-lactose-fermenting 2-3 kBa©úMecj GMBIfñalbNþúH dMbUg rYcepÞreTAkñúgbMBg;EkvEdlmanpÞúk UREA.

2- dak;kMedAbMBg;EkvenaHcMnYn 2-4 em:ag kñúgsItuNðPaB 35 GgSaes nig rg;caMemIlkarpøas;bþÚrBN’ elOgeTApáaQUk ¬ Urease viC¢man ¦. e)aHbMBg;EkvEdlman Urease viC¢manecal .

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3- eFVIkarbNþúHbnþeTotedayykecjGMBIbMBg;Ekv Urease GviC¢man eTA MIL nig KIA ¬emIlxag

eRkam ¦ rYcdak;bNþúHbMBg;EkvTaMgGs;edayrYmbBa©ÚlTaMgbMBg;Ekv Urease GviC¢manEdlman UREA mYyyb;enAsItuNðPaB 35GgSaesenAkñúgkEnøgEdlmanxül; .

rebobbNþúH nig karGanlT§plelIfñalbNþúH MIL nig KIA

1- bNþúHelI MIL edaycak;tRmg;cuHeTA)atTIbRbEhl 2 mIlIEm:RtBI)atTIbmk. dkm¢úlecjtam TisedAEtmYy .

2- bNþúHenAelI KIA edaycak;tRmg;eTAeRkam rYcqUtelIGNþatfñalbNþúHedayclnakavcuHkaveLIg 3- bg;elxelIbMBg;TIbfñalbNþúHrYcdak;bNþúHkñúgsItuNðPaB 35 GgSaes. 4- BinitüemIlbMBg;TIb Urease GviC¢man UREA¬emIlxagelI¦sRmab;Binitü[c,as;elIBYk Urease

EdlmanRbtikm μyWty:av . e)aHecalfñalbNþúH Urease GviC¢manRbtikm μyWty:avenHecal . 5- ®tYtBinitüemIlfñalbNþúH MIL edIm,IrkRbtikmμ Motility lysine nig Indole. Motile rbs;

emeraK nwgsayPayecjGMBIsñamEdlcak;rYcecjeTAkEnøgepSgeToténfñalbNþúH. emeraK Non-motile nwgduHEtenAtamkEnøgEdl)ancak;Etb:ueNÑaH. rIÉRbtikm μ Lysine viC¢manvij nig bgðaj[eXIjtamry³RbtikmμGal;kaLaMgmYy ¬BN’sVay¦enAnwg)atrbs;fñalbNþúH rIÉRbtikm μ GviC¢manvijnwgbgðaj[ eXIjtamry³RbtikmμGasuItmYy ¬BN’elOg¦ enAnwg)atrbs;fñalbNþúH ¬bNþalmkBIkareLIgem Glucose¦. edIm,IeFVIetsþrkkarbegáItCa indole eyIgRtUvbEnßm 2-4 dMNk;énRbtikr Kovacs eTAelIfñalbNþúH. karbgðajBN’Rkhm b¤ páaQUk)anbBa¢ak;y:agc,as; fa ³ mankarbegáIt Indole rIÉebIenAEtBN’elOgdEdlbgðaj[eXIjfaetsþenaHGviC¢man .

6- BinitüelIfñalbNþúH KIA vijmþg. ral;BBYk Enterobacteriaceae eLIgemCati Glucose plit CatiGasuIt nig]sμ ½n b¤CYnkalmanEtGasuItmYymuxb:ueNÑaH EdleFVI[GNþatfñalbNþúHmanBN’ elOg. kñúgkrNIEdlmankarbgábegáItCa]sμ ½n eKeXIjmanBBuH b¤eFVI[fñalbNþúHeRbH b¤Ebk b¤ CYnkal]sμ ½n)anrujfñalbNþúHmkxagelIkñúgbMBg;TIb ebIsinCabrimaN]s μ ½neRcIn¬]TahrN_enAkñúg krNI Enterobacter spp.). ebIsinCamaneLIgem Lactose kñúgeBltMNalKñaenaH TaMgGNþat nigEpñkxageRkamrbs;fñalbNþúHnwgkøayeTACaGasuItKWfaeLIgBN’elOg ¬]TahrN_ kñúg E. coli) ebIsinCaBuMmankareLIgem Lactose eTenaH¬]TahrN_kñúgkrNI Shigella nig Salmonella

spp.) EpñkxageRkamrbs;fñalbNþúHeTACaBN’elOg EtEpñkxagelI ¬GNþat¦ rbs;fñalkøayCa Gal;kaLaMg

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rUbPaBTI7 b KMnUsbM®BYjsRmab;viPaKdMbUgeTAelIBYk)asuI Gram-positive minRtUvkarxül;

¬BN’Rkhm¦. kareLIgBN’exμAenAtamsñamEdlcak;bgðaj[eXIjfa man karbegáItGuI®dUEsns‘ulPIt (Hy-

drogen sulfide) . cUrraykarN¾BIlT§pl nigeFVIkarkMNt;emeraKCabeNþaHGasnñmYy edayBwgEp¥kelItarag TI10 nig TI11 CaCMnYy. RkumBYk Salmonella KWCaBYk Oxidase-negative, Motile nig Indole-negative. BYkvamin Hydrolyse

Urea eT elIkElgEtBYk S. paratyphi A ehIyBYkva Lysine-decarboxylase-positive. enAelIfñal bNþúH KIA vabegáItGNþatGal;kaLaMg GasuItenAEpñkxageRkam H2S nig]sμ ½nelIkElgEt S. typhi ecj EdlCa Anaerogenic nig S. paratyphi A EdlCa H2S-negative. RbsineKeBjcitþnwglkçN³TaMgGs; enHehIy cUrraykarN¾ ³ :rkeXIjBYk Salmonella ¬karkMNt;GtþsBaØaNbeNÑaHGasnñ¦ :. rIÉBYk Shigella vij CaBBYkman Oxidase-negative, Non-motile, Lysine-decarboxylase-negative, nigmin Urea hydrolysed eT. enAelIfñalbNþúH KIA va)anbegáItCamCÄdæanGal;kaLaMgenAnwgGNþat nig GasuItenAEpñkxageRkamrbs;fñalbNþúH. eKk¾BuMeXIjmankarbegáItCa H2S nig]sμ ½neTelIkElgEt S.

flexneri serotype 6 ¬RbePT Newcastle nig Manchester¦ S. boydii Serotype14 EdlCa Anaero-

genic.

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BYkvaplitnUv Catalase elIkElgEt S. dysenteriae Serotype 1 EdlCa Catalase-negative. ebIsinCa lkçN³TaMgGs;enHRtUv)anbMeBj cUrraykarN¾³ rkeXIjBYk Shigella ¬karkMNt;GtþsBaØaN beNÑaHGasnñ¦

rUbPaBTI7 c KMnUsbM®BYjénkarviPaKbzménBBYk)asuI Gram-negative minRtUvkarxül ; Yersinia enterocolitica kBa©úMemeraKEdlcuHecjmktUc²BN’esøk b¤KμanBN’ enAelIfñalbNþúH MacConkey b¤ SS eRkayeBleKdak; bNþúHmYyyb;mkGacCa Yersinia enterocolitica. ykkBa©úMemeraKEdlc,as;eTAdak;bNþúHenAelI KIA rYc TukeGayvaduH kñúgsItuNðPaB 25 GgSaes ry³eBlmYyyb;. eKk¾RtUvdak;bNþúHkBa©úMemeraKEdlsgS½yeTAkñúg fñal UREA BIr nigfñal MIL BIr rYcTukeGayfñal1énfñalnImYy²duHenAkñúgsItuNðPaB 25 GgSaes nigmYy eTotdak;enAsItuNðPaB 35 GgSaes. enAelIfñalbNþúH KIA BBYk Yersinia enterocolitica nig begáItCa mCÄdæanGasuItenAnwg)atrbs;fñalbNþúH ehIyGal;kaLaMgenAnwgGNþat nig edayKμankarbegáItCa]sμ ½n b¤ H2S eT. RbsinebIemeraK Motile nig Urease-positive enAkMedA 25GgSaes nig Non-motile nig man Urease-positive exSay b¤ Urease-negative enAsItuNðPaB 35 GgSaesenaH cUrraykarN¾³ :rkeXIjBYk Yersinia ¬karkMNt;GtþsBaØaN beNÑaH Gasnñ¦ :.

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Vibrio cholerae nig V. parahaemolyticus BYk Vibrio duHlUtlas;CakBa©úMBN’esøk Non-lactose-fermenting enAelIfñalbNþúH MacConkey. enAelIfñalbNþúH TCBS emeraK V. cholerae )anduHCakBa©úMemeraKFMlμm e)a:g relag BN’elOg EdlxusBI V. parahaenolyticus duHecjCakBa©úMemeraKFM² sMEb:t BN’exov-ébtg. eKeXIjman V. cholerae mYy cMnYnGacbgðajecj[eXIjCakBa©úMemeraKEdlmanBN’ébtg b¤ K μanBN’enAelIfñal TCBS edaysarEtman PaByWty:avénkareLIgem Sucrose. enAelIfñal TTGA vij kBa©úMemeraKenH)anvivtþn_eTACakBa©úMemeraKEdl BN’l¥k;enAcMkNþal edaysarEtmankarkat;bnßyén Telluride nigB½T§CuMvijedaytMbn;minc,as;las;mYy edaysarEtRbtikm μ Gelatinase. enAelIfñal BSA nig MEA vij V. cholerae )anduHecjCakBa©úMemeraK føamanEpøsMEb:t nigmanCayc,as;las;. eKGaceFVIkarEbgEckedaygay®sYlrvagkBa©úMemeraKrbs;BYk V.

cholerae nig BBYk Enterobacteriaceae enAeRkamkarbBa©aMgBnøWbBaäit b¤k¾BinitüedaycaMgbBaäitnwgBnøWéf¶. cMeBaHkBa©úMemeraK EdlsgS½yKYrRtUveKBinitüedayetsþ oxidase nig etsþExS ( string test ).

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taragTI9 ³ rUbragkBa©úMemeraKén)ak;etrIkñúgeBaHevonEdlCYbjwkjab;enAelIfñalbNþúHEbgEck nig CeRmIs

BYk)ak;etrI fñalbNþúH

MacConkey manlay Crystai BN’sVay

fñalbNþúH XLD fñalbNþúH SS DCA HEA

Escherichia coli BN’páaQUkeTApáakULab FM sMEb:t elOg nig Rkhm BN’páaQUkeTARkhmduHBuMsUv)anl¥

páaQUkmankMNkB½T§CuMvij

FM páaQUkeTATwkRkUc mankMNkB½T§CuMvij

Shigella spp. BuMsUvmanBN’ Rkhm BuMsUvmanBN’ BuMsUvmanBN’ eTABN’daMEdg ébtg esIm nig e)a:gx<s; Salmonella spp. BuMsUvmanBN’ Rkhm man b¤ K μan

cMNucexμAenAkNþal BuMsUvmanBN’ man b¤ K μan

cMNucexμAenAkNþal BuMsUvmanBN’ eTABN’daMEdg edayman b¤ K μancMNucexμAenA

kNþal

exov-ébtg man b¤ K μan cMNucexμAenAcMkNþal

Enterobacter/Klebsiella. spp.

páaQUk Gn§il² elOg Gn§il² [páaQUk duHBuMsUv)anl¥ FM Gn§il²esøkmanBN’páaQUkenAcMkNþal

FM BN’TwkRkUcepøk²

Proteus/Providencia spp. BuMsUvmanBN’ BuMsUvduHlUtlas;l¥ ENnNan;tan;tab;

RkhmBBYk Proteus spp. mYycMnYn

mancMNucexμAenAcMkNþal

BuMsUvmanBN’ man b¤ K μan cMNucexμA b¤ RbepH enAkNþal

FM BuMsUvmanBN’ eTABN’daMEdg edayman b¤ K μancMNucexμAenAcM

kNþal

exov-ébtg edayman b¤ K μan cMNucexμAcMkNþal

Yersinia enterocolitica BuMsUvmanBN’ elOg ERb®bYl BuMsUvmanBN’ BuMsUvmanBN’ BN’R)ak;epøk²laypáaQUk Enterococci BuMduH BuMduH b¤ duHedaylM)ak BuMduH BuMduH b¤ duHedaylM)ak BuMduH b¤ duHedaylM)ak

XLD : Xylose-Lysine-Deoxycholate DCA : Deoxycholate-citrate SS : Salmonella-Shigella HEA : Hektoen enteric

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taragTI10 ³ karbkRsayRbtikmμénBYk Enterobacteriaceae enAelIfñalbNþúH Kligler’s iron (KIA) Rbtikmμ karbkRsaylT§pl

GasuIt¬elOg¦enAépÞxageRkamrbs;fñalbNþúH Gal;kaLaMgenAnwgGNþatrbs;fñalbNþúH ¬Rkhm¦

eLIgemEt Glucose b:ueNÑaH

GasuIteBjfñalbNþúH ¬TaMgEpñkxageRkam TaMgGNþatrbs;fñalbNþúHBN’elOg ¦ eLIgemTaMg Glucose nig Lactose

Gal;kaLaMgeBjépÞfñalbNþúH ¬EpñkxageRkam nig GNþatrbs;fñalbNþúHBN’Rkhm ¦ minmaneLIgem TaMg Glucose nig Lactose

BBuH]s μ ½nenAEpñkxageRkamfñalbNþúH b¤ eFVI[eRbHfñalbNþúH )ak;etrIbegáItCa]sμ ½n eLIgBN’exμAenAEpñkxageRkam mankarbegáIt H2S

taragTI11 ³ Rbtikm μCak;Esþgrbs;BYk Enterobacteriaceae enAelIfñalbNþúH Kligler’s iron (KIA)

Rbtikmμ eLIgemCatisár RbePT)ak;etrIEpñkxageRkam ³ GasuIt EpñkxagGNþat ³ GasuIt man]s μ½nenAEpñkxageRkam BuMmanbegáIt H2S

Glucose ³ GasuIt nig ]sμ ½nLactose ³ GasuIt nig ]sμ ½n

Escherichia coli Klebsiella Enterobacter Citrobacter diversus Serratia liquefaciens

EpñkxageRkam ³ GasuIt EpñkxagGNþat ³ Gal;kaLaMg man]s μ½nenAEpñkxageRkam begáIt H2S

Glucose ³ GasuIt nig ]sμ ½nLactose ³ mineLIg

Salmonella Proteus Citrobacter freundil*

EpñkxageRkam ³ GasuIt EpñkxagGNþat ³ Gal;kaLaMg BuMmanbegáIt]s μ ½nenAEpñkxageRkam BuMmanbegáIt H2S

Glucose ³ GasuItEtmYymuxKt;Lactose ³ mineLIgem

Shigella Yersinia Serratia marcescens* Providencia stuartii Providencia erttgeri*

EpñkxageRkam ³ GasuIt EpñkxagGNþat ³ Gal;kaLaMg man]s μ½nenAEpñkxageRkam BuMmanbegáIt H2S

Glucose ³ GasuIt nig ]sμ ½nLactose ³ mineLIg

Salmonella paratyohi A Hafnia alvei Serratia marcescen* Morganella morgani

EpñkxageRkam³ Neutral/Gal;kaLaMg EpñkxagGNþat ³ Gal;kaLaMg BuMmanbegáItCa]s μ ½n BuMmanbegáItCa H2S

mineLIgemCatisár Alcaligenes Pseudomnas Acinetobacter

*Atypical reactions

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rebobeFVIetsþ Oxidase

1- dak;Rbtikr OxidaseBIr-bItMNk; (1% Tetramethyl-para-phenylenediamine)eTAelIRkdas

eRcaHenAkñúg Petri dish. 2- cUkykkBa©úMemeraKEdleTIbduHfμ I² BIfñalbNþúH MacConkey edayeRbI Loop )aøTIn ¬minEmneFVIBI

nIRkUm¦ b¤cgáwHeQI b¤eQIcak;eFμjEdls¥at. )a:t)ak;etrIenAelIRkdaseRcaHEdlepSImrYcCaeRsc. 3- RbtikmμviC¢manEsþg[eXIjnUvBN’sVaycas;enAelIRkdasenA 10 vinaTIeRkaymk . BYk)asuI Gram-

negative dUcCa Vibrio, Aeromonas, Plesiomonas, Pseudomonas, nig Alcaligenes CaBYk Oxidase-positive. ral; Enterobacteriaceae TaMgGs;KW Oxidase-negative. Rbtikr Oxidase KYrEtRtUv)an®tYtBinitüCaeTogTat;CamYynwg)ak;etrIsMrab;RtYtBinitüEdlman oxidase viC¢man nigGviC¢man .

rebobeFVIetsþExS (String test)

1- dak;l,ay Sodium deoxycholate 0,5% mYydMNk;eTAelIbnÞHkBa©k; rYclay[sBVCamYynwgkBa©úM emeraKEdlduHenAelIfñalbNþúH MacConkey .

2- etsþviC¢mannwgbgðaj[eXIjenA 60 vinaTIeRkay³ l,ayenaH)at;PaBl¥k;rbs;va ehIykøayeTACaxab; Gn§il². eKGacTaj “ Mucoid string ” mYy enAeBlEdleKelIk Loop yWt²BIbnÞHkBa©k;. man BBYk Aeromonas mYycMnYnGacbgðaj[eyIgeXIjGMBIPaByWty:avénkarkk b¤ xab;enAeRkay 60 vinaTI. ebIsinCaetsþenHviC¢man eKRtUvqáwHykkBa©úMemeraKxøHeTAdak;bNþúHenAelIfñalbNþúH KIA nigTuk eGayduHcMnYnmYyyb; rYcsegátemIlBN’elOgenAEpñkxageRkam (Butt) énfñalbNþúH nigGal;kaLaMg enAnwgGNþaténfñalbNþúHehIyK μan]sμ ½n b¤ H2S eT. ebIsinCaetsþTaMgGs;enH RtUv)aneKrkeXIjdUc xagelIenaH cUrraykarN¾³ :rkeXIjBYk Vibrio cholerae ¬karkMNt;GtþsBaØaN beNþaH Gasnñ¦ :.

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Campylobacter jejuni nig Campylobacter coli BinitüemIlfñalbNþúHEdleRbIsRmab;bNþúHBYk Campylobacter enA 48-72 em:ageRkayeBlbNþúH. kBa©úM emeraKEdlsgS½yKYrEtRtUv)aneKbBa¢ak;edaysarkareFVIetsþ3³ Oxidase test, Wet mount preparation

under dark-field b¤ Phase-contrast microscope nigkarbMBak;BN’ Gram. ebIsin Dark-field b¤ Phase-

contrast microscope minGaceFVIeTAekIt eKRtUvykemeraKenaHeTAeFVIkarbMBak;BN’ Gram Pøam² edIm,IrkemIl rUbragekasikaCak;lak;. cMeBaHkarbMBak;BN’ Gram eKeRbIR)as; 0/3° én Carbol fuchsin edIm,IRbqaMgBN’ (Counter-stain). BYk Campylobacter CaBYk Oxidase-positive va Motile with a darting, Tumbling

motility ehIyvabgðaj[ eXIjCaragekagFm μta b¤Ca)asuIragdUcruWs½r ¬ragCasøabstVrMeBr b¤ragCaGkSr S¦. ebIsinCaeKc,as;ehIy cUrraykarN¾³ :rkeXIjBYk Campylobacter ¬karkMNt;GtþsBaØaN beNþaHGasnñ¦ :. Clostridium difficile kBa©úM Clostridium difficile duHenAelIfñalbNþúH CCFA manlkçN³FM BN’elOg nigdUcépÞkBa©k;. enAelIfñal bNþúHmanQamEdleKbNþúHkñúgmCÄdæanKμanxül; rUbragrbs;kBa©úMemeraKmankarERb®bYlmineTogTat; ehIyeKRtUv rkemIllkçN³Biess²epSg²eTot edIm,IkMNt;rk)ak;etrIRbePTxagelIenH. CalkçN³Biess kBa©úMemeraKrbs; C. difficile manBN’RbepHl¥k; nigminmankarbMpøajRKab;QameT enA 24-48 em:ageRkayeBlbNþúH. b:uEnþeK eXIjmanBBYkGm,Úr)ak;etrIenHmYycMnYnGacbegáItCakBa©úMemeraKEdlmanBN’ébtg exov edaysarEtlkçN³ Biessén α-type Haemolysis. enA 48- 72 em:ag eRkayeGayduH kBa©úMemeraKénBYk Clostridium difficile )anvivtþn_BIBN’RbepHx©I eTACamanBN’senAcMkNþalkBa©úMemeraK . tamry³bTBiesaFn_ knøgmk C. difficile KW Ca)ak;etrImYyEdlgay®sYlkñúgkarviPaKedaysarEtPaBERb®bYlénkarduHlUténkBa©úM emeraK nigkøinBiessrbs;va køinenaHmanlkçN³Rbhak;RbEhleTAkøinGacm_esH b¤ dMrI. ebIsinNakBa©úM emeraKenaHCa Lecithinase nig

Lipase-negative nigEsþg[eXIjCaBN’elOg-ébtg Fluorescence enAeBldak;bBa©aMgemIlnwgcegáóg Wood enaH cUrraykarN¾ :rkeXIjBYk Campylobacter ¬karkMNt;Gtþ sBaØaNbeNþaHGasnñ¦ :. karviPaKrkemeraKedaymIRkUTsSn¾CacugeRkay munnwgeFVIr)aykarN¾cugeRkay eKRtUv®tYtBinitükarbNþúH[)anl¥itl¥n; edIm,IrkemIlkarduHemeraKsuT§ ehIykar kMNt;GtþsBaØaNemeraK KYrEtRtUveKbBa¢ak;edayeFVIetsþCIvKImIsaRsþbEnßmeTot.

1- qáwHykkBa©úMemeraKEdlsgSy½EdlduHl¥ecjBIkBa©úMemeraKepSgeTot rYceFVIkarbNþúHbnþeTotenAelIfñal bNþúHravf μ IEdlsm,ÚredaycMNIGahar sRmab;eFVIetsþCIvKImI nig enAfñalbNþúHrwgragCRmalsRmab;eFVI etsþesr:Umsa®sþ nigbNþúHenAelIfñalbNþúH MacConkey edIm,IbBa¢ak;emIlBIPaBsuT§énkBa©úM)ak;etrI Edl duHmk .

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2- eFVIetsþCIvKImIbEnßmeTotedayBwgEp¥kelItaragviPaK. Binitü nigviPaKrkeQμaH)ak;etrItamry³Rbtikmμ EdlekItmanelIetsþnImYy² bnÞab;BITukeGayduHkñúgry³eBlmYyyb;mk .

CYnkaleKGacCYbbBaðamYycMnYnkñúgkarviPaKrk Salmonella nig Shigella BIeRBaHmankarERb®bYlRbtikmμCIvKImI rbs;BYkva ehIyCYnkalGacpøas;bþÚrGg;TIEsn (Antigens) CamYynwg)ak;etrI Gram-negative déTeTot. BBYk E. coli mYycMnYnEdl Non-motile, lactose-negative nigBuMRtUvkarxül; RtUv)aneKTTYlsÁal;faCa)ak;etrIEdl Bi)aknwgeFVIkarEbgEck[dac;ecjBI Shigella ehIykarviPaKelI)ak;etrIRbePTenH nwgeFVI[eyIgmanpllM)ak nigsμ úKsμajkan;EtxøaMgedayehtufaBYkvaGacbgáCm¶WraKmYl. Salmonella ebIsinNaCaetsþbzmeXIjfaCa Salmonella eKRtUveFIVkarbNþúHbnþeTotenAelI Ornithine Decarbo Xylase,

Simmons citrate, ONPG nigfñalbNþúHTwk Peptone Edlsm,ÚreTAeday Mannitol, Rhamnose,

Trehalose b¤ Xylose. BinitüemIlRbtikm μeRkayBITukeGayduHmYyyb;rYcmk rYceFVIkarkMNt;GtþsBaØaNemeraK tamry³ taragTI12. ebIsinCalT§plepÞógpÞat;faCa Salmonella ehIyeKRtUveFVIetsþesr:Umsa®sþbnþeTot . Shigella ebIsinNaetsþbzmbgðaj[eXIjfaCa Shigella eFVIkarbNþúHbnþeTotenAelI Ornithine Decarboxylase,

Phenylalanine Deaminase (ONPG sucrose nigTwk Xylose peptone). BinitüemIlRbtikm μKImI eRkay eBlTukeGayduHmYyyb; rYcviPaKrk)ak;etrIenHtamtaragTI13. ebIsinNalT§plEdlTTYl)anepÞógpÞat;faCa Shigella eKRtUveFVIetsþesr:Umsa®sþbnþeTot . BYk Shigella man 4 RbePTKW S. dysenteriae, S. flexneri, S. boydii nig S. sonnei. BYkTaMg 4 RbePTenH RtUv)aneKniymehAfa GnuRkum A, B, C nig D tamlMdab;lMeday. man Serotypes mYycMnYnRtUv)aneKkMNt; GtþsBaØaNCabeNþaHGasnñedayRbtikmμCIvKImIsaRsþ ehIyEbgEckCa Biotypes .

taragTI12 ³ RbtikmμCIvKImIrbs; Salmonella biotypes nig)ak;etrIepSg²eTot

Swarming H2S KIA Indole Lysine Ornithine Citrate ONPG Urease Mannitol Trehalose Rhamnose Xylose

Salmonella - - - + + + - - + + + +

(most serotypes)

S. choleraesuis - d - + + d - - + - + +

S. arizonae - + - + + + + - + + + +

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taragTI12 ³ RbtikmμCIvKImIrbs; Salmonella biotypes nig)ak;etrIepSg²eTot ¬t¦

Swarming H2S KIA Indole Lysine Ornithine Citrate ONPG Urease Mannitol Trehalose Rhamnose Xylose

S. typhi - +w - + - - - - + + - +

S. paratyphi A - d- - - + - - - + + + -

Edwardsiella tarda - + + + + - - - - - - -

Citrobacter freundii - + - - - + + d + + + +

Proteus spp. + + -/+ - +/- v - + - + - +

GkSrkat; ³ ± : viC¢man >95° d: viC¢man 26-27° d-: viC¢man 5-25° -: viC¢man <5° V: lT§pl ERb®bYl d: Rbtikm μexSay

H2S/KSA: begáIt hydrogen sulfide enAkñúg fñalbNþúH kligeler’s iron Lysine: lysine decarboxylase, Ornithine

decarboxylase, Citrate: fñalbNþúH Simmons citrate ONPG: β-galactosidase .

taragTI13 ³ RbitkmμCIvKImIrbs; Shigella biotypes nig)ak;etrIepSg²eTot

Oxidase Motility Indole Lysine Urease VP Citrate Ornithine Phenylalanine ONPG Sucrose Xylose

Shigella sonnei - - - - - - - + - d+ - -

Shigella, other species - - d - - - - - - - - -

E. coli, inactive strains - - d+ d - - - d- - d d- d

Providencia - + + - v - + - + d- d -

Morganella - d+ + - + - - + d+ d- - -

Hafnia alvei - + - + - d+ d- + - + d- +

Serratia marcescens - + - + d- + + + - + + -

Samonella paratyphi A - + - - - - - + - - - -

Plesiomonas shigelloides + + + + - - - + - + - -

GkSrkat; ³ + : viC¢man >95° d + viC¢man 75-95° d: viC¢man 26-74° d-: viC¢man 5-25° - viC¢man <5° Lysine:

lysine decarboxylase, VP: Voges-Proskauer, Citrate: Simmons citrate Ornithine: ornithine decarboxylase,

phenylalanine: phenylalanine deaminase: ONPG: β-galactisidase .

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taragTI14 ³ RbitkmμCIvKImIrbs; Shigella nig Serotypes

Ornithine Fermentation: Fermentation: Catalase Glucose decarboxylase lactose/sucrose mannitol gas

Shigella dysenteriae

Serotype 1 (shigae) - - - - -

Serotype 2 (schmitzii) - - - + -

Serotype 3-10 - - - + -

Shigella flexneri

Serotype 1-5, X and Y - - + + -

Serotype 6 newcastle - - - + +

Serotype 6 Manchester - - + + +

Serotype 6 Boyd 88 - - + + -

Shigella boydii

Serotype 1-13, 15 - - - - -

Serotype 14 - - - - +

Shigella sonnei + +(delayed) + + -

S. dysenteriae ¬GnuRkum A¦ man 10 serotypes. Serotype 1 KWman Catalase-negative nigbegáItCati Bul Shiga. rIÉ Serotypes déTeTotman Catalase-positive. BYk S. dysenteriae PaKeRcInBMueFVIeGayeLIg em Mannitol nig Lactose eT. S. flexneri ¬GnuRkum B¦ man 8 Serotypes. BYkenH PaKeRcIneFVIeGayeLIgem Mannito b:uEnþmineT cMeBaH Sucrose b¤ Lactose. BYk Newcastle én Serotype 6 mineFVIeGayeLIgem Mannitol eT EtvabegáItCa]sμ ½n edaysarEtkareLIgem glucose. rIÉBYk Manchester vijbegáItCaGasuIt nig ]sμ ½n edaysarkareRbIR)as; Glucose nig Mannitol . cMeBaHBYk Boyd 88 vij begáItCaGasuIt b:uEnþminbegáItCa]sμ ½necjBI Glucose nig

Mannitol eT . S. boydii ¬GnuRkum C ¦ man 15 Serotypes . eFVIeGayeLIgem Mannitol b:uEnþmineLIgem Lactose eT . S. sonnei ¬GnuRkum D¦ man 1 Serotype EckecjCaBIr :dMNak;kal : KW ³ I nig II. mankareRbIR)as; Mannitol. eKsegáteXIj ONPG viC¢man b:uEnþkareLIgem Lactose nig Sucrose KWBnüareBlelIsBI 24 em:ag ¬emIltaragTI14 ¦ .

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Yersinia enterocolitica ebIsinCalT§plénkarviPaKdMbUgcg¥úlbgðajfaCaRkum Yersinia eKRtUveFVIkarbNþúHbnþeTot enAelIfñalEdlman Ornithine decarboxylase, Voges-Proskauer ONPG, fñalbNþúH Simmons citarte nig Twk Peptone Edlsm,ÚreTAeday Sucrose, Rhamnose, Mellibiose, Sorbitol b¤ Cellobiose. BinitüemIlRbtikm μeRkay eBlTukeGayduHry³eBlmYyyb; nigeFVIkarviPaKedayBwgEp¥kelItaragTI15 . ebIsinCalT§plepÞógpÞat;nigRtwm RtUvtamlkçN³ Y. entrocolitica ehIyeKGacsnñidæanCacugeRkayfaCa)ak;etrIRbePTenH .

Vibrio cholerae ebIlT§plviPaKdMbUg faCaBYk Vibrio eKRtUveFVIetsþnigbNþúHCabnþeTotenAkñúg Ornithine ecarboxylase fñal bNþúH Simmons citrate sUluysüúg Peptone Edlman Sucrose nigTukeGayduHcMnYnmYyyb;. ebIsinCaman RbtikmμNamYykñúgcMeNamxagelIGviC©man eKRtUveFVIetsþrk Aesculin hydrolysis, Voges-Proskauer

kareLIgem Mannitol arabinose nig Arbutin. BinitüemIlRbtikm μ bnÞab;BITukeGayduHmYyyb; nigviPaKrk )ak;etrIRbePTenHtamtaragTI16 . taragTI15³RbitikmμCIv-KImIrbs; Yersinia enterocolitica nigBYk Yersinia EdlminbgáCm¶WdéTeTot

MIL Urease Ornithine VP 25 oC Citrate Sucrose Rhamnose Mellibiose Sorbitol Cellobiose

Y. enterocolitica +/v/- + + v - v - - + * +

Y. frederiksenii +/+/- + + + d + + - + +

Y. intermedia +/+/- + + + + + + + + +

Y. Kristensenii +/d/- + + - - - - - + +

Y. pseudotuberculosis +/-/- + - - - - + + - -

GkSrkat; ³ + : viC¢man >95° d: viC¢man 26-74° - viC¢man <5° V: lT§plERb®bYl MIL: fñalbNþúH motility-indole-lysine-

medium, VP 250C: fñalbNþúH Voges-Proskauer bNþúHenA kñúgsItuNðPaB 25 GgSaes Citrate: fñalbNþúH Simmons

Citrate . *

elIkElgEt biotype 5

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taragTI16 ³ Rbtikm μCIv-KImIrbs;BYk Vibrios EdlrkeXIjenAkñúglamk

Oxidase KIA MIL Ornithine Citrate Sucrose Mannitol Arbinose Aesculin Comments

butt/slant

Vibrio cholerae + K/A +/+/+ + + + + - -

V. minicus + v/A +/+/+ + + - + - -

V. parahaemolyticus + K/A +/+/+ + - - + d+ -

V. fluvialis + K/A +/d/- - + + + + -

V. furnissii + K/AG +/-/- - + + + + -

V. hollisae + K/A +/+/- - - - - + - Poor growth

Aeromonas hydrophila + A/AG +/+/+ - d + + + + Arb +/VP +

A. caviae + A/A +/+/- - + + + + d Arb -/VP -

A. veronii biotype sobria + A/AG +/+/+ - + + + - - Arb -/VP +

Plesiomonas shigelloides + K/A +/+/+ + - - - - + Arb -/VP -

GkSrkat; ³ + : viC¢man >95° d + viC¢man 75-95° d: viC¢man 26-74° - viC¢man <5° KIA: fñal bNþúH Kligler’s iron, MIL:

fñalbNþúH motility-indole-lysine-medium, ornithine: ornithine decarboxylase, Aesculin: aesculin hydrolysis, K:

Gal;kaLaMg A: GasuIt G: ]sμ ½n Arb: eRbIR)as; arbutin fermentation, VP: Voges-Proskauer .

taragTI17 ³ karEbgEck Biotypes én Vibrio cholerae

Biotype Classical El Tor Haemagglutination RbtikmμGviC¢man minduH* RbtikmμviC¢man duH* Polymyxin B ( 50 units ) Sensitive Resistant Voges-Proskauer RbtikmμGviC¢man minduH* RbtikmμviC¢man duH* Haemolysis RbtikmμGviC¢man minduH ERb®bYl * RbtikmμminRbRktIGacekItmaneLIg ebIsinNaCamanesr:Um anti-Vibrio cholerae serogroup O1 BiessmYy cUreFVIetsþ agglutination rh½s enAelIbnÞHkBa©k;. kñúgkrNIeXIjmankkrtamry³EPñkTeT enaHeKeFVIkarsnñidæanfaCa “Vibrio cholerae O1”. ebIsinNaCaK μan Antiserum BiessenHeT b¤k¾karviPaKminc,as;las;RtUvbBa¢ÚnemeraKenHeTAkan;mnÞIrBiesaFn_ bEg¥kNamYyepSgeTot . karEbgEck V. cholerae O1 CaRbePT Classical nig El Tor biotypes enaHBuMmansar³sMxan;kñúgkarBüa)al b¤Tb;sáat;eT b:uEnþcMeBaHkarEjkrkemeraKxøH vaKYrEteFVI tamry³etsþNamYydUcxageRkamenH ¬taragTI17¦ .

83

etsþ Haemagglutination edayRbeyal

1- erobcMl,ay 2/5° énRKab;QamRkhmrbs;stVman; b¤ ecom edayykeTAbgVileRcIndg niglay CamYynwgesr:UméRb.

2- EbgEckbnÞHkBa©k;Edls¥atCaeRcInkaer:edayeRbIexμAéd rYcdak;l,ayRKab;QamRkhmmYy Loop

eBjkñúgRbeLaHkaer: nImYy² . 3- dak;kBa©úMemeraKEdlqáwHykmkBIGNþaténfñalbNþúH KIA rYclayCamYyRKab;QamRkhmkñúgRbeLaH

kaer:nImYy² . duMkMNkrbs;RKab;QamRkhmnwgekIteLIgenA 30-60 vinaTICamYynwgBYk El Tor biotype. emeraKEdleFVI eGayman Haemagglutinating ¬El Tor¦ nig Non-aemagglutinating EdleKdwg KYrEtRtUveKeRbIR)as; sMrab;epÞógpÞat;enAerogral;etsþl,ayRKab;QamRkhmf μ I²eTot. emeraKEdleKeTIbEtbNþúH)anfμ I² énBYk Classical biotypes CaTUeTAetsþ Haemagglutination EtgEtGviC¢man EtcMeBaHBBYk Classical biotypes cas;²enAkñúgmnÞIrBiesaFn¾vij Gacnwgminpþl;[nUvlT§plGviC©maneT. etsþeTAelIPaBkbnwg Polymyxin B

1- yk)ak;etrIEdlbNþúHenAkñúgfñalbNþúHTwk Peptone mYyyb;mYy LoopeBj eTAdak;bNþúHkñúgfñal bNþúH Mueller-hinton b¤fñalbNþúH Meat-extract .

2- dak;fasEdlman 50 Éktaén Polynyxin B enAkNþalfñalbNþúHenaH . 3- dak;fñalbNþúHEdlerobcMrYcenaHenAkñúgTUTwkkkry³eBlmYyem:ag . 4- TukeGayvaduHenAkMedA 35 GgSaes ry³eBlmYyyb; .

BBYk Classical nig El Tor Biotypes EdleKsÁal;c,as;KYrEtRtUv)aneKeRbICaetsþsRmab;®tYtBinitü. BBYk Classical biotypes kbnwg Polynyxin B ehIyeKeXIjmantMbn;s¥atK μanemeraKduHmYyenACuMvij Disk. rIÉBYk El Tor vijFn;CamYynwg Polynyxin B ehIyBuM)anbegáIt[manCatMbn;KμanemeraKenACuM vij Disk eT . Campylobacter jejuni nig Campylobacter coli manetsþcMnYntictYcb:ueNÑaHEdlRtUv)aneKeRbIenAkñúgmnÞIrBiesaFn_KøInikedIm,IviPaKrkBYk Campylobacter nigGnu- Rkum (Subspecies) rbs;va. eKGaceFVIkarEbgEckBBYk Campylobacter CaBIrRkumedayEp¥keTAelIkarduH lUtlas;rbs;vaenAkñúgsItuNðPaBepSg²Kña³ BYkFn;nwgkMedAEdlduHenAsItuNðPaB 42-43 oC nig BYkEdlminFn; nwgkMedAEdlduHenAsItuNðPaB 15-25 oC .

84

BBYkEdlFn;nwgkMedA KWCaBBYk Campylobacter jejuni GnuRkum Jejuni, C. coli, C. lari, C. upsaliensis

nigBYk C. hyointestinalis. C. coli nig C. hyointestinalis Fn;nwgGasuIt Nalidixic EdlxusGMBI C. jejuni

, C. coli nig C. upsaliensis Edlsg;suIb (Sensitive). C. jejuni GnuRkum jejuni C. coli nig C. lari Fn; CamYynwg Cefalotin EdlpÞúyGMBI C. hyointestinalis nig C. upsaliensis Edl Sensitive. PaBxusKñaén RkumTaMgGs;enHKWEp¥kelIkarbegáIt H2S nig Hippurate hydrolysis enAelIfñalbNþúH KIA. rIÉBBYkEdlminFn;nwgkMedAvij KWmanBBYk C. jejuni GnuRkum doylei, C. fetus nig Arcobacter butzleri . rIÉBBYk C. jejuni GnuRkum Doylei nwgminduHenAsItuNðPaB 15 oC nigminduHpgEdrenAsItuNðPaB 25 oC Et C.

fetus vij nwgduHenAsItuNðPaB 25 oC b:uEnþminduHenAsItuNðPaB 15 oC eT nigxusGMBI A. butzleri EdlduHenA sItuNðPaBTaMgBIrxagelI. A. butzleri Fn;nwg Cefalotin xN³eBlEdlGnuRkum Doylei nig C. fetus

Sensitive ¬emIltaragTI18 ¦ . karviPaKedayeRbIetsþesr:Umsa®sþ (Serological identification) Salmonella karEbgEcknigkarehAeQμaHrbs; Salmonella )anpøas;bþÚrCaeRcIndgehIyk¾enAEtbnþBiPakSa. GaRs½yelIkar ehAeQμaHnaeBlbc©úb,nñ eKeFVIkarEbgEckBYk Salmonella Ca 6 GnuRkumtUc²eTot ¬eKGacehApgEdrfa Sub-

species¦ edaymanrab;bBa©ÚlTaMgRkumcas; Arizona pgEdr. GnuRkum1 RtUvnwgRkum Salmonella BitR)akd Edlmanrab;bBa©Úl Salmonella typhi, S. paratyphi A, S. enteritidis, Styphimurium nig S. cholerae-

suis. GnuRkumenHEbgEckCaCag 2000 Serotypes bnþeTotEdlxusKñaBImYyeTAmYyedaysar Antigenic

Formula rbs;va ¬Gg;TIEhSn O, H nig Vi ). Serotypes enAkñúgGnuRkum1 edayehtufavaCa RbePTBitR)akd enaHRtUv)aneKbnþehAeQμaHfa Salmonella Subgroup 1 serotype typhimurium b¤ eKehAedaysamBaØfa S. typhimurium . 99° én Salmonella EdleKrkeXIjenAelImnusSCaBYkGnuRkum1 .

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taragTI18 ³ karviPaKedayRbtikm μCIv-KImIedIm,Irk Campylobacter enAkñúglamk

Growth at H2S/KIA Hippurate

hydrolysis Nitrate

reduction Susceptible to

15 oC 25 oC 42 oC Nalidixic acideb Cefalotinc

Campylobacter jejuni - - + - + + S R

Subsp. jejuni

C. jejuni subsp. Doylei - - - - d - S S

C. coli - - + + - + S R

C. lari - - + - - + R R

C. upsaliensis - - + - - + S S

C. fetus subsp. Fetus - + - - - + R S

C. hyointestinalis - + v + - + R S

Arcobacter butzleri d + + - - - + v R

GkSrkat; ³ + : viC¢man >95° d + viC¢man 75-95° d: viC¢man 26-74° d-: viC¢man 5-25° - viC¢man <5° V: lT§plERb®bYl S: sg;suIb R: Fn; ¬ er:suIsþg; ¦ H2S/KIA: fñalbNþúH Kligler’s iron

aEtBN’sVaycas;Edlcat;TukfaviC¢man

bfasGasuIt nalidixic 30 mIRkURkam cfas cefalotin 30 mIRkURkam dcefalotin GviC¢man b¤ viC¢manexSay enAelIfñalbNþúH Kligler’s iron

Gg;TIEhSnsMxan;²sRmab;viPaKrk Serotypes rbs;BYk Salmonella KWGg;TIEhSnenAnwgsMbk O (Somatic O) nigGg;TIEhSnenARbemay H (flagellar H). Gg;TIEhSn O KWCaGg;TIEhSnEdlmanTaMgenAelIemeraK Motile

nig Nonmotile ehIyFn;nwgkardutkMedA cMENkGg;TIEhSn H vijmanEtenAelI)ak;etrIEdl motile Etb:ueNÑaH ehIyvanwggayxUcxatedaysarkMedA. BYk Salmonella mYyPaKFM CaBYkBIrvKÁ (Diphasic) enAkñúgsPaB

Motile ehIyGacbgðajGg;TIEhSnBIr TRmg;CavKÁTI1 nig2. Gg;TIEhSnTaMgBIrvKÁenHman Gg;TIEhSn O dUcKña Et pþl;[Gg;TIEhSn H xusKña. edIm,IviPaKrk Serotypes rbs; Salmonella CakarcaM)ac; EdleKRtUvrkGg;TIEhSn H BiessTaMgBIrvKÁ. TaMgGs;enHGacminEmneKrkeXIjTaMgGs;enaHeT ehIykarlubbM)at;vKÁGacnwgcaM)ac;edIm,I bBa¢ak;ry³eBlsMgM.

86

Gg;TIEhSn O RtUv)aneKkMNt;yktamelxGara:b; . Gg;TIEhSn H vKÁ1 RtUv)aneKkMNt;tamGkSr r:UmuaMgtUc rIÉ Gg;TIEhSn H vKÁ2RtUv)aneKkMNt;yktamelxGara:b;. ]TahrN_ rUbmnþGg;TIEhSnrbs; S. typhimurium KW 1,

4, [5], 12 : i : 1, 2 EdlkñúgenaHGg;TIEhSn O KW 1, 4, 5 nig 12 rIÉvKÁTI1 énGg;TIEhSn H KW “ i ” nigvKÁTI2én Gg;TIEhSn H KW 1 nig 2. elxEdleRbIR)as;enAkñúgvg;Rkckbgðajfa Gg;TIEhSnenHGacGvtþman nigGg;TIEhSn EdlmanKUsbnÞat;BIxageRkambBa¢ak;fa Gg;TIEhSnenHlayLMCamYynwg Lysogenic Coversion edaysar Bacteriophage. karpøas;bþÚrrcnasm<½n§Gg;TIEhSnenHGacekItmaneLIgEtkñúgkrNIman Bacterio-phage

b:ueNÑaH ehIyRbEhlCakarxusKñaEtmYyKt;rvag Serotypes mYycMnYn. BYkSalmonella RtUv)aneKdak;eTAkñúgRkumnana eTAtamvtþmanrbs;Gg;TIEhSn OmYycMnYn. RkumTaMgenHCaerOy² RtUv)aneKsMedAeTArkRbBn§½rbs; Kauffmann-White . GkSrr:UmuaMgFMsMKal;Rkum O. enAkñúgRbBn§½edImRkumTaMg enaHman A, B, C, D nig E. ehIyEdleRkaymkRkumTaMgenaH)anBRgIkeTA A-Z edayman GnuRkum 4 kñúgRkum C Rkum D man 3 E man 4 nigRkum G man 2 GnuRkum eTot. Rkum O RtUv)aneKkMNt;edaysarEtvtþmanrbs; Gg;TIEhSn O dUcerobrab;xageRkamenH ³ Rkum³ A B

1 (a) C1 C2 D E1 F Gg;TIEhSn³ 2 4;5 6;7 6;8 9 3;10 11 eKeXIjmankarERb®bYlepSgeTotenAkñúgrcnasm<½n§rbs;Gg;TIEhSn³ eKeXIjmankarERb®bYlrUbrag rbs;kBa©úM emeraKBIrelageTAeRKIm nigvtþman b¤ Gvtþmanrbs;Gg;TIEhSn Vi. enAeBlEdlman vtþman Gg;TIEhSn Vi Gg;TIEhSn Vi enH)anTb;Tl;min[manRbtikmμkkr (Agglutination) edaysar Homo-logous O

Antiserum. Gg;TIEhSn Vi CaTUeTAeKrkeXIjenAelI)ak;etrIEdleTIbEtduHfμ I²ehIyva nwg)at;bg;eTAvijy:ag rh½scMeBaHfñalbNþúHEdlrkSaTukyUréf¶ . Gg;TIEhSn Vi KWCaEpñksMxan;mYykñúg karviPaKrk S. typhi EdlCa erOy²mineFVI[kkredaysarEt Heterologous H Antisera.

rebobrviPaKrkGg;TIEhSnsMbk O (Somatic O)

kareFVIetsþ Agglutination enAelILampÞal; 1> RtUvykesr:UméRb nigRbtikreTATukkñúgsItuNðPaBmnÞIrBiesaFn_muneBlcab;epþImeFVIetsþ 2> dak;esr:UméRbmYytMNk;elILamEdls¥at . 3> CamYynwg Loop s¥atKμanemeraK qáwHykkBa©úMemeraKEdlduHelIfñal-bNþúHEdlmansMeNIm

rYcdak;eTAkñúgtMNk;Twkesr:UméRb rYckUr[sBVeGayl¥k;kkresI μsac; .

1 (a) RKab; Salmonella GnuRkum B man Gg;TIEhSn 4 b:uEnþmanxøHmanGg;TIEhSn 5

87

4> Binitül,ayemeraKenHCamYyEkvBRgIk b¤ BinitünwgmIRkUTsSn_edayeRbIEkvBRgIkTab (x10) edIm,IbBa¢ak;fa l,ayenHnwgminkkedayÉkÉgCamYynwgesr:UméRb.

5> yk 10 mIRkUlIRténesr:Um Salmonella Polyvatent O antiserum ( A-I and Vi ) rYc dak;vaenAelILamEdlenAEk,rl,ayemeraKEdllayrYcxagelI.

6> laybBa©ÚlKñarvag Antiserum nig l,ay)ak;etrI rYcTajLameTAmuxeTAeRkaycMnYn1naTI. BinitürkemIldMukMNkenAeRkamBnøWePøIgRKb;RKan;. dMukMNkc,as;las;EdlEsþgecjenAeBl enHeFVI[eKsnñidæanfa lT§pletsþviC¢man .

7> ebIsinCalT§plviC©man eKRtUveFVIetsþelILammþgeTotCamYynwg Single-factor Anti-

serum. BBYk Salmonella mYycMnYn manGg;TIEhSnenAnwgsMbk (Vi) enAeBlvaenArs; b¤minRtUveKkMedA KWminman RbtikmμkkrCamYynwg Antisera Rkum C1 (O:6,7) b¤ Rkum D (O:9). kMedAl,ay)ak;etrI enAkñúgTwkBuHry³eBl 20 naTIedIm,IkMeTcGg;TIEhSn Vi ecj. Tukva[RtCak; nig Ejkyk)ak;etrIedaybgVilrYc eFVIl,ayCafμ Ieday layCamYyTwkesr:UméRbfμ I² nigeFVIetsþCamYynwg Antisera dEdl . rebobrkGg;TIEhSn H karviPaKCaelIkdMbUgrk Gg;TIEhSn elIRbemay H GacRtUv)aneKeFVItamry³etsþeFVI[kkr (Agglutination) enAelIbnÞHkBa©k;dUc)anerobrab;kñúgrebobénkarGnuvtþn_rkGg;TIEhSn O (somatic O antigen) Edr. mþgmáalva mansar³sMxan;EdrkñúgkarbegáIn Motility rbs;etsþemeraKedayeFVIkarepÞrCabnþbnÞab;enAkñúgfñalbNþúH Edlsm,Úr cMNIGaharBak;kNþalTn;-rwg ¬“Swarm agar” emIlxageRkam¦. Antisera EdlRbqaMgnwgGg;TIEhSnTaMgenaH mandak;lk;enAkñúgTIpSar. EteTaHCa y:agNak¾edaykarlubbM)at;vKÁmYyRtUveKtMrUveGayeFVI ebIsinCaGg;TIEhSn H TaMgBIrRtUv)aneKKitfa manGtßRbeyaCn_kñúgkarviPaKrkeQ μaH)ak;etrIenaH. TaMgenHCaerOy²RtUv)an eFVICakar RtLb;vKÁ ( Phase inversion ) edayeRbIesr:UmEdleKpliteLIgsRmab;kic©karenH1 (1) .

1> erobcMfñalbNþúHBak;kNþalrwg-ravEdlmanpÞúk 0/2-0/4°éncah‘Yyrbs;fñalbNþúH. Efmfñal bNþúH 1ml eTAkñúgbMBg;sak.

2> CMnYsqñúkrbs;bMBg;EkvsRmab;eFVIetsþedayrmUrsMLI . 3> rMlayfñalbNþúHkñúgTwkBuH rYcepÞrfñalbNþúHEdlrlaydak;kñúgbMBg;Ekv rYcrkSaTukkñúgepIgTwk

450C ry³eBl 30 naTI.

1(1) Gacrk)anenAÉ Statens Serum Institut, 5 Artillerivej, 2300 Copenhagen S, RbeTsdaNWm:ak

88

4> kt;taelxrbs;vtßúviPaK nig H antisera ( H:b, H:i, nig H:1,2) enAelIbMBg;Ekv. bBa©ÚlbMBg; sakEdlsMrab;eFVIkar®tYtBinitü (Control test-tube) .

5> Efm Heterologous H antiserum 10 mIRkUlIRténetsþb®Ba©as;vKÁnImYy² eTAelIfñalbNþúH EdlTak;TgrYc RkLúkbMBg;TIbedayRbugRby½tñ cugbBa©b;TukfñalbNþúHenH[rwgedayrkSa sßanPaBCaCRmal.

6> eFVIl,ay)ak;etrIEdlbNþúH)an[xab;enAkñúgesr:UméRb rYcqUtl,ay)ak;etrIenHenAelICRmalén fñalbNþúHenH edayeRbI Loop nigdak;bNþúHry³eBlmYyyb; .

7> edayeRbI Loop yk)ak;etrIecjBIfñalbNþúHRtg;CRmal rYcdak;eTAkñúg 1 mIlIlIRténesr:UméRb 8> edayeRbI Loop yk 10 mIRkUlIRtén Heterologous H antisera mYy rYcdak;enAelIbnÞH

kBa©k;Ek,rl,ay)ak;etrI . 9> kUrlaybBa©ÚlKña antiserum nig l,ay)ak;etrI rYcep¥ógp¥gbnÞHkBa©k;cuHeLIgBImuxeTAeRkay

cMnYn 1 naTI. BinitüemIlkkreRkamBnøWRKb;RKan;mYy . kalNaeKeXIjkkrc,as;las;enAeBl enHbgðaj faetsþenaHviC¢man .

10> eFVIetsþ Agglutination mþgeTotCamYynwg Heterologous Antisera epSgeTot ebIsin RtUvkarnigviPaKrk Serotype edaymanCMnYyGMBIlMhUrdüaRkam.

89

rUbPaBTI8 ³ karviPaKrkBYk Samonella edayetsþesr:Umsa®sþ

*cMeBaHEtkrNIEdl Anti-Vi man agglutination CamYy)ak;etrI RtUves¶arl,ay)ak;etrI rYceFVIetsþmþgeTotCamYy Antiserum O:D

90

Salmonella typhi edIm,IbBa¢ak;karkMNt;GtþsBaØaNemeraKedayetsþCIvKImIsaRsþ eKetsþCamYynwg Antisera Vi ORkum D (O:D) nig H:d. karbNþúHemeraKEdlkkrCamYy Vi GacGviC¢manCamYy O:D edaysarEt]bsKÁEdlbegáIteLIgeday sarEtGg;TIEhSn Vi. kMeTcGg;TIEhSn Vi edaykMedAl,ayry³eBl 20naTIeRkamkMedA 1000

C nigeFVIetsþ CamYynwg O:D antiserum mþgeTot. ebIsinNaviC©manCamYynwg Vi O:D nig H:d cUrraykarN¾fa³ “Salmo-

nella typhi”. ebIsinviC¢manEtCamYy O:D cUrraykarN¾fa³ “Salmonella Rkum D ”. Salmonella paratyphi A edIm,IbBa¢ak;karkMNt;GtþsBaØaNemeraKedayetsþCIv-KImIsaRsþ eKRtUveFVIetsþCamYynwg Salmonella Rkum A

Antiserum. ebIsinCaviC¢manCamYyRkum A Antiserum eFVIetsþbnþCamYynwg H:a Antiserum. ehIyebIsin NaviC¢man cUrraykarN¾fa³ “Salmonella paratyphi A” . ebIsinCaGviC¢manCamYy H:a cUrraykarN¾fa³ “Salmonella Rkum A”. ebIsinCa Non-motile enaHGacCa S. flexneri RbePT 6 b¤ S. boydii RbePT 13 b¤ 14 ehIyeKKYrEteFVIetsþCamYynwg Shigella Antisera B nig D . Salmonella Serotypes déTeTot enAeBlEdletsþbBa¢ak;fa ³ Ca Salmonella ehIy eFVIetsþCamYy Salmonella O Rkum A, B, C, D nig E

Antisera .

• ebIsinCaviC¢manCamYyRkum B cUretsþCamYynwg Flagella Antiserum H:b, H:i, H:1,2. ebI viC¢manCamYynwg H:b, Antiserum )ak;etrIenaHGacCa S. wien b¤ S. paratyphi B . eKGac Ejk S. wien ecjBI S. paratyphi B edayeFVIetsþCamYynwg H:1, w nig H:2 Antisera ¬ebI Gac¦. S. wien man Rbtikm μ Agglutination CamYynwg H:1, w cMENkÉ S. paratyphi B manRbtikmμCamYynwg H:2.

• ebIsinCaviC¢manCamYynwg H:i b¤ H:1,2 Antiserum eFVIkarbNþúHb®Ba©as;vKÁ Phase Inversion

nigeFVIetsþCamYynwg Seterologous H Antiserum. ebIsinCaviC¢maneKGacsnñidæanfaCa S.

typhimurium. ebIGviC¢maneKGacsnñidæanfa Ca “Salmonella Rkum B” . • ebIsinCaviC¢manCamYyRkum C Antiserum snñidæanfaCa “Salmonella Rkum C ”. • ebIsinCaviC¢manCamYyRkum D Antiserum eFVIetsþCamYy Vi, H:d nig H:m Antisera. ebIsin

CaviC¢manCamYyVi, H:d eFVIkarsnñidæanfaCa “ Salmonella typhi ”. ebIviC©manCamYynwg H:m snñidæanfa Ca “Salmonella enteritidis ”. ebIsinCaviC¢manCamYynwg Vi, H:d nig H:m snñidæanfa Ca “ Salmonella Rkum D ”.

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• ebIsinetsþCIv-KImIbgðajfaCaBYk Salmonella b:uEnþGviC¢manCamYyRKb;Rkum O Antisera eKRtUv snñidæanfa {sn μt;faCaBYk Salmonella } ehIybBa¢ÚneTAkan;mnÞIrBiesaFn_bEg¥kfñak;Cati.

Shigella Shigella GacRtUveKEbgEckCa Serogroups nig Serotypes edayBwgEp¥kelIetsþ Agglutination elIbnÞH kBa©k;nigbMBg;TIbCamYynwgO-Antisera Cak;lak;. kareFVIetsþ Agglutination enAbnÞHkBa©k;CaTUeTAvaRKb;RKan; ebIsinCalT§plEdlTTYl)anc,as;las;. l,ayGg;TIEhSnKYrEtRtUv)aneKykecjGMBIfñalbNþúHEdlminCeRmIs dUcCaenAelIfñalbNþúHFm μta b¤ KIA ehIyl,ay)ak;etrIenaHeTotesat RtUvTTYlkarBinitü[)anhμt;ct;elI Agglutination edayÉkÉg (Auti-agglutination) muneBldak;layCamYynwg Antiserum . kareFVIetsþCamYynwg Antisera rbs; Shigella Rkum A, B, C nig D

ebI Agglutination ekIteLIgCamYynwgRkum A eFVIkarbkRsaylT§plfaCa “Shigella dysente-

riae ” . eFVIetsþbnþCamYynwg S. dysenteriae RbePT 1 antiserum . ebIsinCaviC¢manRtUvbk- Rsayfa “Shigella dysenteriae RbePT 1”.

ebI Agglutination ekIteLIgCamYynwgRkum B RtUvbkRsaylT§plfaCa “Shigella flexneri ”. ebI Agglutination ekIteLIgCamYynwgRkum C RtUvbkRsaylT§plfaCa “Shigella boydii”. ebI Agglutination ekIteLIgCamYynwgRkum C RtUvbkRsaylT§plfaCa “Shigella sonnei ” .

mþgmáalBYk Shigella BuMmanRbtikmμ Agglutination CamYynwg Homologous Antiserum eT edaysarEt vtþmanrbs;Gg;TIEhSn K. kMedAesr:UméRbCamYy)ak;etrIenAkñúgTwkBuHry³eBl 20 naTIrYceFVIetsþmþgeTot. etsþ elIkeRkayenHGacnwgpþl;lT§plb®Ba©as;mkvij . BYk)ak;etrI Gram-negative déTeTotGacmankarpøas;bþÚrGg;TIEhSnCamYynwgBYk Shigella nigGacpþl;Ca lT§pl Agglutination viC¢man-xusCamYynwgesr:UmsRmab;rkRbePT Shigella. Rbtikmμ-ExVg ( Crossre-

action) EdleKCYbjwkjab;KWBYk Plesiomonas Shigelloides CamYynwg Shigella vKÁ 1 nigRkumxøHén Halfnia CamYynwg Shigella flexneri serotype 4a. b:uEnþGVIEdlsMxan;bMputenaH KWRbtikmμExVgCamYy nwgBBYk Diarrhoeagenic E. coli . Yersinia enterocolitica Yersinia enterocolitica manGg;TIEhSn Somatic O mYycMnYnEdlRtUv)aneKeRbIR)as;kñúgkarEbgEckBBYkenH eTACay:agtic 17 Serogroups eTot . BBYk Serotype EdlbgáCm¶Wjwkjab;CageKenARbeTskaNada enATVIb GWr:ub Cb:un KWBBYk Serotype O3 . karbgáCm¶WEdlbNþalmkBI serotype O9 RtUv)aneKrkeXIjenARbeTskñúg tMbn; Scandinavia rIÉ Serotype O8 vij swgEtTaMgGs; RtUv)aneKrkeXIjenAshrdæGaemrik. eKeXIj Rbtikmμ-ExVg (Cross-reaction) ekItmanpgEdrrvag Y. enterocolitica O9 CamYy Brucella spp..

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karlakpøÚvdegðImEpñkxagelI esckþIepþIm pøÚvdegðImEpñkxagelIlatsn§wgBIbMBg;xül; (Larynx) rhUtdl;rn§RcmuH nigman Oropharynx nigNasopharynx CamYynwgRbehagTMnak;TMng KWrn§suInus (Sinuses) nigRtecokEpñkkNþal (Middle). RbBn§½pøÚvdegðImEpñkxag elIGacCakEnøgsMrab;RbePTénkarbgáeraKmYycMnYn³

- rlakbMBg;k (Pharyngitis) CYnkalGacbnþ[rlakGamIdas (Tonsillitis) nigpþl;[eTACa :QWbMBg;k : .

- Nasopharyngitis - rlakRkdasRtecokkNþal ¬Otitis media ) - rlaksInus ¬Sinusitis) - rlakkenøIt ( Epiglottitis )

RKb;krNIrlakxagelI eKCYbRbTH Pharyngitis jwkjab;CageK. ebIsinCaBuM)anBüa)al[)anRtwmRtUveTenaH vaGacbNþal[manplvi)akF¶n;F¶r. manEt Pharyngitis b:ueNÑaHEdlnwgRtUvelIkykmkBiPakSaenAkñúg esovePAenH . esÞIrEtRKb;krNI Pharyngitis bNþalmkBIvIrus. EteTaHCay:agNak¾eday k¾manRbEhl 20° bNþalmkBI )ak;etrI ehIyCaTUeTATamTar[mankarBüa)al[)anRtwmRtUvCamYynwgfñaMGg;TIb‘Íy:UTik (Antibiotics). kñúgnam CaRKUeBTüBüa)al eKBi)akeFVIkarEbgEckkarlakEdlbNþalmkBI)ak;etrI b¤vIrus Etmñak;ÉgNas; dUecñHral;kar Büa)alTaMgLayRtUvBwgEp¥kelIlT§plviPaK nig Binitürk)ak;etrI . kareFVIeraKvinicä½yelI)ak;etrIEdlbNþal[rlak Pharynx manPaBsμ úKsμaj edayFatuBitkñúg Oropharynx )an )ak;etrIeRcInRcbUkRcbl;bBa¢ÚlKña TaMg Flora Fm μtaEdlRtUvkarxül; nigTaMgminRtUvkarxül;. Flora Fm μtaCa TUeTAmancMnYneRcInCagBYkbgáCm¶W dUcenHtYnaTIrbs;Gñkbec©keTsxag)ak;etrIsa®sþ (Bacteriologist) KWeFVIkar EbgEckrvag)ak;etrI»kasniym nig)ak;etrIEdlbgáCm¶W. ebIsinCaGac KWmanEtlT§plmnÞIrBiesaFn¾ )ak;etrI-saRsþEdleKKYrpþl;[RKUeBTüBüa)al. emeraKFmμtaenAkñúg Pharynx emeraKFm μtaEdlmanenAkñúg Pharynx mancMnYneRcInEdleKminKYreFVIkarviPaKeBjelj b¤pþl;CalT§pldl; RKUeBTüeLIy enAeBlEdleKrkeXIjkñúgkarbNþúHvtßúviPaKEdleKykecjBIbMBg;k.

93

emeraKTaMgenaHman ³

Viridans (α-haemolytic ) Streptococci nig Pneumococci Neisseria spp. minbgáCm¶W Moraxella ¬BImuneKehAfa Branhamella¦ catarrhalis ¬enHGacCa)ak;etrIEdlbgáCm¶WelIpøÚv

degðImpgEdr¦. Staphylococci ( S.aureus nig S. epidermidi ) Staphylococci ( S.aureus nig S. epidermidis )

Diphtheroids ( elIkElg C. diphtheriae ) Haemophilus spp. BBYkpSitmYycMnYn ( Candida spp.) kñúgcMnYnkMNt;mYy

BBYkkuksuI Gram-positive nig)asuI Gram-negative minRtUvkarxül;mYycMnYn. BYk spirocha-

tes nigBYkmanTRmg;Casrés ( Filamentous Forms ) . enAkñúgbMBg;krbs;GñkCm¶Wv½ycas; GñkCm¶WmansuaMcuHexSay nig GñkCm¶WkgVHGaharUbtßmÖ CaBiessenAeBlEdlBYkeK eRbIR)as;Gg;TIb‘Íy:UTik eKGaceXIjmankarelcecjnUv)ak;etrImYycMnYndUcCaBBYk Enterobacteriaceae ¬man

Escherichia coli, Klebsiella spp. CaedIm¦ nigmanBYkRkum Gram-negative mYycMnYn (Acinetobacter

spp. nig Pseudomonas spp.) CaedIm. manemeraKmYycMnYndUcCa S. aureus b¤ Candida spp. b¤ BYkpSit epSgeTotmYycMnYn k¾eKeXIjmanduHenAelIGñkCMgWRbePTenHEdr. eTaHbICaBYkGtisuxumR)aNTaMgenHminbgáeGay man Pharyngitis k¾edayelIkElgEtkrNIEdlmanrYmCamYynwg Granulocytopenia k¾eKKYrEtpþl;Bt’manenH eTAkan;RKUeBTüBüa)alEdr edaysarEtmþgmáalvtþmanrbs;BYkenHGacbNþal[rlakpøÚvdegðImEpñkxageRkam ¬]TahrN_ rlaksYt¦ b¤ Bacteraemia. EteTaHCay:agNak¾eday k¾eKminKYreFVIetsþGg;TIb‘Íy:URkam CaTUeTA Fm μtacMeBaHkarduHdalénGtisuxumR)aNTaMgenHEdr. )ak;etrIEdlbgá[rlak Pharynx Streptococcus pyogenes ¬Lancefield group A¦KWCaGñkbgá[rlak Pharynx nigGamIdal; jwkjab; CageK ehIyCaBiesseTAelIkUnek μg ¬5-12 qñaM ¦. enAeBlEdlkarrlak Pharynx edayBYk Streptococcus enHekItmanCamYynwglkçN³Es,kBN’RkhmenaH GñkCMgWenHRtUveKniyayfa manCMgW Scarlet fever. enAelI Tark karrlakbMBg;kedayemeraK Streptococcus GacCajwkjab;Tak;Tgnwg Nasopharynx ehIymanecjxÞúH tamRcmuH.

94

BYk Streptococci EdlminEmnCaRkum A, β-haemolytic ¬]TahrN_ Rkum B C nig G¦ KWCaBYkEdlminbgáCm¶W jwkjab;eTAelI Pharynx eT b:uEnþebIsinCaeKrkeXIjeKRtUvpþl;Bt’mandl;RKUeBTü b¤evC¢bNÐit . karrlak Pharynx EdlbNþalmkBI S. pyogenes ebIsinNaeKmineFVIkarBüa)al[)anRtwmRtUveTenaH vaGacnwgbgá [ manpllM)akepSgeTotdUcCa eFVI[QWsnøak; nigmþgmáalbNþal[rlaktMrgenam. kareFIVkarviPaKrk nigkar Büa)aledayeRbIR)as;fñaMGg;TIb‘Íy:UTikRbqaMgnwg S. pyogenes KWCakic©karEdlRtUvykcitþTukdak;Cabzm kñúgkar karBareraKQWsnøak; . Corynebacterium diphtherial KWCamUlehtuénCm¶Wxan;søak; EdlCaCMgWEdlmaneRbva:Lg;x<s;CaRbcaM enAtam tMbn;mYycMnYnenAkñúgRbeTsCaeRcIn. )ak;etrIenHGacsayPayratt,atenAkñúgRbeTsCaeRcIn EdlkmμviFIcak;fñaM bgáarRtUv)ankat;pþac;. CalkçN³sMKal;Biess ¬mankrNIelIkElgxøH¦ C. diphtherial )anbegáIt[manCa lkçN³Cak;lak;énkarbgáeraKEdlEsþgecjCabnÞHBN’s-RbepH esIþg²elIEs,kRtg;kEnøg EdlmanbgáeraK ¬Pharynx GamIdal; RcmuH b¤ Larynx¦. Cm¶Wxan;søak;KWCaCm¶WF¶n;F¶rmYy ehIykareFVIeraKvinicä½yKWRtUvBwgEp¥kelI sBaØaKøInikEdl)anrkeXIj. evC¢bNÐit b¤RKUeBTüKYrEtesñIsMueFVIkarbNþúHCalkçN³Cak;lak;mYycMeBaH)asIu Diph-

theria enH. karrlak Pharynx EdlbgáeLIgedayBYk Gonococci RtUv)aneKykcitþTukdak; edaysarmankarekInnUvkar bgáCm¶WedaysarEt)ak;etrIRbePTenHenAkñúgRbeTsmYycMnYn edaymanGRtaRsbKñaénkrNIeraKRbemHmat;s,Ún nig bgðÜrenam. karbNþúHrk Gonococci GMBIvtßúviPaKEdlykecjGMBIbMBg;k KYrEt)aneKeFVItamkaresñIsMurbs;RKUeBTü edayeRbIR)as;fñalbNþúHCeRmIsEdlsmRsb ¬fñalbNþúH Thayer-Martin¦ . Vincent angina b¤dMe)ArlYy Pharynx KWlkçN³BiessmYyEdlkRmCYbRbTH EdlEsþgeLIgeday dMe)ArlYy edayman b¤Kμan Pseudomembrane. karbgáCm¶WenH GaclayLMKña enARtg;kEnøgbgáCMgW CamYynwgBYk Flora

EdlminRtUvkarxül;dac;xat EdlPaKeRcInRKbdNþb;eday Fusiform Gram-negative manragCarMBat; nigCa rYj²dUcrWsS½ EdlCaTUeTAKWCa Fusobacterium spp. nig Treponema vincentii nigGacBBYkepSg²eTot. eTaHbICa)ak;etrITaMgBIrRbePTxagelIRtUv)aneKsÁal;fa Ca)ak;etrImanRbeyaCn_enAkñúgmat;k¾edayEtvtþmand¾eRcIn elIslubénBBYkenHenAkñúgkar bMBak;BN’ Gram EdlykecjGMBIvtßúviPaK kñúgkrNIdMe)AEdlrlYy KYrEtRtUv raykarN¾fa “Fusospirochaetal Complex”.eKmincaM)ac;eFVIkabNþúHelIfñalEdlminRtUvkarxül; edIm,IeFVIkar bBa¢ak;GMBIkareFVIeraKvinic½äytamry³karBinitüedaymIRkUTsSn_enHeT eRBaHvamankarlM)akkñúgkarbNþúH nigRtUveRbI ry³eBlyUr . EteTaHCay:agNak¾eday vtþmanénPaBsμ úKsμajenH min)anminrab;bBa©ÚlesckþIRtUvkarviPaKrk emeraKbgáeraKdéTeTot enaHeT CaBiess S.pyogenes.

95

eTaHbICavtþmanbnþicbnþÜcrbs; C.albicans b¤BBYk Candida d¾éTeTot RtUv)aneKKitfaCa Flora Fm μta enAkñúg mat;k¾eday eraKpSitkñúgmat;nwgekItman enAeBlEdlcMnYnemeraKenHekIneLIgelIslub enAkñúgsßanPaBCMgWmYy cMnYndUcCa kñúgkrNITarkEdlkgVHGaharrUbtßmÖekItminRKb;Ex kñúgkrNIGñkmanRbB½n§karBarcuHexSay ¬Cm¶W HIV/

AIDS¦ b¤GñkEdlTTYlkarBüa)aledayGg;TIb‘ÍyUTikRbsiT§PaBTUlMTUlay b¤GñkTTYlkarBüa)alCm¶WmharIk. kEnøgEdlTTYlnUvplb:HBal;eRcIn KWenAelIGNþat GamIdal bMBg;k Es,kkñúgmat; EdlGacmankarrlakeLIg Rkhm b¤RKbdNþb;edaybnÞHBN’s edrdas b¤eLIgBN’ s-RbepH . kareFVIeraKvinicä½yEdlsnñidæanfa mankar rlakEdlbgáedayBYk Candida ¬Candidiasis¦ KWkarrkeXIjnUvekasikarbs;BYkpSitCaeRcIn ¬Yeast Cells¦ edayxøHeToteKeXIjmandUcCa Mycelium EdlmanlkçN³Casrés² ¬Filaments¦ EdleKrkeXIjenAkñúgkar bMBak;BN’ Gram EdlykecjGMBITwkrégRtg;kEnøgEdlmankarrlak . tM)arvtßúviPaKecjGMBIpøÚvdegðImEpñkxagelI GacRtUveKepJIeTAmnÞIrBiesaFn_ minEmnedIm,IeFVIeraKvinicä½yKøInikenaHeT b:uEnþKWedIm,IrkemeraKEdlmanskþanuBlbgáCm¶WeTAelImnusSEdlmansuxPaBl¥ nigGñkEdlpÞúknUv)ak;etrIEdlbgá Cm¶WTaMgenHenAelI Pharynx b¤rn§RcmuH. karenH KYrEtRtUv)aneKeFVIeLIgenAkñúgEpñkmYyénkarRsavRCaveGBIedmI- saRsþ EdlkMNt;c,as;las;Etb:ueNÑaH. )ak;etrIxageRkamenH Gacbgá CaCm¶WenAkñúgpøÚvdegðImEpñkxagelI ³

• Staphylococcus aureus: karyktMNagvtßúviPaKecjGMBIRcmuHrbs;GñkCm¶W b¤buKÁlikmnÞIreBTü CYnkalCaEpñkmYyénkarGegátrkénkarpÞúHeLIgén S. aureus enAkñúgmnÞIreBTürbs; Metici-

llin-resistant (MRSA) . • Neisseria meningitidis: GñkEdlpÞúkBBYk Meningococci GacmaneRbv:aLg;x<s; ¬RbEhl

20° b¤elIsBIenH¦ eTaHbIminEmnkñúgeBlmankarratt,atk¾eday. eKkRmnwg viPaKrkGñkpÞúk Megococci enAelI Pharynx Nas; ehIyk¾mincaM)ac;eFVIkarkarBaredaykarelbfñaMbgáarcMeBaH RkumRKYsar b¤mitþPkþiEdlCitsñitnwgGñkCm¶WrlakeRsamxYrenHEdr .

• Streptococcus pyogenes: GñkEdlpÞúk)ak;etrIenHmancMnYntictYc ehIyCaBiesseRcInmanenA elIek μgEdlcUlsala ¬20-30°¦

• Corynebacterium diphtheriae: GRtaénGñkpÞúk)ak;etrI Diphteria bacillus mancMnYnx<s; kñúgcMeNamGñkEdlBMu)ancak;v:ak;saMgkarBarCm¶WenH. eKRtUveFVIkarviPaKrk)ak;etrIenH ehIyeFVI karBüa)alcMeBaHmnusSTaMgLayNaEdlTak;TgpÞal; b¤b:HBal;pÞal;CamYYynwgGñkCm¶Wxan;søak; enH. enAkñúgshKmn_ eKkRmnwgCYbRbTHnUvGñkEdlpÞúknUvemeraKRbePTenHNas;enAeBlEdl RbCaCnenAkñúgshKmn_enaH )anTTYlnUvkmμviFIcak;fñaMbgáar)anl¥ nigRtwmRtUv .

96

karyk nigkarbBa¢ÚnvtßúviPaK CakarRbesIrbMput vtßúviPaKKYrRtUv)anykedayRKUeBTü b¤buKÁlikEdlmankarhVwkhVWnRtwmRtUv. GñkCm¶WKYrGgÁúyEbr muxeTArkBnøW rYcGNþatRtUvrkSaeTAeRkam edayeRbIRbdab;sgát;GNþatsgát;BIelI. bnÞab;mkykeQIrmUrsMLIeTA RtdusxøaMg²elIGamIdalCBa¢aMgxageRkayrbs; Pharynx nigenAelIkEnøgEdlmanrlakd¾éTeTot. eKRtUveFVIkar edayRbugRby½tñ edaykMu[rmUlsMLIeTAb:HnwgGNþat b¤sac;f<al;. eKRtUvykvtßúviPaK[)anBIrtM)ar enARtg;kEnøg EtmYyedaytM)armYy GacRtUv)aneKeRbIR)as;kñúgkareFVILam nigmYyeTotRtUvrkSaTuk enAkñúgRbGb; C½r)øasÞik b¤Ekv ehIybBa¢ÚneTAkan;mnÞIrBiesaFn_ . ebIsinCaeKminGaccat;EcgvtßúviPaKenHenAkñúgGMLúg 4 em:ageT eQIrmUrsMLIenH KYrEtRtUv)aneKrkSaTukenAkñúgfñaldwkCBa¢Ún ¬]TahrN_ ³ Amies b¤ Stuart¦ . karBinitüpÞal;edaymIRkUTsSn_ Fusospirochaetal complex éndMe)ArlYyenAelI Pharynx ¬Vincent angina¦ nig Candida emIleXIj c,as;l¥enAelIPñasEdlbMBak;BN’ Gram EdleKKYrEterobcM ebIsinRKUeBTü b¤evC¢bNÐiteFVIkaresñIsMu. b:uEnþkar bMBak;BN’ Gram minmanRbeyaCn¾sMrab;karviPaKrkBBYk Streptococci b¤BYk Neisseria spp.eLIy. elIsBI enHeTAeTotkareFVIPñaspÞal;man Sentivity nig Specificity minl¥eLIysMrab;karRsavRCavrk Diphtheria

bacillus elIkElgEtvtßúviPaKRtUv)aneKykedayRbugRby½tñ nigeFVIkarviPaKedayGñkCMnajxagGtisuxumCIvsaRsþ EdlmanbTBiesaFn_. kñúgkrNIEdlBMumankaresñIsMuGMBIevC¢bNÐit b¤RKUeBTüeTenaH eKminKYreFVIkarbMBak;BN’ Gram cMeBaHrmUrsMLIEdlykvtßúviPaKecjBIbMBg;kenaHeT.

karbNþúH nigkarviPaK karbNþúH Streptococcos pyogenes Pøam² bnÞab;BITTYl)annUvrmUrsMLIrYcehIy rmUrsMLIenHKYrEtRtUv)aneKykeTAbNþúH edayykvaeTA)a:telI cMENkmYyPaKbYnénfñalbNþúHEdlmanQam ehIycMENkfñalbNþúHEdlenAsl;RtUv)a:tedayeRbI Loop s¥at KμanemeraK. fñalbNþúHEdlKμanQamKYrEtRtUv)aneKerobcMecjGMBIfñalbNþúH)asmYyEdlKμan Glucose b¤man tictYc ¬]TahrN_³ Triptic soy or TSA¦ . karbegáItCatiGasIutén Glucose eday S. pyogenes Ca]bsKÁ dl;karbMEpøgrbs; Haemolysin. QamRss;EdlykecjBIstV nig mnusS dUcCaQammnusSRss;² GacRtUv )aneKeRbIkñúgkMhab; 5° kñúgkareFVICafñalbNþúHmanQam. fñalbNþúHnImYy² KYrEtRtUvbMeBj[)an CMerARbEhl 4-5 mIlIEm:Rt. QamecomCaQamRss; EdleKniymeRbI eRBaHvaGacbgðaj[eXIjnUvkarbMpøajRKab;Qam rbs;BYk)ak;etrI»kasniymmYycMnYn dUcCa BBYk Haemophilus spp. ehIyBMueXIjmankarbMpøajRKab;Qam eday Zymogens EdlbegáIteLIgeday Enterococcus faecalis eT.

97

kBa©úMemeraKEdleKsÁal;fa CaBBYkbMpøajRKab;QamRbePT β-haemotytic GacRtUv )aneKviPaK nigCMruj[)an elOntamry³kardak;bnÞH Co-trimoxazole ¬dUcEdleKeRbIkñúgetsþGg;TIb‘ÍyURkam¦ nigbnÞH Bacitracin Edl mankMhab;TabeTAelIfñalbNþúHEdlqUtrYcehIy. edaysarEt S.pyogenes Fn;nwg Co-trimoxazole kñúgxN³ eBlEdl)ak;etrImYycMnYneRcIneTotsg;sIubCamYynwg Co-trimoxazole dUecñaH eKGac niyayfa bnÞH Disc enH Gac[eyIgeXIj β-haemotysis kan;Etc,as;. kardak;bNþúHkñúgRkLEdlduteTon GaceFVI[eKbNþúH)an BBYk Streptococci EdlbMpøajRKab;QamRbePT β )anesÞIrEtTaMgGs;. meFüa)ayEdlsamBaØkñúgkarbegáInnUvkar bMpøajRKab;Qam KWcak;épÞcahYyrbs;fñalbNþúHedayeRbI Loop eTAkñúg nigEkgnwgfñalbNþúH. enA 18em:ag nig mþgeTot 48em:ageRkayeBldak;bNþúHkñúgsItuNðPaB 35-37 GgSar fñalbNþúHEdlmanQamKYrRtUv)aneKBinitü emIlkBa©úMemeraKtUc² ¬0/5-2 mIlIEm:Rt¦ EdlB½T§CMuvijedaytMbn;føa CasBaØafamankarbMpøajRKab;Qam. bnÞab; mkeFVIkarbMBak;BN’ Gram edIm,IbBa¢ak; . ebIsinCaeKBinitüeXIjfa Cocci Edlman Gram-negative kBa©úM emeraKenaH KYrEtRtUv)aneKykeTAeFVIetsþbnþedIm,IviPaKrk S.pyogenes. kñúgeKalbMNg KøInik GacviPaKrk S.pyogenes CadMbUg KWRtUvBwgEp¥kelIPaBsg;sIubeTAelI Bacitracin EdlmankMhab;Tab . kñúgn½yenH bnÞHDIs Bacitracin BIrepSgKñaRtUv)aneKeRbI KWkMhab; 0/02-0/05 IU én Bacitrancin . bnÞHDIsFmμtaEdleKykmk eRbIKW 10 Ékta ¬ Units ¦ EdlminsmRsbkñúgkarykmkviPaKrk)ak;etrI Streptococci enH eLIy . BYk β-

haemolytic Streptococcus )anbgðajnUvtMbn;c,as;mYyK μanBYkenHduHenACMuvijbnÞHDIs. kñúgkrNIEdleKeXIj dUecñHeKGacsnñidæanfa CaBBYk S.pyogenes . ebIsinCakBa©úMénemeraKmancMnYneRcInvtþman b¤GvtþmanéntMbn;føa CuMvijkBa©úMemeraKGacRtUv)aneKeXIjtaMgEtBIkarbNþúHEdlmanQamRss;mkemøH. ebIsinCakBa©úMemeraKenaHman tictYc kBa©úMemeraKcMnYnmYy b¤BIrKYrEtRtUv)aneKykecjGMBIfñalbNþúHdMbUg rYcdak;bNþúHelIEpñkmYyPaKR)aMénfñal bNþúHfμ I ¬TIBIr¦ edIm,ITTYl)annUvkBa©úMemeraK[)aneRcIn . rIÉkEnøgbNþúMsaCaf μ InImYy² RtUvmanbiTdak;BIelIeday bnÞHDIs Bacitracin. bnÞab;GMBIkarbNþúHry³eBlmYyyb; fñalbNþúHf μ IenHKYrEt RtUv)aneKBinitürkemIltMbn; KμanemeraKduHenACMuvijbnÞHDIs . enAkñúgmnÞIrBiesaFn_mYycMnYn karviPaKRtUv)aneKeFVItamry³kareFVIetsþesr:UsaRsþ. eKGaceFVItamry³ bec©keTs eFVIkkrtambec©keTscas; nigtamry³EdlelOnedayeRbIkareFVIetsþ Agglutination elIbnÞHkBa©k;. ebIsinCa BYk Streptococci Edlman β-haemolytic EtFn;nwg Bacitracin eKRtUveFIVkarviPaKrkeQμaH)ak;etrI enaHbnþ eTotedayeRbIetsþ Physologic Fm μtabnþeTot ¬emIltaragTI 19¦ . karBinitüelIkBa©úMemeraKénBBYk Strepto-

cocci Edlman β-haemolytic RbePTenH Gac[eKeXIjfa enAeBlEdlvaduH nigeFVIetsþesr:UsaRsþ kñúgkarrk Rkum KWvaminman Agglutination CamYynwgRkum A antiserum eT . BBYk Streptococci RbePTenH minRtUv)an eKKitfa Ca S.pyogeneseT ehIyk¾minbNþal[mankarrlakF¶n;F¶rdUcBBYk Streptococci Rkum A Edr. kñúgkar raykarN¾vtþman én S.pyogenes enAkñúgkarbNþúHvtßúviPaKbMBg;k eKKYrpþl;cMelIyCabrimaNBak;kNþal ¬kRm/ ÷/ ÷÷/ b¤÷÷÷¦. cMeBaHGñkCm¶WEdlrlak Pharynx edaysarBBYk Streptococcus pyogenes CaTUeTAbgðaj

98

vtþmand¾eRcInelIslubénkBa©úMemeraKenAelIfñalbNþúH. cMeBaHGñkEdlpÞúkemeraKEtminQWbgðaj[eXIjkBa©úM emeraKmantictYc KWmanticCag 20 kBa©úMemeraKkñúgfñalbNþúHmYyfñal. b:uEnþeTaHCay:agNak¾eday brimaNkBa©úM emeraK Streptococci Edlman β-haemolytic enHKYrEtRtUveK[CaBt’man nigbBa¢ak;eTAkan;RKUeBTü.

taragTI19³ PaBxusKñaén Streptococci EdlmankarbMpøajRKab;QamRbePT β (β-haemolytic)

)ak;etrI S.pyogenes S. agalactiae

E.faecalis var.zymogenesa epSg²eTot

Rkum A B D C,G,F

karbMpøajRKab;Qam rgVg;EdlsßitenACMuvij

β βb β β

bacitracin disc epSg²Kña fñalbNþúH βile-aesculin

+ oc oc od

¬karduHlUtlas; nigBN’exμA o o + o

etsþ CAMP b®Ba©as; o + o o

PaBsg;sIubCamYynwg co-trimoxazole o o o +

etsþ PYRf + o + o

aE. faecalis var. zymogenes begáItCa β-haemolycis EdleKemIlenAelIfñalbNþúHQamesHRss; . b5% minmankarbMpøajRKab;Qam . c5%viC¢man . d10%viC¢man . cbnÞHDIsEdleKeRbIdUcKñaenAkñúgbec©keTs Kirby-Bauer. PYR: pyrrolidonyl-β-naphthylamide .

karbNþúH Corynebacterium diphtheriae eTaHbICaBBYk diphtheria bacillus duHlUtlas;)anl¥enAelIfñalbNþúHEdlmanQam b:uEnþeKGac begáInkarduH lUtlas;rbs;vaenAelIfñalbNþúHBiess²mYy b¤BIrepSgeTot ³

• Löffler Edlmanesr:Umkk b¤fñalbNþúH Dorset egg. eTaHbICafñalbNþúHTaMgBIrenH minEmnCafñal bNþúHCeRmIsk¾eday k¾b:uEnþvaGacGnuBaØati[BBYk Diphtheria bacillus duHlUtlas;)any:agl¥ bnÞab;BI TukeGayduHry³eBlmYyyb;. rUbragrbs;)ak;etrI)anbgðajy:agc,as;Ca)asIuEdlCab;BN’mindUc²Kña xøIeTAEvg ExSragekagbnþic bgðaj[eXIjCaRKab;² manBN’minsIuKña ehIyteRmobKñaCaTMrg;GkSr V b¤ Rsb² Kña . karBinitüeXIjmanlkçN³CaRKab;² nigmines μ IKña RtUv)aneKBinitüeXIjenAkñúgkarbMBak; BN’ Methylene BN’exov b¤ Albert CaCagkarbMBak;BN’ Gram .

99

• fñalbNþúHCeRmIsmanQamRss; nig Tellurite ¬Tellurite blood agar¦³ fñalbNþúHenHpþl;PaBgay RsYlkñúgkarbNþúHrkBYk Diphtheria bacillus enHkñúgeBlEdlBBYk)asIuenHmancMnYntictYc dUcCa³ enAkñúg krNIGñkEdlmansuxPaBFm μta nigpÞúk)ak;etrIRbePTenH. enAelIfñalbNþúHenH kBa©úMemeraKrbs;BYk Diphtheria bacillus manBN’RbepH b¤exμA ehIyduHlUtlas;eBjeljkñúgry³eBl 48 em:ag. kBa©úM emeraKEdlsgS½y ehIyBinitüeXIjfa BBYk)asIumanTRmg;Ca Coryneform enAkñúg karbMBak;BN’ Gram KYrEtRtUv)aneKeRCIserIsykmkbNþúHbnþeTotenAelIfñalbNþúHEdlmanQam edIm,IRtYtBinitüemIl PaBsuT§ nigrUbragBiessrbs;va. vaKYrEtRtUv)aneKcgcaMfa kBa©úMemeraKEdlCa Biotype kUnkat;rbs;BYk C. diphtheria EdlmancMnYnPaKeRcInenaH )anbgðaj[eXIjnUvtMbn; β-haemolysis enAelIfñalbNþúH EdlmanQamRss; .

lT§plsn μt;EdlbBa¢ak;fa manvtþman C. diphtheria GacRtUv)aneKeFVIeLIgenAkñúgdMNak;kalenH. Et eTaHCa y:agNak¾eday lT§plTaMgenHKYrRtUvbBa¢ak; b¤Tat;ecaledaysarkareFVIetsþviPaKCIvKImIsamBaØmYycMnYn nigtam ry³karEsþgeLIgénkarbegáItCatiBulrbs;va. karbNþúHcugeRkay KWeKtRmUv[eFVIkarbNþúHenAelIkNþúrsMeBA ¬Guinea-pigs¦ b¤eFVIetsþrkCatiBul ¬Elek¦ nigGnuvtþenAkñúgmnÞIrBiesaFn_fñak;mCÄwmmYy. kñúgeBlenHmanEt etsþEdlgay nigmanel,ÓnelOnRtUv)aneKeRbI. C. diphtheria man Catalase nig Nitrate viC¢man Et Urea

GviC¢man. CaTUeTAminmankarbegáItCa]sμ ½nedaykareRbIR)as; Glucose nig Maltose EtvamineRbIR)as; Saccha-

rose eT. etsþrkkareRbIR)as; Glucose rbs;)ak;etrIenH RtUv)aneKeFVIenAelIfñalbNþúH Klisler . skm μPaB Urease RtUv)aneKeFVIenAelIfñalbNþúH MIU nigkareRbIR)as; Nitrate enAkñúgfñalbNþúH Nitrate dUcKña nwgkar GnutþedIm,IrukrkBBYk Enterobacteriacae pgEdr. enAkñúgkareRbIR)as; Maltose nig Saccharose Twk Andrade peptone GacRtUv)aneKeRbIdUcCafñalbNþúHRKwH 1° énkMhab;cugeRkayénCatisárnImYy². lT§pl GacRtUv)aneKbkRsayenAeRkayeBl 24 em:ag eTaHbICaeBlxøHvaRtUvkarTukeGayduHeLIgvijmYyyb;k¾eday. eKGacniyay[TUlayfa mnÞIrBiesaFn_GtisuxumR)aN mantYnaTIkñúgkarbBa¢ak;GMBIeraKvinicä½yKøInikrbs;BBYk Diphtheriae. karBüa)alminRtUv)aneKeFVIeLIgedayBMu)anTTYllT§plNamYyBImnÞIrBiesaFn_eLIy. Bt’man lMGitbEnßmGMBIkarviPaKrk C.diphtheriae Gacrk)anenAkñúg Guidelines for the laboratory diagnosis of

diphtheria1 . kareFIV Test Gg;TIb‘Íy:URkam kareFVIetsþGg;TIb‘Íy:URkamenAelI)ak;etrIenAkñúgbMBg;k b¤ Pharynx Cajwkjab;minRtUv)aneKesñIsMu b¤GacBMumankar cab;Garm μN_ . )ak;etrIEdlbgáCm¶WsMxan;²kñúgkarbgá[rlak Pharynx KW S. pyogenes nig C.diphtheriae

ehIyEdleKGaceRbIR)as; Benzylpenicilline nig Erythromycin )any:agmanRbsiT§iPaBbMputkñúgkarBüa)al karrlakEdlbgáeLIgeday)ak;etrITaMgBIrRbePTenH. enAkñúgkrNI Diphtheria eKk¾RtUveFVIkarBüa)alCamYy Antitoxin )anpgEdr .

1 begg n. Manual for the management and control of diphtheria in the European region Copenhagen, WHO Regional office for Europe, 1994.

100

CMgWrlakpøÚvdegðImEpñkxageRkam (Lower Respiratory Tract Infection)

esckþIepþIm karrlakpøÚvdegðImEpñkxageRkam ¬LRTI¦KWCakarrlakEdlekIteLIgxageRkam larynx dUcCa enAkñúgbMBg;xül; TgsYt b¤enAekasikasYt ¬rlakbMBg;xül; rlakTgsYt Gab;EssYt rlaksYt¦ . CYnkal enAkñúgkarrlaksYt RsTab;Es,kEdlRKbdNþb;sYtenACitkEnøgrlakenaH GacnwgbNþal[rlakEdr ehIyCalT§pleLIge)a:g ¬rlakeRsamsYt¦ ehIyCYnkalmankarbegáItCaTwkrég rYcFøak;cUleTAkñúgRbehageRsamsYt . lkçN³Biessén LRTI KWeRcInEtbgáeLIgedayeraKrebg ¬Tuberculosis¦ EdleKCYbjwkjab;CageK enAkñúg RbeTsCaeRcIn. GñkCm¶WEdlmanpÞúkemeraKrebg¬Mycobacterium tuberculosis¦k¥k ehIybegáIt)anCaBBuH xül;tUc² EdlpÞúkeTAeday)ak;etrI ehIy)ak;etrIenH RtUv)anRsUbcUleTAkñúgsYtedaymnusSepSgeTot. Cm¶WenHKW CaCm¶WEdlqøgraldal)any:aggay BImnusSmñak;eTAmnusSmñak;eTot nigKWCaCm¶Wqøgd¾F¶n;F¶r. GñkCm¶WCaeRcInEdlman LRTI k¥kmkmanlayxÞúHenAkñúgkMhakEdlCaTUeTAmanBN’elOg b¤ébtg. kMhakenH GacRtUv)aneKykeTAeFVIkarbNþúH b¤BinitüedaymIRkUTsSn_ . enAmankarbgáeraKxøHeTotEdlbegáItCakMhaktictYc b¤K μankMhakGVIKYr[kt;sMKal;eLIy dUcCaCm¶W Legionnaire

¬bgáeLIgedayBBYk Legionnaire pneumophilia¦ rlaksYtedaysar Mycoplasma pneumoniae nig Chlamydia pneumonia CaedIm. Cm¶WTaMgenHtRmUv[eFVIeraKvinicä½ytamry³bec©keTs Biess² ¬esr:UsaRsþ b¤ karrukrktamry³kareRbIR)as;fñalbNþúHBiess¦ b:uEnþTaMgGs;enHnwgminRtUv)aneKelIkykmkbriyaykñúgesovePA enHeT. bEnßmBIelICm¶WrebgsYt ¬emIlxageRkam¦ karesñIsMuBinitükMhakedaymIRkUTsSn_ nigbNþúHRtUv)aneKyk citþTukdak;cMeBaHkarrlakpøÚvdegðIm EdlmanlayLMnwgkMhakEdlmanxÞúH . karbgáeraKEdlCYbjwkjab;CageK Cm¶WrlakTgsYtRsYcRsav nigraMuér: cMeBaHGñkCm¶WEdlmanCm¶WrlakTgsYtRsYcRsav ¬CaTUeTAekIteLIgbnÞab;mkGMBIkarrlakF¶n;F¶rEdlbgáeLIgeday BBYkvIrus eRkayCm¶Wpþasay b¤pþasayFM¦ kMhakCaTUeTAminRtUv)aneKeFVIkarbNþúHeT luHRtaEtGñkCm¶WBMumanbgðaj sBaØaénkarCasHes,IyeLIy. cMeBaHkarrlakTgsYtraMuér:vij KWCaCm¶WsYtEdlekIteLIgeRkayeBldMNak;kalRsYcRsav ehIybnþenAkñúgry³eBl Evg. GñkCm¶WesÞIrEtTaMgGs;CaTUeTA k¥kmanlaykMhakEdlmanBN’RbepHnigxab;. enAkñúgdMNak;kalenH Gñkqøg

101

eTAmYydMNak;kaleTot edayGñkCm¶WmansßanPaBkan;EtlM)ak ehIyEtgEtmanxÞúHenAkñúgkMhakCanic©. emeraK bgáCm¶WenAelIpøÚvdegðImenHeKeXIjman ¬Haemophilus influenzae streptococcus pneumoniae b¤ CYbBMusUv jwkjab;CaBBYk Moraxella ¬Branhamella¦ catarrhalis¦EdleKrkeXIjenAkñúgsMNakkMhak . Gab;EssYt Gab;EsGacbgáenAkñúgsYt eRkayBIkarhWtcUlénsarFatucEmøk GMBIsarFatuenAkñúgRkeBH b¤TwkrégEdlbeBa©jmk BIpøÚvdegðImEpñkxagelI ¬mat; b¤bMBg;k¦. CYnkaleKehABaküenHfaCa :karrlaksYtedaykarRsUbcUl :. karviPaK rkemeraKedaykarbNþúH GacRtUv)aneKeFVIenAkñúgkMhakEdlk¥kecjmk ¬Edlmankøins¥úyxøaMg¦ b:uEnþeKRtUveFVIkar viPaKTaMgeRbImIRkUTsSn_ nigkarbNþúHkñúgeBlEdlmanxÞúHrbs;Gab;Es ¬bgðajkñúgrUbft¦. EtKYreGaysþayeday BMumankaryl;RsbKñaenAkñúgEpñkevC¢saRsþGMBIbec©keTsénkarykxÞúHBIGab;EseT b:uEnþkarcak;tRmg;eTArkkEnøg Gab;EsbUmykxÞúH KWCaviFImYyEdleKeRbI. BBYk)ak;etrI Anaerobes mYycMnYndUcCa Prevotella melanino-

genica ¬BImunehAfa Bacteroides melaninigenicus¦nig Peptostreptococcus spp. EdlmanRbPBmkBI Flora enAkñúgmat; nigbMBg;k KWCaPñak;garbgáeraKy:agsMxan;. xÞúHrbs;Gab;Es KYrEt RtUv)aneKbBa¢ÚnnigBinitüeTA tambec©keTssþg;darkñúgkarbNþúHrkBBYk)ak;etrIEdlminRtUvkarxül;. Cm¶WrlaksYt nigTgsYt karrlakEkøbsYtRsYcRsav CaTUeTAb:HBal;EtenAsYtmçagEtb:ueNÑaH. karbgáCm¶WenHeRcInEtbNþalmkBI S.pneu-

moniae. lkçN³énkarrlaksYtEbbenH mþgmáalekItCarUbPaBénkarratt,at¬Epidemic form¦. mankar rlaksYtedaykRmEdlbgáeLIgeday Klebsiell pneumoniae. enAeBlEdlmanGñkCm¶WmYycMnYnmankarbgáCm¶Wedaysar K. pneumoniae b¤ S. pneumoniae vanwgGacmanCa karrlaksYtmYyEdlehAfa Bronchopneumoniae CamYynwgsñambnÞHrlak ¬BaküenHehAfa Consolida-

tion¦EdlGacsayPayeTAsYtmYycMhog b¤sYtTaMgBIrEtmþg . eKGaceXIjman)ak;etrI b¤vIruseRcInRbePTEdlbgáCm¶W ehIylayLMCamYynwg Bronchopneumonia. eRkAGMBI S.pneumonia nigCYnkalCa H. influenzae Staphytococcus aureus KWCa)ak;etrImYy EdlbegáIt[manCa Bronchopneumonia CaBiesskñúgeBlmankarratt,atedaysarpþasayFM b¤kRBa©il. BYk)asIu Gram-

negative mYycMnYndUcCa E. coli K. pneumonia nig P.areuginosa k¾RtUv)aneKeXIjjwkjab;Edr. karbgá Cm¶WTaMgGs;enH RtUv)aneKCYbjwkjab;enAeBlEdlmankareRbIGg;TIb‘ÍyU:TikEdlman\T§iBlTUlMTUlayedayBMu)an RtYtBinitü[)anl¥ nigPaBeFVsRbEhskñúgkartamdanGñkCm¶W[)anditdl;taMgBIdMNak;kaldMbUg .

102

ebIsinCamanTwkeRsamsYt eKKYrEtBinitüvaedaymIRkUTsSn_ nigbNþúHvaedayGnuvtþn_eTAtambec©keTs nig viFIsaRsþénkarbNþúHxÞúH nigvtßúviPaKCaTwkrégepSg² . Cm¶WrebgsYt CaTUeTAkMhakrbs;GñkCm¶WrebgsYt BMusUvxab;xøaMgeT b:uEnþeKk¾minRtUveFVsRbEhs nigTat;ecalkarviPaKrkemeraK rebgedaysarEtdUecñaHEdr. karbMBak;BN’ Ziehl-Neelsen KYrEtRtUveKeFVI nigBinitüedaymIRkUTsSn_edIm,IBinitü BBYk)ak;etrIEdlcab;ykBN’Ziehl-Neelsen enH1. bnÞab;BIeFVIkarbMBak;BN’rYc eKRtUvykkMhakeTAeFVIedIm,IkMu[ mankarqøgGMBI)ak;etrIepSg² tamry³viFIsaRsþénkareFIVkMumankarqøgBI)ak;etrIepSg²eTot edayrkSaTukEtBYk emeraKrebgsMrab;ykeTAbNþúHenAkñúgfñalbNþúH Löwenstein-Jensen . edaysarEtbec©keTs nigviFIsaRsþ)ak;etrIsaRsþénkareFVIeraKvinic½äyelIkarrlakpøÚvdegðImmanxÞúH dUcCakarrlak TgsYt rlaksYtxusKñaCasarvnþ½CamYynwgviFIsaRsþénkarviPaK nigrkeraKvinicä½yrbs;Cm¶WrebgenaH eKRtUvBicarNa dac;edayELkBIKña. dUcenHRKUeBTüRtUvEtbBa¢ak;[)anc,as;las;eTAkan;mnÞIrBiesaFn¾fa etIKat;cg;eFIVkarBinitü edIm,Irk ³

• )ak;etrI pyogenic ¬dUcCa H. influenzae, Sstroptococcus pneumoniae etc.¦ • )ak;etrIEdlbgá[manemeraKrebg ¬M. tuberculosis¦b¤ • rk)ak;etrITaMgBIrRbePT .

karykkMhak karykkMhakEdll¥ KWCaeTBekaslü nigbec©keTsmYyEdlRtUv)aneKbriyayenAkñúgesovePAepSgeTot 2 . karBinitükMhakEdlykBMu)anRtwmRtUvl¥ GacbNþal)anlT§plBMuCak;lak; edaysarEtmankarqøgCamYynwg Flora Fm μtaEdlmanenAkñúgmat; nigbMBg;k. kMhakTaMgLayNaEdlmansuT§EtTwkmat; nigkMeTckMTI cMNIGahar eKminKYreFVIkarBinitüeT .

1 emIlkñúg Manual of basic techniques for a health laboratory, 2nd ed. Geneva, World Health Organization, 2003

2 Specimen collection and transport for microbiological investigation. Alexandria, WHO Regional office for the Eastern Mediterranean, 1995 (WHO Regional Publications, Eastern Mediterranean Series 8). Manual of basic techniques for a health, 12 nd ed Geneva, World Health Organization, 2003 Technical guide sputum examination for tuberculosis by direct microscopy. Bulletin of the International Union Against Tuberculosis and Lung Disease, 4th ed. 1996.

103

eKKYrykkMhakedaydak;vaeTAkñúgkMb:ugEdlmanmat;TUlay KμanemeraK GacbiTCit)anl¥ rYcRKbehIybBa¢ÚneTA kan;mnÞIrBiesaFn_CabnÞan;. ebIsinCaeKTukkMhakyUr eRkayeBlykvarYcenaH eKeXIjmankarduHlUtlas;én )ak;etrIEdlqøgcUly:agelOn EdleFVI[lT§plénkarBinitüelILam nigbNþúHmanPaBlMeGogy:ageRcIn. eday sarEtehtuplenHehIy eTIbeKminGnuBaØati[epJIkMhaktaméRbsNIy¾eLIy. mankrNIelIkElgEtmYyKt;KW kMhakTaMgenaHRtUv)aneKykeTAviPaKrkemeraKrebgb:ueNÑaH EdleKRtUvepJIeTAkan;mnÞIrBiesaFn_fñak;Rsuk b¤tMbn; . bTbBa¢aéRbsNIy¾mUldæan nigCati cMeBaHsMPar³cMlgeraK ¬EdlGacbgáCMgW¦ RtUvEtGnuvtþ ya:gtwgrwgbMput. dMeNIrkarénkarBinitükMhakenAkñúgmnÞIrBiesaFn_ ¬sMrab;karbgáeraKEdlminEmnCaeraKrebg¦ bnÞab;BIRbmUl eKRtUvEteFVIkarBinitükMhakPøam² b¤k¾RtUvrkSaTukkñúgTUTwkkk . karvaytMélsPaBxageRkA sPaBxageRkArbs;kMhak EdlBinitüeXIjedayEPñkpÞal; KYrEtRtUv)ankt;RtaTuk. eKRtUvBiBN’naGMBI ³ manxÞúH BN’exov manxÞúH BN’elOg xab; mansMe)arlayxÞúH ¬]TahrN_³ EpñkxøHmansPaBxab;sMe)ar EpñkxøHmanxÞúH¦ manQam manQam nigmankkdMuBN’exov * BN’RbepH xab; * BN’RbepH manBBuH * BN’s xab; * BN’RbepH manBBuH * BN’s xab; * BN’s manBBuH * BN’s xab;mankMeTckMTIcMNIGahar * suT§EtTwk ¬manEtTwkmat;¦ * mansuT§EtTwkmat; nigmanlaykMeTckMTIcMNIGahar kMhakTaMgLayNaEdlmandak;sBaØa¬*¦ CaFm μtaminRtUv)aneKBinitü nigeFVIkarviPaKrkBBYk)ak;etrI EdlminEmn CaemeraKrebgeT .

104

karBinitüedaymIRkUTsSn_ kMhakEdlmanxÞúH b¤mansMe)arxab;layxÞúHmYy KYrEtRtUv)aneKerobcMPñasbMBak;BN’ Gram. ebIsinCaeKBMueXIjmandMukkénkMhakxÞúHeTenaH ¬]Ta>enAkñúgsMNakkMhakmanBN’RbepHxab;¦ enAelILamEdl bMBak;BN’ Gram GacbgðajEtsMNkekasikaEs,kEdlmanTMhMFM²eRcInCagekasikaEs,kEdlmanragkaerEdl RKbBIelIedaydMu)ak;etrIs’i¥tCab;Kñay:ageRcInenAelIekasikaTaMgenaH. enHbBa¢ak;[dwgfa vtßúviPaKpÞúkCacm,gCa Twkmat; b¤TwkrégBIbMBg;k ehIyeKminRtUveFVIkarbNþúHkMhakenHeTeRBaHvamanlT§pllMeGogeRcIn. eKalkarN_ énkarTat;ecalénkarbNþúH KWenAeBlEdleKBinitüeXIjfaenAkñúgkMhakmanticCag 10 Polymorphonuclear

Neutrophils kñúgekasikaEs,kmYy 1. cMeBaHGñkCMgWEdlmanrlakpøÚvdegðImRsYcRsav ¬]TahrN_³ rlaksYt¦ nigmanxÞúHkñúgkMhak karBinitübnÞan;nUvPñas EdlbMBak;BN’ Gram Gacpþl;mKÁúeTsn¾dl;RKUeBTüBüa)alkñúgkareRCIserIsfñaMsRmab;Büa)al. lT§plEdlGac TTYl)anrYmman ³

• Gram-positive diplococci EdlB½T§CMuvijedayépÞTeTmYy BI Capsules Edlmincab;BN’ ¬GacCa S.pneumoniae¦

• Gram-negative coccobacilli tUc² ¬RbEhlCa H. influenzae¦ • Gram-negative diplococci EdlmanenAkñúgekasikab¤eRkAekasika ¬GacCa Maraxella catarrhis) • kuksIu Gram-positive EdlmanragCakBa©úM ¬KitfaCa S. aureus¦ • )asIu Gram-positive ¬KitfaCa Enterobacteriaceae b¤ Pseudomonas spp.¦ • ekasikaFM² Gram-negative ehIymanExñgrbs;va ¬KitfaCa Candida spp¦

bec©keTsénkarbNþúH nigkarbkRsaylT§pl enAeBlEdlkarBinitüedaymIRkUTsSn_bgðajfa kMhakmanKuNPaBRKb;RKan;ehIy cUrqáwHykdMuxÞúHeday eRbIeQI rmUrsMLI b¤ Loop rYcdak;bNþúHenAelIfñalbNþúHepSgKña . QutfñalbNþúHEdleKeRbIR)as;CaRbcaMKW³

• fñalbNþúHEdlmanQamRss;edaymanqUt S. aureuedIm,IgayRsYl[ H. influenzae duH)anl¥ nig mandak;bnÞH Optochin disc enAkNþalqñÚtelIkTI 2

• fñalbNþúHmanQamq¥in • fñalbNþúH MacConkey

1 Heinermann HS&Radano. Acceptability and cost saving of selective sputum microbiology in a community

teaching hospital. Journal of clinical Microbiology, 1979, 10:567-573.

105

fñalbNþúHEdlmanQamRss; nigQamq¥inRtUv)aneKTukeGayduHkñúgsItuNðPaB 35-36GgSar enAkñúgmCÄdæan Edlman]s½ μnkarbUnik ¬]TahrN_ enAkñúgRkLEdlduteTon¦ nigfñalbNþúH MacConkey RtUv)aneKTukeGayduH enAkEnøgFm μta . ebIsinCaeKrkeXIjvtþmanrbs;kuksIu Gram-positive manragCakBa©úMdUccegáamTMBaMg)ayCUrenAkñúgbnÞHkBa©k; bMBak;BN’ Gram ehIy eKKYrEtbNþúHenAelIfñal Mannitol Salt ¬MSA¦mYyeTot . ebIsinCaeKBinitüman eXIjBBYkpSitEdlman Gram-positive vij eKRtUvbEnßmfñalbNþúH Sabouraud dextrose mYyeTot ¬RtUvrkSa TukkñúgkMedA 35-37 GgSarry³eBly:agtic 3 éf¶¦ . fñalbNþúH MSA nig Sabouraud enHminKYreKdak;bNþúH nUvRKb;kMhakenaHeT . fñalbNþúHnImYy²KYrEtRtUv)aneKtamdan bnÞab;BIdak;bNþúH)anmYyyb;rYcmk ¬18em:ag¦ b:uEnþeKRtUvdak;bNþúH 24 em:ageTotenAkñúgkrNIEdlmankarduHlUtlas;ticCagGVIEdleyIgrkeXIjedaymIRkUTsSn_ b¤eXIjmankBa©úMemeraK tUc²eBk . KMehIjEdlmanlkçN³CaemeraKbgáCMgWpøÚvdegðImc,as;las; mandUcteTA³ • sMEb:t BN’føa ragptEpñkkNþal nigmantMbn;BN’ébtgén α- haemolysis nigtMbn;minmanemeraKduHenA

CMuvij Optochin disc dUcenH vaGacCa S. pneumoniae. ebIsinCalT§plrbs; Optochin disc emIlBMu c,as;las;enAnwgfñalbNþúHelIkTImYyeT etsþenHKYrEtRtUv)aneFVIetsþmþgeTotenAelIkarbNþúHbnSúT§ enA fñalbNþúHfμ I. eyIgminRtUvePøceTfa manBBYk α-haemolysis epSg²eTot GacCa ¬Viridans Strepto-

cocci¦ EdlFmμtavaCa Flora Fm μtaEdlmanenAkñúgmat; nigbMBg;k . • kBa©úMemeraKtUc² nigmanrage)a:gdUctMNk;Twk Non-haemolytic duHenAelIfñalbNþúHmanQamRss; Etva

duHragFMnigføa enAelIfñalbNþúHEdlmanQamq¥in b¤manlaycMNIGaharbEnßm lkçN³enHGacCaBBYk H.influenzae. BBYkenH CaTUeTAmanduHkñúgcMnYneRcIn manelIsBI 20 kBa©úMemeraKkñúgmYyfñalbNþúH. mnÞIrBiesaFn_mYycMnYn)anbBa¢ak;faCa H.influenzae tamry³kareRbIR)as;etsþ Factor X nig Factor

V dependence b:uEnþetsþTaMgenHRtUvEtmankarRtYtBinitüya:gRbytñ½RbEyg nigmincaM)ac;dac;xatenaHeT kareFVIetsþesrU:saRsþrkRbePTemeraKpøÚvdefðIm CaTUeTAminmanRbeyaCn¾eT eRBaHPaKeRcInénBYkemeraK TaMgenHva “Rough” nigminGackMNt;RbePT)an .

106

• kBa©úMemeraKEdlpuy² s¶Üt s-RbepH enAfñalbNþúHEdlmanQamRss; nigq¥in ehIyGacqáwH )ankBa©úM

TaMgmUledayeRbI Loop GacRtUv)aneKKitfaCaBBYk M. catarrhallis . ebIsinCaeKcg;eFVIetsþkñúgkar eRbIR)as;Catisárvij eKGaceFVIetsþTaMgenH)an ¬RKb;etsþTaMgGs;GviC¢man ¦ b:uEnþmnÞIrBiesaFn_PaKeRcIn minGnuvtþetsþenHeT. BBYkemeraK Moraxella man Oxydase viC¢manxøaMg ehIyrUbragrbs;kBa©úMemeraK nigrUbragrbs;emeraKEdlBinitüenAbnÞHbMBak;BN’ manlkçN³c,as;las; bMput. edaysarEtrUbragrbs; Moraxella manlkçN³Rbhak;RbEhlnwg Neisseria spp. EdrenaH etsþ Tributyrin GacRtUv)aneK eRbIedIm,IeFVIkarEbgEck [dac;edaysarEt Moraxella va hydrolyses tributiryn .

• kBa©úMemeraKEdlmanTMhMlμm BN’masKWCaTRmg; b¤lkçN³rbs; S. aureus. etsþ Coagulase nig etsþ Mannitol fermentation viC¢man ebIeTaHbICaeBlxøHetsþ Coagulase (“Bound” Coagulase Test) enAelIPñaskBa©k;mþgmáalGviC¢man. ebIsinCamanPaBpÞúyKñarvag rUbragrbs;kBa©úMemeraK nigkareFVIetsþelI PñaskBa©k;enaH kareFVIetsþ coagulase enAkñúgbMBg; (“free” coagulase)mYyKYrRtUv)aneKGnuvtþ .

• ebImankBa©úMemeraKEdlduHenAelIfñalbNþúH MacConkey eKKitfaCaBBYk Enterobacteriaceae b¤ Pseudominas spp. b¤ Acinetobacter spp .

• kBa©úMemeraKEdlmanBN’s mUl nigKeRKImenAelIfñalbNþúHEdlmanQamRss; nigQamq¥in GacCaBBYk Candida albicans ehIyCYnkalvaGacnwgduHenAelIfñalbNþúH Sabouraud dextrose enAkñúgrvag 2-3 éf¶ .

eKRtUvbBa¢ak;fa vtþmankBa©úMemeraKrbs;GtisuxuR)aN xagelIecjmkGMBI Flora »kasniym FmμtaenAelIpøÚvdegðIm ¬]TahrN_ Coliforms b¤pSit¦ . edaysarEtvaminTak;TgeTAnwgkarcat;Ecg RKb;RKgGñkCm¶W . dUecñHlT§pl TaMgenHminRtUv)aneKpþl;CUndl;RKUeBTü b¤k¾Gacpþl;CUnfaCa Flora Fmμta . etsþGg;TIb‘Íy:URkam ¬Susceptibility Testing¦ kareFVIetsþGg;TIb‘Íy:URkam KYrEtRtUv)aneKeFVIeLIgkñúgxN³eBlEdlbrimaNénemeraKduHlμmRKb;RKan; nigKYr[kt; sMKal;faGaceFVI)an. dUecñHeKminGaceFVIGg;TIb‘Íy:URkam edayeRbIEt)ak;etrIbnþicbnþÜcenAelIfñalbNþúHeLIy . karbkRsaylT§plGg;TIb‘Íy:URkamRtUv)aneKbBa¢ak;enAkñúgtaragTI 20.

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taragTI 20³ karbkRsaylT§pletsþGg;TIb‘Íy:URkamelIemeraKEdleq¥Im

viC¢maRtKitCamIlIEm:Rt

Resistant Intermediate Susceptible

S. pneumoniae (Muller-Hinton CamYyQammFüm5° bNþúHkñúgmCÄdæan]s½ μnkabUnik 5°¦

Oxacillin ¬1mIRkURkam¦ ¬cMeBaH Benzylpenicillin ¦ ≤ 19b - ≥ 20

Tetracycline ¬30mIRkURkam¦ ≤ 18 19-20 ≥ 22

Erythromycine ¬15mIRkURkam¦ ≤ 15 16-20 ≥ 21

Chloramphenicol ¬30mIRkURkam¦ ≤ 20 - ≥ 21

Co-trimoxazole ¬25mIRkURkam¦ ≤ 15 16-18 ≥ 19 M.catarrhalis (Mueller-Hinton) Tetracyclie ¬30mIRkURkam¦ ≤ 14 15-18 ≥ 19

Erythromycin ¬15mIRkURkam¦ ≤ 13 14-22 ≥ 23

Co-trimoxazole ¬25mIRkURkam¦ ≤ 10 11-15 ≥ 16 a National Committee for Clinical Laboratory Standards (NCLLS). Performance Standards for antimicrobial susceptibility testing. M 100-58 Vol 18, 1998. b Resistant or Intermediate cMeBaH Enterobacteriaceae nig Staphylococci bec©keTseFVIGg;TIb‘Íy:URkamedayeRbIDIs ¬Kirby-Bauer¦ KYrRtUv)aneKeRbI. S. pneumoniae KYrEtRtUv)aneKetsþGg;TIb‘Íy:URkamenAelIfñalbNþúH Mueller-Hinton Edl manQammFüm 5° sRmab; Tetracycline chloramphenicol erythromycin nig Benzyl penicillin. eKk¾GaceRbIR)as;fñalbNþúHEdlmanQamRss;Fm μta)anEdr. cMeBaHBBYk benzyl penicilline eKcUlcitþ eRbIR)as;bnÞHDIs Oxacillin ¬1 mIRkURkam¦ CageK eRBaHvaGacpþl;llT§pll¥cMeBaH MIC nigmankMhab;nwgl¥ . RtUvcgcaMfa bnÞHDIsBYk Benzyl penicilline GacRtUv)anxUcxat nigfykMhab;y:ag elOnkñúgGakasFatuekþA ehIyEdlGacpþl;nUvlT§plEdlminKYr[eCOCak;)an . H. influenzae KYrEtRtUv)aneKeFVIetsþrk β-lactamase production tamry³kareRbIR)as;etsþ Nitrocefin. manBYk H. influenzae edaykRmEdlbegáItCa Ampicillin-resistant edayminplit β-lactamase. enAkñúg dMNak;kalenH eKminRtUveFVIetsþGg;TIb‘Íy:URkamelI H. influenzae tambec©keTsDIseT . M.catarrhalis EdleKrkeXIj KYrEtRtUv)aneFVIetsþ β lactamase production. kareFVIetsþRbqaMg nwg tetracycline nig erythromycin minRtUv)aneKtRmUv[eFVIdac;xatenaHeT .

108

BBYk Candida albicans EdleKbNþúHeXIjmincaM)ac;eFVIetsþCamYynwgGg;TIb‘Íy:URkamNamYy eT . mnÞIrBiesaFn_PaKeRcInpþl;lT§pl Semi-quantitative eTAelI)ak;etrIEdleKbNþúHenAelIfñalrwg dUc xageRkam ³ ¬÷¦ = mankBa©úMemeraKBIr b¤bI ÷ = duHtictYc ÷÷ = duHeRcInbgÁÜr ÷÷÷ = duHeRcInelIslub karbNþúHrk Mycobacterium tuberculosis bEnßmBIelIkarerobcMsMPar³sMrab;eFVIPñaskBa©k; ¬CaTUeTAKWkMhak EtminEmnCanic©kalenaHeT¦sMrab;karBinitüpÞal; edaybMBak;BN’GasIut-elOn eKKYreFVIkarbNþúHrkBYk M. tuberculosis enAeBlEdlmankarsgS½y. manGñk Cm¶WmYycMnYnEdlmankarsgS½yfa manCm¶WrebgsYtBMumank¥k nigbeBa©jCakMhakGVIKYr[kt;sMKal;eT. tamkarBit mankMhakbnþicbnþÜcGacbegáIteLIg b:uEnþGacnwgRtUv)aneKelbeTAvijPøam². enAkñúgkrNIdUcxagelIenH RKUeeBTü KYrEtykkMhakEdlmanlayrsrbs;RkBH ¬CaTUeTAeKTTYl)anenAeBlRBwkRBlwm¦ enHrYcykeTAbnSabeday eRbI Sodium bicarbonate ¬100 mIlIRkam¦muneBlepJIeTAkan;mnÞIrBiesaFn_. mankarcMNayeRcInNas;kñúgkar bNþúHkMhakedIm,IrkBBYk)ak;etrIEdlbgá[maneraKrebgenH eTAelIkMhakEdleKRbmUlral;éf¶ ¬ebIeTaHCaman GñkCMgWEdleKminsgS½yEtmYycMnYnb:ueNÑaH EdleKrkeXIjk¾eday¦. dUecñHeKnwgminesñIsMueFVIkarbNþúHkMhakenH CaRbcaMeT . viFIsMlab;emeraKEdlqøgcUlBIeRkAeday Concentration-digestion kMhakEdleKyk)anBIGñkCm¶WEdlmanCm¶Wrebg CaerOy²EtgEtCadMukMhakBit²EdlecjmkBIsYt ehIyvaKYrEt RtUv)aneKeRCIserIsykeTAeFVIkarbNþúH. eTaHCay:agNak¾eday kMhakEdlxakecjmkRtUvqøgkat;bMBg;k nigmat; dUecñHkarqøg Flora BI PharynxKWCabBaðaEdlminGaceCosrYc. )ak;etrIEdlqøgTaMgGs;enH KYrEtRtUv)aneKsmøab; [Gs;edIm,IkMu[vaduHlUtlas;enAkñúgfñalbNþúH Löwenstein Jensen. viFIsMlab;emeraKEdlqøgcUlBIxageRkA eday Concentration-digestion enHKYrEtRtUv)aneKGnuvtþeTAelIRKb; vtßúviPaKTaMgGs;EdlmankarqøgcUleday Flora Fmμta. manbec©keTsbIxageRkamEdleKeRbIR)as;ya:gTUlMTUlay ³

- Sodium hydroxide (NaOH) (Petroff) - N-acetyl-L-cystein-sodium hydroxide (NALL-NaOH) nig - Zephiran-trisodium phospate

109

bec©keTs Sodium Hydroxide (Petroff) bec©keTsenH )anBRgavPaBxab;rbs;kMhak nigbMpøaj ¬sMlab;¦emeraKEdlqøgcUlTaMgGs;. EteTaHCay:agNa k¾eday Sodium hydroxide )anbgá[ Mycobacteria Bul dUcenHeKRtUvRbugRby½tñenAeBlEdleRCIserIsyk bec©keTsenHmkGnuvtþ . eKRtUv[R)akdfa ³

- kMhab;cugeRkayrbs; NaOH minelIsBI 2°eT - minRtUvdak;emeraKrebg[sßitenAkñúg NaOH [elIsBI 30 naTI edayrab;bBa©ÚlTaMgry³eBlbgVilpg

1- cak;bBa©ÚlKñarvagkMhak nig Sodium hydroxide 4° 40Rkam¼lIRt ¬sMlab;emeraKrYckñúg

Autoclave¦ edaybrimaNesμ IKñaenAkñúgdbEkv b¤RkLcMNuH 50 mIlIlIRtEdlrMgab;emeraK nigmin RCabTwk b¤k¾bMBg;TIbsMrab;bgVil )aøsÞikEdlman)atCaragsaCI .

2- rkSaTukenAkñúgsItuNðPaBmnÞIrBiesaFn_ ¬25-30GgSar¦ cMnYn 15 naTI rYcGRgYn ¬RkLúk¦l,ay enHedayRbugRby½tñenAerogral; 5naTImþgedayeRbIm:asIunRkLúk¬GRgYn¦. enAkñúgtMbn;EdlekþAxøMag eKGacRtUvkarrkSava[RtCak;bnþic b¤k¾bnßyry³eBleFVIRbtikm μ KWbnßyenAcenøaH 10-15 naTI.

3- bgVilCabnÞan; b¤k¾layl,ayenHCamYynwgTwksuT§ b¤ Phosphate buffer ¬PH 6, 8¦ [dl;Rkit Rtg;elx 50 mIlIlIRtedIm,IbBaÄb;Rbtikm μrbs; NaOH.

4- bnÞab;BITuk 15 naTIeRkaymk eKRtUvykl,ayenaHeTAbgVil 15 naTI eTotkñúgel,Ón 3000 g. cak;EpñkxagelIecaledayRbugRby½tñeTAkñúgRbGb; b¤FugEdlpÞúkeTAedayTwkfñaMsMlab;emeraK ¬Phenol b¤ Glutaraldehyde¦ eFVIkarbnSabdMNk;kkrenaH edaysUluysüúgGasIutkørIRDIc 2m:Ul¼lIRt Edlman phenol BN’Rkhm 2°. laybBa©ÚlKñaeedayGRgYnpg rhUtdl;mankar ERbBN’BIRkhmeTAelOg. CaCMnYs eKGacbEnßmsUluysüúgGaMgDIkaT½rmYytMNk; ehIybnÞab;mk bEnßmsUluysüúg HCl mþgmYytMNk;² nigGRgYnCab;rhUt .

5- ebIsinCaeKRtUveFIVkarbNþúHPøam²enaH eKRtUvlaysUluysüúgEdlbnSabehIyenHCamYynwg 1-2 mIlIlIRténesr:UméRb0/85°Edls¥atK μanemeraK b¤enAkñúgTwksuT§ b¤GaclayenAkñúg1-2mIlIlIRt én Albumin fraction V Edls¥atKμanemeraKrbs;stVeKa b¤RkbI .

bec©keTs N-acetyl-L-cysteine-sodium hydroxide kMhab;Gas‘UtTabEdllayCamYynwgPñak;garkat;xÞúH dUcCa N- acetyl-L-cysteine ¬NALC¦KWman plb:HBal; elIBYkemeraKrebgtictYc ehIyry³eBlTukeGayduH b¤sItuNðPaB k¾minsMxan; dUcenAkñúgbec©keTs NaOH eT. EteKRtUverobcMsUluysüúg NALC-NaOH EdlGacrkSaTuk)anminelIsBI 24 em:agenHCaerogral;éf¶ .

110

1- layesμ IKñaénsUluysüúg Sodium citrate ¬29Rkamén Sodium citrate dihydrate kñúgmYy

lIRtTwksuT§¦ CamYynwgsUluysúüg 4° én NaOH 40Rkam¼lIRt¦ rYcbnÞab;mkdak;rm¶ab;emeraK enAkñúg Autoclave. sUluysüúgenHGacRtUv)aneKrkSaTukenAkñúgsItuNðPaBmnÞIrBiesaFn_pgEdr.

2- enAmuneBleRbIR)as; bEnßm 0/5 Rkamén NALC eTAkñúg 100 mIlIlIRténsUluysüúg NaOH-

Sodium citrate . 3- GaRs½yelIcMnYnénvtßúviPaKEdleKRtUvsMGatemeraK erobcM 2/5Rkamén NALC eTAkñúg 500

mIlIlIRténsUluysüúg NaOH-sodium citrate b¤ 5 Rkamén NALC eTAkñúg 1000 mIlIlIRt énsUluysüúg NaOH-sodium citrate. eRkayBI 24 em:ageKRtUvcak;RbtikrenHecal.

4- bEnßmkñúgbrimaNesμ IKñaénsUluysüúg NALC-NaOH EdlRtUvykmkGnuvtþkargarCamYynwg kMhakedaydak;enAkñúgbMBg;Ekv b¤db b¤bMBg;)øasÞikmanRkitRtwm 50mIlIlIRtEdlman)atrag saCI. mUlKMrbTIb[Citl¥ rYcpáab;cuHpáab;eLIg ehIyGRgYnfñm² min[elIsBI 30 vinaTI .

5- dak;TIbbBaÄrenAkñúgsItuNðPaBmnÞIrBiesaFn_ ¬20-25 GgSar¦ ry³eBl 15 naTI . 6- layl,ayenHCamYynwgTwksuT§ b¤CamYynwg phosphate buffer (ph 6,8) EdlmankMhab; 67

mIlIm:Ul¼lIRt edIm,IbBaÄb;Rbtikm μrbs; NaOH. cak;TwkføaEpñkxagelIecaleTAkñúgRbGb; b¤kMb:ug Edlmandak;l,aysMlab;emeraKRtwmRtUv ¬Phenol b¤ glutaraldehyde¦ .

7- ebIsinCaeKRtUveFVIkarbNþúHPøam² laykkr ¬kMNk)atTIb¦ CamYynwgesr:UméRbkMhab;0/85° b¤TwksuT§cMnYn 1-2 mIlIlIRt b¤k¾layCamYynwg Albumine fraction V rbs;eKa b¤RkbIs¥at KμanemeraK.

bec©keTs Zephiran-trisodium phosphate

BYk Mycobacteria GacFn;CamYynwgkarsMGatyUr ebIsinCakareFVIenaHeFVIeLIgedayfñm². dUcenHehIyry³ eBlénkarrkSaTuknwgsItuNðPaBminsMxan;eT.

1- erobcM 1 KILÚRkamén Trisodium phosphate¬Na3po4. 12 H2O¦eTAkñúgTwksuT§ekþAcMnYn 4lIRt rYcbEnßm 7/5mIlIlIRtén Benzalkonium chloride 17° ¬Zephiran¦bnÞab;mklaycUlKña[ sBVnigrkSaTukenAsItuNðPaBmnÞIrBiesaFn_.

2- laycUlénbrimaNesμ IénkMhak ¬rhUtdl; 10 mIlIlIRt¦ CamYynwgsUluysüúg Zephirantri-

sodium phosphateenAkñúgbMBg;Ekv b¤TIb)aøsÞikEdlman)atragsaCIcMNuH 50mIlIlIRt. mYlRKb [Citl¥ rYcGRgYnedayeRbIm:asIunGRgYncMnYn 30naTI .

3- Tukl,ayEdlRkLúkrYcenHecalcMnYn 30 naTI .

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4- bgVilcMnYn 15 naTI edayel,Ón 3000g . cak;TwkføaEpñkxagelIecal edayRbugRby½tñeTAkñúg

bMBg; b¤RbGb;EdlmanpÞúksarFatusMlab;emeraK ¬phenol b¤ glutaraldehyde¦ rYclaykMNk )atTIbenAkñúg 20 mIlIlIRtén neutralizing phosphate buffer [)an pH6,61 .

5- bgVilmþgeTotcMnYn 15 naTI kñúgel,Ón 3000g. cak;TwkføaxagelIecal rYcykkMNkeTAbNþúHenA elIfñalbNþúH.

karbNþúH

1> dak;kMNkcMnYn 3dMNk;¬RbEhl 0/1mIlIlIRt¦eTAkñúgfñalbNþúH Löwenstein-Jensen y:agticbIfñal 2> kMNt;nUvGRtaqøgeraKcUlrbs;fñalEdl)anbNþúH CaeTogTat; nigkt;RtacMnYnfñalEdlqøg.

GRtaénkar qøgRtUvsßitenA 3-5°. karqøgelIslb; ¬elIsBI 5°¦ enAelIkarbNþúHkñúgfñalbNþúH Löwenstein-

Jensen bBa¢ak;[eXIjfa bec©keTskarBarkuMeGayemeraKqøgcUl ¬Decontamination procedure¦ minman RbsiT§PaBRKb;RKan;. kMriténkarqøgticCag 3°bgðaj[eXIjfa bec©keTsénkarsMlab;emeraKxøaMghYsehtueBk GacnaM[ Mycodacteria EdlmanenAkñúgvtßúviPaK ¬kMhak¦ minGacduHlUtlas;)an. karbkRsaylT§plénkarbNþúHrk M. tuberculosis fñalbNþúH Löwenstein-Jensen KYrEtRtUv)aneKdak;bNþúHedayepþk nigcMhrKRmbBak;kNþalcMnYn 2-3 éf¶ enAkñúgsItuNðPaB35-37GgSar. bMBg;fñalbNþúH bnÞab;mkKYrTukeGayduHenAsItuNðPaB 37GgSarcMnYn 6s)aþh_ ehIyRtUv)antamdanemIlkarduHlUtlas;rbs;vaerogral;s)þah_. kñúgeBltamdanral;s)aþh_enH kBa©úMemeraKEdl duHenAelIfñalbNþúHKYrRtUv)aneKkt;Rta. eKRtUveFVIPñasenAelILam ehIyeFVIkarbMBak;BN’ Ziehl-Neelsen. ebIsinNaCa)asIuTaMgenaHBMucab;BN’ Ziehl-Neelsen eTenaH eKGacpþl;lT§plfa karbNþúHenHmankarqøg. lkçN³BiessénkBa©úMemeraKrbs; Mycobacterium tuberculosis EdlekItelImnusSKW }eRKImsVit nigmanBN’ elOg} nigCYnkaleKGacBinitüemIleXIjfaduHenAkñúg 2-3s)aþh_eRkayBIkarbNþúH ¬b:uEnþmaneBlxøHGacelOn CagenH¦. BYk Mycobacteria EdlekItenAelIstVBahn³ ¬eKa RkbI¦¬M.bovis¦ kBa©úMemeraKrbs;va CaTUeTA

1 erobcM Neutralizing phosphate buffer 67 mIlIm:Ul¼lIRt sUluysüúgsMrab;rkSaTuk ³

lay 9/ 47 Rkamén Anhydrous disodium phosphate eTAkñúgTwksuT§ 1 lIRt. lay 9/07 Rkamén Anhydrous disodium phosphate eTAkñúgTwksuT§ 1 lIRt. sMrab; PH 6,8 buffers ³ lay 50 mIlIlIRténsUluysüúg ACamYynwgsUluysüúg B. sMrab; PH 6,8 buffers ³ lay 37/5 mIlIlIRténsUluysüúg ACamYynwgsUluysüúg B. BinitüemIl PH. EfmsUluysüúg A edIm,IbegáIn PH b¤ sUluysüúg B edIm,Ibnßy PH.

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relagmanlkçN³ragdUcERkmBN’s. manBBYk Mycobacterial minbgáeraKepSg²eTotGacduHlUtlas;y:ag elOn ¬CYnkalduHenAEtry³eBlb:un μanéf¶ eRkayeBlbNþúHb:ueNÑaH¦ ehIyCYnkalman b¤minmanbegáItCaBN’ RkhmelOg b¤TwkRkUc¦ enAelIkBa©úMemeraKenaH. ebIsinCaeKBinitüeXIjfa kBa©úMemeraKenHmanlkçN³Biess ehIykarbMBak;BN’ Ziehl-Neelsen k¾bgðaj[eXIjCak;c,as;fa CaBBYk)ak;etrIEdlcab;BN’enaH eKRtUveFVIkar bkRsaylT§plCadMbUgfa Ca “Mycobacterium pp nigRbEhlCa M.tuberculosis”. )ak;etrIEdlbNþúH)an mkBIenH KYrEtRtUv)aneKbBa¢ÚneTAkan;mnÞIrBiesaFn_fñak;Cati b¤mnÞIrBiesaFn_bEg¥kNamYy edIm,IeFVIkarviPaKbnþ nig eFVIetsþGg;TIb‘Íy:URkam. suvtßiPaBkñúgkarbMeBjkargar karGnuvtþkargarelIkMhak RtUvEteFVIeLIgedayRbugRby½tñ ehIykMb:ugEdleRbIkñúgkardak;kMhakRtUvEtCakMb:ugEdl manKMrbbiTCitminehor b¤kMBb;ecjeLIy. lkçN³BiessénkMb:ugEdleRbIR)as;enHmansar³sMxan;Nas; ebIsinCa kMhakenHRtUv)aneKepJItamb:usþéRbsNIy_. vamansar³sMxan;pgEdrfa ral;karbMeBjkargarEdlTak;TgnwgkMhak ¬eTaHbICaminmankarbBa¢ak;fa manCm¶WrebgenAelIRkdasesñIsMuk¾eday¦KWRtUveFVIenAkñúgbnÞb;EdlmansuvtßiPaB. mnÞIrBiesaFn_KYrEtmany:agehacNas;k¾bnÞb;suvtßiPaBRbePTTI 2 1 EdrkñúgkarGnuvtþkargarTaMgLayEdlTak;Tg nwgkMhak . EteTaHCay:agNak¾eday eKRtUvEtRbugRby½tñCanic©enAerogral;eBlebIk-biT b¤GRgYnbMBg;TIbb¤db nigkñúgeBl bgVilvtßúviPaK. karbegáItCaBBuHTwktUc²EdlbgáeraKGacbgáCm¶Wdl;buKÁlikmnÞIrBiesaFn_ dUecñHeKRtUvEtmanviFI nig bec©keTsmYyc,as;las;ykmkGnuvtþ 2. kardwkCBa¢ÚnfñalbNþúHEdlmandak;bNþúH M.tuberculosis tamry³b:usþéRbsNIy_eTAkan;mnÞIrBiesaFn_bEg¥k b¤ fñak;CatiCakarRbfuyRbfanmYynwgkarEbk)ak;RbGb;EdlepJIenaH. dUecñH eKRtUveRbIRbGb;TaMgLayNa Edlb:usþ éRbsNIy_tRmUv[eRbInigmankaryl;RBmpg.

1 Manual of basic techniques for a health laboratory, 2nd Geneva, World Health Organization, 2003 2 Laboratory senices in tuberculosis control Part I: Oraganization adn manegement. Geneva, World Health Organization, 1998 (Unpublished document WHO/TB98.258)

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Cm¶WkameraK esckþIepIþm cMnYnénGtisuxumR)aNEdleKdwgfa)anqøgtampøÚvePT ehIynigsBaØaKøInikénemeraKTaMgGs;enaH )anekIneT,IgKYr[ kt;smÁal;enAkñúgry³eBl 20qñaMknøgmk. enAkñúgtaragTI21)anbgðajGMBIGtisuxumR)aNEdlGacqøgtampøÚvePT nigCm¶WEdlekItmaneT,IgedaysarBYkTaMgenaH. eraKvinicä½yénBYkenH KWCabBaðaRbQmmYyEdlmnÞIrBiesaFn_ evC¢sa®sþCYbRbTH. eraKvinicä½yEdl)anmkBImnÞIBiesaFn_KWCaFatupSMmYyy:agsMxan;kñúgkarBüal)al nigTb;sáat; Cm¶WdUcCa Cm¶WsVay b¤RbemH b:uEnþminEmnmanRbeyaCn_EtGñkCm¶WxøÜnÉgpÞal;eT EtmanRbeyaCn_dl;édKUrYmePT rbs;eKpgEdr .

taragTI21 ³ GtisuxumR)aNEdlqøgtampøÚvePT nigbNþúMeraKsBaØaEdlBak;B½n§

Pñak;garbgáehtu bNþúMeraKsBaØaNeisseria gonorrhoeae rlakRkeBj Bartholin rlaks,Ún rlak Chorion & amnion rlaksn§anrbs;EPñk mankarraldalEdlbNþalmkBIemeraKRbePTenH ¬ rlaksnøak; rlakEs,k rlaksésBYr ¦ rlaksac;s,Ún rlak epidermia eraKGarK μankUn rlak pharynx ehImeyanI rlakeRsam Es,krbs;eføIm rlak rectum rlakRkeBj prostat rlakéds,Ún rlak TVarenamrbs;burs . Chlamydia trachomatis ( serovars D-K)

rlakRkeBj Bartholin rlaks,Ún rlaksn§anrbs;EPñkrbs;Tark rlaksac;s,Ún rlaksYtrbs;Tark GarKμankUn GMe)AGMEbkTark rlaks,Ún¬

PID¦ rlakeRsameføIm ehImeyanI rlak rectum, syndrom Riter

rlakéds,Ún rlakbgðÜrenamburs . Chlamydia trachomatis ( serovars L1 , L2, L3)

Lymphogranuloma venereum

Teponema pallidum Cm¶WsVay Haemophilus ducreyi dMe)ATamT,a Calymmatobacterium- granulomatis ehImkUnkNþúrRkelon ¬donovanosis) Mobiluncus spp. Bacterial vaginosisHuman (alpha) herpesvirus (HSVI nig HSVII ) Cm¶W Herpes enAelIRbdab;ePT nig bbUrmat; rlakeRsamxYr Cm¶W Herpese

elITarkeTIbekIt eraKGaKμankUn Cytomegalovirus (CMV) dMe)ArlakBIkMeNIt

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Pñak;garbgáehtu bNþúMeraKsBaØa

Human philloma virus (HPV) Cm¶WmharIks,Ún Cm¶Wesrman; Human immunodeficiency virus (HIV) eGds_ nig Cm¶WepSg²Tak;TgnwgCmøWeGds_ Hepatitis B virus (HBV) rlakeføImRbePT B Gardnerella vaginalis rlakbgðÜrenamburs narI Candia albicans rlakRkeBj nig Es,kB½T§CMuvijRkeBj rlakRbdab;ePT nig rn§ePTrbs;RsþI

EpñkxagelIenHerobrab;RtYs²GMBIkarviPaKrkemeraKEdlqøgjwkjab;tampøÚvePT EdlRtUv)aneKrkeXIjkñúgvtßúviPaK ecjBIRbdab;bnþBUCburs nignarI. Pñak;garbgáeraKEdlrYmTaMgBBYkvIrus nig)ak;etrIdUcCa Ureaplasma urealyti-

cum Mycoplasma hominis nig Mobiluncus spp.CaedIm nwgminRtUv)aneKelIkmkniyayenATIenHeT. edIm,I TTYl)annUvBt’maneRcInCagenH GñkGanTaMgGs;GacGannUvGtßbTe)aHBumÖpSaynanarbs; WHO1.

rlakbgðÜrenamburs Cm¶WrlakbgðÜrenambursmanlkçN³ enamecj b¤ minecj b:uEnþeKeXIjmankarrlakEdlbgáeT,Ig Neisseria

gonorroeae b¤ Chlamydia trachomatis EdlminbgðajCaeraKsBaØa)anekIteT,Igjwkjab;Edr. ebIsinCaBMu mankarBüa)al[Tan;eBleT karrlakbgðÜrenam edayBBYkemeraKRbemH nig Chlamydia trachomatis vaGac vivDÆn¾eTA Epididymitis. karrlak Rectum¬rn§KUT¦nigOropharynx edaysar EtemeraKRbemH(N.gonorr-

hoeae) nig C.trachomatis TaMgenH GacekIteT,IgcMeBaHbursEdlrYmePTCamYybursdUcKña. eKGaceFVIkarEbgEckCm¶WrlakbgðÜrenambursenHCa 2 RbePT KWkarrlakbgðÜrenamedaysaremeraKRbemH nigCm¶WrlakbgðÜrenamEdlminbNþalmkBIemeraKRbemH (NGU). tamkar)a:n;sμanRbEhl Bak;kNþalénGñkCm¶W NGU enHbgáeT,Igedaysar C.trachomatis b:uEnþmUlehtuepSgeTotcMeBaHkarEdlesssl;enAEtBMuGaceFVIkar bMPøW)anc,as;las;eT,Iuy. tamry³karsikSamYycMnYn Ureaplasma urealyticum k¾GacbNþal[rlakbgðÜr enam)anEdr nig Trichomonas vaginalis vijeKGacrkeXIjRbEhl 1-3% énkrNI NGU enH. karrlak xagkñúgbgðÜrenamrbs;bursedaysarEt Humanherpes virus Gacpþl;[mankarhUrTwkrég ecjGMBIbgðÜrenamEdr manBBYk)ak;etrImYYycMnYn dUcCa Staphylococci BBYk Enetrobacteriaceae Acinetobacter spp. nig Pseudomonas spp.k¾GacRtUv)anrkeXIjenAk μ úgbgðÜrenamrbs;bursmansuxPaBFm μta b:uEnþeKBMumaneXIj karbgðajc,as;las;BImUlehtuEdlbNþal[rlakbgðÜrenameT .

1 Van dyck E, Meheus A2, piot p.Laboratory diagnosis of sexually transmitted diseases . Geneva, World Health Organization, 1999.

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karBinitü C.trachomatis manlkçN³sμ úKsμaj nigminykmkBiPakSaenAkñúgEpñkenHeT. eRkAGMBIkarviPaKrkenA kñúgkarbNþúHekasika eKGaceFVIetsþepSg²eTotEdlminTak;TgnwgkarbNþúH dUcCa karviPaKrkGg;TIEhSnrbs; Chlamydia edaysarEt Gg;sIum Immunoassays, Immunofluorescence assays nigkareFVIetsþ Nucleic Acid Amplification. eTaHbICay:agNak¾eday etsþTaMgGs;enHKWenAEtCaetsþEdlmantémøéfø hYsehtu .

karykvtþúviPaK nigkardwkCBa¢Ún edIm,IykvtßúviPaKecjBIbgðÜrenam eKRtUvyktm,arsMT,Ixagcugy:agtUc b¤ loop tUc Edls¥atK μan emeraKs‘k RbEhl 3-4 sg;TIEm:RteTAkñúgbgðÜrenamrbs;bursf μm² rYcbgVilmuneBldkecj. xÞúHEdlhUrecjmkGacRtUv )aneKyktamry³ Loop b¤ tm,arsMT,IEdl)ans‘kcUlenaH. smasFatuTaMgcugnigdgrbs;tM)arKWsMxan;. sMrab; karbNþúH N.gonorrhoeae eKcUlcitþeRbIcugEdlmansMLI Charcoal-treated b¤ Calcium Alginate b¤ Dacron. RbsinebItM)arsMrab;ykvtßúviPaKBiessEdleKerobcMsMrab;TIpSarenH minmanGBa©wgeKeRbIsMLItM)arFmμta ehIyvtßúviPaKKYrykeTAdak;bNþúHPøam². karRc)ac;GEg¥l Prostate min)anbegáInGRtarkeXIj Gonococci b¤ Chlamydiae enAkñúgkrNIrlakbgðÜrenameLIy. vtßúviPaKBI Anorectal RtUvykedayruktM)arcUl 4-5 s>m eTAkñúgrn§KUT. cMeBaHvtßúviPaKBImat;-bMBg;kEpñkxag eRkayénbMBg;k nigeCIgGamIdal;KYrRtUvt,aryknigdak;bNþúHPøam². Cakarl¥bMput karbNþúHvtßúviPaKedIm,Irk N. gonorrhoeae KYrRtUveFVIedaypÞal;enAelIfñalbNþúHenAkñúgKøInik. fñal EdlbNþúHemeraKKYrdak;enAkñúgRkLEdlduteTon b¤enAkñúgmCÄdæanEdlman]sμ ½nkabUnik 5-10° edaymanPaB esImx<s;. RbsinebIkarbNþúHminGaceFVIeTA)anPøam²eT eKKYreRbIfñalsMrab;dwkCBa¢ÚndUcCa Amies b¤ Stuart. ry³eBldwkCBa¢ÚnKYrEtxøIEdlGaceFVIeTA)an ticCag12ema:g enAkñúgsItuNðPaBxageRkA dl;30GgSaes. RtUv eCosvagkarbgák.

karBinitüedaypÞal; nigkarbkRsaylT§pl karsikSaPaKeRcIn)anbgðajfa vtþmanénBBYk Polymorphonuclear cMnYn 4 b¤eRcInCagenH enAkñúgmYyrgVg;Ekv BRgIkmIRkUTsSn_EdleRbIeRbgsRmab;BRgIkbBa¢ak;fa mankarrlakbgðÜrenamrbs;burs. lkçN³enH)anCYydl; RKUeBTükñúgkarseRmccitþfaetIRtUvBüa)al b¤minBüa)alGñkCm¶W Edlt¥ÚcEt¥rya:geRcInBIbBaðabgðÜrenam. esÞIrEtRKb;karN_Cm¶WenHenAelIburs eKsegáteXIjmanxÞúHhUrecjmkBIRbdab;ePTrbs;eK ehIyeKGacemIleXIj eKalikas Polymorhonuclear¬elIsBI 10eKalikaenAkñúgmYyrgVg;EkvBRgIkrbs;mIRkUTsSn_EdleRbIeRbgBRgIk

116

CMnYy¦ GacRtUv)aneKBinitüeXIjenAelIbnÞHkBa©k;. EteTaHCay:agNak¾eday enHminEmnekIteT,IgenARKb;krNI NGU manRbtikm μénkarrlakminsUvxøaMg. bnÞHkBa©k;TaMgT,ayNaEdleKBinitüeXIjfa manticCag 4 eKalika PMN kñúgmYyrgVg;EkvBRgIkmIRkUTsSn_ EdleRbIeRbgBRgIkedayBMueXIjmanBBYk Gram-negative diplococci

enAkñúgeKalikaenaH RtUv)aneKKitfaCaBYk NGU PaKeRcIn . bnÞHkBa©k;Edl):atedayvtßúviPaKykecjBIRbdab;ePTburs ¬remoltm,arsMT,IelIbnÞHkBa©k;¦ RtUv)aneKP¢ab;eday eRbIkMedA rYcbnþeTottamry³karbMBak;BN’emTIET,nBN’exov b¤ Gram. vtþmanrbs; Gram-negative doplo-

cocci enAkñúgeKalikasRbePT PMN Edl)anmkGMBIbgðÜrenamrbs;burs RtUv)aneKsnñidæanfa CaemeraKRbemH EdlbgáCm¶WRbemHTwk)ay . eKmineFVIkarbMBak;BN’ Gram eTAelIvtßúviPaKTaMgT,ayEdlykecjBIkñúgbgðÜrenam rbs;bursEdlBMumanbgðaj eraKsBaØa tamkarykvtßúviPaKedayt,arrn§KUT b¤BImat;-bMBg;k enaHeT. b:uEnþeKeFVIkarBinitüedaymIRkUTsSn_eTAelI vtßúviPaKEdlmanxÞúH nig TTYl)antamry³kareRbIR)as; anoscopeEdlGaceGay tMéleraKvinicä½yx<s;KYrsm.

karbNþúH Neisseria gonorrhoeae eFVIkarbNþúHenAelIfñalbNþúH Thayer-Martin EdlEkERb (MTM)1 b¤fñalbNþúH New York City (NYC)1 nigTukeGayduHkñúgsItuNðPaB 25GgSar EdleBareBjeTAedaysMeNIm nigsßitenAkñúgmCÄdæan]sμ ½nkabUnik¬RkT,-manduteTon ¦. fñalbNþúHKYrEtRtUv)aneKBinitüerogral;éf¶cMnYn 2éf¶Cab;²Kña. mnÞIrBiesaFn_Edlmmajwk nigman vtßúviPaKeRcInkñúgkarbNþúHrk N.gonorrhoeae CaerOy²eKniymeRbIR)as;fñalbNþúúHQamq¥inEdlmanCeRmIs b:uEnþmanbEnßm Iso Vitalex b¤vtßúbEnßmepSg²eTotRbhak;RbEhlenH bEnßmBIelIfñalbNþúHCeRmIs MTM. karniymeRbIR)as;dUcenHedaysarEtBBYk N.gonorrhoeae 3-10 % kñúgtMnn;mYycMnYnsg;sIubeTAnwgkMhab; Vancomycin EdlmanenAkñúgfñalbNþúHCeRmIs MTM. kBa©MúemeraKrbs; N.gonorrhoeae GacenAEtminTan; rkeXIj 24ema:geRkayBIkarbNþúH. BYkenHGacnwgduHenA 48 em:ag CakBa©úMemeraKEdlCaBN’seTARbepHRsGab; e)a:g nigcaMgBnøWEtmanTMhMEbøk² nigrUbragxus²Kña .

1 fñalbNþúH New York City EkERbRtUv)aneKerobcMedaymanbEnßm 500 mIlIliRt énfñalbNúþúH GC ekþAG‘unK μanemeraK CaRKWHCamYynwgsarFatubEnßmdUcteTA ³

- Qamq¥inrbs;esH 50 mIlIliRt nig manbEnßm 5 mIlIliRt¼ liRt Saponin

- sarFatupSitEdlrMlayxøÜnÉgKμanemeraK ¬Yearst autosate) - l,ayGg;TIb‘Íy:UTikEdlman vancomycin colotin amphothericin nig Trimethoprim. sarFatubEnßmTaMgGs;Gacrk)anGMBI Oxoid Ltd, Wade Rd, Basingstoke, Hants RG248 pw, England .

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karviPaKrk Neisseria gonorrhoeae lT§p;lviPaKdMbUgénkarviPaKrk N.gonorrhoeae EdlykecjBIvtßúviPaK GMBIrn§bnþBUCrbs;burs KWBwgEp¥kelI etsþ Oxydase viC¢man nigkarBinitüenAbnÞHkBa©k;bMBak;BN’eXIjfaCaBBYk Gram-negative diplococci . etsþbBa¢ak;bnþeTotGacRtUv)aneKeFVIKW Carbohydrate degradation assays b¤etsþepSgeTot. rIÉkareRbIR)as; bec©keTs nigfñalbNþúHRtUv)aneKBiPakSaenAkEnøgepSgeTot 1.

etsþGg;TIb‘Íy:URkam eKeXIjmankarERbRbYlya:gsMebIménPaBsg;sIubrbs; N.gonorrhoeae cMeBaH Benzylpenicillin eTAtam tMbn;epSg²Kña. enAkñúgtMbn;xøHdUcCatMbn;sahara:énTVIbGaRhVic b¤ GasIuGaeKñy_ BYk N.gonorrhoeae sBVéf¶enH mankarbegáIt β-lactamase. ersIusþg;tamry³RkUm:UsUm ¬Chromosomic Resistance) eTAelI Benzylpeni-

cillin EtminmanbegáIt β-actamase RtUv)aneKrkeXIjmanekIteRcIn nigCYbRbTHjwkjab;enAkñúgRbeTsCaeRcIn. EteTaHCay:agNak¾edaybec©keTsénkareFVIGg;TIb’Íy:URkamedaybnÞH Discs minEmnCaetsþEdlKYr[eCOCak; )aneT. enAkñúgtMbn;EdlBBYk benzylpenicillin ampicillin b¤ amoxicillin enARtUv)aneKeRbIR)as;sRmab;Büa)al BBYkCm¶WRbemHenH BBYk N.gonorrhoeae ¬sMxan;ykecjGMBIkrNIBüa)albraC½y¦ KYrEtRtUv)aneKeFVI etsþrk karbegáIt β-lactamase tamry³etsþmYyEdleKehAfa etsþNitrocefin2 . edIm,IeFVIetsþ Nitrocefin enHGac RtUverobcMl,ay)ak;etrIEdl)anmkBIkarqáwHyk4-5kBa©úMemeraKeTAdak;kñúgbMBg;tUcEdlmanesr:UméRb0>2mIlIlIRt én Nitrocefin eTAkñúgl,ayemeraKxagelI rYclaybBa©ÚlKña[sBVry³eBl 1 naTI. karpøas;bþÚrBN’y:agelOn BIelOgeTACapáaQUk b¤Rkhm bBa¢ak;R)ab;fa N.gonorrhoeae enHbegáIt β-lactamase . kareFVIetsþGg;TIb‘Íy:URkameTAelI N.gonorrhoeae edayeRbIR)as;bec©keTs Disc-diffusion assay minRtUv)an eKpþl;Gnusasn¾eGayeRbIR)as; kñúgkarGnuvtþkargarRbcaMéf¶eLIy.

1 Van Dyck E, Meheus AZ, Piot P. Laboratory diagnosis of sexually Transmitted diseases. Geneva, World Health Organization, 1999. 2 Rbtikr Nitrocefin Gacrk)anBI Oxoid Ltd, Wade Road, Basingstoke, Hants RG 248pw, England nigman 1 mIlI

Rkam én Nitrocefin (SR 112 ) nig rehydration fluid mYydbtUc (SR 112A ). bMBg;tUcsRmab;eFVIetsþGacCMnYs)aneday discs sRmab;eFVIetsþ . eRbIR)as; discsRkdas EdlGaceP¢ak Nitrocefin ) )an ( discs Cefinase Gacrk)anBI BD Diagnostic systems, 7 loveton Circle, Sparks, MD 21152, USA ) .

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vtßúviPaKykecjBIRbdab;ePTrbs;RsþI Flora EdlmanenAkñúgRbdab;ePTRsþIEdlmunmkrdUvCaFmμtasm,ÚreTAeday Lactobacilli BBYk)ak;etrIEdlRtUv karxül; nigminRtUvkarxül; mindac;xat. xÞúH b¤ TwkrégEdlehorecjmkBIRbdab;ePTrbs;RsþIGacmankñúgkrNI ³

- rlakTVarmas (Vaginities) : Gardnerella vaginalis, Candida albicans

- rlakTaVrmasedayBYk)ak;etrI (Bacterial vaginosis): edaysarEtkarduHlUtlas;elIslb;én BBYkminRtUvkarxül; nig Moviluncus spp.

- rlakmat;s,Ún (Cervicitis) : Neisseria gonorhoea, Chlamydia trachomatis. BBYk)ak;etrIepSg²eTotdUcCaBBYk Enterobacteriaceae minEmnCamUlehtubBa¢ak;fa rlakTaVrmasRsþIeT,Iy. eKGaceXIjmanrlakrn§bnþBUCrbs;RsþImuneBleBjv½yRkmMu EdlbgáeT,Igeday N.gonrrhoeae b¤ Chlamydia

trachomatis Edr . Bacterial vaginosis ¬minEmnCakarrlakrn§bnþBUCRsþICak;lak;¦ KWCalkçN³mYyEdlEsþgeLIgedaykarekIn eT,IgelIslb;énvtßúravEdlhUrecjmkBIyUnI køinGaRkk; bUkpSMnwgkarekIneT,Ig énBBYk Mobiluncus spp. nig BBYk)ak;etrIminRtUvkarxül;epSg²Kña nigmankarfycuHén Lactobacilli Edlrs;enAnwgRbdab;bnþBUCrbs;RsþI . kareFVIeraKvinicä½yEdlQaneTArkkarsnññidæanfa Cakarrlakrn§bnþBUCrbs;RsþIeday)ak;etrIy:agehacNas;RtUvman sBaØa3sMxan;²³ mankarhUrTwkecjmk edayminFmμta pH rbs;eyanIKW > 4>5 ekasikaeKal¬ekasikaEs,kEdl man)ak;etrIenAetagCab;enAtamEKmrbs;vaEdleFVIeGayvaggwt¦ nigmankøinq¥abdUcRtI b¤køindUc Amine enAeBl eKbnþk; Potassium hydroxide mYytMNk;enAelITwkEdlhUrecjmkenaH . karrlakrn§bgðÚrenamrbs;RsþICajwkjab;k¾GacbNþalmkBI N.gonorrhoeae nig C.trachomatis Edr. karbgá eraKraleLIgeTAelI eday N.gonorrhoeae nig Chlamydia trachomatis EdlCaBBYk)ak;etrIEdlminRtUvkar xül;enAkñúgrn§bnþBUCrbs;RsþI nigBBYkRtUvkarxül;mindac;xatenH Gacbgá[manCaCm¶WrlakGagRtKak (PID) nig GacekItmanCaGarK μankUn b¤ kUneRkAs,Ún EdlCapllM)akyUrmkeTotrbs;CMgWenH. karrlakRbdab;bnþBUCedaysarEt)ak;etrIEdlmanrab;bBa©Úl N.gonorrhoeae nig C.trachomatis kñúgeBl EdlRsþIkMBugmanépÞeBaHGacnwgpþl;nUvpllM)akdUcCakUnekItminRKb;Ex karEbkTwkePøaH yUrrlak chorioamnio-

nitis rlaks,Únrbs;mþayeRkaysMral rlakCalikarsn§anEPñkrbs;kUn rlaksYt nigmanbNþúMeraKsBaØaénkar rlakTwkePøaH cMeBaHTarkeTIbnwgekIt .

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kñúgkrNImankaresñIsMuCaBiess vtßúviPaKEdleKykecjBIks,Ún nig rn§bnþBUCGacRtUv)aneKbNþúHrkBBYk S.aureus (toxic shock syndrome) S.agalactiae(Group B streptococci EdlbgáCm¶WelITarkeTIbekIt¦ Listeria monocytogenes ¬bgáCm¶WelITark ¦ Clostridiym spp. ( karrlUtkUnedaymanemeraK¦. eTaHbICaCm¶WEdlbgáeT,Igeday C. trachomatis nig Human herpesvirus RtUv)aneKCYbRbTHjwkjab; nigGac bgáCMgWeRcIny:agNak¾eday kareFVIeraKvinicä½ymnÞIrBiesaFn_rbs;BYkvaTamTarnUv]bkrN¾ nigRbtikrEdlmantémøéfø nwgminykmkBiPakSakñúgeBlenHeT .

karykvtßúviPaK nigkardwkCBa¢Ún RKb;vtßúviPaKKYrEtRtUv)aneKykenAeBlEdleKBintüs,ÚnedayeRbI]bkrN_ebIkRbdab;bnþBUC. ]bkrN_KYrEtRtUv epSImCamYynwgTwkekþA]NÑ²munnwgykmkebIk EteKminRtUveRbIR)as;fñaMsmøab;emeraK b¤ ERkmEdleRbIR)as;kñúg vis½yeraKRsþIenHeT eRBaHvaGacbNþal[BBYk Gonococci søab;)an . karBinitürkBBYkpSit G. vaginalis nig )ak;etrIepSg²EdleFVI[rlakrn§bnþBUC vtßúviPaKKYrEt RtUv)aneKykeday eRbIR)as;eQIrmUrsMT,I Rtg;EpñkxageRkayrbs;rn§bnþBUC. vtßúviPaKsRmab;ykmkviPaKrkBBYk Gonococci nig Chlamydia KYrEt)aneKykenARtg;ks,Únxagkñúg. bnÞab;BIyk]bkrN_ebIkeyanIehIy esøsEdlenAnwgks,Ún KYrEtRtUv)aneKCUtsMGatedayrmUlsMLI. ykeQIrmUlsMLI s‘kcUleTAkñúgrn§énks,Ún rYcbgVil[)any:agtic 10 vinaTImunnwgdkecjmkvij . cMeBaHkarykvtßúviPaKecjBIbgðÜrenam rn§KUT nig Oropharynx sMrab;RsavRCavrkBBYk Gonococci GacRtUv)an eKGnuvtþdUcCakñúgkrNIbursEdr. kñúgRKb;krNICm¶Wrlaks,Ún ¬PID¦ vtßúviPaKEdleRbIR)as;sMrab;bNþúHrk N. gonorrhoeae KYrEtRtUv)aneKyknUv nwgks,Ún. vtßúviPaKEdlykecjGMBIéds,ÚnrwtEtsuRkitEfmeTot b:uEnþtMbn; Cul-de-sae KWCakEnøgEdll¥bMput sMrab;ykvtßúviPaK. cMeBaHkUnek μgEdlmanrlaksn§anEPñk nigmanTwkrég b¤xÞúHeKRtUvykeQIrmUlsMLI b¤ loopeTApþityk . fñaldwkCB¢Úan Amies nig Stuart KWCafñalbNþúHEdlgayRsYl nigTukcitþkñúgkardwkCBa¢ÚnvtßúviPaKEdlykecjBI ks,Ún nigrn§Rbdab;ePTrbs;RsþIelIkElgEtvtßúviPaKEdleRbIR)as;sMrab;eFVIetsþrk C. trachomatis.

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karBinitþpÞal; nigkarbkRsaylT§pl karBinitüedaypÞal;énTwkrégb¤xÞúHEdlhUrecjmk CaviFIEdleKeRCIserIskñúgkareFVIeraKvinicä½yénCm¶WrlakpøÚvbnþBUC rbs;RsþI b:uEnþvaBMusUvmanGtßRbeyaCn_kñúgkareFVIeraKvinic½äykñúgkarrlakmat;s,Ún eT . ykeQIrmUlsMLIeTAremolenAelIbnÞHkBa©k;EdlmantMNk;esr:UméRbenATIenaH rYcRKbbnÞHkBa©k;esþIgmYyeTot BIelI. kareFVIrebobenH GaceFVI[ekasikaTaMgLayEbkecjBIKña. eKBinitüedaymIRkUTsSn_kñúgsnÞsSn_BRgIk x400 sRmab;BinitürkemIl Trichomonas vaginalis CamYynwgclnarbs;va BBYkpSit nig Clue cells. C. albicans GacbegáItCaRbemay ¬Pseudomycelia¦ EdleKBinitüeXIjedayécdnükñúgvtßúviPaKEdlykecj BIrn§bnþBUCrbs;RsþI. Clue cells vijRtUv)aneKrkeXIjenAesÞIrEtRKb;RsþIEdlrlakrn§bnþBUCedaysar)ak;etrI. ¬Bacterial vaginasis¦. sPaBRKab;² b¤PaBRkxVk;én Cytoplasm rbs;ekasikaEs,k vaBMumanlkçN³GVIKYr[ cab;Garm μN_b:un μaneT? EtGVIEdlKYr[cab;Garm μN_enaHKWkar)at;bg;énekasikaenaHeTAvijeT. kareFVIkarBinitüeday mIRkUTsSn¾én Wet mount énvtßúviPaKEdleKykmkBIks,Ún eKminpþl;Gnusasn¾eGayeFVIeT. karerobcMbnÞHkBa©k;sMrab;eFVIkarbMBak;BN’ Gram KWCakic©karmansar³sMxan;kñúgkarrkeraKvinicä½yénkarrlakrn§ bnþBUCRsþIeday)ak;etrI ¬Bacterial vaginosis¦. bnÞHkBa©k;KYrEtRtUv)aneKerobcMfμm²tamry³karyktM)arsMLI eTARbemolfμm²elIbnÞHkBa©k;. bnÞHkBa©k;Edlbgðajfa rn§bnþBUCrbs;RsþImanlkçN³Fm μtaKWbnÞHkBa©k;enaH eK BinitüeXIjmansMbUreTAeday Lactobacilli ¬)asIu Gram-positive FM² nigEvg²¦ nigmaneKalikas ticCag 5 kñúg 1 rgVg;énEkvBRgIkrbs;mIRkUTsSn_. bnÞHkBa©k;Edlbgðajfamankarrlakrn§bnþBUCRsþIenaH eKeXIjman Clue

cells EdlRKbdNþb;eTAedayBBYk)asIu Gram-negative tUc²CaeRcIn ehIyenAlayLMCamYynwg Flora cRmuH Edlsm,ÚreTAedayBYk)asIu Gram-negative tUc²y:ageRcInelIslb; nig)asIuEdlmanBN’ Gram ERbRbYl nig BBYk Coccobacilli nigCagenHeTAeTotKWBYk Gram-negative ragekag EtminmanvtþmanBBYk)asIu Gram-

positive FM² nigEvg²eT. rUbPaBEbbenHKWCaGaMgDIkaT½rd¾resIb nigCak;lak;sMrab; Bacterial vaginosis. brimaNeRcInelIslb;éneKalikas¬>10eKalikakñúgmYyrgVg;mIRkUTsSn_¦ enAelIPñasvtßúviPaKBITaVrmasEdlbMBak; BN’ Gram GacfaCa Trichomoniasis b¤ CaCm¶Wrlakmat;s,Ún. karbMBak;BN’GramminEmnCakareFVIeraKvinicä½yd¾sMxan;kñúgkarrukrkkarbgáCm¶WenAelIGñkCm¶WRsþIeT. karBinitüeday karbMBak;BN’ Gram eTAelIvtßúviPaKEdlykecjBIks,ÚnxagkñúgsMrab;rkBYk Intracellular Gram-negative

diplococci manRbsiT§PaBEt 50-70°b:ueNÑaH nigmanRbsiT§PaBEt 50-90°kñúgkareFVIeraKvinicä½yrkCm¶WRbemH Twk)ay edaysarEtlT§plEdlTTYl)anmkBMusUvsuRkit nigeRbva:Lg;rbs;Cm¶WRbemHTwk)aymankMritTab. kñúg krNIEdlmankarBinitüeXIjBBYk Intracellular Gram-negative diplococci enAelIbnÞHkBa©k;EdlerobcMBI vtßúviPaKecjBIks,Ún eKKYrEtraykarN¾faGBa©wg nigminRtUvraykarN¾fa Ca N.gonorrhoeaeb¤ Gonococci eT

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karbkRsaylT§plBenøIsGMBIPñasvtßúviPaKBIks,Ún EdlCajwkjab;pÞúkeTAeday Gram-negative Coccobaci-

lli nig)asIuEdlmanbMBak;BN’enAcugsgxag RtUvEteCosvag . plRbeyaCn¾sMxan;kñúgkarBinitüPñasks,ÚnenaH KWRbsiT§PaBrbs;vakñúgkareFVIeraKvinicä½y énkarrlakks,Úneday manhUrxÞúH vtþmanéneKalikas RbePT Polymorphanuclear elIsBI 10 eKalikaenAkñúgmYyrgVg;EkvBRgIkrbs; mIRkUTsSn_EdleRbIeRbgBRgIkCMnYy KWbBa¢ak;[c,as;fa karrlakks,ÚnEdl manlayLMedayxÞúHenaH Cajwkjy bgáeLIgeday N.gonorrhoeae nig¼b¤ C. trachomatis . karBinitüemIlbnÞHkBa©k;EdlbMBak;BN’ GraménvtßúviPaKEdlykBIkarrlakCalikasn§anrbs;EPñkKWCabec©keTs EdlmanPaBsuRkitbMputkñúgkarrkeraKvinicä½yénkarrlakCalikarbs;EPñkedaysareraKRbemHTwk)ay. vtþman rbs; Intracellular Gram-negative diplococci GacRtUv)aneKsnñidæanfa CakarrlakCalikasn§anEPñk eday sarBBYkemeraKRbemHTwk)ay ¬Gonococcal conjunctivitis¦ . karbNþúH vtßúviPaKEdlykecjBIs,Ún rn§KUT Calikasn§anEPñk nig Cul-de-sac GacRtUv)aneKbNþúHrk N.gonorrhooeae

edayeRbIR)as;bec©keTsBiessdUc)anerobrab;. vtßúviPaKKYrEtRtUv)aneKcab;epþImdMeNIrkarBinitü nigbNþúHenAeBl mkdl;mnÞIrBiesaFn_Pøam² b¤ebI[kan;EtRbesIrKWeFVIkarBinitüenAKøInikenAnwgkEnøgEtmþg. mindUcKñaCamYynwgburs eT karbNþúHmansar³sMxan;xøaMgNas;kñúgkarrkeraKvinicä½yénkarbgáCm¶WeraKRbemHcMeBaHRsþI. Sensitivity énkar bNþúHEtmYyelIksMrab;eraKvinicä½yemeraK Gonorrhoea cMeBaHRsþI KWmanEt80-90°b:ueNÑaH. Sensitivity TabCagenHcMeBaHvtßúviPaKTaMgLayEdleKykenACMuvijeBlsRmal. eKminpþl;Gnusasn¾[eFVIkarbNþúHrk G. vaginalis b¤BBYk)ak;etrIEdlminRtUvkarxül; sMrab;kareFVIeraKvinicä½y Bacterial vaginosis eLIy kñúgxN³eBlmanvtþmanrbs;BYkenHman 20-40° cMeBaHRsþIEdlBMumankarrlak. vtþmanrbs; G. vaginalis enAkñúgTwkEdlhUrecjmkBIRbdab;bnþBUCRsþI BMuEmnmann½yfa CakartRmUv[eFVIkar Büa)alenaHeT manEtGñkCm¶WEdlmaneraKsBaØaRKb;lkçN³énkarrlakRbdab;bnþBUCRsþIb:ueNÑaHEdlRtUv)aneKeFVI karBüa)al . ebIeFobeTAnwgkarBinitüedaymIRkUTsSn_ karbNþúHGacbegáInkarrkeXIjBBYk C. albicans BI 50-100° . karbNþúHKWCabec©keTsEdlmanRbsiT§PaBkan;EtxøaMgkñúgxN³eBlEdlbrimaNemeraKmancMnYntic. eTaHCay:ag Nak¾eday brimaNtictYcén C. albicans GacRtUv)aneKrkeXIjkñúgrn§bnþBUCrbs;RsþIRbEhl 10-30° énRsþI EdlKμanbeBa©jeraKsBaØaénkarrlakRbdab;bnþBUC. manEtkrNIEdleKBinitüeXIjfamanvtþman C. albicans

cMnYneRcInb:ueNÑaHEdleKKitfaCaPsþútagmYybBa¢ak;fa CamUlehtuEdlbNþal[mankarbgáCm¶WenARbdab;bnþBUC RsþIenH. CalT§pleKminpþl;Gnusasn¾eGayeFVIkarbNþúHemeraKeT. karbNþúHrkBYk G. vaginalis KWeFVIeLIgEt

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sMrab;rkemeraKelIGñkpÞúkemeraKenHEtminmaneraKsBaØab:ueNÑaH enAeBlEdlkarbNþúHenHeFVIeLIgbEnßmeTAelI Wet amount EteKBuMKYreFVIvaeT . vtßúviPaKEdlykecjBIdMe)ARbdab;bnþBUC dMe)AenAelIRbdab;ePT KWCabBaðaEdleKCYbRbTHjwkjab;enAkñúgRbeTskMBugGPivDÆn_CaeRcIn. kareFVIeraKvinicä½y mUlehtuKWCakic©kard¾lM)akmYyrbs;evC¢bNÐitb¤RKUeBTü nigEfmTaMgmnÞIrBiesaFn_pgEdr. karrlakEdlbgáeday GtisuxumR)aNeRcInmuxcUlKña k¾eKCYbRbTHjwkjab;Edr. dMe)ArlakRbdab;ePTGacbNþalmkBIPñak;garcMlgtam pøÚvePTepSg² ³

- Human herpesvirus - Treponema pallidum - Haemophilus ducreyi - Calymmatobacterium granulomatis EdlCaGñkbgá[ehImRkelon (Donovanosis)

- Chlamydia trachomatis serovars L1, L2, L3 Cm¶W Herpes enAelIRbdab;ePT KWCamUlehtucm,gEdleKCYbjwkjab;kñúgCm¶WdMe)ARbdab;ePTenAkñúgRbeTseCOn elOnelIBiPBelak nigCaGñkyayIGayuCIvitrbs;GñkCm¶WEdlmanRbB½n§karBarcuHexSay nigRsþIeTIbEtsRmalkUn fμ I². eraKvinicä½yedaymnÞIrBiesaFn_minRtUv)aneKBiPakSaenAkñúgesovePAenHeT. eraKsVayKWenAEtCaCm¶WF¶n;F¶r edaybgár[manCm¶WenAelIRbdab;bnþBUC nigGacpþl;CalT§plF¶n;F¶rbnþmkeTot nig QaneTAdl;karqøgemeraKsVayBIkMeNIt. kñúgxN³eBlEdletsþesr:UsaRsþmantYnaTIy:agsMxan;kñúgkareFVIeraK vinicä½yenARKb;dMNak;kalénCm¶WsVay EtmanEtkarBinitüedaykEnøgggwt¬Dark-field¦ b:ueNÑaHEdlnwgRtUv)an eKBiPakSaenATIenH. bec©keTs nigkarbkRsaylT§pletsþesr:UsaRsþRtUv)aneKelIkykmkBiPakSa enAkEnøg epSgeTot1. dMe)ATamLa KWCamUlehtud¾sMxan;mYykñúgdMe)ArlYyenAelIRbdab;nþBUCenAkñúgtMbn;epSgénRbeTskMBugGPivDÆn_. eKeXIjmaneraKsBaØaKøIniksMxan;dUCa QWcab; xÞúH dMe)ArlYymanxÞúHedayrYmpSMnwgkarQWcab; nigmþgmáalmanduMxÞúH enAnwgRbdab;bnþBUC nigehImRKelon. plvi)akEdlekIteRkaymkeTotenAEtBMuTan;)andwgc,as;las;eT. vaman karlM)akkñúgkarEbgEck[dac;ecjBICm¶WdMe)ArlYyrlakelIRbdab;ePTepSg²eTotNas;. dMe)ATamLaenH begáIn karRbQrmux[ekItCaCm¶W HIV Nas;.

1 Van Dyck E, Meheurs Az, Piot P. Laboratory diagnosis of sexually transmitted diseases. Geneva, World

Health Organization, 1999.

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dMe)ArlYyRbdab;ePTmanlkçN³Biessrbs;va KWeLIge)a:g ehIm Rkhm . karbegáIt[manCa ehImRkelon kRm CYbRbTHNas; . Lyphogranuloma ¬ehImkUnkNþúr¦ EdlbNþalmkBIBBYk Chlamidia KWGacekItmanlayLM b¤minlayLMKña CamYynwgkarehImRkelon nigminCajwkjab;KWvamandMe)ArlYytUc²EdlGaceRkomeTAvijedayxøÜnÉg)an. kareFVI etsþrkeraKvinicä½yKWRtUvBwgEp¥kelIetsþesr:UsaRsþ nigkarbNþúH C. trachomatis serovars L1, L2, nig L3. karRbmUlykvtßúviPaK Treponema pallidum: eKKYrBak;eRsamédEdleRbIR)as;sRmab;eFVIkarvHkat;. cab;Rc)ac; dMe)AedayeRbIR)as; RmamédTaMgBIr ehIysMGatépÞdMe)AenaHedayesr:UméRb ep¥abCamYynwgés,. qáwHykRkm:recj ebIman. bnÞab;mk CUtecjnUvtMNk;QammYytMNk;dMbUg ¬ebIman¦ ykvtßúviPaKecjBITwkrégedayykbnÞH kBa©k;s¥atKμanemeraKeTA pþitenAelIépÞdMe)ApÞal;. Pøam²enaHdak;bnÞHkBa©k;esþIgmYyeTotBIelIbnÞHkBa©k;Edlmandak;TwkrégenaHrYcCaeRsc. rMeBcenaHEdr vtßúviPaKEdlykecjBIkEnøgdMe)AGacRtUv)aneKbUmedayeRbIsWraMug nigm¢úls¥atK μanemeraK b¤bUmyk ecjBIkUnkNþúrEdleLIgehIme)a:genaH. eKRtUveFVIkarBinitüedaymIRkUTsSn_CabnÞan;edayGñkbec©keTsmnÞIr-BiesaFn_EdlmanbTBiesaFn_kñúgrgVg;mIRkUTsSn_ggwt¬Dark-field microscopy¦. Haemophylus ducreyi: vtßúviPaKKYrEtRtUv)aneKykecjGMBIdMe)ArlYyedayeRbIR)as;eQIrmUrsMLI rYcykeTA dak;bNþúHpÞal;CamYynwgfñalbNþúH. vtßúviPaKGacCavtßúviPaKEdleKbUmykmkBIkUnkNþúr EtbNþúHrk H. ducreyi enAkñúgvtßúviPaKRbePTenHmanRbsiT§PaBticCagvtßúviPaKEdleKykecjBIdMe)AénRbdab;bnþBUC. fñaldwkCBa¢Ún H.

ducreyi minRtUv)aneK[tMéleLIy. ebIsinNamankarsgS½yfa man Granuloma Inguinale eKRtUveFVI Biopsy edayykEs,kEpñkxageRkamRtg; kEnøgdMe)AkMBugEtmanskm μ. eKKYrEterobcMpgEdrnUvbnÞHkBa©k;EdlGnuvtþeTAelIvtßúviPaKCaRkm:rénEpñk Biopsy enH. manpøÚvmYyepSgeTotKW eKGacerobcMbnÞHkBa©k;tamry³karekasyképÞrbs;kEnøgdMe)A. karBinitüedaypÞal; vtþmanrbs; Treponema EdlmanenAkñúgdMe)AEdleKemIleXIjelIbnÞHkBa©k; KWCabec©keTsbzmmYy EdlnaMeTA rkkareFVIeraKvinicä½y. eTaHbICa T. pallidum GacRtUv)aneKbMBak;BN’ ¬CamYynwgR)ak;nIRtat¦k¾eday. b:uEnþkar BinitüedayeRbIR)as;;mIRkUTsSn_EdlmanépÞggwt ¬Dark-field microscopy¦ RtUv)aneKykmkGnuvtþ BIeRBaHva pþl;nUvlT§plBitR)akd)anl¥. mIRkUTsSn_enH bMBak;edaycegáógEdlpþl;BnøW)anl¥ nigman)at Condenser ggwt EdlGacykeTAeRbIR)as;kñúgbec©keTs Dark-field. Condenser Edlman)at )anTb;sáat;BnøWcegáóg ehIy[ EtBnøWEdlsayPaytamcMehog²[qøgkat; .

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dak;eRbgBRgIkBIreTAbItMNk;elI Condenser énmIRkUTsSn_Edlman)atggwt.bnÞab; Condenserbnþic. dak;bnÞH kBa©k;BIelImIRkUTsSn_ ehIyelIk Xodenser eLIgrhUtdl;eRbg nigépÞxageRkamrbs;bnÞHkBa©k;b:HKña)anl¥ . cUrRbugRby½tñ minRtUvbegáIt[manCaBBuHxül;enAkñúgeRbgBRgIkeT .

rUbPaBTI 9³ rUbragrbs; T. pallidum BinitüenAelImIRkUTsSn_Edlman)atggwt ¬GviC¢man¦

eRbIR)as;EkvBRgIkmIRkUTsSn_tUc ¬X 10¦ edIm,IBinitüemIlvtßúviPaK[)anc,as;. tRmUvBnøWerobcMkNþalénEkv BRgIkedayeRbIR)as;ex©AedIm,IsRmYl[cMkNþal ¬Centring screws¦ EdlsßitenAelI Condenser ehIyerobcM sRmYl Condenser edaytemøIg b¤dak; Condenser cuHrhUtdl;TTYl)anBnøWtUcCageKmYy. tRmUv[BnøWenAcM kNþalebIcaM)ac;. bnÞab;mkeRbIR)as;EkvBRgIks¶Üt ¬X 40¦edIm,IBinitüemIlvtßúviPaK[)anc,as; rYcBnitübnÞHkBa©k; edayRbugRby½tñ. BnøWEdlcaMgpøat nigcaMg)anl¥enAeBlEdlkarBinitümIRkUTsSn_RtUv)aneKBinitüenAkñúgTIggwt. eCosvagBinitüenAeRkamBnøWéf¶ . T. pallidum EsþgecjBN’ s PøWc,as;enAelIépÞggwt¬emIlrUbPaBTI 9¦. vaRtUv)aneKsÁal;tamry³ rUbragBiess TMhM nigclnarbs;va. T. pallidum enHKWCaGtisuxumR)aNEdlmanragesþIg ¬0/25-0/3mIRkUEm:Rt¦ manRbEvg 6-16 mIRkUEm:RtCamYynwgrgVg;;rWs½urBI 8-14 . vabgðaj[eyIgeXIjnUvclnay:agelOn nigPaBbt;Ebnrbs;va. vabgVilxøÜnyWt²RsbtamRbEvgxøÜnrbs;va ¬dUcCa]bkrN_xYgqñúkdb. karbgVilxøÜnrbs;valayLMCamYynwgkarbt; cuHeLIgEpñkkNaþl. eKeXIjvaGacbRgÜj nigBnøaxøÜnvacuHeLIg)an ¬dUcCarWs½redleKTajBnøa¦. rUbragrbs;va GacxusEbøkBIlMnaMedImenAeBlEdlvaeFVIkarbt;EbnenaH. enAeBlEdlGtisuxumR)aNRbePTenH CYbnwg]bsKÁ edaysarCYbRbTHnwgvtßúEdlF¶n;Cagva b¤vaCab;KaMgCamYynwgvtßúF¶n;Cag vaeFVIclnaremol xμ Ülxμaj;rmUlCargVg;

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edIm,IrMedaHxøÜnecjBIvtßúenaH. BBYkemeraKEdlmanragCarWs½r ¬Spirochaetes¦ minEmnemeraKsVayd¾éTeTot min sUvrmUlxøÜn RkasCag clnarwg² minTn;Pøn; nigbt;Ebnl¥dUcBBYkemeraKsVayeT. clnarbs;BYkminEmneraKsVay CaTUeTAxusKñaCamYynwgBBYkemeraKsVay ¬mindUcCa]bkrN_xYgqñúkdbeT¦ b:uEnþvaman lkçN³rmYl karbt;Ebn nig karminbt;EbnCaregVlBiessrbs;BYkva . karemIleXIjrUbrag nigclnarbs;BYk Treponemes )anbBa¢ak;[eyIgdwgc,as;BIlkçN³Biessrbs; T. palli-

dum ehIyEdlGac[eKeFIVkarsnñidæanfa Cm¶WsVaykñúgdMNak;kalTI 1 b¤TI 2. cMeBaHGñkCm¶WEdlsßitenAkñúg dMNak;kalTI 1 eKeXIjfa viC©manenAnwgkarBinitümIRkUTsSn_Edlman)atggwt b:uEnþGacGviC¢manenAnwgetsþ esr:UsaRsþ . ehIyvaGacGviC¢mankñúgGMLúgCaeRcIns)aþh_ .

karrkmineXIjGtisuxumR)aN minEmnmann½yfaminGacrkeXIjeraKvinicä½yCm¶WsVay)anenaHeT. lT§plGviC¢man kñúgeBlenHGacmann½yfa³

• brimaNénGtisuxumR)aNminRKb;RKan; ¬mancMnYntic¦ ¬karBinitüedaymIRkUTsSn_)atggwt mþg Gac[eKTTYl)anlT§plviC¢manminelIsBI 50°eT¦ .

• GñkCm¶W)anTTYlkarBüa)aledayfñaMGg;TIb‘Íy:UTikrYc • dMe)AGacQaneTArkkarCasHes,Iy • dMe)AEdlbgáeLIg BMuEmnbNþalmkBIBBYkemeraK T. pallidum

EteTaHCay:agNak¾eday eKRtUvEteFVIkarBinitürkemeraKRbePTenH tamry³karBinitüedaymIRkUTsSn_ nigkareFVI etsþesr:UsaRsþ . enAkñúgkareFVIeraKvinicä½yelIBBYk Granuloma Inguinale enAeBlEdleKeRbI Acetone sMrab;P¢ab;PñasEdlRtUv bMBak;BN’ Giemsa eKeXIjmanlkçN³BiessCa)asIumaneRsamB½T§CMuvijsßitenAkñúgeKalikas RtUv)aneKsegát eXIjenAlayLMCamYynwgekasika Histocytes. karbriyayeraKvinicä½ylMGiténCm¶WenH manenAesovePA epSgeTot 1 kñúgkrNICm¶WdMe)ATamLavij eKmincaM)ac;erobcMbMBak;BN’ Gram eT eRBaHlT§plEdlTTYl)anBIbec©keTsenH mancMnYnticCag 50°eTAeTot . cMENkÉkarbMBak; Giemsa edIm,IeFVIeraKvinicä½ykñúgkrNIehImkUnkNþúr ¬Lym-

phogranuloma¦ EdlbgáeLIgedayBBYk Chlamydia k¾mincaM)ac;Edr. EtvtßúviPaKEdlykecjBIdMe)ArlYy KYrEtRtUv)aneKBinitüedaymIRkUTsSn_EdlmanépÞggwtkñúgkarrukrk T. pilladum.

1 Van dyck E, Meheus A2, piot p.Laboratory diagnosis of sexually transmitted diseases . Geneva, World Health

Organization, 1999.

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karbNþúH BBYkemeraKRbemHTwk)ay Gonococci GacmþgmáalRtUv)aneKrkeXIjenAkñúgdMe)ArlYyénRbdab;bnþBUC b:uEnþ lkçN³Biessrbs;vaenAkñúgvtßúviPaKRbePTenHenAEtminc,as;las;. eRkAGMBI H. ducreyi eKBMueXIjmanBBYk )ak;etrINaepSgeTot TaMgBBYk)ak;etrIRtUvkarxül; TaMgminRtUvkarxül;mindac;xat CaedImehtubgá [manCm¶W dMe)AenAelIRbdab;ePTeLIy . vtßúviPaKEdlnwgRtUvBinitürk H. ducreyi KYrEtRtUv)aneKbNþúHPøam²enAfñalbNþúHCeRmIs b¤fñalbNþúH EdlsMbUr cMNIGahar 1. fñalbNþúHEdlykmkbNþúHRtUvEtCafñalbNþúHEdlf μ I nigminTuk[elIsBImYys)aþh_eLIy. fñal bNþúHKYrEtRtUv)aneKdak;bNþúHenAsItuNðPaBBI 33-35 GgSar enAkñúgRkLEdlmanduteTon nigmandak;kEnSg esImenAnwg)atRkL b¤RbGb;enaHpg. enAeRkayry³eBl 48-72 em:agénkarbNþúH kBa©úM)ak;etrI tUc²minGnøay ¬s¥it¦elOg-RbepH esÞIføaesÞIRsGab; b¤CYnkall¥k;elceLIg. lT§plEdleyIgeFVIkarbNþúHEtmþgedIm,IrkBBYk H. ducreyi enHmanEt 70-80° b:ueNÑaH. kareFVIeraKvinicä½yén H. ducreyi GaceFVIeTA)antamry³rUbragén kBa©úMemeraKenAelIfñalbNþúHCeRmIs nigkarbgðaj)ak;etrItUc² manTMrg;ERbRbYlragCa Coccobacilli Gram-

negative CaerOy² CaRcvak; ¬Streptobacilli¦ ragCaRcvak;Rsb²Kμa ¬dUchVÚgRtI¦ b¤enApþúMKñaCakBa©úMemeraK. eTaHbI H. ducreyi KWCa)ak;etrIEdlBwgEp¥kelIQam ¬Haemin-dependent¦ b:uEnþeK eXIjfa vaTTYlbraC½y y:ageRcInkñúgkarbNþúHBBYk H. ducreyi enH eTaHbICaeRbIR)as; V nig X factors k¾ eday . esÞIrEtRKb; H.

ducreyi EdleKbNþúH)anenAkñúgRbeTskMBugGPivDÆn_begáIt β- lactamase.

1 Mueller-Hinton agar base, supplemented with 5% sterile horse blood heated to 75°C, 1% isoVitalex and 3g/ml

vancomycin.

127

TwkrégmanxÞúH dMe)A nigbUs

esckþIepþIm dMeNIrvivtþn_rbs;karrlakmYy)anEsþgecjeLIgtamry³karbegáItCaxÞúH¬CYnkalTwkrégmanxÞúH¦ EdlCalT§plén kareRCotcUlrbs;)ak;etrIeTAkñúgrn§ ¬Rbehag¦ ekasika b¤srIragÁrbs;xøÜnmnusSeyIg. karrlakTaMgGs;enaH CYnkalFm μtaminbgá[manCaeRKaHfñak;F¶n;F¶r b¤bNþal[manbNþúMxÞúHCab;²Kña EdleKrkeXIjkñúgbUsEdlGacekIt maneLIgenARtg;kEnøgmYy b¤eRcInénsarBagÁkayrbs;eyIg. TwkrégTaMgGs;enaHmanpÞúkeTAedayeKalikas CaTUeTAsMbUreTAedayBBYk Polymorphonuclear emeraKEdlbgáeraK nigl,ayénTwkrég nig Fibrin. eBlxøH TwkrégGacRtUv)anbiTmuxCitedaysarRsTab; Fibrin nigRbB½n§eKalikarbs;sarIragÁeyIg ]TahrN_ épÞxYrk,al kñúgkrNImanCm¶WrlakeRsamxYreday)ak;etrIRsYcRsav. kñúgkrNIxøHeTot Twkrég GacRtUv)anP¢ab; eTAnwg Fibrin

nigbNþajekasikakñúgCalikadUcCa kñúgkrNIbUs b¤bUsRTnicEtkñúgkrNIxøHeTotTwkrég GaceTAlayLMkñúgdMe)A EdlebIkmuxEdlvaGachUrecjmkeRkACaxÞúH b¤CaTwkrégxab; . TIkEnøgEdlmankarbegáItCaTwkrégGacmankarpøas;bþÚrBIkEnøgmYyKYr[Kt;sMKal;. CYnkal)ak;etrIEdlCa Flora

Fm μta)aneRCotcUleTAkñúgxøÜnehIyGacbegáItCaTwkrég)anEdr. manBBYkpSitmYycMnYn CaBiessBBYkEdlGacman lT§PaBduHlUtlas;enAkñúgCalikarbs;xøÜnmnusS GaccUlrYmcMENkkñúgkarbegáItCaTwkrégeLIg. EtpÞúyeTAvij BBYkvIruskRmnwgbegáIt[manCaxÞúHNas; . kñúgzan³CaGñkCMnajkñúgGtisuxumCIvsaRsþ eKKYrEtdwg[c,as;GMBIkEnøgEdlmanbgáCm¶WRBmTaMgGtisuxumR)aNNa xøHEdlbgáCm¶WRtg;kEnøgenaH. eKRtUvEteFVIkarBinitü[)anc,as;las;TaMgBinitüedayEPñkemIlsPaBBIxageRkA TaMgkarBiinitüedaymIRkUTsSn_ RBmTaMgeFVIkarbNþúHrk)ak;etrIEdlbgáCm¶WenaH. enAeBlEdl)ak;etrIRtUv)aneKrk eXIj nigeFVIkarviPaKrYcral;ehIy eKRtUveFVIetsþGg;TIb‘Íy:URkambnþeTot[)anelOnbMputtamEdlGaceFVIeTA)an. PaBR)aRs½yTak;TgKñarvagRKUeBTüBüa)al nigGñkbec©keTsxagGtisuxumCIvsaRsþ KWmansar³sMxan;xøaMgNas; kñúgkareFVIeraKvinic½äy nigBü)alGñkCm¶WEdlmanCm¶WEdlmanbgáCaxÞúHenH. GñkCMnajxagGtisuxumCIvsaRsþ RtUvEt eFVIkarshkarN_CamYynwgRKUeBTüBüa)al edIm,IbBa¢ak;[c,as;fa vtßúviPaKEdlyk)anCavtßúviPaKEdlRtwmRtUvnig bBa¢ÚnvtßúviPaKTaMgenaHmkkan;mnÞIrBiesaFn_[)anTan;eBl nigykvtßúviPaKRtwmRtUvtamk,Ünxñat .

128

lkçN³KøIniksMxan;²EdlCYbRbTHjwkjab; nigPñak;garbgáeraKsMxan;² vtßúviPaKEdlykedaykarvHkat; vtßúviPaKmYycMnYnTTYl)anmkBIkarbUmRtg;kEnøgbUs b¤k¾Gacyk)antamry³bec©keTsvHkat;epSg²eTot. slüeBTü GacRtUv)aneKENnaM[yknUvCalikatictYc b¤TwkrégxÞúHmYycMnYnEdlRtUv)aneKykmkeFVICavtßúviPaK. ebIsinCaGacrmUrsMLIKYrEteCosvageRbI kñúgkarykvtßúviPaKRbePTenH EtvtßúviPaKKYrEtRtUv)aneKyk edayeRbIm¢úl nigsWraMugbUmyk. ebIsinNavtßúviPaKRtUv)aneKykedayeRbIR)as;rmUrsMLIvij eKRtUvdak;vaeTAkñúgRbGb; b¤]bkrN_ pÞúk[)anRtwmRtUvrYcbBa¢ÚneTAkan;mnÞIrBiesaFn_CabnÞan;. eRkayBI)anTTYlvtßúviPaK mnÞIrBiesaFn_KYrEtBinitüral; Bt’manEdleKpþl;[bnÞab;eRtomeFVIkarbNþúHrkemeraK EdleKGacrkeXIjenAkñúgvtßúviPaKBiess²mYycMnYn. ]TahrN_xøH²énlkçxNÐ½CMgWnana nig emeraK EdleKeXIjenAkñúgRbePTepSg²énvtßúviPaKslükar mandUcteTA³ • cenøaHeRsameBaH ¬Peritoneal Cavity¦ pÞúkeTAeday)ak;etrIkñúgeBaHevon Gram-negative ¬Entero-

cocci¦ BBYk)asIuminRtUvkarxül; Gram-negative ¬Bacteroïdes fragilis¦ nig BBYk Clostridia. • Gab;EsbiTmux ³ GacpÞúkeday)ak;etrIepSg²eTot GacCa)ak;etrIEtmYyRbePT b¤eRcInRbePT ³ eKeRcInCYb

RbTHBBYkuksIu Gram-positive nig)asIu Gram-negative. BBYk)ak;etrI)asIu EdlminRtUvkarxül; nig BBYkGamIub k¾GacRtUv)aneKrkeXIj nigRtUvRbugRby½tñpgEdr GaRs½yeTAtamTIkEnøgrbs;Gab;EsenaH.

• kUnkNþúr³ CaTUeTAeRcInEtbgáeLIgCakarrlakmYyc,as;las;. karrlakenAelIkUnkNþúreRcIn EtbNþal[ ehIm nigeLIgtwg rIÉTwkrégCaxÞúHeRcInEtekIteLIg. ebIsinCakUnkNþúr enAmansPaBTn;RKUeBTüGacbUm ykTwkmanenAkñúgkUnkNþúrenaH. Biopsies kUnkNþúr b¤TwkxÞúH EdlbUmykBIkUnkNþúrrbs;kUnek μgKYrEtRtUv eKbNþúHrkBBYkemeraKrebg ¬Mycobacterium tuberculosis¦nigBBYk Mycobacteria d¾éTeTot. bEnßmBIelIkarbNþúHrkBBYk Staphylococci steptococcinigBBYk)ak;etrIkñúgeBaHevon Gram-negative

vtßúviPaKykecjBIkUnkNþúrGacCavtßúviPaKd¾l¥bMputsMrab;eRbIR)as;eFVIeraKvinicä½yénBBYk Mycoses kñúg RbBn§½Qam nigeRkamEs,kmYycMnYn ¬Histo plasmosis nig Spori trichosis¦.

• Es,k nigekasikaeRkamEs,k KWCaeKaledAsMxan;bMputTaMgkñúgkrNIGab;Es nigdMe)Akøay. CalkçN³TUeTA Gab;EsEdlenAeRkamEs,keRcInEtbNþalmkBIBBYk Staphylococci. CaerOy²BBYkdMe)AEdlebIkmux eRcInEtbNþalmkBIBBYk Streptococci EdlbMpøajRKab;RbePT β ¬β- haemotytic streptococci¦ b¤ BBYk Staphylococci dUcCaenAkñúgrNIbUsmuxmYyry ¬Impetigo¦. manBBYkrlakEs,kepSg²eTot EdltMrUv[eFVIkarvHkat;ykEdlCajwkjab; eKeXIjfaCadMe)AEdlqøgBImnÞIreBTüdUcCa BBYkdMe)ArlYyesI Es,k nigcMeBaHGñkCm¶WEdledkCab;nwgERK. )ak;etrITaMgGs;enaH CaTUeTACaBBYk)ak;etrI»kasniymelI Es,k b¤Ca Flora kñúgeBaHevonEdlCaGñkbgáeraKenAEpñkxageRkAéndMe)ArlYy ehIybegáItCakøinnig sßanPaBminl¥. karbNþúHrkBBYkGtisuxumR)aNTaMgenaHkñúgkic©karRbcaMéf¶ BMumansar³sMxan;eT. esIÞrRKb;

129

GtisuxumR)aNEdleKCYbRbTHjwkjab;EdleKrkeXIjkñúgCalika Biopsy CaBBYk)ak;etrIkñúgeBaHevon ehIyBBYk)ak;etrIdUcKñaenH k¾RtUv)aneKrkeXIjpgEdrenAkñúgkarbNþúHTwkrégEpñkxagelI ¬EpñkesIr²¦én dMe)A. vaminEmnCakic©karcaM)ac;kñúgkarviPaKrk)ak;etrITaMgenaH enAkñúgdMe)AesIrEs,keLIyeRBaHdMe)ATaMg enaHnwgCasHes,Iymkvijtamry³eFVIy:agNa[dMe)AenaH s¥at s¶Üt nigmin[b:HBal;)ak;etrIbEnßmeTot. mþgmáalGtisuxumR)aNenAkñúgdMe)A esIrEs,kGaceRCotcUleTAkñúgcrnþQam ehIybegáItCaPaBsμ úKsμaj y:agF¶n;F¶r.

• karrlak³ CaBiesskñúgkarrlakenAdMNak;kalTI 2 nigTI 3 eRcInEtqab;TTYlnUvkarbgáCm¶W edaysar )ak;etrIepSg. vaCakarsMxan;Nas;EdlkarecorkMeTcdMe)ARtUveKeFVIeLIgya:gRbugRbytñ½ munnwg ykvtßúTaMg enHsMrab;karbNþúH. )ak;etrIEdleKrkeXIjjwkjab;CageKenAkñúgkrNIenH KWBBYk Staphylococci nig

Pseudomonas aeruginosa. • Twkrég ³ CYnkalCaesr:Um b¤xÞúHEdlRbmUlpþúMenAkñúgkavIet ¬Cavity ¦EdllkçN³Fm μta vamansarFaturav

s¥at KμanemeraK ]TahrN_dUcCaeRsamebHdUg eRsamsYt snøak;CaedIm. kareRbIR)as;m¢úl nigsWrMuagbUm ykTwkTaMgGs;enaH eRkamlkç½NÐs¥atnwgpþl;[mnÞIrBiesaFn_nUvvtßúviPaKmYysuRkitecjGMBICalikaEdl rlakenaH. CaTUeTA )ak;etrIKWCaGñkbgáehtucMbgCageK b:uEnþ BBYkpSit nigvIrusk¾GacbgáCm¶W)anEdr. Ca TUeTAkarrlakeRcInekIteLIgedaysarEtemeraK mYymux EteBlxøHeKeXIjmankarbgáeraKbgá eLIgeday )ak;etrIeRcInmuxcUlKña taMgBIBBYkRtUvkarxül; nigminRtUvkarxül;. TwkrégEdleKbUm)anGMBIeRsamsYt eKGaceXIjmanBBYk Pneumococci streptococci H.influenzae, Anaerobic streptococci, b¤ Anaerobic Gram-negative (Prevotella nig Porphyromonas) b¤ M. tuberculosis.

dMe)AEdlekIteLIgBIkareRCotcUlrbs;emeraK dMe)ATaMgLayNaEdlekIteLIgBIkareRCotcUlrbs;emeraKeTAkñúgEs,k eRcInEtbgáeLIgedayGtisuxumR)aNeRcIn RbePT. BBYkGtisuxumR)aNTaMgGs;enaHKWCaEpñkmYyén Flora rs;enAnwgEs,k Flora Fm μtaEdlrs;enAkñúgdI nig enAkñúgTwk . dMe)AEdlekIteLIgBIkareRCotcUledaysaremeraKrbs;eBaHevon EdlTak;TgnwgkarxUcxateBaHevonGacbgáCakar KMramKMEhgkan;EtxøaMgBIeRBaH Flora rbs;eBaHevonGacbNþal[ekItCadMe)A nigrlakkarIetrbs;eBaH. dMe)AEdlekIteLIgBIkarmut GacbNþalmkBI]bkrN_EdlRsYc nigmut dUcCa elah³ Ekv b¤eQICaedIm CaerOy² CamUlehtuénkarekIteLIgCadMe)A eTaHbIekIteLIgedayécdnü b¤karKitTukCamun ¬]TahrN_ dMe)Aedaysarkar cak; b¤dMe)Aedaysarkar)aj;nwgRKab;kaMePøIg¦. Cm¶WettaNUsEdlCalT§plénkareRCotcUlrbs;)ak;etrI Edlbgá Cm¶WKWCaCm¶WmYyEdlEdl)anKMramKMEhgGayuCIvitrbs;GñkEdlBMu)anTTYlkarcak;fñaMbgáarCm¶WenH. lkçN³Rsedog KñaenHEdr dMe)ABisFüÚg ¬dMe)AekIteLIgedaysar C.botulinum¦GacnwgminRtUv)aneKeFVIvinicä½y ebIsinNaRKUeBTü

130

Bü)al nigGñkÉkeTsxagGtisuxumCIvsaRsþ BMu)anykcitþTukdak;GMBIeRKaHfñak;EdlGacekItmaneLIg. kareFVIkar vinicä½yeTAelIGñkCm¶WettaNUs nigCm¶WBisFüÚgTaMgenH KYrEtRtUv)anpþl;[edaymnÞIrBiesaFn_bEg¥kNamYy. Gñk EdleFVIkarCamYystV b¤k¾plitplEdlekItecjBIstVBahn³ RbQmmuxnwgkarbgáCm¶WEdlbgáeLIgeday Spores

rbs; Bacillus anthracis Edl)ak;etrIRbePTenHGaceRCotcUleTAkñúgdMe)AtUc² b¤Es,kEdldac;rlat; ehIy begáItCadMe)AexμAmuxénCm¶W Anthrax ¬Cm¶WbUsFüÚg¦. BBYkGtisuxumR)aNmYycMnYneTotEdlrs;enAkñúgdI dUcCa Clostridium perfringens CaedIm k¾GacbegáIt[manCadMe)A ehIybegáIt )anCadMe)As¥úyrlYy . stVxaM b¤stVRkejA KWCaeRKaHfñak;EdleRcInekItmaneLIgTaMgenATIRkug nigenACnbT. karxaMTaMgLayGacbNþal mkBIstVciBa©wmkñúgpÞH stVkñúgksidæan b¤stVéRB. eraKEqáqáÜtRtUvEtCaCm¶WmYyEdleKRtUvykcitþTudak; nigRbugRby½tñ bMput. enAeBlEdleKTat;ecallT§PaBfaCaCMgWEqáqáÜt lT§PaBbgáeLIgedayemeraKepSg²eTot maneRcIn nig ERbRbYl. kareFVIeraKvinicä½yGMBIeraKEqáqáÜt vamanlkçN³BiesshYsehtueBk EdlRtUvykmkBiPakSakñúgesovePA enH 1 . enAkñúgmat;rbs;stV pÞúkeTAeday FloraeRcInRbePTTaMg)ak;etrIEdlminRtUvkar nigRtUvkarxül;pSit Protozoa nig vIrus. karbgáeraKEdlbNþalmkBIstVRkejAeRcInEtbNþalmkBIBBYk)ak;etrI. karbgáCm¶WCacm,gKWbNþalmkBI Pasteurella multocida Edlqøgtamry³Eqá nigqμaxaMkñúgeBlEdleKBMu)anlagsm¥at nigBüa)aleRkayBIstV TaMgenaHxaMrYc. eKGaceXIjmankarbgáeraKF¶n;F¶rmYycMnYnEdlbgáeLIgedaysarEtBYk)ak;etrIEdlRtUvkarxül;nig minRtUvkarxül;eRkayBIRtUvmnusSxaM. dMe)AEdlqøg tamry³mnÞIreBTü Nosocomial would infections karykcitþTukdak;Cacm,genAkñúgkarEfTaM nigBüa)alGñkCm¶WsRmakenAÉmnÞIreBTüKWeFVIya:gNaminRtUvBYkeKTTYl nUveRKaHfñak;EdlekIteLIgBIkarBüa)alCm¶Wrbs;BYkeKeT. EtCaGkusl eKsegáteXIj 5-10°énGñkCm¶WsRmak kñúgmnÞIreBTü)anqøgeraKBIkñúgmnÞIreBTükñúgkMLúgeBlkarsRmakBüa)alrbs;BYkeK. Cm¶WEdlqøgtamry³mnÞIreBTü KWCaCm¶WEdlRtUvcMNayfvikaBüa)alGs;eRcIn nigGacRtUv)aneKbeBa¢ós nigkat;bnßy)an. Cm¶WTaMgLayEdlqøg tammnÞIreBTüPaKeRcIn eRcInekItenAEpñkxagvHkat;. GRtaqøgeraKeRkaykarvHkat; mankarERbRbYlBImnÞIreBTü mYyeTAmnÞIreBTümYyeTot ehIyqøgkan;Etx<s;bMput cMeBaHGñkCm¶WEdleFVIkarvHkat;eBaH edImRTUg b¤vHkat;Ek smösS. dMe)AkøayeraKeRkaykarvHkat; ekItmaneLIgya:gqab; b¤ry³eBl 2-3éf¶bu:eNÑaHeRkayeBlvHkat;. ehIyTIkEnøgEdlbgá[CadMe)AenaH KWsßitEttMbn;tamefñrecs b¤k¾GacrIkraldal enAkEnøgEdlvHkat;. BBYk

Staphytococcus aureus ¬Fn;CamYynwg Benzyl penicillin eRkaymkFn;nwg Meticillin¦ KWPñak;garbgáeraK cm,gCageK rYcbnÞab;mkKWBYk E. coli nigBBYk)ak;etrIkñúgeBaHevond¾éTeTot. BBYk)ak;etrIEdlminRtUvkarxül; 1 Meslin F-X, Kaphlan MM, Koprowski H, eds. Laboratory techniques in rabies, 4th ed . Geneva, World Health Organization, 1996

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mYycMnYn k¾GaceRCotcUleTAkEnøgEdleFVIkarvHkat; ehIybgáCaCm¶WxøaMgkøa ehIyeRcInekItmanenAkñúgmnÞIreBTü TaMgLayNaEdlkm μviFIEfTaM nigkarBarenAexüay. Bacteroides fragilis nigmþgmáalKWBBYk Clustridium

perfringens GaceRCotcUleTAkñúgcrnþQam ehIyGacbgáCm¶WRbBn§½Qam nigCajwkjab; CakarbgáeraKeRkay vHkat;EdlGacsMlab;GñkCMgW)an . eRkaydkeFμjb¤vHkat;kñúgmat;k¾CabBaðaRbQmnwgkarbgáeraKEdr Etvaminjwkjab;eT.vaekItenAeBlEdlpøÚvsIunus BIkEnøgEdleKvHkat;eTAb:HépÞrbs;Es,kmux b¤k ehIyTwkrégenaHmanRKab; : Sulfure :: én Actinomycosis. karyk nigkardwkCBa¢ÚnvtßúviPaK eKBMuGacbriyay[)anlMGitenATIenHGMBIbec©keTs KWkarRbmUlvtßúviPaKGMBIdMe)A b¤Gab;EsCaedImenaHeT. Cakar Cak;Esþg kic©karTaMgGs;enHtRmUv[mankarshkarN_l¥rvagRKUeBTüBüa)al nigmnÞIrBiesaFn_. enAkñúgkal³eTs³ CaeRcIn eKGacman»kasEtmþgKt;kñúgkarTTYlvtßúviPaKvtßúviPaKCaelIkTI 2 KWBMuGacmanlT§PaBeLIy enAkñúgkrNI CaeRcIn. dUecñHehIyeKRtUvykvtßúenH[)anRtwmRtUv nigsuRkitelIsBIenaHeTAeTot kardwkCBa¢Ún karrkSavtßúviPaK Cakic©kar sMxan;bMputEdr eCosevogdac;xatkMu[mankarxUcxat. enAeBleKykvtßúviPaK)anehIy eKRtUveFVIkarevc x©b;[)anl¥ nigbBa¢ÚneTAkan;mnÞIrBiesaFn_CabnÞan;ebIGaceFVIeTA)an. bnÞab;BIkarBinitübzmcb;sBVRKb; ehIykar bNþúHRtUv)aneKeFVIvtßúviPaKEdlenAesssl; KYrEtRtUv)aneKbiTsøak[)anRtwmRtUvRKb[Cit nigrkSaTukkñúgTUTwk kk rhUtdl;ral;kic©karRtUv)anbBa©b; nigrhUtdl;eKc,as;fanwgBMumankarBinitüNaepSgeToteKRtUvkareLIy . Gab;Es enAeBlEdlmanGab;EsmYykEnøg b¤eRcInkEnøgRtUv)aneKBinitüeXIjRKUeBTüBüa)al b¤slüeBTü nigGñkCMnaj xagGtisuxumkayCIvsaRsþ KYrEtpøas;bþÚreyabl;KñaeTAvijeTAmkfa etIGVIEdlRtUveFVI. bec©keTsénkarykxÞúH b¤ bMENkénCBa¢aMgGab;EsNamYyKWCakic©karrbs;RKUeBTü nigslüeBTüeRkameKalkarN_énkarvHkat;. eKeRbIm¢úl nigsWraMugedIm,IbUmykxÞúH[)aneRcIntamEtGaceFVIeTA)anrYc epÞredayRbugRby½tñdak;eTAkñúgbMBg;TIb b¤vtßúrkSavtßú viPaKEdls¥atKμanemeraK. ebIsinNaeKBMumanbMBg;TIb b¤]bkrN_sMrab;dak;xÞúHTaMgenaHeT eKKYrEtrkSaxÞúHenaH enAkñúgsWraMugrYcRKbKMrbm¢úl[)anRtwmRtUv ehIybBa¢ÚnsWraMugenaHeTAkan;mnÞIrBiesaFn_. vtßúviPaKenHKYrEtRtUv)an eKBinitü nigbNþúH[)anRbjab;enAÉmnÞIrBiesaFn_ edaybNþúHrktaMgBI)ak;etrIEdlRtUvkarxül; nigminRtUvkarxül; ecjGMBIvtßúviPaKEtmYy . sßanPaBRbhak;RbEhlKñaenHEdr GacekIteLIgenAeBlEdlslüeBTürkeXIjGab;EsbiTmuxmYy b¤eRcInenAkñúg srIragÁNamYydUcCa kñúgedImRTUg eBaH b¤RtKakenAeBlEdlRKUeBTükMBugeFVIkarvHkat;kñúgeKalbMNg epSg. edIm,I cUlrYmcMENkkñúgkarsRmYlkargar[)anrlUn mnÞIrBiesaFn_KYrEterobcMsMPar³sMrab;rkSaTuk TukCamunrYcrkSaTuk enAkñúgbnÞb;slüKarsMrab;dak;sMPar³rkSaxÞúHrbs;Gab;EsEdlmaneXIjCayfaehtuenaH ehIyvtßúviPaKenHGacRtUv

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)aneKbBa¢ÚneTAkan;mnÞIrBiesaFn_[)anrh½s. RtUvrkviFIedaHRsay[Gs;lT§PaB cUreCosvageRbIR)as;eQIrmUr sMLI¬Swab¦edIm,IRbmUlykvitßúviPaKEdlmancMnYntictYc enAeBlEdlvtßúviPaKmanbrimaNd¾eRcInenaH. CaFm μta eKeRbItM)arEtsMrab;vtßúviPaKEdlmantictYcb:ueNÑaH b¤k¾sMrab;kEnøgEdlRtUvkarkarykcitþTukdak;]TahrN_ dUcCa enAnwgEPñkCaedIm. enAeBlEdleKTTYl)ancMENkekasikaecjBICBa¢MagGab;EsNamYy Gñkbec©keTsRtUvEtkindMu ekasikaTaMgenaH rYclayCamYynwgfñalbNþúHravbnþic rYckat;dMuekasika b¤sac;TaMgenaHCakMeTctUc²edayeRbIkaMbit b¤kéRnþEdls¥atKμanemeraK. karbNþúHrkBBYk)ak;etrIRtUvkarxül; nigminRtUvkarxül;KYrEt)aneKeFVIdUc)anbBa¢ak;. karbgáeraKelIrbYsEdldac;efñr rbYsedaykarcak; dMe)AeRkaykarvHkat; karrlak nigdMe)A edaykaredkyUrelIERK BMumanbec©keTs b¤eKalkarN_sþg;darNamYy RtUv)aneKbegáIt b¤eRbIR)as;kñúgkarykvtßúviPaKTaMgGs;enaHeT. Et eTaHCay:agNak¾eday eKRtUvGnuvtþtamkarENnaMCasarvnþ½mYycMnYnedIm,ITTYl)annUvvtßúviPaKmYyl¥RbesIrRtwmRtUv EdlbMerIkñúgkarviPaKrbs;mnÞIrBiesaFn_. bnÞab;BIsMGatRtg;kEnøgGab;Es)ans¥at RtwmRtUvl¥ ehIyslüeBTüKYr BinitüemIledayp©itp©g;elIépÞrbs;Gab;EsedIm,IerobcMykxÞúH ekasikaEdlsøab;¬sac;rlYy¦ sþab; emIl]s μ ½nEdl Payecjmk b¤k¾sBaØaepSg²eTot. eKRtUvkat;;ykkMeTcsac; b¤ekasikaEdlsßitenAkñúgGab;EsenH rYcdak;enAelI és,s¥atK μanemeraKedIm,IykeTAeFVIkarbNþúH. xÞúH b¤TwkrégepSgeTotKYrEtRtUv)an eKykedayRbugRby½tñ nigdak; enAkñúgbMBg;TIbs¥atK μanemeraK. eQIrmUlsMLIGacRtUv)aneKeRbIR)as;pgEdr ebIsincaM)ac;. xÞúH b¤TwkrégGMBIRbehagsIunus b¤kUnkNþúr enAeBlEdlmankarhUrxÞúH b¤TwkrégedayÉkÉgGMBIRbehagsIunus b¤k¾kUnkNþúrmk Twkrég b¤xÞúHTaMgenaH KYrEtRtUv )anRbmUlykedayeRbIR)as;]bkrN_sMrab;bUmdUcCa bMBg;bWt Pasteur EdlCab;CamYyedayekAs‘UbWt rYcdak;vtßú viPaKenaHeTAkñúgbMBg;TIbs¥at KμanemeraKmYy. ebIsinNaxÞúH b¤TwkrégBMu)anhUrecjmkeT eKRtUveRbIR)as;m¢úl nig sWraMugedIm,IbUmykvtßúviPaKTaMgenaH. Cafμ ImþgeTotRtUvcgcaMfa eQIrmUrsMLIKYrRtUv)aneKeRbIR)as;EtkñúgkrNIK μan bMBg;bWt Pasteur s¥atKμanemeraKEtb:ueNÑaH . Twkrég karRbmUlpþúMTwkrégenAkñúgkavIet ¬Cavity¦ enAkñúgsrIragÁepSg²dUcCaenAkñúgeRsamsYt snøak; b¤eRsameBaH tRmUv [eKGnuvtþbec©keTsvHkat;edIm,IbUmykTwkrégEdlRbmUlpþúMenaH. TwkrégEdlbUm)anRtUv)aneK epÞrdak;eTAkñúg ]bkrN_rkSaTukEdls¥atKμanemeraK rYcbBa¢ÚneTAkan;mnÞIrBiesaFn_edIm,IeFVIkarrukrkGtisuxumR)aN nigviPaKrk ekasika nigeKalikaepSgeTot. enAkñúgkrNIEdlkarkkpþúMenAEtman ehIyeKdak;sMrab;bgðÚrcMhrmYy enaHcaM)ac; RtUvRbmUlykTwkTaMgenaH kñúglkçN³s¥atRtwmRtUv min[mankarqøgemeraK sMrab;TukeRbIR)as;kñúgkarbNþúH nigeFVI etsþepSg²eTot .

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karviPaKelIsPaBxageRkA xÞúH b¤TwkrégEdleKykmkeRbIR)as; eQIrmUrsMLImankarBi)akkñúgkarvaytémøsPaBxageRkAedayEPñkNas; CaBiessenAeBlEdlrmUrsMLIRtUv)aneKRClk;cUleTAkñúgfñaldwkCBa¢Ún. xÞúHEdldak;enAkñúgsWraMug nig]bkrN_ rkSaTukepSg²eTotEdls¥atK μanemeraK KYrEtRtUv)aneKeFVIkarvaytémøedayRbugRby½tñedayGñk bec©keTsmnÞIr BiesaFn_eTAelIBN’ kMhab; nigkøinrbs;va . BN’ BN’rbs;xÞúHERbRbYlBIBN’ébtg-elOg eTAetñat-Rkhm. BN’RkhmCaTUeTAbBa¢ak;fa vamanlayQam b¤ eGm:UkøÚb‘Ín. karbUmykxÞúH b¤TwkrégBIGab;EseføIm edaysarGamIbmansPaBxab;Gn§il manBN’etñatcas; eTABN’ elOgetñat. xÞúHEdlekItBIdMe)AeRkaykarvHkat; b¤b:HTgáic¬rlak¦GacmanBN’ébtg-exovedaysarBN’ Pyo-

cyanin EdlbegáIteLIgedaysar Pseudomonas aeruginosa. PaBrwgb¤Tn; kMhab;rbs;xÞúHGacERbRbYlBIsPaBravl¥k;eTAxab;Gn§ilGnøay. Twkrég b¤xÞúHEdleKbUmykmkBIkavIetrbs; eRsamsYt eRsamebHdUg b¤eRsameBaH CaTUeTArav nigmanTaMgBIkMritTwkréghUrxøaMgrhUtdl;suT§EtxÞúHEtmþg. xÞúHEdl)anmkBIRbehagsIunus KYrEtRtUv)aneKBinitüemIlRKab;BN’elOgtUc²EdlCalkçN³Biessén kBa©úMrbs; Actinomyces israelli. vtþmanrbs;RKab;² s<an;F½rbgðaj[eXIjGMBIkarbgáCm¶W Actinomycosis enARtg;mþúMk nigmux . RKab;tUc²EdlmanBN’xusKña ¬BN’s exμA Rkhm b¤etñat¦ KWCalkçN³sMKal;d¾BiesséndMu Bkmanrlak ¬Mycetoma¦ dMuBk² ehIyCaTUeTAeRcInekItenAcugeCIg ¬]Ta> Madura foot¦edaymanGab;EsCaeRcIn nigTwk réghUrecjmkBIsIunus. BN’rbs;RKab;²EdlmanenAkñúgxÞúH b¤Twkrég vaTak;TgnwgBBYk)ak;etrIEdlmanragCa srés² b¤BBYkpSitEdlmanknÞúy . xÞúHEdlekItmkBICm¶Wrebg } Gab;EsRtCak; }¬maneraKsBaØénkarrlakmYycMnYn¦ CYnkalRtUv)aneKeRbobeFobeTA nwgRbhuk)araMgEdlTn; ehIyRtUv)aneKehAfaCaxÞúH Caseum b¤ Caseous.

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køin køins¥úydUcKRmg; KWCakøinBiessénkarrlakEdlbgáeLIgedayBBYk)ak;etrIEdlminRtUvkarxül; b¤l,ayénBBYk RtUvkarxül; nigminRtUvkarxül; . køinrYmpSMCamYynwglT§plEdleKTTYl)anmkBIkareFVIkarbMBak;BN’ Gram KYr EtRtUv)aneKpþl;[RKUeBTüBüa)al eRBaHvaGacCYydl;RKUeBTüBüa)alkñúgkareRCIserIsGg;TIb‘Íy:UTikedIm,IBüa)al. vak¾CYykñúgkarkMNt;faetIRtUveFVIkarbNþúHrkBYkminRtUvkarxül;b¤Gt; . karBinitüedaymIRkUTsSn_ PñasnigkarbMBak;BN’ Gram edIm,IBinitüKYr EtRtUveKeFVIeLIgRKb;vtßúviPaKTaMgGs;. enAkñúgkrNIBiessmYycMnYn b¤enAkñúgkrNImankaresñIsMuGMBIRKUeBTüBüa)al karBinitüedaypÞal;nUv Wet mount nigbMBak;BN’ Ziehl-Neel-

sen mYyRtUv)aneKeFVIeLIg. PñasEdlbMBak;BN’ Gram edayeRbIR)as; Loop erobcMPñaskBa©k;mYyedayykxÞúHRtg;kEnøgEdlxab;CageKeTA)a:telIbnÞHkBa©k;s¥atenaH. ebIsinNavtßúviPaKRtUv)anRbmUlykedayeRbIR)as;eQIrmUrsMLI eKRtUv rm¶ab;emeraKenAelIbnÞHkBa©k;Camun eday dak;vaBIelIGNþatePøIgrbs;cegáóg Bunsen rYcTuk[RtCak;munnwgykvtßúviPaKeTA):atBIelI. eKRtUvykrmUrsMLI eTARbemolfñm²elIépÞbnÞHkBa©k;edayminsgát;[manCasMBaFxøaMgeT. TukbnÞHkBa©k;enaH[s¶Ütedayxül;karBar kMu[b:HBal;CamYynwgstVl¥it b¤rkSaTukenAkñúgTUkMedA. bnÞab;mkP¢ab;emeraKedayeRbIkMedA eFVIkarbMBak;BN’ nigcug bBa©b;BinitübnÞHkBa©k;enaHedayeRbImIRkUTsSn_edaymanCMnYyBIeRbgBRgIk nigEkvBRgIk ¬x100¦. eFVIkarBinitü edayRbugRby½tñ nigkt;RtanUvvtþman nigbrimaNénsarFatuepSg² ¬cUreRbIsBaØa÷CasMKal;¦ dUcCa ³

- BBYkeKalikas Polymorphonuclear ¬ekasikaxÞúH¦ - BBYkkaksIu Gram-positive ragCakBa©úM EdlRtUv)aneKsnñidæanfaCaBBYk Staphylococci . - BBYkkuksIu Gram-positive ragCaRcvak; RtUv)aneKGacdwgfaCaBBYk Streptococci b¤ Enterococci - BBYk)asIu Gram-negative EdlmanragRbhak;RbEhlnwg Coliform ¬Escherichia coli b¤Kleb-

siella CaedIm¦ BBYk Enterobacteriaceae epSgeTot ¬Proteus Serratia CaedIm¦ BBYk)asIuEdl mineRbIR)as;Catisár ¬Pseudomonas spp.¦ b¤BBYk)ak;etrIEdlminRtUvkarxül;dac;xat ¬Bactero-

ides spp.¦. - BBYk)asIuFM² Evg² Gram-positive Edlmancugrbs;vaCaragkaer RtUv)aneKKitfaCaBBYk Clostri-

dium perfringens EdlCaPñak;garbegáItCa]s μ ½ns¥úy b¤BBYk Bacillus anthracis EdlCaPñak;gar begáItCaCm¶W Anthrax .

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- )ak;etrIeRcInedrdas; ehIyRcbUlRcbl;cUlKña edaymanrYmbBa¢ÚnTaMgBBYk Stroptococci )asIutTMhM Ebøk²KñaTaMgBBYk Gram-positive nig Gram-negative Edlman EdlmanragCa)asIu Fusiform. rUbragxagelIRtUv)aneKeFVIsnñidæanfaCakarbgáCm¶WmYybgáeLIgeday karrYmbBa©ÚlKñaén BBYk)ak;etrImin RtUvkarxül; .

- BBYk Candida b¤ekasikapSitdéTeTot EdlRtUv)aneKeXIjCaragBgRkeBI Gram-positive nigman kMBkragmUl ¬Budding spheres¦ CaerOy²CaBBYkEmkFagén Pseudomycelia.

sPaBxÞúHRKab;²EdlekIteLIgBIBBYk Actinomycosis b¤RKab;xÞúHEdlekItBI mycetoma KYrEtRtUv)aneKkinbMEbk elIbnÞHkBa©k;munnwgykeTAbMBak;BN’ Gram. BinitüemIlbnÞHkBa©k;enaHedayRbugRby½tñrkemIlbMENkesþIg² nig kMNat;srés²EdlmanBN’ Gram-positive ¬Gram-positive filaments¦. karBinitüpÞal;edaymIRkUTsSn_ enAeBlEdlmankaresñIsMu b¤enAeBlEdlmankarsgS½yfamankarbgáCm¶WedayBBYkpSit b¤)a:rasIut enaHkarerobcM WetmYyKYrRtUveKBinitü. ebIsinCaxÞúHenaHmansPaBxab;xøaMg RtUvdak;esr:UméRbmYydMNk;layCamYyxÞúHenaH rYckUr [sBV. ebIeKcg;BinitürkemIlBBYkpSit ¬Fungi¦RtUvdak;sUluysüúgb:UtasüÚmGIuRduksIut 10° edIm,IsMGatvtßú-viPaK. dak;bnÞHmYy)aMg nigeRbIEkvBRgIk x10 nig x40 eKBinitürk³

- skm μPaB Motile rbs;BYkGamIbenAkñúgvtßúviPaKykecjBIGab;EseføIm - BBYkpSitdUcCa Histoplasma capsulatum ¬rab;bBa©ÚlTaMgAfrican var.duboisii) Blasto-

myces dermatitidis ¬enAtamtMbn;EdlmaneRbv:aLg;x<s;CaRbcaM¦ Candida app.. - BBYkpSit Hyphae nig)ak;etrIragCasrésqμar²EdlmanenAkñúgRKab;xÞúHkinbMEbkykBI Mycetoma - )a:rasIutdUcCaBBYk Microfilariae scolices b¤TMBk;rbs; Echinococcus nigBgrbs;BBYk Schi-

stosomo Faciola b¤ Paragonimus. karbMBak;BN’GasIutelOn Ziehl-Neelsen karbMBak;BN’ Ziehl-Neelsen KYrRtUv)aneKeFVIeLIg enAeBlEdlmankaresñIsMuBIRKUeBTüBüa)al. eKKYrEteFVIkar bMBak;BN’ Ziehl-Neelsen enAeBlEdleKBMueXIjman)ak;etrIGVIesaHenAelIbnÞHkBa©k;EdleKbMBak;BN’ Gram

b¤CYnkaleXIjmansuT§EtBBYk)asIu Gram-positive “Coryneform” . eKKYrEtsgS½yelIBBYk )ak;etrIEdlbgá [manCaemeraKrebg CaBiessenAkñúgxÞúH b¤TwkrégEdlykmkBIeRsamsYt snøak; Gab;Esq¥wg b¤ kUnkNþúr. BBYk )asIiuEdlcab;ykBN’ Ziehl-Neelsen EtminEmnCaBBYk Tuberculous ¬eKGacehAfa BBYk “Atypical”¦ CYnkalRtUv)aneKrkeXIjenAkñúgGab;EskMeb:HKUTenARtg;kEnøgcak;fñaM. BBYkGab;EsenHCaerOy² bgáeLIgeday

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BBYk Mycobacteria EdlduHlUtlas;y:agelOn EdlsßitenAkñúgRkum Mycobacterium fortuitum-chelo-

nei. vtßúviPaKEdlyk)anBIxÞúH b¤TwkrégEdlsßitenA)atxageRkambMputénEs,krlYyEdlsßit enAelIeCIg b¤éd GacbNþalmkBIBBYk)ak;etrIEdlcab;BN’ Ziehl-Neelsen EdleKehAfa M.ulcerans¬dMe)A rlYy Buruli¦ . M. marinum KWCaBBYk)asIucab;BN’ acid-fast bgá[manCm¶WrebgmYyeTotEdleKrkeXIjenAkñúgdMe)AraMuér: b¤ rlYyepSg²EdlekItmanenAelIRbGb;éd éd nigenAelIEs,krbs;GñkEhlTwk b¤GñkensaT . karbNþúH ebIsinNamanvtþmanrbs;BBYkpSit b¤)ak;etrIRtUv)aneKrkeXIjedaymIRkUTsSn_ eKRtUveFVIkarbNþúHemeraKTaMgGs; enaHenAelIfñalbNþúHEdlsmRsbeTAnwgemeraKTaMgenaH. edaymincMNuHeTAelIlT§plEdlTTYl)anBIkarBinitü edaymIRkUTsSn_ vtßúviPaKTaMgGs;EdlCaxÞúH b¤TwkrégKYrEtRtUv)aneKbNþúHenAelIfñalbNþúHy:agtic3 ³

- fñalbNþúHEdlmanQam sMrab;bNþúHrkBBYk staphylococci nig streptococci - fñalbNþúH MacConkey sMrab;bNþúHrk)asIu Gram-negative nig - fñalbNþúHTIbEdlCafñalbNþúHsMbUrcMNIGaharsMrab;bNþúHTaMgBBYk)ak;etrIEdlRtUvkarxül;

nigminRtUv karxül; ¬fñalbNþúH thioglycollate b¤fñalbNþúH cooked meat¦ . brimaNénvtßúviPaKEdlRtUv)aneKykeTAbNþúHelIfñalbNþúH KWGaRs½yelIlT§plBinitüedaymIRkUTsSn_ nigGac ERbRbYlBImYy Loop eBjeTABIr b¤bItMNk;. ebIsinCaeKeXIjbrimaNGtisuxumR)aNeRcInenAelIPñasbMBak;BN’ Gram vtßúviPaKKYrEtRtUv)aneKBRgavkñúgbrimaNticeTAkñúgfñalbNþúHravCamunsinmunnwgykvadak;bNþúH. ebIsin CavtßúviPaKRtUv)aneKykedayeRbIR)as;eQIrmUrsMLIenaH eKRKan;EtykrmUrsMLIenaHremolelIfñalbNþúHenARCug NamYybnþic rYceFVIqñÚteTAkEnøgepSgeToténfñalbNþúHedayeRbI Loop. ebIsinCaeQIrmUrsMLIenaHs¶Üt eKKYrEt epSImsMLIenaHbnþicedayeRbIfñalbNþúHrav b¤esr:UméRbmunnwgykeTAeFVIkarbNþúH. enARKb;krNITaMgGs; karbNþúH KYrEtpþl;nUvkBa©úMemeraKEtmYyRbePTedIm,IykeTAviPaK nigeFVIetsþGg;TIb‘Íy:URkam. muneBleFVIkarbNþúHfñal KYrEtRtUv)aneKsm¶ÜtcMnYn 20naTI enAkñúgm:asIunkMedA ¬m:asIunbNþúHemeraK¦ edIm,IbnßynUv karduHlUtlas;elOneBkén Proteus spp.. fñalbNþúHEdlRtUv)aneKbNþúH KYrEtrkSaenAkñúgsItuNðPaB35GgSar enAkñúgRkLEdlduteTon. CaFm μtaRKb;fñalbNþúHTaMgGs; KYrEtRtUv)aneKbNþúHcMnYn 2éf¶ ehIyeFVIkarBinitütam danCaerogral;éf¶edIm,IemIlkarduHlUtlas;rbs;va. ebIsinCakarbNþúHrkBBYkGtisuxumR)aNEdlBi)akduH eKRtUv rkSavaTukyUéf¶bnþic ¬GacBI 1-2s)aþh_ b¤eRcInCagenH¦. ebIsinCaeKeXIjmankarduHlUtlas;elIfñalbNþúHrav EdlsMbUrcMNIGahar eKRtUveFVIPñasbMBak;BN’ Gram nigbNþúHenAelIfñalbNþúHfμ IeTotEdlsmRsbeTAtamRbePT )ak;etrIEdl)anrkeXIjenH. fñalbNþúHbEnßmepSgeTot KYrEtRtUv)aneKeRbI ebIsinCamankaresñIsMubNþúHlkçN³

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BiessNamYy lT§plénkarbMBak;BN’ Gram )annaMeTArkkarseRmccitþeRCIserIsfñalbNþúHedIm,IykmkbNþúH ]TahrN_³ • ebIsinCaeKBinitüeXIjBBYk Staphylococci eKRtUvbEnßmfñalbNþúH Manitol salt edIm,I[)ak;etrIEdlduH

mksuT§l¥ niggayRsYleFVIkarEbgEckCadMbUgrvag Staphylococcus aureus nigBBYkkuksIuepSg²eTot. • ebIsinCaeKBinitüeXIjfaCaBBYk Streptococci eKRtUvdak;bnÞH Differential bacitracin enAkEnøgEdl

qUtdMbUgenaH. • ebIsinCaeKeXIjBBYkpSit eKRtUvbNþúHvtßúviPaKenaHenAkñúgbMBg;fñalbNþúH Sabouraud dextrose cMnYn 2

edaymYydak;bNþúHenAsItuNðPaB 35 GgSar nigmYyeTotdak;bNþúHenAsItuNðPaBmnÞIrBiesaFn_ ehIyRtUv Tuk[duHrhUtdl;mYyEx. ¬fñalbNþúHmanQamKWCafñalbNþúHl¥ RKb;RKan;edIm,IbNþúHrk Candida spp.¦.

• ebIsinCaeKrkeXIjBBYk)asIuEdlcab;BN’ Ziehl-NeelseneKRtUveFVIkarbNþúHvtßúviPaKTaMgenaH eTAkñúgfñal bNþúH Löwenstein Jensen [)an3TIb. ebIsinenAkñúgvtßúviPaKmanBBYk)ak;etrIEdlmincab;BN’ Ziehl-

Neelsen EdrenaHkarbNþúHenaHR)akdCakarqøg ehIybNþal[xUcxatfñalenaHEtmþg. BBYk Mycobac-

teria EdlduHlUtlas;elOndUcCa M.fortuitum k¾GacRtUv)ansMlab;edaysarEtdMNak;kalénkarqøgenH Edr. BBYk Mycobacteria EdlduHelOnenH GacduHpgEdrenAelIfñalbNþúHEdlmanQam nig MacCon-

key kñúgry³eBl 3-7 éf¶. BBYk)ak;etrI EdlCaBBYkEbkEmkFagqμar² ehIyCa)asIucab;BN’ Ziehl-

Neelsen pgEdr ehIyRtUv)aneKrkeXIjBIxÞúHecjBIeRsamsYt b¤Gab;EsxYrk,alGacsnñidæanfa CaBBYk Nocardia asteroides EdlGacduHenAelIfñalbNþúHman QamBIr b¤bIéf¶pgEdr .

• cMeBaHxÞúHEdlykmkBIGñkCm¶WEdlrlaksnøak; eRsamsYt q¥wg b¤rlakeRkamEs,k CaBiesscMeBaHkUnek μg GayueRkam 5 qñaM KYrEtRtUv)aneKbNþúHpgEdrenAelIfñalbNþúHQamq¥in CaRbeyaCn_enAkñúgkarrukrk H.

influenzae . • karbNþúHenAkñúgmCÄdæanminmanxül;enaH vamansar³sMxan;xøaMgNas; enAeBledlbnÞHkBa©k;bMBak;BN’

Gram bgðajGMBIBYk Flora eRcInmuxbBa©ÚlKña b¤enAeBlEdlvtßúviPaKenaH[køins¥úyxaøMg. fñalbNþúHman Qam¬bNþúHenAmCÄdæanK μanxül;¦RtYv)aneKeRbIR)as;y:agsMxan;sMrab;bNþúHrkBBYk Actinomyces. kar bNþúHrkBBYk)ak;etrIBMuRtUvkarxül;RtUv)aneKeFVIenAeBlmansMeNIresñIsMuBIsMNak;RKUeBTüBüa)al edaysar BYkeKmankarsgS½ymankarbgáCm¶WedayBBYk Clostridium EdlbegáItCa]s μ ½nmankøins¥úy. bec©keTs sMrab;eFVIkarbNþúHrkBBYk)ak;etrIminRtUvkarxül; RtUv)aneK elIk ykmkbriyay.

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karviPaK edayminKitGMBIkarqøgBImCÄdæanCMuvijxøÜndUcCa BIEs,k ¬dUcCa Staphylococcus Epidermidis¦ RKb;)ak;etrI TaMgGs;EdleKrkeXIjenAkñúgdMe)A xÞúH b¤Twkrég KYrEtRtUv)aneKykcitþTukdak; nigRbwgERbgeFVIkarviPaK. karviPaK RKb;)ak;etrITaMgGs;BMuEmncaM)ac; nigmansar³sMxan;enaHeT CaBiessenAkñúgkrNImankarRcbUkRcbl;Kñaén Flora. )ak;etrI nigBBYkpSitEdleKrkeXIjecjBIxÞúH nigTwkrég KWsßitenAkñúgesÞIrEtRKb;RkumemeraK. karviPaKEdlelIk ykmkbgðajenATIenHKWCakarviPaKrkEtBBYk Staphylococci EdlEtgbegáItCaxÞúH nigBBYk)ak;etrIbgáCm¶WBIr RbePTeTotKW Pasteurella multicida nig Bacillus anthracis EdleKkRmrkeXIjenAkñúgdMe)A b¤karrlak enAelIEs,kb:uEnþkarviPaKrkBYk)ak;etrIbgáeraKTaMgenH pþl;plRbeyaCn_xøaMgNas;dl;karBüa)al. eKKYrEtBieRKaH CamYynwgesovePAGtisuxumCIvsaRsþKøIniksþg;darmYysMrab;karbriyay)anBisþarBIviFIsaRsþénkarkMNt;GtþsBaØaN emeraK. enARKb;krNITaMgGs;dMNak;kalTI 1 énviFIsaRsþKWkarBinitükarduHdald¾l¥rbs;emeraK edayRbytñ½-RbEyg qáwHykkBa©úM)ak;etrIEtmYydMuBIRbePTemeraKnimYy² rYceFVIkarbMBak;BN’ Gram bnÞab;mkBinitüemIlrUbrag edaysamIRkUTsSn_ . Staphylococci BBYk Staphylococci KWCa)ak;etrIEdleKCYbCaerOy² ehIybgá[manCaxÞúH. BBYk Staphylococci enHduHlUt las;)anl¥enAelIfñalbNþúHEdlmanQamkñúgmCÄdæanRtUvkarxül; nigmankBa©úMemeraK ragl¥k;BN’s b¤ERkmman Ggát;p©it 1-2 mIlIEm:Rt eRkayeBldak;bNþúH)anmYyyb;rYcmk. BYkenHKWCaBYk)ak;etrImYymuxKt;EdlGacduHenA elIfñalbNþúHEdlmanbrimaNGMbilx<s;dUcCa fñalbNþúH MSA CaedIm. BYkvaGacRtUv)aneKeFVIkarEbgEck[dac; BI Staphylococci edaysarEtrUbrag nigkarbegáItCa Catalase. karbegáIt Catalase rbs; Staphylococci bgðajeLIgtamry³kardak; H2O3 3%mYytMNk;eTAelIkBa©úMemraKEdldak;enAelIbnÞHkBa©k;s¥atmYy. BBuHGuk-sIuEhSnEdlecjmkbBa¢ak;y:agc,as;fa mankarbegáItCa Catalase . sRmab;CaeKalbMNgKøInik BBYk Staphylococci GacRtUv)aneKEbgEckCaBBYkEdlbegáItCa Coagulase nig BBYkminbegáIt Coagulase. BBYk Staphylococci EdlbegáItCa Coagulase CaBBYk S. aureus EdlCaBBYk RtUv)aneKykcitþTukdak;tamdanCageKkñúgvis½yevC¢saRsþ. manBBYk Coagulase GviC¢manmYycMnYn manEtBIr RbePTb:ueNÑaHEdleKykmkBiPakSaenATIenHKW S.epidermidis nig S. saprophytycus. eTaHbICa S. aureus KWCa)ak;etrIminbgáCm¶WenAkñúgRcmuH ¬40°énmnusSeBjv½ymansuxPaBl¥pÞúkBYk enH¦ Es,k nigkñúgeBaHevon EtBYkenHGacbNþal[manCabUsRTnic Gab;Es dMe)Arlak bgáCm¶WenAkñúgdMe)ArlYy b¤rlakq¥wg Gab;EsedaH xÞúHkñúgeRsamsYt dMe)AxÞúHkñúgsac;dMu eraKsBaØasðúkedayCatiBul nigRbePTCm¶WmanxÞúHepSg²eTot.

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S. epidermidis KWCa)ak;etrI»kasniymelIEs,k RcmuH nigelIRTnab;Es,kesþIg b¤CalikaesþIgdéTeTot Etvak¾ GacbgáCm¶Wy:agtictYcbMput. EteTaHCay:agNak¾eday vtþmanrbs;BYkvaenAkñúgxÞúHminKYrCanic©CakalRtUv)aneK Tat;ecalfaCakarqøgeraKEs,kEdr. eRkABIkarbgáeraKy:agtictYcbMputenaH S.epidermidis GacbgáCm¶welIEs,k enARtg;kEnøgEdlcak; Catheter b¤]bkrN_epSg²eTot. karbgáCm¶WCamYynwg S. epidermidis KWCakarbgáCm¶WKYr [RBYy)armÖkñúgkrNICm¶WebHdUg nigkarvHkat;EksmösS EdlbNþalmkBIkarjat;cUlnUv]bkrN_sib,nimitþ ¬eRbI ebHdUg nigRtKaksib,nimitþ¦ S. saprophyticus RtUv)aneKsÁal;pgEdrfaCaBBYkbgáCm¶Wjwkjab;kñúgbMBg;TwkenamcMeBaHRsþIv½yek μg ehIysßit kñúglMdab;elx2 bnÞab;BIBBYk E. coli cMeBaHkarbgáeraKelImnusSmYycMnYn. karlkçN³dac;BIKñaénBBYk Staphylococcus TaMgbIRbePT RtUv)aneKbriyayenAkñúgtaragTI22. düaRkamEdl bgðajBIkarkMNt;GtþsBaØaNCabzmelIBYk Staphylococci manbgðajkñúgrUbPaBTI 10 . edaysarEtetsþ Coagulase mansar³sMxan;sMrab;viPaKrk S. aureus dUecñHetsþenHRtUv)aneKerobrab;y:ag lMGit. Coagulase KWCaGg;sIummYyEdleFVI[)øas μakk. BBYk Staphylococci Edlman Coagulase viC¢man manCaBIrTRmg;³ Bound coagulase b¤Clumping factor Edlbgðaj[eXIjenAelIPñas nig Free coagulase

Edlbgðaj[eXIjtamry³kareFVIetsþenAnwgbMBg;Ekv.

taragTI22³ karEbgEckRbePT Staphylococci sMxan;²enAkñúgKøInik

S. aureus S. epidermidis S.saprophyticus

karbegáItCa Coagulase viC¢man GviC¢man GviC¢man kareRbIR)as; Manitol enAelIfñalbNþúH MSAa GasIut ¬BN’elOg¦ NWt ¬Rkhm¦ GasIut ¬elOg¦ BN’rbs; Colonies RbepH ERkm b¤elOg BN’s BN’s etsþGg;TIb‘Íy:URkamelI Novobiocin eRkAxøÜn Gg;sIub Gg;sIub Fn;b fñalbNþúH DNase duH minduH minduH a mankrNIelIkElg b tMbn;KμanemeraKduH 16 mIlIEm:Rt edayeRbIR)as;bnÞHDIs 5 mIRkURkamenAkñúgbec©keTsDIssþg;dar

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rUbPaBTI 10 ³ rMhUrdüaRkamsMrab;eFVIkarviPaKelIBBYk Staphylococcus

• etsþelIbnÞHkBa©k;³ enAelIbnÞHkBa©k;Edls¥at rMlaykBa©úM Staphylococci mYy b¤BI b¤bI kBa©úM enAkúñg

esr:UméRbmYytMNk;. l,ayemeraKenHRtUvEtxab;. ykExSlYsmYyeTAdak;kñúg)øasμa ehIyeRbIExSlYs dEdlenH eTAkUrl,ay)ak;etrIenaH. BinitüemIlkBa©úMenAry³eBl 10 vinaTI. etsþGviC¢man-xusmanekIt eLIgRbEhl 10° én S. aureus. ebIsinNaetsþenAelIbnÞHkBa©k;GviC¢man ehIy)ak;etrIEdldHuemIl eTARbhak;RbEhlfaCaBBYkbgáCm¶WenAelITidæPaBepSg²eTotenaH ¬kkr RbPBKøInik¦eKKYreFVIkarBinitümþg eTotenAkñúgetsþkñúgbMBg;Ekv.

• etsþkñúgbMBg;Ekv³ lay 2 eTA 3 tMNk; ¬0/5 mIlIlIRt¦én)øasμaeTAkñúgbMBg;Ekvs¥atKμan emeraKTMhM 12 x 75mIlIlIRt rYcbEnßm2tMNk;énl,ayemeraKEdllaykñúgfñalbNþúHrav. l,ayEdlmandg;sIuetesIμKña mYyGacRtUv)aneKerobcMedayqáwHykkBa©úMemeraKpÞal;BIfñalbNþúHmanQam. dak;bMBg;EkvbNþúH enAkñúg sItuNðPaB35GgSakñúgry³eBl 4-18 em:ag ehIyBinitüemIlkMNkrbs;va .

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)øasμaEdleKeRbIkñúgetsþ Coagulase GacCa)øasμarbs;mnusS b¤TnSayEdlrkSakMu[kkeday EDTA (Ethyle-

nediamine tetracetic acid). )aøsμaTaMgenHKYrEtRtUv)aneKrkSakñúgTUTwkkk kñúgbrimaNbnþicbnþÜckñúg ¬1mIlI-lIRt¦ ehIylT§plkargarrbs;vaKYrEtRtUveKepÞógpÞat;CamYynwgkarbNþúHBBYk S. aureus nig S.epidermidis EdleFVIRsbKñaenaH. Pasteurella multocida brimaNén)asIu Gram-negative mYycMnYnEdlqøgmkBIstVxaM ehIyGacbgáCm¶W¶F¶n;F¶rcMeBaHmnusS eyIgeRcInekIt mkBI Pasteurella multocida. P. multocida KWCaBBYk)ak;etrIEdlminbgáCm¶WenAkñúgmat;rbs; stVmYycMnYnFM dMe)AEdlekIteLIgedaysarstVxaM ehIybgáeday P. multocida Gacpþl;[manCakarrlakeRkamEs,k ehIy GacbnþeTAdl;snøak; begáItCarlaksnøak;. karrlakq¥wg Bacteraemia nigCm¶WrlakeRsamxYr RtUv)aneKBiBN’na rYcmkehIy . eKRtUvBinitürkemIl P. multocida kñúgTwkrég b¤xÞúHEdlhUrecjmkBIdMe)A ebIeKdwgfabNþalmkBIstVxMa b¤ sgS½yfaman)ak;etrIRbePTenHenAnwgkEnøgdMe)A. P. multocida KWCa)ak;etrI Coccobacillus KμanclnatUc² Gram-negative . vaduH)any:agl¥enAelIfñalbNþúHmanQamenAkMedA 35 GgSar b:uEnþminGacduH)anenAelIfñal bNþúHCeRmIssRmab;BBYk)ak;etrIkñúgeBaHevonedaysarEt Bile salt ]TahrN_ dUcCafñalbNþúH MacConkey CaedIm. bnÞab;BIdak;bNþúHkñúgm:asIunkMedAmYyyb;rYcmk eKeXIjkBa©úMemeraKtUc²enAelIfñalbNþúHEdlmanQam BMumankarbMpøajRKab;Qam RsGab;caMgBnøW nigmansPaBGnøay² ¬edayasarvamansMbkkarBarxageRkA enAkñúg TMrg;Edlsahav¦ . karviPaKrksmasPaBCIv-KImIrbs;vaBwgEp¥kelIlkçN³Biess²dUcxagRkam ³ - eLIgem Glucose EtminbgábegáItCa]s½ μn ³ P. multocida duHenAelIfñalbNþúH Kligler iron edaybegáIt

CaGasIutenAnwg)atrbs;fñalbNþúH. - etsþ Oxydase bgðajfaviC¢many:agexSay - Catalase-viC¢man - mankarbMEpøgBI Nitrate eTACa Nitrite ¬0/1én Potassium nitrate kñúgfñalbNþúHravsMbUrcMNIGahar¦ - Urease-GviC¢man - Indole-viC¢man EdleKGaceFVIetsþenAkñúgfñalbNþúHrav Trypsic Soy (TSB) b¤enAelI MIU eRkay

eBldak;bNþúH)an 48 em:ageRkaymk . - manPaBsg;sIubxøaMgCamYynwg Benzyl Penicillin enAkñúgetsþGg;TIb‘ÍyURkamedayeRbIbec©keTsDIs .

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Bacillus anthracis Bacillus pSMeLIgeday)ak;etrIRtUvkarxül;eRcInBYk edaymankarbegáItCa Spores)asIu Gram-positive ehIy rs;enAkñúgdI. )ak;etrI B. anthracis KWCa)ak;etrIEdlbgá[manCm¶WelIEs,k nigRtUv)aneKykcitþTukdak;tamdan bMputenAkñúgsßanPaBsuxPaBsaFarN³. cMENkÉBBYk Bacillus epSg²eTotEdlrk eXIjenAkñúgxÞúH b¤Twkrég b¤ dMe)A RtUv)aneKKitfa karqøgBIxageRkA b¤CaBBYk»kasniym . B. anthracis KWCaPñak;garbgáCm¶Wy:agsMxan;mYyenAelIeKaRkbI b¤bsustVFM² ecom BEB nigstVciBa©wmdéTeTot. vaGacbgá[maneRKaHfñak;dl;stVEdlrs;enAkñúgéRBpgEdr. Cm¶W Anthrax GacekItmanenAelImnusS CaBiess RbCaCnEdlrs;enAkñúgEpñkxøHénTVIbGaRhVic GasIu EdleFVIkar b¤rs;enAy:agCitsñitCamYystVciBa©wm. karbgáCm¶WelI mnusSGacbNþalmkBIkareRbIR)as;plitpleFVIGMBIstVEdlmanpÞúk Spores rbs;)ak;etrIRbePTenHdUcCa eram Es,k nigq¥wgCaedIm . karbgáCm¶WEdljwkjab;bMputelImnusSKWCm¶W Anthrax elIEs,kEdlGacbnþrhUtdl;køayCa Septicaemia nig rlakeRsamxYr. Spores)aneRCotcUleTAkñúgEs,kEdlrlat; ehIybegáIt)anCadMe)AedaybNþal[søab;ekasika enARtg;tMbn;kNþaléndMe)AenaHehImB½T§CMuvij. eKGacBinitüeXIjmanCa)asIuFM² mancugCaragkaer: Gram-posi-

tive mansMbk ¬Capsule¦ B½T§CMuvij Kμan Spores enAkñúgTwkrégEdlhUrecjBIdMe)AenaH. B. anthracis duHenAkñúgmCÄdæanEdlRtUvkarxül;. vaGacduHenAelIfñalbNþúHmanQamedaybgábegáItCakBa©úM emeraKFM² GacmanTMhMdl;eTA 5mIlIEm:Rt sMEb:tBN’RbepH edaymanépÞkKeRKIm nigmanERbRbYl minesμ Ir man ragdUcsk;EdlduHlyecj ¬dUck,alstVmwk¦. vamansar³sMxan;Nas;kñúgkarEbgEck[dac;rvag B. anthracis EdlbgáCm¶Wy:agsahaveTAnwgBBYk Bacillus EdlminbgáCm¶WdéTeTotrbs;BBYkenH. karEbgEckCadMbUg KWKYrEt)aneKBwgEp¥keTAelIkarminbMpøajRKab;Qamsg;sIubCamYynwg Benzyl penicillin nig kgVHclnarbs; B. anthracis. pÞúyeTAvijBBYk Bacillus EdlminbgáCm¶WesÞIrEtTaMgGs; manclna nigman karbMpøajRKab;Qamy:agelOn. lkçN³RKwHTaMgbIenH Gac[eKeFIVkarEbgEck nigviPaK )anc,as;las;. sRmab; eraKvinicä½ysßaBrdMNuHsuT§Edl)anmkBIkarbNþúH KYrRtUvepJIPøam²eTAkan;mnÞIrBiesaFn_EpñkcMNIGahar b¤suxPaB-saFarN³. B.anthracisKWCa)ak;etrIEdlbgá[manCadMe)Ay:agxøaMgkøaelIsarBagÁkaymnusSeyIg ehIyvtßúviPaK nigkarbNþúH KYrEtRtUv)aneFVIeLIgedayykcitþTukdak;bMputedIm,IeCosvagkarqøgraldal b¤sayPayeTAmCÄdæanxageRkA nig gaybgáCm¶WelIbuKÁlikmnÞIrBiesaFn_xøÜnÉgpÞal; .

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etsþGg;TIb‘Íy:URkam Gg;TIb‘Íy:UTikGacniwgmincaM)ac;eRbIR)as;enAelIRKb;GñkCm¶WEdlmandMe)A Gab;Es b¤manhUrTwkrég enaHeT b:uEnþkareFVI karkat;sMGat karecaHbgðÚrxÞúH b¤Twkrég nigkarsMGatkMeTckMTI b¤xÞúH)anRtwmRtUv s¥atl¥ CaTUeTAvamansar³sMxan; CagkareRbIR)as;fñaMGg;TIb‘Íy:UTikeTAeTot. lT§plénkareFVIetsþGg;TIb‘Íy:URkam KYrEteFVIKWkúñgry³eBl48 em:agKit cab;BIeBl)anTTYlvtßúviPaKrYc .

kareFVIetsþGg;TIb‘Íy:URkamCalkçN³RbcaMéf¶ minKYrRtUv)aneKeFVIeLIgeTcMeBaH)ak;etrIEdleKdwgGMBIlkçN³sg;sIub rbs;varYceTAehIyenaHeTdUcCa BBYk Streptococci Pasteurella nig Actinomyces EdlCaTUeTAsg;sIubCamYy Benzyl penicillins TaMgGs;. cMeBaHBYk Enterobacteriaceae EdlCa)asIumineRbIR)as;Catisár Gram-negatve nig Staphilococcu etsþ bnSayDIsEbbsþg;dar ¬Kirby-Baureu¦ KYrRtUv)aneKeRbI. eFVIetsþEtGg;TIb‘Íy:UTik TaMgLayNaEdlkMBugRtUv eKeRbIR)as; nigesñIsMuBIsMNak;RKUeBTüBüa)al. Gg;TIb‘Íy:UTikfμ I² nigmantémøéfø KYrRtUv)aneKeFVIEtkñúgkrNIesñIsMu CaBiessNamYy b¤enAeBl)ak;etrIEdl)anrkeXIjenaHFn;eTAnwgfñaMepSg²eRcIn b¤TaMgGs;.

bBaðaRtUv)aneKCYbRbTHjwkjy enAeBleFVIetsþGg;TIb‘Íy:URkameTAelIBBYk Staphylococci TaMg S. aureus nig S. epidermidis. mancMnYnelIsBI 80°én Staphylococci EdleKbNþúHeXIj eTaHbICaenAkñúgshKmk¾eday k¾)ak;etrIenHbegáItnUv β-lactamase EdlGacFn;eTAnwgfñaM Benzyl penicillin nig Ampicillin. ral;dMe)A b¤ karbgáCm¶WTaMgLayedayBBYk Staphylococci EdlFn;CamYynwg Benzylpenicillin eKRtUveFVIetsþCamYynwg RkumPenicillin EdlFn;CamYynwg β-lactamase bnþeTotKWRkum Meticillin (Oxacillin cloxacillinCaedIm¦. bnÞH Oxacillin disc ¬1mIRkURkam¦ KWRtUv)aneKeRbIR)as;kñúgkareFVIetsþGg;TIb‘Íy:URkamsMrab;BYk Staphylococci enH. bnÞH Oxacillin disc manlMnwg rhs½kñúgkarrkeXIjPaBFn;nwgfñaMrbs;Rkum Staphylococci TaMgGs;enH. PaBFn;enHCaerOy²CaRbePT Heteroresistant ]TahrN_vaekIteLIgenAelIEt Staphylococci mYycMnYn b:ueNÑaH. edaysarEt Heteroresistance énBBYk Staphylococci enHgayemIldwg enAsItuNÑPaBTab dUcenH sItuNÑPaBkñúgma:sIunkMedAminRtUveGayelIsBI 35GgSareLIy. BYk Heteroresistant bgðajnUvExSmYyduHRsBic RsBil¬ebIminGBa©wgeTenAkñúgtMbn;EdlK μanemeraKduHesaHEtmþg¦ b¤karduHkBa©úMemeraKtUc²CaeRcInEdlCajwkjab; eKTat;ecalfa CakarqøgcUlBI)ak;etrIepSg²eTot. ebIsinNamankarduHecjmkrebobenH eKRtUveFVIkarbMBak;BN’ Gram )anbBa¢ak;c,as; BMuEmnCakarqøg)ak;etrIepSg² ¬Contaminant¦ cUleLIy.

BBYk Heteroresistant CalkçN³KøInikvaFn;CamYynwgRKb;Gg;TIb‘Íy:UTik β-lactamase TaMgGs;edaybUkrYmTaMg Rkum Cefalosporins carbapenems nig Meticillin pgEdr. edaysarEtehtuplenHehIy)anCaBBYk Sta-

phicocci minRtUv)aneKeFVIetsþGg;TIb‘Íy:URkamCamYynwgBBYk Cefalosporins enaHeT . eKeXIjmanPaBFn;qøg ¬Cross-resistance¦rvag Cenzylpenicillin nig Ampicillin . dUecñHPaBsg;sIubeTAelI Ampicillin minKYr RtUv)aneKeFVI[dac;ecjBIKñaenaHeT .

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karsikSaBI)ak;etrIEdlminRtUvkarxül; ¬Anaerobic bacteriology¦

esckþIepþIm esovePAenHCajwkjab;briyayGMBIkarbgáCm¶WedaysarBBYk)ak;etrIEdlminRtUvkarxül; niglkçN³rbs;)ak;etrI EdlminRtUvkarxül;. emeraKenHGacbgáehtuCak;EsþgenAelIRKb;Calikaragkay nigenARKb;TIkEnøgelIsarBagÁ-kaykñúglkç½xN½ÐFm μtasmRsb . Cm¶WEdlbgáeLIgedayBBYk)ak;etrIEdlminRtUvkarxül;PaKeRcIn bNþalmkBI)ak;etrIenAkñúgxøÜneyIg EdlCaEpñk mYyén Flora Fm μta EdlGacrs;enAkñúgxøÜneyIgmansuxPaBl¥rhUtdl;manGVImYyekIteLIgedayeFVI[)at;lMnwgén Flora FmμtaenAkñúgxøÜneyIg b¤k¾mankarqøgkat; b¤pøas;bþÚrTIkEnøgrbs;)ak;etrITaMgenH BIkEnøgmYyeTAkEnøgmYy eToténrUbkayrbs;eyIg. cMENkÉBBYk)ak;etrIEdlminRtUvkarxül;EdlqøgmkBIxageRkACabzm KWmanBYk Clo-

stridium tetani C. botutium ehIymþgmáalmanBYk C. perfringens nigBBYk Clostridium epSg²eTot Edl)aneRCotcUleTAkñúgdMe)A ¬rbYs¦ ehIybNþalCaCm¶WettaNUs dMe)A Botulism b¤ dMe)ABis rlYy. Gab;Es EdlsßitenAelIsrIragÁ Bacteriaemia rlakeRsameBaH rlakbMBg;k bUs ¬Empyema¦ rlakeRkamEs,k nig rlakExñgeBaHevonKWRKan;EtCalkç½NÐBIr b¤bIEdlBBYk)ak;etrIminRtUvkarxül;bgáehtub:ueNÑaH. vaCakarsMxan;Nas; EdlGñkCMnajxagGtisuxumR)aNdwgfa enAeBlNaEdlRtUvbNþúH nigRtUvbNþúHrk)ak;etrIminRtUvkarxül;rebobNa cMeBaHvtßúviPaKEdl)anmkBIKøInik. karBiBN’naBI)ak;etrI Tak;TgnwgtRmUvkarGuksIuEhSn RbEhlCamankarsμ úKsμajbnþic b:uEnþRbEhlCaGacyl;)anGMBITMnak;TMngrvag)ak;etrI nigtRmUvkarGuksIuEhSn rbs;va . )ak;etrIEdlRtUvkarxül;dac;xat³ RtUvkar]s μ ½nGuksIuEhSnedIm,IbMeBjnUvdMeNIrkarbegáItfamBlrbs;va

dUcenHBYk)ak;etrITaMgGs;enHminGacduHlUtlas;edayBMumanvtþman]s μ ½nGuksIuEhSnenHeLIy. ]TahrN_ dUcCa Micrococcus nig Nocardia asteriides .

)ak;etrIEdlminRtUvkarxül;dac;xat³ BYkenHminRtUvkarxül;GusIuEhSnedIm,IeFVIkarbMEbkxøÜn b¤duHlUtlas; eLIy. tamkarBiteTAGuksIuEhSneFVI[Buldl;BYkenH. BYk)ak;etrIRbePTenHGacbegáItCafamBl)antam ry³kareRbIR)as;Catisár ehIybegáItCakøins¥úyxøaMg. ]TahrN_dUcCa Bacteroides fragilis nig Pepto

streptococcus magnus.

145

)ak;etrIminRtUvkarxül;mindac;xat³ KWCa)ak;etrIEdlminRtUvkarxül;dac;xat edIm,IduHlUtlas; b¤begáItCa

famBleLIy. BYkenHGaceRbIR)as;GuksIuEhSn b¤k¾GacduHlUtlas;edayynþkm μrbs;BBYk)ak;etrIEdlmin RtUvkarxül;dac;xat. )ak;etrITMagenHGacrs;enA)ansBVEbby:ag ehIyGacRbQmmuxeTAnwgbrisßanenA CMuvijxøÜnrbs;va GacbegáItCafamBlsMrab;duHlUtlas; nigbMEbkxøÜnedaysarEtynþkard¾manRbsiT§PaB rbs;va. )ak;etrITaMgenHmandUcCa E. coli nig S. aureus.

bEnßmBIelI)ak;etrIdUc)anerobrab;xagelI eKeXIjman)ak;etrI Microaerophilic EdlCaBBYkEdlduHlUtlas;)an y:agl¥bMputenAeBlEdleKbnßybrimaNGuksIuEhSn kñúgenHeKeXIjman Campylobacter jejuni KWCa)ak;etrI Microaerophilic mYy. )ak;etrIsaRsþ manRkum)ak;etrIminRtUvkarxül; 4RkumsMxan; EdlTTYlxusRtUv 80° énCm¶WEdlbgáeLIg edayBBYk)ak;etrImin RtUvkarxül;enH. BYkTaMgenaHman Bacteroides, Prevotella and Porphyromonas spp., Peptostrepto-

coccus spp nig Clostridium spp.. BBYkEdleKrkeXIjCaerOy² enAkñúgBUCnImYy² KWBacteroides fragi-

lis, Peptostreptococcus magnus nig Clostridium perfringens. viFIsaRsþCak;lak;sMrab;rknigkMNt; GtþsBaØaNBUCTaMg3enH nigRbePTrbs;va KYrRtUveRbIpgEdrCaKMrUsMrab;viFIbNþúH nigpþÜcepþImkarkMNt;GtþsBaØaN )ak;etrIminRtUvkarxül;ÉeTot Edlmansar³sMxan;KøInik . karykvtßúviPaK nigkardwkCBa¢ÚnvtßúviPaKeTAkan;mnÞIrBiesaFn_ kic©karTaMgGs;enHRtUv)aneKerobrab;enAEpñkmunrYcehIy. tM)arsMLIKWCavtßúEdleKKYrEteCosvageRbIR)as;sMrab; ykvtßúviPaK eRBaHfaBBYk)ak;etrIEdlminRtUvkarxül;qab;søab;bMputeBlRtUvxül; nigs¶Üt. vtßúviPaKEdleKyk sMrab;eRbIR)as;kñúgkarbNþúHrkBBYkminRtUvkarxül; KYrEtRtUv)aneKykedayRbugRby½tñecjBIkEnøgEdlbgáeraK skm μ. eKGacnwgRtUvkaresvaBIslüeBTükñúgkarykvtßúviPaKmYycMnYn. CakarRbesIrbMput vtßúviPaKKYrEtRtUv)aneK ykedayeRbIR)as;sWraMug nigm¢úledIm,IbUmykxÞúH ekasika b¤CalikaEdlmanlayxÞúHecjBIkEnøgdMe)A Empyema b¤bgðÚrecjBIGab;Es. vtßúviPaKKYrEtRtUv)aneKdak;eTAkñúg]brN_Edls¥at K μanemeraK biTCit)anl¥ b¤ebIsinCaBMuman]bkrN_enHeT vtßúviPaKEdleKbUmyk)anmk RtUvrkSaTukenAkñúgsWruaMg ehIyRKbm¢úl[)anRtwmRtUv b¤k¾karBaredaysarekAs‘U karBarenAxagcugm¢úl rYcbBa¢ÚneTAkan;mnÞIrBiesaFn_CabnÞan; .

146

karbegáItmCÄdæanKμanxül;sMrab;bNþúH)ak;etrI manbec©keTsCaeRcInEdleKeRbIR)as;sMrab;begáItCamCÄdæanEdlKμanxül;. manbec©keTsmYyEdlsamBaØ nig Gs;témøefakKWkareRbIR)as;RkLminmanxül;EdleFVIeLIgBIEkv Polycarbonate EdlmanlT§PaBpÞúk 2/50 eTA 3/50 lIRtehIyP¢ab;edaykBa©ab;]s½n μbiTCitEdlGacdak; nigpøas;ecj)anRsYl. bnÞab;BIdak;RbGb; Petri Edl bNþúHkñúgRkLrYcehIy mCÄdæanEdlK μanxül; KWRtUv)aneKbegáIteLIgedayeRbIR)as;sMPar³EdlbegáItCamCÄdæanKμan xül; nigmandak;lk;enATIpSar rYcbiTKRmb. ]brkN_EdlbegáItCamCÄdæanK μanxül;manragsMEb:tsMbkkBa©b;esþIg ehIyGacbeBa©jGIuRdUEhSn nig]sμ ½nkabUnic bnÞab;BIbEnßmTwkenAkñúgkBa©b;enaH. sMPar ³ TaMgGs;enaHeTaHCay:ag Nak¾eday vaRtUvkarkatalIkr Palladium P¢ab;eTAnwg)atxageRkaménRkL. katalIkrenH køayeTACaminman skm μPaBGVITaMgGs;kñúgGMLúgeBleRbIR)as; dUecñHvaKYrEtRtUv)aneKpøas;f μ IenA erogral;kareRbIR)as;mYyelIk²tam karENnaMrbs;Gñkplit. bnÞH Redox-indicator EdleRbIehIye)aHecal ERbBN’BIexov ¬b¤Rkhm¦eTACaman BN’ticCagmun enAkñúgmCÄdæanEdlKμanxül; ehIybnÞH Redox-indicator enHGacrk)anenAtamTIpSar. bMBg;fñalbNþúHEdleRbIsMrab;bNþúHBBYk)ak;etrIminRtUvkarxül; dUcCafñalbNþúH Thioglicollate b¤ Cooked

Meat mincaM)ac;dak;bNþúHkñúglkç½NÐKμanxül;eT eRBaHsarFatupSMrbs;vamansarFatuEdlGacbegáIt)anCamCÄdæan EdlKμanxül;rYceTAehIy enAeBlEdlbrimaNrbs;fñalbNþúHravenHRKb;RKan; ¬10-12 mIlIlIRt kñúgTIbEdlman KRmbmYlmanviC¢maRt 15mIlIlIRt¦ nigfñalbNþúHeTIbEterobcM)anf μ I² lkç½xNÐKμanxül;GacbegáIteLIgenAnwg)at énbMBg;TIb. ebIsinCaeKmineRbIenAéf¶EdlerobcMPøam²enaHeT bMBg;TIbmanfñalbNþúHKYrRtUv)aneKrMlay b¤kMedA mþgeTot edaybnßyKRmbTIbedaydak;vaes¶arenAkñúgTwkdaMBuH ry³eBl 15 naTIedIm,IykGuksIuEhSnEdlrlay cUleTAkñúgfñalbNþúHenaHecj. bnÞab;mkmYlKRmbbMBg;TIb[twgeLIgvij ehIyTuk[RtCak;muneBleFVIkarbNþúH. fñalbNþúHsMrab;bNþúHBBYk)ak;etrIminRtUvkarxül; karbNþúHrkBBYk)ak;etrIminRtUvkarxül;KYrEtRtUv)aneKeFVIeLIgenAeBlmankaresñIsMuBIRKUeBTüBüa)al b¤enAeBl EdleKsegáteXIjfavtßúviPaKEdlTTYl)anmankøins¥úyxøaMg b¤enAeBllT§plénkarbMBak;BN’ Gram bgðajBI lT§PaBénkarbgáCm¶WedaysarBBYk)ak;etrIEdlminRtUvkarxül; ]TahrN_ vtþmanén Flora EdlmanrUbragERb RbYleRcInénBBYk)asIu nigkuksIu Gram-positive nig Gram-negative vtþmanénBBYk)asIu fusiform Gram-

negative b¤vtþmanénBBYk)asIuFM²Edlmancugragkaer: Gram-positive EdlGacCaBBYk Clostridium. karbNþúHrkBBYk)ak;etrIEdlminRtUvkarxül;RbcaMéf¶ minKYrRtUv)aneKeFVIeTenAkñúgkrNIvtßúviPaKCaTwkenam Twkrég ecjBIRbdab;bnþBUC lamk b¤kMhak. vtþmanrbs;BYk)ak;etrIEdlminRtUvkarxül;kñúgvtßúviPaKTaMgGs;enH bgðajBI kaqøgBIeRkAcUlmkkñúgvtßúviPaKenaH. RKUeBTüBüa)alKYrEtR)ab;dMNwgCamunfa vtßúviPaKEdlman Flora Fm μtaqøg cUlminRtUv)anGnuBaØt[eFVIkarbNþúHeT elIkElgEtmanehtuplc,as;las; .

147

fñalbNþúHmanQam KWCafñalbNþúHEdll¥bMputEdleRbIR)as;sMrab;rkBBYk)ak;etrIbgáCm¶WminRtUvkarxül;sMxan;². kñúgkarbNþúHrk)ak;etrIEdlBi)akduHenaH fñalbNþúHsMbUrcMNIGaharEdlmanQamlayCamYysarFatuCMnYykñúgkar lUtlas; ¬Haemin nig Menadione¦RtUv)aneKeRCIserIykmkeRbI. fñalbNþúHRKwHenH Gacrk)annigdak;lk; enATIpSar nigmaneQμaHfa fñalbNþúH Wikins-Chalgren Anaerobe. BYk)ak;etrIminRtUvkarxül;CaerOy² CaEpñkmYyén Microflora (Flora tUc²) RcbUkRcbl;Kña ehIyCYnkalenA layLMKñaCamYyBBYk)ak;etrIEdlRtUvkarxül; ebIfñalbNþúHEdlmanQamsRmab;bNþúHBBYkminRtUvkarxül; KYrEt RtUv)aneKplitedayBiess edaymanbEnßmGg;TIb‘Íy:UTikmYy b¤BIrmuxbEnßmeTot. ]TahrN_dUcCa karbEnßm Aminoglycoside(Neomycin kanamycin) kñúgkMhab;cugeRkay[)an50mIRkURkam¼mIlIlIRt EdlGacTb;sáat; karduHlUtlas;BBYk)ak;etrIEdlRtUvkarxül;mYyPaKFM nig)ak;etrIEdlRtUvkarxül;mindac;xatmYyPaKFMpgEdr. l,ayén AminoglucosideRtUv)aneKerobcMedayrMlay 500mIlIRkameTAkñúgTwk 100mIlIlIRtTwksuT§. rMlay 100 mIlIlIRténfñalbNþúHRKwHrbs;BYk)ak;etrIminRtUvkarxül;. enAeBlEdlman kMedA56 GgSarbEnßmQamEdl dkyk Fibrin ecjcMnYn 5 mIlIlIRt nig1 mIlIlIRténsUluysüúgGg;TIb‘Íy:UTik . layva[sBV rYccak;15-18 mIlIlIRt[)ans¥atKμanemeraKeTAkñúgRbGb; petri . RbGb;TaMgGs;enaHKYrEtRtUv)aneKeRbIR)as;[)anelOnbMput tamEtGaceFVIeTA)an b¤rkSaTukenAkñúgTUTwkkkCakarRbesIr eKRtUvrkSaTukvaedaymanRckfg;pøasÞikBIxageRkAmYy Can;eTot. bec©keTsbNþúH nigEjkrk)ak;etrI vtßúviPaKEdlykmkBIkEnøgEdlsgS½yfa bgáeraKedayBBYk)ak;etrIminRtUvkarxül; KYrEtRtUv)aneKdak;bNþúH[ )anRbjab;bMputenAelIfñalbNþúHdUcxageRkam ³ - fñalbNþúHmanQamsMrab;BBYk)ak;etrIEdlBMuRtUvkarxül;³ fñalbNþúHTaMgenHKYrEtRtUv)aneKdak;bNþúHenAkñúg

RkLBMumanxül;. - fñalbNþúHmanQamsMrab;BBYk)ak;etrIEdlRtUvkarxül;³ fñalbNþúHRtUv)aneKbNþúHkñúgRkLmanduteTon. - fñalbNþúH MacConkey - fñalbNþúHravEdlerobcMdak;kñúgbMBg;TIb ¬Thioglycollate b¤ Cook meat¦ karbNþúHEdlmanGuksIuEhSnKYrEtRtUv)andak;bNþúH nigeFVIdUcFm μta ehIyBinitüenA 24-48 em:ag sMrab;BBYk )ak;etrIRtUvkarxül;mindac;xat. tMbn;tUcmYyénfñalbNþúHmanQamsMrab;bNþúH)ak;etrIRtUvkarxül; KYrEtRtUv)an bNþúH nigqUtCamYynwg Loop s¥atKμanemeraK. fñalbNþúHKYrEtRtUv)aneKdak;bNþúHnwgRkLsMrab;bNþúHBBYk )ak;etrIminRtUvkarxül; KYrRtUv)anebIkenA 48em:ageRkayedIm,IBinitü. ebIsinCa)ak;etrIenaHduHmkehIyBMuRKb;RKan;

148

fñalbNþúHenaHGacRtUv)aneKdak;bNþúHbnþeTotcMnYn 24-48 em:ageTot. fñalbNþúHravKYrEtRtUv)aneKbNþúH[)an eRcInjedayeRbIbMBg;EkvbWt Pasteur . 48 ema:geRkaymkkarduHlUtlas;rbs;)ak;etrIEdlduHenAelIfñalbNþúHmanQamsMrab;BBYk)ak;etrIEdlminRtUvkar xül;KYrEtRtUv)aneKBinitü nigeRbobeFobCamYyfñalbNþúHmanQamsMrab;bNþúHrkBBYk)ak;etrIEdlRtUvkarxül;. RbePTkBa©úMemeraKelIfñalnImYy² KYrEtykeTAbMBak;BN’ Gram. )ak;etrIEdlmanrUbrag dUcKña eRkayBIeFVIkar BinitüedaymIRkUTsSn_ ehIyEdlduHTaMgenAelIfñalbNþúHsMrab;)ak;etrIRtUvkarxül; nigTaMgfñalbNþúHsMrab;)ak;etrI minRtUvkarxül;RtUv)aneKKitfa KWCa)ak;etrIminRtUvkarxül;mindac;xat . kBa©úM)ak;etrIEdlelcecj b¤duHEtenAelI fñalbNþúHsMrab;BBYk)ak;etrIEdlminRtUvkarxül;RbEhlCaBBYk)ak;etrIEdlminRtUvkarxül; ehIyEdlRtUv)aneK eFVIkarbNþúHmþgeTotenAelIfñalbNþúHmanQamcMnYnBIreTot edaymYyTukedIm,IbNþúHkñúgmCÄdæanKμanxül;nigmYy eTotsRmab;dak;kñúgRkLduteTon. ebIsinCaeKeXIjvaduHEtenAkñúgmCÄdæan Kμanxül;enaH karviPaKenAelI)ak;etrI EdlbnSúT§TukrYcEdlBMuRtUvkarxül; KYrEtRtUv)aneKviPaKedayRbugRby½tñ . ebIsinCakarduHlUtlas;RtUv)aneKBinitüeXIjenAnwg)atrbs;fñalbNþúHrav sMrab;bNþúHrkBBYk)ak;etrI EdlminRtUv karxül; vaKYrEtRtUv)aneKeFVIkarbNþúHmþgeTotenAelIfñalbNþúHmanQamsMrab;rkBYk)ak;etrIRtUvkarxül; nigmin RtUvkarxül; nigBinitüviPaKdUcKñanwgkarbNþúHelIfñalbNþúHrwgelIkdMbUgEdr. edaysarEtdak;xÞúHeRcIn enAelIfñal bNþúHravvaGacnwgmanduHenAeBlEdlfñalbNþúHelIkTImYyGviC¢man. karviPaKrk)ak;etrIminRtUvkarxül;EdlsMxan;sMrab;KøInik Rkum Bacteroides fragilis RkumenHrab;bBa©ÚlBBYk)ak;etrImYycMnYnEdlCa Flora Fm μtaenAkñúgeBaHevon nigkñúgRbdab;bnþBUCRsþI . )ak;etrITaMg enHCaerOy²bgáCm¶WkñúgeBaH nigenAkúñgGagRtKak ehIybNþal[manCa Bacteraemia. B. fragilis KWCaBBYk )asIuEdlminmanclna Gram-negative CaerOy²bgðajrUbragERbRbYlduHy:agelOnenAelIfñalbNþúHmanQam rkSaTukkñúgmCÄdæanKμanxül;. enA 48 em:ageRkayBIkarbNþúH eKeXIjmankBa©úMemeraKEdlmanTMhMFMl μm ¬rhUt dl;manGgát;p©it 3mIlIEm:Rt RsGab;PøW BN’RbepH nigBMumankarbMpøajRKab;Qam. eFIVkarviPaKelOnGaceFVIeTA )anCamYynwgetsþCMrujTwkRbm:at;. fñalbNþúHEdleKbnSúT§)ak;etrIEdlsgS½y ehIyRtUv)aneKdak;bNþúHenAkñúgTIb BIrénfñalbNþúHrav Thioglycollate EdlbMBg;TIbmYymandak; 20° ¬mIlIlIRtkñúg 10mIlIRt¦ TwkRbma:t;s¥at KμanemeraK ¬dak;kñúgGUtUkøav¦rbs;eKaeQμal. enA 24 ema:geRkayBIbNþúHrYcmkBinitüemIlkarduHlUtlas;TaMgBIr TIbrYceRbobeFob B. fragilis xøaMgenAelIfñalbNþúHEdlbEnßmTwkRbma:t;eTAkñúgenaH.

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Clostridium perfringens Rkum Clostridium pÞúkedayBBYk)asIuman Spores Gram-positive EdlmanxøHCa flora Fmμtarbs; eBaHevon kñúgFUlI nigdI. BBYkEdleKCYbRbTH nigbgáCm¶WsMxan;CageKKW C. perfringens. vaCaTUeTAEtgEtbegáIt[mankøin s¥úy nigGacbNþal[manCa bacteraemia nigdMe)AeRCA²déTeTot. mindUcKñaTaMgGs;eT BBYk Clostridium

mYycMnYBMumanclna nigminbegáItCa Spores enAelICalikaEdlQW b¤enAkñúgemeraKEdlduHek μg² . C. perfringens duHlUtlas;y:agelOnkñúgfñalbNþúHEdleRbIsMrab;bNþúH BBYk)ak;etrIminRtUvkarxül; edayman karbegáItCa]sμ ½ny:ageRcIn. enAelIfñalbNþúHmanQamEdlrkSaTukenAkñúgmCÄdæanKμanxül; kBa©úMemeraKEdlman TMhMFMl μm ¬2-3 mIlIlIRt¦RtUv)aneKrkeXIjenA 48 em:ageRkaymk. esÞIrEtRKb;BYkenHTaMgGs;begáItCatMbn; bMpøajRKab;QamBIrCan; EdltMbn;xagkñúgmankarbMpøajRKab;Qamy:agc,as; nigCan;xageRkAmankarbMpøajRKab; QamxøH . eFVIkarviPaKrk[)anelOntamEtGaceFVIeTA)anCamYynwgetsþ CAMP bRBa©as; ¬Reverse CAMP test¦1 Edl eKeFVIdUcteTA ¬emIlrUbPaBTI 11¦2 ³

1- erobcMfñalbNþúHmanQamedaymanbEnßm 5° énQamecomEdllagbIdg 2- qUt Streptococcus agalactiae suT§tambeNþayGgát;p©itrbs;fñalbNþúH . qUtdMNuH Clostri-

dium EdleKsgS½y CabnÞat;Ekg Etminb:HeTAnwg Streptococcus agalactiae.

3- bNþúHenAkñúgRkLEdlCamCÄdæanBMumanxül; 24 em:ag . C. perfringens begáItCatMbn;ragdUck,alRBYjedaysarEtkarbMpøajRKab;QamenARtg;cMNucCYbén qñÚtTaMgBIr. ebIetsþ CAMPbRBa©as; ¬Reverse CAMP test¦GviC¢mannUvBBYk Clostridia enHGacRtUv)aneK snñidæanfaCa “Clostridium spp. minEmn perfringens” .

1 etsþ CAMP bRBa©as; ³ RtUv)andak;eQμaHenAeRkayeBlEdl Christry, Adkins nig Munch-Peterson CaGñkbgðaj

Rbtikm μenHTI 1 enAkñúg Streptococcus Rkum B . 2 Hansen MV & Elliot LP. New Presumtive identification test for Clostridium perfringens : Reverse test. Journal of clinical microbiology, 1980, 12:617-619

150

rUbPaBTI11 ³ etsþ CAMP bRBa©as;

Peptostreptococcus manBBYk)ak;etrIEdlminRtUvkarxül;dac;xatmYycMnYnCaBBYkkuksIu Gram-positive Edlrs;enACa Flora Fm μta kñúgpøÚvdegðIm RbB½n§rMlayGahar pøÚvePT nigpøÚvTwkenam. BYkenHbgáCm¶WlayLMCamYynwgBBYk)ak;etrI EdlRtUvkar xül; nigminRtUvkarxül;mYycMnYnenAkñúgGab;EsbitmuxrbYs nig Bacteraemia. karduHlUtlas;énBBYkkuksIuEdl minRtUvkarxül;enAelIfñalbNþúHmansPaByWty:avCagBBYk Bacteroides b¤ Clostridium ehIyCaTUeTABMueXIj manduHenAelIfñalbNþúHmanQamRss;rhUtdl; 48 em:ageRkayeBlbNþúH . karviPaKrkBBYkenHminRtUv)aneKGnuvtþenAkñúgkic©karRbcaMéf¶enaHeT. kuksIu Gram-positive EdlbegáIt)anCa kBa©úM)ak;etrIEdlmanragtUc e):ag BN’ s enAelIfñalbNþúHmanQamRss;EdlbNþúHkñúgmCÄdæanminRtUvkarxül; b:uEnþminduHenAelIfñalbNþúHQamRss;EdlrkSaenAkñúgmCÄdæanmanxül; GacRtUv)aneKsnñidæanfaCa Peptostrep-

tococcus spp..

A. mCÄdæanbNþúHeRbIQamecom

B. Streptoccoccus agalactiae

C. sgS½y Clostridium perfringens

D. tMbn;sIuEnsIumank,aldUcRBYj

151

etsþGg;TIb‘Íy:URkam etsþGg;TIb‘Íy:URkam minKYrRtUv)aneKGnuvtþCakic©karRbcaMéf¶cMeBaH)ak;etrIEdlminRtUvkarxül;enaHeT edaysarEt BMumanPaBcuHsRmugKñakñúgkarGnuvtþkareFVIetsþedayeRbIDIssþg;darmYy . PaKeRcInénkarbgáeraKedayBYkemeraKminRtUvkarxül; KWkbCamYy Penicillin elIkElgEtBBYk)ak;etrIEdlman RbPBmkBIpøÚveBaHevon b¤Rbdab;bnþBUCRsþI . karbgáCm¶WTaMgGs;enaHCaTUeTAbNþalmkBI Bacteroides fragilis EdlCaGñkbegáIt β-lactamase nigFn;CamYynwg Penicillin ampicillin nigesÞIrEtRKb;BBYk Cefalosporins . Cm¶WTaMgGs;enaHGacRtUv)aneKBüa)aleday Clindamycin metronidazole b¤ Chloramphenicol. Amino-

glycocides nig Quinolones BMumanskm μPaBGVIRbqaMgnwgBBYk)ak;etrIminRtUvkarxül;eT b:uEnþeKeRbIBYkvaCajwk jab;kñúgkarBüa)alGñkCm¶WEdlmankarbgáeraKbgáeday)ak;etrIcMruH BIeRBaHEtRbsiT§PaBrbs;vaRbqaMgnwgBBYk )ak;etrIEdlRtUvkarxül;EdlCaEpñkmYyénl,ay Flora.

152

etsþGg;TIb‘Uy:URkam (Antimicrobial susceptibility testing)

esckþIepþIm enAkñúgkic©RbCMumYyEdlerobcMeLIgedayWHO kñúgRkughSWENvkñúgqñaM1977 eK)anelIkeLIgBIcMNab;Garm μN¾ nigbBa¢ak;GMBIkarekIneLIgén)ak;etrIFn;nwgfñaMenATUTaMgBiPBelak CamYynwgkarduHlUtlas;RcbUkRcbl; nigkareRbI R)as;fñaMGg;TIb‘Íy:UTikeTAelImnusS nigstV. enAkñúgb:un μanqñaMfμ I²enH PaBFn;nwgfñaMrbs;)ak;etrI CaRbPBnaM[mankar ekIneLIglkçN³F¶n;F¶rénCm¶W nigbNþal[søab;CaeRcInkrNI. TaMgenHehIyEdleFVI[eKRtUvkarcaM)ac;nUvkm μviFI tamdanelIPaBFn;nwgfñaMrbs;)ak;etrIfñak;Cati nigGnþrCatikñúgkareFVIetsþGg;TIb‘Íy:URkam edayeRbIR)as;bec©keTs EdlGaceCOCak;)an nigpþl;[nUvTinñ½yGacTTYlyk)an. vtþmanrbs;Bt’manEpñkGtisuxumCIvsaRsþ nigkarqøg raldalnwgGacCYy[RKUeBTüeRCIserIs)annUvfñaMEdlmanRbsiT§PaBmYyEdlRtUveRbIR)as;sMrab;Büa)alCm¶WepSg² EdlbgáeLIgedayBYk)ak;etrI . ebisinCalT§plTTYl)andUcCaGVIEdleKTayTuk b¤sgS½yenaH eKcaM)ac;RtUveFVIetsþGg;TIb‘Íy:URkam edayeRbIR)as; bec©keTsmYyBitR)akdRtwmRtUv ehIylT§plEdlTTYl)anKYrEtepÞógpÞat;eTAnwgsßanPaBKøInik. lkçN³EdlKYr [eCOCak;)anénbec©keTsetsþGg;TIb‘Íy:URkamTaMgLayKWkareqøIytbrbs;;etsþenaHeTAnwgkarBüa)aledayGg;TIb‘Í y:UTikeTAelIGñkCm¶W. kñúgCMnYbrbs; WHO epþateTAelIbec©keTseRbIR)as; Disc-diffusion rbs; Kirby-Bauer EdltMrUvkar nig lkçnþik³TaMgLayRtUv)anbegáIteLIgeday WHO enAkñúgqñaM 1976 nigRtUv)aneKykmkeRbIsMrab;eKalbMNg tamdanedaysarEtbec©keTsd¾samBaØénlT§plrbs;va. bec©keTsTaMgenH KWl¥bMputkñúgkareRbIR)as;eTAelIRkum RKYsar Enterobacteriaceae b:uEnþvaGacRtUv)aneKENnaM[eRbIkñúgeKalbMNgCabec©keTsTUeTAsMrab;GnuvtþelI RKb;)ak;etrIEdlbgáCm¶W nigduHlUtlas;elOn. vaGacRtUv)aneKeRbIpgEdrelI)ak;etrIEdlBi)akbNþúH b:uEnþminEmn )ak;etrIEdlminRtUvkarxül;dac;xat nig MycobacteriaeT. dUecñH eKTamTar[mankarBnül;ENnaM niglMGitGMBI etsþTaMgenaHeTAbuKÁlikmnÞIrBiesaFn_.

153

eKalkarN_TUeTAénetsþGg;TIb‘ÍyU:Rkam etsþGg;TIb‘Íy:URkamvas;lT§PaBrbs;Pñak;garRbqaMgnwg)ak;etrI kñúgkarTb;sáat;karduHlUtlas;rbs;)ak;etrIenAkñúg Vitro. lT§PaBenHGacRtUv)aneK)a:n;sμanedaybec©keTseFVIl,ay b¤bec©keTs Diffusion-disc. etsþtamlkçN³bec©keTslayl,ay edIm,I)a:n;sμanGMBIskm μPaBénfñaMGg;TIb‘Íy:UTikelI)ak;etrI eKGacerobcMCal,ayrbs;Gg;TIb‘Íy:UTik kñúgfñalbNþúHrav ehIybnÞab;mkeKGacykvaeTAeFVIetsþtamry³yk)ak;etrIeTAbNþúHkñúgenaH. ebIsinCakMhab;EdlTabCageKbMput GacTb;Tl;nwgkarduHlUtlas;rbs;)ak;etrI bnÞab;BIeFVIkarbNþúHry³eBlmYyyb;ehIyenaH eKGacdwgBIkMhab;Edl TabbMputEdlGacsMlab;)ak;etrI)an ¬MIC¦ rbs;Gg;TIb‘Íy:UTikenaH. MIC rkeXIjenH bnÞab;mkGacRtUv)aneK ykmkeFVIkareRbobeFobCamYynwgkMhab;rbs;fñaMEdleKdwgfa GacsßitenAkñúgesr:Um nigkñúgTwkrégepSg²rbs;eyIg edIm,I)a:n;sμankareqøIytbKøInik. etsþ Diffusion bnÞHDIsRkdas RClk;CamYynwgcMnYnGg;TIb‘Íy:UTikCak;lak; dak;enAelIfñalbNþúHesμ Isac;CamYynwgemeraKEdlRtUv eFVIetsþ. kMriténkMhab;rbs;fñaMGg;TIb‘Íy:UTikEdleKdak;enAelI Disc-diffusion )anbBaÄb;karduHlUtlas;rbs; )ak;etrIkñúgrgVg;cMgaymYyecjGMBIépÞDIsbgðajBIPaBsg;sIubrbs;emeraK . manPaBTak;TgKñaesÞIrEtCa Linear relation rvag Log MIC Edlvas;Evgedayl,ayetsþ nigbnÞat;p©ittMbn; Tb;sáat;min[emeraKduHenAkñúgetsþsMNay ¬Diffusion). bnÞat; rIeRhássüúgEdlEsþgnUvPaBTak;TgenHGacRtUv eKTTYl)an edayeFVIetsþcMnYnemeraKd¾eRcIn edayviFITaMgBIrRsbKña ¬emIlrUbPaB 12 nig 13¦. niymn½yKøInikénBakü {Fn;} nig {sg;sIub{ ¬RbB½n§3-RbePT¦ lT§plrbs;etsþGg;TIb‘Íy:URkamEdleKpþl;eTAeGayRKUeBTü KWCacMNat;fñak;emeraKenAkñúgRbePT Susceptibility

mYykñúgcMeNam2 b¤eRcInRbePT. RbB½n§EdlsamBaØbMputKWmanEtBIrRbePTEtb:ueNÑaHKWsg;sIub nigFn;. karEbg EckenH eTaHbICapþl;GtßRbeyaCn_eRcInkñúgvtßúbMNgsßiti nigeGBIedmIsaRsþk¾eday Etvaminpþl;PaBbt;EbnTal;Et esaHsMrab;RKUeBTüedIm,IeRbIR)as;. dUecñHehIycMNat;fñak;RbBn§½ 3-RbePT Cajwkjab;RtUveKsMrbyk. bec©keTs Kirby-BauerehIynwgkarEksMrYlrbs;va sÁal; Susceptibility bIRbePT ehIyvasMxan;EdlfaTaMgRKUeBTü nig GñkmnÞIrBiesaFn¾yl;Cak;nUvniymn½y nigsar³sMxan;KøInikénRbePTTaMgenH .

154

rUbPaBTI12 ³KMnUsRkahVicbgðajBITMnak;TMngrvag Log2 MIC nigGgát;p©itrbs;tMbn;KμanemeraKduH EdlTTYl)anedayetsþ Diffucion disc edayeFVIenAelIkMhab;EtmYyrbs; Gg;TIb‘Íy:UTik

rUbPaBTI 13> karbkRsayénTMhMtMbn;sg;sIub (s) Intermidia (I) nigFn; (R) edaysarTMnak;TMng

rbs;va nig MIC

CakarsMxan;Nas;EdlmanTaMgRKUeBTü nigGñkmnÞIrBiesaFn¾yl;BIniymn½yBitR)akd nigsar³sMxan;én RbePTTaMgBIrenH

S- RtUv I- mFüm R- suaM

155

sg;sIub (S)³ emeraKmYyEdleKniyayfa :sg;sIub :¬S¦ CamYynwgGg;TIb‘Íy:UTikmYy enAeBl)ak;etrIbgáCm¶W enaH eqøIytbeTAnwgkarBüa)aledayGg;TIb‘Íy:UTikeTAnwgkMriteRbIR)as;fñaMEdlkMNt;rYc .

Intermedia (I)³ RtUv)aneKykcitþTukdak;eTAelIsßanPaBBIrcMNuc. krNIenHGacRtUv)aneKGnuvtþeTAelI )ak;etrITaMgLayNaEdl :sg;sIubl μm² :nwgGg;TIb‘ÍyU:TikEdleKGaceRbIR)as;)ankñúgkMriteRcInkñúgkarBüa)al ¬]TahrN_BYk β-lactams¦edaysarBYkenHmanCatiBulTab b¤edaysarGg;TIb‘Íy:UTikvamankMhab;x<s; enA Rtg;kEnøgEdlbgáeraK ¬]Ta> Twkenam¦. cMNat;fñak;k¾RtUv)aneKGnuvtþpgEdreTAelI)ak;etrImYycMnYnEdlbgðajfa : Intermediate susceptability : cMeBaHGg;TIb‘Íy:UTikEdlmanCatiBulxøaMg ¬]TahrN¾ Aminoglycoside¦ EdleKminGaceRbIkñúgkMritx<s; CagenH. kñúgsßanPaBenH RbePT Intermediate RtUv)aneKeRbobeFob)anCatMbn;kNþal ¬RTnab;¦ rvag sg;sIub nigFn; . edaysarEtRKUeBTüBü)alPaKeRcIn minFøab;nwgPaBl¥itl¥n;enH ebIeTaHCavamansar³sMxan;KøInIkk¾eday karEbgEckdac;BI Kñarvag Intermediate nigsg;sIubl μm² EdleFIV[mnÞIrBiesaFn_mYycMnYnFM eRCIserIsviFI kMNt;yk } Intermidiat } sMrab;eFVIkarraykarN¾ .

Fn;³ BaküenHmann½yfa )ak;etrIRtUveKrMBwgfanwgmineqøIytbcMeBaHGg;TIb‘Íy:UTikEdleKeRbIenaHeT edaymin KitBIkMrit nigTIkEnøgbgáeraKeLIy.

enAkñúgsßanPaBmYycMnYn ]TahrN_ kareFVIetsþGg;TIb‘Íy:URkamelIBBYk Staphylococci CamYynwg Benzyl peni-

cillin edayykEtRbePTsg;sIub nigFn;CamYynwg Benzyl penicillin¬Tak;TgeTAnwgkarbegáIt β-lactamase¦ RtUv)aneKsÁal;. kareRCIserIsEdlRtwmRtUvkñúgkareRbIR)as;fñaMGg;TIb‘Íy:UTikNamYy nigkMritEdlRtUveRbIR)as;enaHnwgBwgEp¥keTAelI karbkRsay GegátBicarNarbs;RKUeBTüBüa)alpgEdr. manktþaepSg²eTotdUcCalT§PaBbgáCm¶Wrbs;)ak;etrI plGaRkk;rbs;fñaM Phamacokinetic PaBCMrabeTAkñúgxøÜnmnusS nigktþaPaBsaMurbs;GñkCm¶WplEdr . karENnaMGMBIkareRbIetsþGg;TIb‘Íy:URkamEdlGnuvtþRbcaMéf¶ etsþGg;TIb‘Íy:URkamGacRtUv)aneKGnutþenAkñúgmnÞIrBiesaFn_kñúgeKalbMNgcMbgBIry:ag ³

• bgðajpøÚvRKUeBTüBüa)alkñúgkareRCIserIsykGg;TIb‘Íy:UTikEdlRtwmRtUvbMput kñúgkarBüa)alGñkCm¶Wmñak;² • cUlrYmcMENkpþl;CaBt’mankñúgkarsayPayemeraKEdlmanPaBFn;EdleKrkeXIjenAkñúgshKmn_ nig

bMerIplRbeyaCn_suxPaBsaFarN³ .

156

etsþGg;TIb‘Íy:URkamCamKÁúeTsn¾kñúgkarBüa)al etsþGg;TIb‘Íy:URkamminKYrRtUv)aneKGnuvtþenAelIkBa©úM)ak;etrI EdlmankarqøgcUledaykBa©úM)ak;etrIepSgeTot EdlminbgáCm¶W CaBiessBBYk Flora Fm μta b¤)ak;etrIEdlBMumankarTak;TgeTAnwgdMeNIrkarénkarbgáCm¶WenaH. ]TahrN_ vtþmanrbs; Escherichia coli enAkñúgTwkenamEdlticCagbrimaNkMNt;mYy minRtUv)aneKykcitþ Tukdak; nigKitfaCamUlehtuénkarbgáCm¶WeT ehIyCakaryl;xus nigBMumanGtßRbeyaCn_EdlRtUveFVIetsþGg;TIb‘Íy:U- RkamkñúgkrNIenHeT . kareFVIetsþGg;TIb‘Íy:URkamKYrEtRtUv)aneKGnuvtþEtenAkñúgkrNI)ak;etrIEdlTTYl)anCa)ak;etrIEdleKbnSúT§rYc ehIy KitfaCa)ak;etrIEdlCaedImcbénkarbgáCm¶WenaH. )ak;etrIKYrEtRtUv)aneKeFVIkarviPaKrk b:uEnþminEmn)ann½yfa )ak;etrITaMgGs;enaHRtUvEt)aneKeFVIetsþGg;TIb‘Íy:URkameLIy . kareFVIetsGg;TIb‘Íy:URkamRbcaMéf¶ minRtUv)aneKeFVIeLIykñúgkrNIdUcxageRkam³ enAeBlEdl)ak;etrIedImcb CaRbePT)ak;etrIEdleKGacdwgCamunGMBIPaBsg;sIubrbs;vaeTAnwg»sfNamYy.

dUcCaenAkñúgkrNI Stretococcus pyogenes nig Neisseria meningitidis EdlenAEtCaBBYk)ak;etrI Edl sg;sIubCamYynwg Benzylpenicillin. ¬bu:EnþeTaHCay:agNak¾eday k¾eKeXIjmanr)aykarN_fμ I²enHfa mankrNIEdlBYk Meniggococci Fn;CamYynwg Benzylpenicillin ¦ . krNI facial streptococci

(Enterococci¦ k¾mansg;sIubnwg Ampicillin Edr edaymankrNIelIkElgtictYc. ebIsinCamanPaBFn; rbs;)ak;etrITaMgenH RtUv)ansgS½yenAkñúgmUldæanKøInik enaH)ak;etrIEdlsgS½yenHKYrRtUv)aneKbBa©ÚneTAkan; mnÞIBiesaFn_bEg¥kEdlmansmtßPaB .

ebIsinCa)ak;etrIbgáehtuRtUvkarfñalbNþúHEdlsMbUrcMNIGahar ]TahrN_ Haemiphilus influenzae nig Neisseria gonorhoeae CaedIm. dUcenHbec©keTseFVIetsþGg;TIb‘Íy:URkamtamry³bec©keTs Disc-diffu-

sion Gacpþl;[nUvlT§plEdlminKYr[eCOCak;)an ebIsinCaeKmineKarBtambec©keTs)anRtwmRtUveT. karbegáItnUvGg;sIum β-lactamase rbs;BYk)ak;etrIepSg²TaMgenaHnaM[mankarcab;epþIménkareFVIetsþCa BiessmYydUckareFIVetsþkarbegáIt β-lactamase enAkñúg Vitro dUcEdl)anBN’na. vaCakarTTYlxusRtUv rbs;mnÞIrBiesaFn_fñak;Cati nigfñak;tMbn; edIm,ItamdanemIlPaBsg;sIubrbs; Pneumoccci gonococci nig Haemophilus. ebIsinCamanbBaða BBYkFn;nwgfñaMelceLIg mnÞIrBiesaFn__sßitenATIkEnøgenaH KYrEtRtUv)an eKpþl;Bt’man nigesckþIENnaMGMBIbec©keTsetsþkñúgkareFVIetsþ[)anRtwmRtUv nigkarBüa)alBitR)akdmYy.

enAkñúgkrNIEdlmankarbgáCm¶Wsμ úKsμajEdlbNþalmkBIBBYk salmonellae ¬epSgBI S. typhi b¤ S.

paratyphi¦. karBüa)aledayeRbIR)as;Gg;TIb‘ÍyU:TikenAelIBYkenHminRtUv)aneKelIkykmkBiPakSaeT eTaHbICarkeXIjfafñaMTaMgenaHmanskmμPaBelIBBYk)ak;etrITaMgGs;enaHenAkñúg Vitro k¾eday. enAeBlenH eKeXIjmanPsþútagRKb;RKan;mYyEdlbBa¢ak;fa karBüa)aledayGg;TIb‘Íy:UTikenAelIBBYk SalamonellaEdl

157

eKCYbjwkjab;kñúgCm¶WrlakRkBH-eBaHevon ¬ehIytamBitesÞIrEtRKb;Cm¶WraKrUsEdlBMudwgmUlehtu¦BMumanpl cMeNjGVITal;EtesaHdl;GñkCm¶W. pÞúyeTAvij Gg;TIb‘Íy:UTikGacBnüaeBlkarbeBa©j nigkarsayPay BBYk Salamonella ehIyGacnaMeTArkPaBFn;nwgfñaMrbs;BYkenH.

kareFVIetsþGg;TIb‘Íy:URkamCa]bkrN¾eGBIedmIsaRsþ kareFVIetsþGg;TIb‘ÍURkamral;éf¶eTAelIBYk)ak;etrIbgáCm¶WsMxan;² ¬S. typhi shigellae¦ RtUv)aneKGnuvtþCaEpñkmYy énkm μviFItamdand¾FMmYyeTAelICm¶WkñúgeBaHevon. BYkvamansar³sMxan;kñúgkarpþl;Bt’mandl;RKUeBTüBüa)alnUvkar elceLIgénBBYkEdlFn;CamYynwg ¬S. typhi EdlFn;CamYy Chloramphenicol nigBBYk Shigellae EdlFn; CamYynwg Co-trimoxazole nig Ampicillin¦ nigkarpøas;bþÚrKMeragBüa)alf μ I². eTaHbICakareFVIetsþGg;TIb‘Íy:U- RkameTAelIBBYk Salmonella EdlminEmnCaBBYk Typhoid EdlbNþal[manCaCm¶WenAkñúgeBaHevonBMumanCab; Tak;TgeTAnwgkarBüa)alGñkCm¶Wk¾eday b:uEnþkarelceLIgnUvBBYkFn;nwgGg;TIb‘Íy:UTikeRcInmuxCakarRbkasGasnñ dl;RKUeBTüBüa)alGMBIkareRbIR)as;Gg;TIb‘ÍyUTikelIshYs nigminRtwmRtUv. kartamdanCabnþbnÞab;eTAelIlT§plRbcaM;éf¶rbs;etsþGg;TIb‘Íy:URkam KWCaRbPBpþl;Bt’mand¾RbesIrmYyGMBI eRbva:Lg;énBYk Staphylococci EdlFn;nwgfñaM nigBBYk)asIu Gram-negative EdlTTYlxusRtUvkñúg Cross-

infections kñúgmnÞIreBTü. karpþl;Bt’manCatMNak;²GMBIeRbva:Lg;f μ I²énlMnaM Susceptibility KWCaCMnYymYyEdl minGackat;éfø)an edIm,IbegáItCaeKalneya)ayeTAelIkareRbIR)as;;fñaMGg;TIb‘Íy:UTikenAkñúgmnÞIreBTüedayrwtbnþwg kareRbIR)as; nig b¤ Rotation of life-saving drugs, dUcCaBBYk Aminoglycosides nig Cefalosporins. kareRCIserIsfñaMsMrab;kareFVIetsþGg;TIb‘Íy:URkamRbcaMéf¶enAkñúgmnÞIrBiesaFn_KøInik kareRCIserIsfñaMsMrab;ykmkeRbIR)as;enAkñúgetsþGg;TIb‘Íy:URkamRbcaMéf¶RtUv)aneKerobcMedayKiteTAelIvisalPaB énfñaMGg;TIb‘Íy:UTikeTAtamclanarbs;»sf PaBBul RbsiT§PaBrbs;fañM nigPaBgayRsYlrk RBmTaMgtMélrbs;fñaM sMrab;GñkCm¶WpÞal; nigshKmn_. kñúgcMeNamfñaMGg;TIb‘Íy:UTikEdleKykeTABüa)alGñkCm¶WmanEtGg;TIb‘Íy:UTikmYy cMnYnb:ueNÑaH EdleKeRCIserIsedayRbugRby½tñ nigdak;bBa©ÚleTAkñúgGg;TIb‘Íy:URkam . taragTI 23 bgðajGMBIGg;TIb‘Íy:UTikEdlRtUv)aneKykmkeRbIR)as;kñúgsßanPaBepSg²Kña. fñaMTaMgGs; EdlmanenA kñúgtaragRtUvEbgEckeTACaBIrEpñk. EpñkTImYyeKrab;bBa©ÚlBBYkfñaMEdlGacrk)anenAkñúgmnÞÍreBTüPaKeRcIn nig sMrab;eFVIetsþGg;TIb‘Íy:URkamRbcaMéf¶ .

158

taragTI23 ³ sMNMGg;TIb‘Íy:UTikmUldæansMrab;eFVIetsþGg;TIb‘Íy:URkameRbIR)as;RbcaMéf¶ a

Staphylococcus Enterobacteriaceae Pseudomonas

aeruginosa Intestinal Urinary Blood & tissues

Set 1 benzylpenicillin ampicillin sulfonamide ampicillin piperacillin

First choice oxacillin chloramphenicol trimethoprim chloramphenicol gentamicin

erythromycin co-trimoxazole co-trimoxazole co-trimoxazole tobramycin

teracycline nalidixic acid ampicillin tetracycline

chloramphenicol teracycline nitrofurantoin cefalotin

nalidixic acid gentamicin

tetracycline amoxy-clav b

Set 2 gentamicin norfloxacin norfloxacin cefuroxime amikacin

Additional drugs amikacin chloramphenicol ceftrixone ciprofloxacin

co-trimoxazole gentamicin ciprofloxacin ceftazidine

clindamycin amoxy-clav b piperacillin

nitrofurantoin amikacin

a Notes on the individual antimicrobial agents are given in the text. b Amoxycillin and clavolanic acid (inhibitor of B-lactamase).

etsþEdleFVIeLIgsMrab;fañMenAkñúgsMNMTI 2 KWeKeFVIeLIgEtkñúgkrNImankaresñIsMuCaBiess BIsMNak;RKUeBTüBüa)al b¤enAeBlEdl)ak;etrIEdlbgáCm¶WFn;CamYynwgfñaMEdlCaCeRmIsTI 1 b¤edaysarehtuplepSg²eTot ¬RbtikmμCa mYynwgfñaM b¤PaBkmSt;kRmrbs;va¦. manBBYkGg;TIb‘Íy:UTikCaeRcInEdlmanskm μPaBl¥CaeRcInRtUv)aneKlb; ecalecjBItaragedayehtufa BYkvakMreKRtUvkarykmkeRbIsMrab;karBüa)alGñkCMgWNas;. enAral;RKb;krNIkRm TaMgGs;fñaMmYy b¤eRcInmuxeTotKYrEtRtUv)anbEnßmenAeBlEdlmanehtuplcaM)ac;NamYyrbs;RKUeBTüBüa)al b¤ enAeBlEdlfñaMfμ I² nigl¥²Gacrk)an. eKKYrEteFVIkarBinitüeLIgvijCaeTotTat;éntaragenH ehIyGaceFVIeLIg bnÞab;BImankarBiPakSa)anl¥itl¥n;CamYynwgbuKÁlikKøInik. eKeXIjmanbBaðaCaeRcIn ekIteLIgkñúgeBlGnuvtþkargar eRBaHEtRKUeBTüBüa)alCaTUeTAmindwgc,as;famanEtGg;TIb‘Íy:UTikmYyKt;CatMNagkñúgRkumGg;TIb‘Íy:UTikmYyEdleKykmkeFVIetsþRbcaMéf¶. lT§plEdleKTTYl)anBI»sfsMxan;² nImYy²GacRtUv)aneKniyayfa CatMNaglT§pl srubrbs;RkumGg;TIb‘Íy:UTiknImYy²enaH. pllM)akekIteLIgkñúgRbeTsmYycMnYn enAeBlEdlRKUeBTüBüa)alsÁal; EteQμaHfñaMCaeQμaHCMnYj b:uEnþminsÁal;BIeQμaHKImI nigRkumrbs;va. karxitxMd¾xøaMgkøamYyKYrRtUv)aneKeFVIeLIgkñúgkar

159

pþl;Bt’mandl;buKÁlikesvaevC¢saRsþTaMgGs;sÁal;BIeQμaHfñaMtamlkçN³KImI nigelIkTwkcitþdl;kareRbIR)as;Edl RtwmRtUvrbs;BYkfñaMTaMgenaH 1 . 1- eKeRbIbnÞH Benzylpenicillin disc kñúgkareFVIetsþsg;sIubcMeBaH BBYk)ak;etrIEdl β-lactama-sensitive

penicillin TaMgGs; ¬dUcCa Phenoxymethylpenicillin RKab; nig Pheneticillin¦kBa©MúBBYk Staphy-

lococci EdlFøak;cUleTAkñúgRbePTFn;nwgfñaM Edlplit β-lactamase RtUveKcat;fa β-lactamase-

resistant penicillin G b¤CamYynwgGg;TIb‘Íy:UTikepSgeTotdUcCa Erythromycin . 2- bnÞH Oxacillin disc KWCatMNag[Rkum β-lactamase-resistant penicillins TaMgmUl ¬rab;bBa©Úl

Meticillin nafcillin cloxacillin dicloxacillin nig Flucloxacillin¦. manGMNHGMNagKøInikmYy cMnYnbgðajfa cross-resistant ekIteLIgrvag meticillin nigRkum cefalosporin. dUcenH ehIyvaK μan RbeyaCn¾ nigyl;xusEdlRtUvbBa©Úl Cefalotin enAkñúgGg;TIb‘Íy:URkamsMrab;BYk Staphylococci. )ak;etrIEdlFn;CamYynwg Meticillin nigfñaMepSg²eTot² CaerOy² KWekIteLIgedaysarRbePT Hetero-

genous KWfaPaKeRcInénekasikaGacnwgsg;sIubeBjelj ehIybegáIt)anCatMbn;K μanemeraKduHy:agFM kñúg xN³eBlEdltMbn;EdlFn;nwgfñaMmanelxecjnUvkBa©úMemeraKesþIg²enAkñúgtMbn;K μanemeraKduHenaH. PaBFn; enHbgðaj[eXIjkan;Etc,as;enAeBlEdlsItuNðPaBbNþúHRtUv)anrkSaenAeRkamkMedA 35GgSar 2 b¤enAeK Bnüarry³eBlénkarbNþúH .

KuNvibtþid¾FMmYyén Meticillin EdlCatMNag[DIssMrab;BBYk β-lactamase-resistant penicillin KW PaBqab;xUcrbs;va ebIeTaHCarkSaTukenAeRkamlkç½x½NÐFm μtak¾eday. bnÞH Oxacillin disc GacTb;Tl;nwg karxUcxat)aneRcInCag dUecñHehIyeTIbeKcUlcitþykeTAeFVIetsþ Disc-diffusion sþg;dar. bnÞH Cloxa-

cillin nig Dicloxacillin minRtUv)aneKeRbIR)as;eTedaysarEtBYkenHmintMNag[BBYk Heteroresi-stance

3- lT§plrbs; Tetracycline discGacRtUv)aneKeFVICatMNag[ Chlortetracycline oxytetracicline nig fñaMepSg²eTotkñúgRkumenH. eTaHbICay:agNak¾edayPaKeRcInénBBYk Tetracicline-resistant Staphy-

lococci enAEtsg;sIubCamYy Minocycline. bnÞH Minocycline disc mYyGacRtUv)aneKeRbIedIm,IeFVI etsþelIBBYk Staphylococci Fn;nwgfñaMeRcInmux ¬Multiresistant strain¦.

4- lT§plrbs; Chloramphenicol disc GacRtUv)aneKniyayedaysrubeTAelI Thiamphenicol EdlCa RbePTfñaMEdlGacmanRbsiT§PaBdUc Chloramphenicol Edr EteKmindwgGMBIPaBbgá[man Aplastic

Anaemia rbs;va.

1. Intornation Nonproprietary Names (INN) for Phamaceutical Substances. Cumulative List No 9. Geneva,

World Health Organization, 1996. 2. Sahm DF ef al. Current concepts and approaches to antimicrobial agent susceptibility testing. In: Cumitech

25, Washigton, DC, American Society of Microbiology, 1988.

160

5- mantMNagEtmYyKt;rbs; Sulfonamide (Sulfafurazole) EdleKRtUvykmkeFVIetsþ. 6- Co-trimoxazole disc pÞúkedaykarbBa©ÚlKñaén Trimethoprim nig Sulfonamide (sulfamethoxa-

zole). sarFatupSMshRbtikm μkMlaMgTaMgBIrenHmanlkçN³clnarbs;fñaM ¬Phamacokinetic¦ Rbhak; RbEhlKña ehIyCaTUeTAedIrtYrdUcCafñaMEtmYy.

7- Ampicillin KWCaKMrUedImrbs;Rkum Penicillin EdlmanvisalPaBTUlay ehIymanskm μPaBRbqaMgnwg )ak;etrI Gram-negative CaeRcIneTot. edaysarEtvasg;sIubeTAnwg β-lactamase dUecñHeKminRtUvyk vaeTAeRbIR)as;kñúgkareFVIetsþelI Staphylococci eT. CaTUeTA)ak;etrIEdlsg;sIubCamYy Ampicillin

RtUvsg;sIubCamYynwgGg;TIb‘Íy:UTikepSgeTotEdlsßitenAkñúgRkumCamYyKña ³ Amoxicillin pivampecillin

talampicillin CaedIm ¬eTaHbICa Amoxicillin manskm μPaBeTVrdgRbqaMgnwgBYk Salmonellae nigEt Bak;kNþalRbqaMgnwg Shigellae nig H. influenzae ¦ .

8- manEt cefalotin mYyb:ueNÑaHEdlRtUv)aneKykmkeFVIetsþkñúgkareFVIGg;TIb‘Íy:URkamRbcaMéf¶ ehIyGg;TIb‘Íy:U TikenHCatMNag[BBYkCMnan;TI 1 én Cefalosporins (Cefalexin cefradine cefaloridine cefazolin

cefapirin). cMENkÉBYkCMnan;TI2 nigTI3rbs;Rkum CefalosporinsnigsarFatuTak;Tgrbs;va¬Cefamy-

cins¦KWCaBBYkGg;TIb‘Íy:UTikEdlmanvisalPaBTUlay ehIyGacrk)an RtUv)aneKykmkeRbIR)as;kñúgkrNI BiessmYycMnYn (Cefoxitin cefamandole cefuroxime cefotaxime ceftriazone). eTaHbICaBYk Cefalosprins GacRtUv)aneKeRbIR)as;edIm,IBüa)alCm¶WF¶n;F¶rEdlbgáeLIgedayBYk Staphylococci k¾ edayEtPaBsg;sIubénBBYkenHeTAnwg Cefalosporins GacTajecjBIlT§plrbs; Oxacillin dUcEdl )anerobrab;enAcMNucxagelI .

9- Erythromycin RtUv)aneKeRbIR)as;sMrab;eFVIetsþrkPaBsg;sIubcMeBaHGg;TIb‘Íy:UTikepSg²eToténRkum Macrolide (Oleandomycin nig Spiramycin) .

10- Aminoglycoside begáIt)anCaRkumfñaMEdlmansarFatuKImITak;TgKñadUcCa Streptomycin gentamycin

kanamycin netilmicin nig Tobramycin. visalPaBrbs;BYkva CaTUeTAminRKb;RKan;edIm,IRbqaMgkñúg krNIman Cross-infection eT b:uEnþPaBsg;sIubrbs;vaRbqaMgnwg)ak;etrI EdlbgáeraKRtUv)aneKbgðajfa manRbsiT§PaBRbhak;RbEhlKña. mankarsikSaCaeRcIn)anbgðajGMBIplb:HBal;elItMrgenam nigRkdas RtecokenAeBleRbIR)as; Gentamycin netilmicin nig Tobramycin b:uEnþBMumankarsnñidæanNamYyEdl bBa¢ak;fa fñaMmYyNakñúgRkumenHBulticCagfñaMmYyNaeT. dUcenHeKRtUvEteFVIetsþGg;TIb‘Íy:URkam edayeRCIs erIsykEtGg;TIb‘Íy:UTikNamYymkeFVIetsþb:ueNÑaH. cMENkÉGg;TIb‘Íy:UTikepSg²eTot KYrRtUv)aneKrkSaTuk edIm,IBüa)alelICm¶WepSg²eTotEdlbgáeLIgeday)ak;etrIEdlFn;nwgfñaM .

11- Nitrofurantoin kareRbIR)as;BYkenHmanRBMEdn KWeKeRbIR)as;vaEtenAkñúgkarBüa)alrlakpøÚvTwkenam b:ueNÑaH ehIyminRtUv)aneKykmkeFVIetsþRbqaMgnwgBBYk)ak;etrIEdlbgáCm¶WwepSgeRkABICm¶WrlaktMrgenam enaHeT .

161

bec©keTsEksMrYl Kirby-Bauer bec©keTs Disc-diffusion RtUv)aneKBiBN’nadMbUgenAqñaM 19661 KWCabec©keTssþg;darmYy nigEdlRtUveKvay tMélya:gTUlMTUlay . Pñak;garpøÚvkarnana)anpþl;Gnusasn¾eGayeRbIR)as;va edaymankarEkERbbnþicbnþÜc Ca bec©keTseKal EdlGaceRbICabec©keTs RbcaMéf¶Fmμta enAkñúgmnÞIrBiesaFn¾KøInik .

taragTI 24³ RBMEdnbnÞat;p©ittMbn;sMrab;)ak;etrI;RtYtBinitü a

Antimicrobial Disc cotency Diameter of zone of inhibition (mm)

S. aureus (ATCC 25923)

E. coli (ATCC 25922)

P. aeruginosa (ATCC 27853)

amikacin 30 μg 20-26 19-26 18-26

amoxy-clav b 20/10 μg 28-36 19-25 -

ampicillin 10 μg 27-35 16-22 -

benzylpenicillin 10 IU 26-37 - -

cefalotin 30 μg 29-37 15-21 -

cefalozin 30 μg 29-35 23-29 -

ceftazidime 30 μg 16-20 25-32 22-29

cefotaxime 30 μg 25-31 29-35 18-22

ceftriaxone 30 μg 22-28 29-35 17-23

cefuroxime 30 μg 27-35 20-26 -

chloramphenicol 30 μg 19-26 21-27 -

ciprofloxacin 5 μg 22-30 30-40 25-33

clindamycin 2 μg 24-30 - -

co-trimoxazole 25 μg 24-32 24-32 -

erythromycin 15 μg 22-30 - -

gentamicin 10 μg 19-27 19-26 16-21

nalidixic acid 30 μg - 22-28 -

nitrofurantoin 300 μg 18-22 20-25 -

norfloxacin 10 μg 17-28 28-35 22-29

1 Bauer AW et al. Antibiotic susceptibility testing by a standardized single disc method. American journal of

clinical pathology, 1966; 45: 493-496

162

oxacillin 1 μg 18-24 - -

piperacillin 100 μg - 24-30 25-33

sulfonamide c 300 μg 24-34 15-23 -

tetracycline 30 μg 24-30 18-25 -

tobramycin 10 μg 19-29 18-26 19-25

trimethoprim 5 μg 19-26 21-28 -

vancomycin 30 μg 17-21 - -

a National Committee for Clinical Laboratory Standard. Performance standards for antimicrobial disc susceptilibity tests. 6th ed. Vol. 21 No 1 (M2-A7 and M7-A5) and 11th information supplement 2001 (M100-S11). b Amoxycillin and clavulanic acid (inhibitor of β-lactamase). cSulfisoxazole. Rbtikr fñalbNþúH Mueller-Hinton 1- eKerobcMfñalbNþúH Mueller-Hinton GMBIsarFatu)as edGIuRdat eTAtamesckþIENnaMrbs;Gñkplit.

eKRtUverobcMvaeTAtamenH edIm,IeGaytMbn;duH sßitenAkñúgRBMEdndUcEdl)ankMNt;¬emIltaragTI 24¦. vaCakarsMxan;EdleyIgminRtUvdutkMedAfñalbNþúHxøaMgeBkeT .

2- dak;kMedAfñalbNþúH 45-50 GgSar rYccak;fñalbNþúHTaMgenaHeTAkñúgcan. cak;[fñalbNþúHenaH hUreTAelI épÞcanehIy[mankMrasRbEhl 4 mIlIEm:Rt. canEdlmanTMhM 9 sg:TIEm:RtRtUvkarfñalRbhak;RbEhl 25 mIlIlIRt .

3- enAeBlEdlfñalbNþúHenaHeLIgrwg eKRtUvsm¶ÜtcanenaHedIm,IykmkeRbIR)as;Pøam² kúñgkMedA 35GgSar ry³eBl10-30 naTI edaydak;RbGb;fñalbNþúHQrRtg;eLIgelI nigKMrbep¥óg.

4- canfñalbNþúHEdlminTan;eRbIR)as;GacRtUv)aneKrkSaTukenAkñúgfg;pøasÞikEdlKYrbiteGayCit nigdak;enA kñúgTUTwkkk. fñalbNþúHTukdak;rebobenH GacrkSa)anrhUtdl; 2 GaTitü.

edIm,IFanafa viC¢maRténtMbn;K μanemeraKduHCaviC¢maRt EdlGaceCOCak;)ankñúgkrNIeFVIetsþ susceptibility cMeBaH Sulfonamides nig Co-trimoxazole fñalbNþúH Mueller-Hinton RtUvEtCafñalbNþúHEdlmankMhab; Inhi-

bitors thymidine nig Thymin EdlCaPñak;garTb;sáat;kMu[)ak;etrIduH Tab. fñalbNþúH Mueller-Hinton KYrRtUv)aneKeFVIetsþCamYynwg)ak;etrIeRbIsMrab;RtYtBinitüdUcCa Enterococcus faecalis (ATCC 29212 b¤ 33186) CamYynwg Co-trimoxazole disc. fñalbNþúHEdlRtwmRtUv nigpþl;[nUvtMbn;K μanemeraKduHmanTMhM 20 mIlIEm:Rt b¤elIsEdlminmankBa©úMemeraKduHRseBcRsBil b¤q μar².

163

DIsGg;TIb‘Íy:UTik bnþHRkdasDIsRtUv)anplitlk;edaymanTMhM nigkMhab;RtwmRtUv. bnÞHRkdasDIsKYrEtRtUv)aneKrkSaTukenAkñúg sItuNðPaB -20GgSar. RbGb;kkénTUTwkk EdleKeRbItampÞHKWRsYlbMput. kúñglkçN³CakareRbIR)as;tictYc bnÞHDIsTaMgGs;KYrEtRtUv)aneKrkSaTukkñúgTUTwkkkrhUt dl; 1 Ex . muneBleRbIR)as; eKRtUvdkbnÞHDIsenaHecj ehIyrkSaTukenAkñúgsItuNðPaBmnÞIrBiesaFn_ry³eBl RbEhl 1 em:ag edIm,I[sItuNðPaBDIsRbhak;RbEhlKña nwgfñalbNþúH. bec©keTsenHRtUv)anbnßynUvkMNk EdlGacekIteLIgenAeBlxül;ekþAeTAb:HnwgRbGb;RtCak;. ebIsinCaeKeRbI]bkrN¾ Disc-dipensing vaRtUvEtmanKMrbbitCit)anl¥ nigrkSaTukenAkñúgTUTwkkk. vak¾KYrEtdak; enAkñúgsItuNðPaBmnÞIrBiesaFn_pgEdr enAmuneBlebIkeRbIR)as; . kMhab;sUluysüúgsþg;dar Turbidity Standard erobcMkMhab;sUluysüúgsþg;daredaycak;sUluysüúg 1° ¬10 Rkam¼lIRt¦én Barium chloride dihydrate cMnYn 0/6mIlIlIRteTAkñúgbMBg;RkitragsIuLaMgcMNuH 100mIlIlIRt nigbMeBj[RKb;100mIlIlIRtedaysUluysüúg GasIut Sulfuric 1° ¬10 mIlIlIRt¼lIRt¦ . sUluysüúgsþg;darenHKYrEtRtUv)aneKdak;enAkñúgbMBg;TIbEdlman TMhM niglkçN³dUcKñanwgTIbEdleRbIsMrab;sMNak BrothEdr. sUluysüúgsþg;darenH KYrEtRtUv)aneKrkSaTukenA kEnøgggwt kñúgsItuNðPaBmnÞIrBiesaFn_cMnYn 6 Ex nigbitRKb[CitkMu[hYtTwkecj)an . tM)ar kardak;sMLIenAnwgcugéneQI KYrRtUv)aneKerobcM. eKGacykvaeTAdak;sMlab;emeraKkñúgkMb:ug bMBg;TIbsMrab;eFIVkar bNþúH b¤enAelIRkdasedaydak;enAkñúgGUtUkøav b¤kMedAs¶Üt . bec©keTs edIm,IerobcMbNþúH edayqáwHykkBa©úMemeraKecjBIfñalbNþúHdMbUg eRbI Loop qáwHykEpñkxagelIénkBa©úMemeraKBI 3-5 kBa©úM EdlmanrUbragRbhak;RbEhlKñaedIm,IykmkeFVIetsþ.

164

epÞrkBa©úMemeraKEdlduHenH eTAdak;kñúgbMBg;esr:UméRb

enAeBlEdlemeraKEdlRtUvbNþúHRtUvEtykBIkarbNþúHEdlsuT§ eKqáwHykemeraKcMnYnmYy Loop eBjeTAlay CamYynwgTwkesr:UméRb . eFVIkareRbobeFobkMhab;rbs;TIbeTAnwgkMhab;sUluysüúgsþg;dar nigtRmUvkMhab;énl,ayenaH edayeGaydUc kMhab;sUluysüúgsþg;dar edaybEnßm)ak;etrI b¤esr:UméRbEdlKμanemeraK.

karEksMrYlkMhab;énrbs;EdlRtUvykmkbNþúH[)anRtwmRtUv KWCasaravnþ½ edIm,IFanafalT§plénkarbNþúH KW ÉkPaBKña b¤esÞIrEtÉkPaB .

165

eFVIkarbNþúHenAelIfñalbNþúHedayRClk;tM)ars¥atKμanemeraKeTAkñúgsUluysüúg)ak;etrI rYcyksUluysüúgEdl elIsecjedaysgát;sMLIelICBa¢MgbMBg;Ekv nigbgViltM)arF¶n;²eTAnwgCBa¢MgTIbxagelIkMritTwk.

yktM)arenHeTAqUtelIépÞfñalbNþúHcMnYn 3dg bgVilcan ¬fñalbNþúH¦kñúgmMu 60 dWeRk bnÞab;BIkarqUtmYyelIk² . cugbBa©b; GUstM)arsMLICMuvijEKmrbs;épÞfñalbNþúH. TukfñalbNþúHEdlbNþúHrYc eGays¶Üt ry³eBl2-3naTI kñúg sItuNðPaBmnÞIrBiesaFn_edaybiTKMrb .

dak; DIsGg;TIb‘Íy:UTikelIfñalbNþúHEdleKbNþúHrYc edayeRbItegáób KμanemeraK. CakarRbesIr eKRtUvykbnÞHEdl eRbIsMrab;erobcMDIs edIm,Idak;DIsenAelIfñalbNþúHeGayÉkPaBKña ¬rUbPaB TI 15¦. cugm¢úls¥atK μanemeraK GacRtUv)aneKeRbIR)as;edIm,Idak;DIsGg;TIb‘Íy:UTikenAelIfñalbNþúHEdleKbNþúHrYcehIy.

166

eKGaceRbIRbdab;sMrab;EckDIs ¬ Disc dispenser ¦edIm,Idak;DIsenAelIfñalbNþúHEdlbNþúHrYc .

DIsy:ageRcInbMput cMnYn7GacRtUv)aneKdak;enAelIfñalbNþúHEdlmanviC¢maRt9-10sg;TIEm:Rt. DIs6Gacnwgdak; enAcenøaHesI μ²Kña RbEhlCa15smBIRCugrbs;fñalbNþúH nigDIs1dak;enAcMkNþalfñalbNþúH. bnÞHDIsnImYy² KYr EtRtUv)aneKsgát;cuHfñm²edIm,I[c,as;fa DIsenaHb:HnwgépÞfñalbNþúH. fñalbNþúHKYrEtRtUv)aneKdak;kñúgm:asIunkMedA35GgSarenAkñúgry³eBlerobcMcMnYn 30naTI. sItuNðPaBelIsBI 35 GgSareFVI[b:HBal;dl;lT§plrbs; Oxacilli/Meticillin. kMudak;bNþúHkñúgmCÄdæanmanCO2 . bnÞab;BIdak;bNþúHry³eBl 1yb;rYcmk Ggát;p©iténtMbn;KμanemeraKduH¬rab;bBa©ÚlTaMgTMhMDIs¦KYrEtRtUv)aneKvas; nigkt;Rtar)aykarN_CamIlIEm:Rt. lT§plKYrRtUv)aneKbkRsayGaRs½yeTAtamTMhMviC¢maRtdUcEdl)anbgðaj kñúgtaragTI 25 . karvas;EvgGacRtUv)aneKeFVIeLIgCamYynwgbnÞat; edayvas;épÞenA)ateRkamcanbNþúHedaymin)ac;ebIkKMrbeT.

ebIsinCafñalbNþúHeLIgRsGab; tMbn;EdlKμanemeraKduH eKGacvas;edayRbdab;sMrab;vas; pair of calipers..

167

xñatKMrU ¬Template¦GacRtUv)aneKeRbIedIm,Ivas;lT§plcugeRkayénetsþGg;TIb‘Íy:URkam.

taragTI 25 taragbkRsayénTMhMtMbn;KμanemeraKduHsRmab;)ak;etrIEdlduHlUtlas;elOnedayeRbIR)as;

bec©keTs Kirby-tbauer EkERba

)ak;etrIEdlbgáeraK TMhMviC¢maRténtMbn;KμanemeraKduH ¬m>m¦

kMhab; Disc Fn; (R) Intermediate (I) sg;sIub (S)amikacin 30mIRkURkam <14 15-16 >17

amoxy-clavb 20/10 mIRkURkam <13 14-17 >18

ampicillin, - Enterobaciteriaeae 10 mIRkURkam <13 14-16 >17

- enterococci 10 mIRkURkam <16 - >17

benzylpenicillin, - staphylococci 10 mIRkURkam <28 - >29

-enterococci 10 mIRkURkam <14 - >15

cefalotin 30 mIRkURkam <14 15-17 >18

168

taragTI 25 taragbkRsayénTMhMtMbn;KμanemeraKduHsRmab;)ak;etrIEdlduHlUtlas;elOnedayeRbIR)as;

bec©keTs Kirby-tbauer EkERba ¬t¦

)ak;etrIEdlbgáeraK TMhMviC¢maRténtMbn;KμanemeraKduH ¬m>m¦

kMhab; Disc Fn; (R) Intermediate (I) sg;sIub (S)cefalozin 30 mIRkURkam <14 15-17 >18

cefotaxim 30 mIRkURkam <14 15-22 >23

ceftazidime 30 mIRkURkam <14 15-17 >18

ceftriaxone 30 mIRkURkam <13 14-20 >21

cefuroxime sodium, cefamendole 30 mIRkURkam <14 15-17 >18

chloramphenicol 30 mIRkURkam <12 13-17 <18

ciprofloxacin 5 mIRkURkam <15 16-20 >21

clindamycin 2 mIRkURkam <14 15-20 ≥21

co-trimoxazole 25 mIRkURkam <10 11-15 ≥16

erythromycin 15 mIRkURkam <13 14-22 >23

gentamicin 10 mIRkURkam <12 13-14 >15

nalidixic acidc 30 mIRkURkam <13 14-18 ≥19

nitrofurantoinc 300 mIRkURkam <14 15-16 >17

norfluxacinc 10 mIRkURkam <12 13-16 >17

oxacillin 1 mIRkURkam <10 10-12 >13

piperacillin, -P. aeruginosa 100 mIRkURkam <17 - >18

- Gram-negaive 100 mIRkURkam <17 18-20 >21

sulfonamidec,d 300 <12 13-16 >17 tetracycline 30 <14 15-18 >19 tobramycin 10 <12 13-14 >15 trirnethoprimc 5 <10 11-15 ≥16 cancomycin, - staphylococci 30 - - >15 - enterococci 30 <14 15-16 >17 a National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial disc susceptibility tests, 6th ed, Vol 21, No 1 (M2-A7 and M7-A5) Wayne, PA, NCCLS, 1997; and 11th informational supplement 2001 (M100-S11).

b Amoxycillin nig clavulanic acid

c RtUv)aneKeFVIenAelIEtemeraKEdlrkeXIjenAkñúgCm¶WrlakRbB½n§bgðÚrTwkenam nigCm¶WrlakeBaHevonmYycMnYn d Sulfisoxazol

169

rUbPaBTI14 xñatKMrUsMrab;kMNt;PaBsg;sIub enAcMNuccugbMputéntMbn;KμanemeraK RtUv)aneKeFVIkarvinicä½yedayEPñkTeT enAnwgEKmEdlCakEnøg)ak;etrI cab;epþImduH b:uEnþeKeXIjmankrNIelIkElg 3 y:ag³

CamYynwg Sulfonamids nig Cotrimoxazol eKeXIjmankBa©úMemeraKduHRsal²bEnßmkñúgtMbn;EdlK μan emeraK karduHrebobenHkuMykCakar .

enAeBlEdleKeFVIetsþ β-lactamase-producing staphylococci Tl;nwg Benzylpenicillin tMbn;Edl KμanemeraKduH )anbegáIt)aneTACaBMnUkeLIg EdlsMKal;edaymanEKmc,as;las;. BMnUkTaMgenHeKGacsMKal; rYceTAehIy enAeBlEdleKykeTAeRbobeFobCamYynwg Sensitive sMrab;RtYtBinitü¬eRbobeFob¦ ehIy edayminKitBITMhMrbs;tMbn;EdlKμanemeraKduH eKRtUvraykarN¾faemeraKenHFn;nwgfñaMEdletsþ.

manBBYk ProteusmYycMnYnGacduHratt,atcUlkñúgtMbn;EdlKμanemeraK CYneTAB½T§CMuvijDIsGg;TIb‘Íy:UTikEtmþg

EteTaHCay:agNak¾eday eKeXIjmanCayc,as;las;enACMuvijtMbn;KμanemeraKduH cMENkÉkBa©úMemeraKtUc² EdlduHcUleTAkñúgtMbn;KμanemeraKRtUv)aneKminykCakar .

karbkRsayGMBITMhMéntMbn;KμanemeraKduH kareRbIR)as;xñatKMrU ³ enAeBlEdlTMhMtMbn;K μanemeraKduH RtUv)aneKeRbobeFobCamYyxñatKMrU xñatKMrUenaHKYrEtRtUv )aneKerobcMrYcCaeRscsMrab;Gg;TIb‘Íy:UTikTImYy ¬emIlrUbPaBTI 14¦ . lT§pl-sg;sIub Fn; b¤ Intermediate GacRtUv)aneKGanfa }sg;sIub} enAeBlEdlEKmrbs;tMbn;enAxageRkArgVg;BN’ex μA. rIÉ }Fn;} vijKWenAeBlEdl BMueXIjmantMbn;KμanemeraKduH b¤CYnkalvaduHenAkñúgrgVg;s. cMENkÉ Intermediate vij KWenAeBlEdlCayén rgVg;rbs;tMbn;K μanemeraKsßitenAelIrgVg;BN’exμA. kareRbIR)as;bnÞat;³ enAeBlEdltMbn;KμanemeraKRtUv)aneKvas;EvgedayKitCamIlIEm:Rt lT§plKYrEtRtUv)aneK bkRsay GaRs½yeTAtamviC¢maRtKMrUEdlmanenAkñúgtaragTI 25.

DIsGg;TIb‘Íy:UTik

tMbn;exμA³ Intermediate (I)

tMbn;eRkA³ sg;sIub ¬S¦

tMnb;xagkñúg³ BBYkFn;nwgfñaM (I)

170

etsþGg;TIb‘Íy:URkamedaypÞal; nigedayRbeyal bec©keTssþg;darEdleKbgðajxagelI RtUv)aneKGnuvtþedayykkBa©úMemeraKecjBIfñalbNþúHdMbUg b¤fñalbNþúH EdleKbnSúT§rYc. enHehAfa }kareFVIetsþGg;TIb‘Íy:URkamedayRbeyal}. kñúgkrNImYycMnYn enAeBlEdleKRtUvkar cMelIycaM)ac;mYy bec©keTsbNþúHsþg;darenHGacRtUv)aneKCMnYsedaykarykvtßúviPaKpÞal;eTAeFVIEtmþg ]TahrN_ TwkenambNþúHQamEdlviC¢manb¤k¾eQIrmUrsMLIEdlecjBIxÞúH. cMeBaHvtßúviPaKCaTwkenam karBinitüedaymIRkUTsSn_ nUvkMNrTwkenam)anmkBIeRkaykarbgVil KYrEtRtUv)aneKBinitümuneKedIm,IrkPsþútagNamYyEdlbBa¢ak;fa mankar bgáCm¶W. ]TahrN_ vtþmanrbs;xÞúH ekasika nigemeraKepSg². Twkenam GacRtUv)aneKeRbI bnÞab;mkeTotedIm,IeFVI karbNþúHenAkñúgetsþsþg;darmYy. dUcKñaenHEdr kareFVIetsþGg;TIb‘Íy:URkam GacRtUv)aneKeFVIenAelIfñalbNþúHEdl bNþúHQamenAeBlEdleKeXIjmanPsþútagbBa¢ak;fa manvtþman )ak;etrIduHenAkñúgfñalbNþúHenaH b¤k¾eQIrmUrsMLI GacRtUv)aneKeRbIR)as;edIm,IeFVIetsþEtmþg enAeBlEdlkarbMBak;BN’ Gram bgðajfa manvtþman)ak;etrIEtmYy muxeRcIn. TaMgenHeKehAfa {kareFIVetsþGg;TIb‘Íy:URkam edaypÞal; }. KuNvibtþirbs;vaEdlelIsBIkareFVIetsþ Gg;TIb‘Íy:URkamedayRbeyalKWeKminGaceFVIkarBinitükarbNþúHenH)anl¥eT. enAeBlEdlcanfñalbNþúHsMrab;eFVI etsþGg;TIb‘Íy:URkambgðajfa man)ak;etrIduHlUtlas;ticeBk b¤eRcIneBk b¤k¾enAeBlEdlkarbNþúHmanduHlay RcbUkRcbl;nwg)ak;etrIepSgeTot enaHlT§plRtUv)aneKeFVIkarbkRsayedayRbugRby½tñ nigeFVIetsþenaHmþgeTot edayeRbIR)as;emeraKEdleKbnSúT§rYc . ktþabec©keTsEdlb:HBal;dl;TMhMtMbn;KμanemeraKduHkñúgviFI Disc-diffusion

kMhab;fñalbNþúH ebIsinCakMhab;fñalbNþúHmankMritTabeBk tMbn;EdlKμanemeraKduHmanTMhMkan;EtFM eTaHbICaPaBsg;sIubén)ak;etrI enaHmin)anpøas;bþÚrk¾eday. BYkEdlminsUvFn;nwgfñaM eKGacbkRsayeTACasg;sIubeTAvij. bRBa©as;mkvij ebIsin CakMhab;fñalbNþúHxøaMgvijenaH tMbn;EdlK μanemeraKduHnwgrYmtUc ehIyBBYk)ak;etrI sg;sIubRtUv)aneKbkRsay xusfa CaBBYkEdlFn;nwgfñaMeTAvij. CaTUeTAlT§plEdlKYr[eCOCak; nigykCa)ankarKWRtUvEtCalT§plEdl TTYl)an edaysarEtkarbNþúHRtwmRtUv nigduH)anRtwmRtUvl¥.

171

ry³eBlénkardak;bnÞH Disc Gg;TIb‘Íy:UTik ebIsinCacanfñalbNþúH eRkayBI)aneRCIserIsCamYynwgemeraKsMrab;etsþ RtUv)aneKTukeGayduH enAkñúgsItuNðPaB mnÞIrBiesaFn_ry³eBlyUrCagry³eBlsþg;dar karbMEbkxøÜnén)ak;etrIenAelIfñalbNþúHenaH GacekIteLIg enAmun eBlEdlbnÞHDIsGg;TIb‘Íy:UTikRtUv)aneKdak;. kMhusqÁgenH )aneFVI[mankarkat;bnßyviC¢maRténtMbn; EdlKμan )ak;etrIduH nigGacbkRsaylT§plxuscMeBaHBBYkEdlsg;sIubeTACafa Fn;nwgfñaMeTAvij. sItuNðPaBénkarbNþúH etsþGg;TIb‘Íy:URkam CaTUeTARtUv)aneKrkSaenAkñúgsItuNðPaB 35 GgSarsMrab;karduHlUtlas;mYyEdlKYr[eCOCak; )an. ebIsinCaeKbBa©úHsItuNðPaB ry³eBlsMrab;karduHdald¾manRbsiT§PaB k¾RtUvBnüar ehIyeGaylT§pltMbn; KμanemeraKduHFMCagFm μta. kñúgkrNIBBYk Staphylococcus aureus EdlFn;nwgfñaMkñúglkçN³ Herotrogenous RtUveKkMBugeFVIetsþCamYynwg Meticilin (Oxacillin) PaBFn;mYyEpñkGacRtUv)aneKrkeXIjenAeBleKdak;bNþúH kñúgsItuNðPaB35GgSar. enAkñúgsItuNðPaBx<s;CagenH bNþúHTaMgmUl)anbgðajnUvlT§plsg;sIub.enAsItuNðPaB 35GgSar b¤TabCag35GgSakBa©úMemeraKEdlFn;nwgfñaM)anduHenAkñúgtMbn;EdlRtUvK μanemeraK. kBa©úMemeraKenHGac RtUv)aneKemIleXIjedayRsYlenAeRkayeBlEdleKdak;canbNþúHecalb:unμanema:genAkñúgsItuNðPaBmnÞIrBiesaFn_ muneBleKGanlT§pl. kBa©úMemeraKTaMgGs;enaHKYrEtRtYv)aneKviPaKCanic©kaledIm,IBinitüemIlfaetIvaCaemeraK qøgcUlmkfμ Ib¤Gt;. ry³eBlbNþúH

bec©keTsPaKeRcIn sMrbykry³eBlbNþúHsßitenAcenaøH 16-18 em:ag. EteTaHCaya:gNak¾eday kñúgkrNI bnÞan;nana r)aykarN¾beNþaHGasnñmYyGacRtUv)aneKeFVIeLIgenAeRkay6em:ag. EtkareFVIEbbenH nwgminGnuBaØat [GnuvtþCaRbcaMenaHeT. lT§plcugeRkaymYyRtUvEteFVIeLIgedIm,IbBa¢ak;GMBIlT§plBitR)akdeTAtamry³eBl bec©keTsRtwmRtUv . TMhMfñalbNþúH kMras;fñalbNþúH nigKmøaténDIsGg;TIb‘Íy:UTiknImYy² etsþGg;TIb‘Íy:URkamRtUv)aneKGnuvtþenAelIcanTMhM 9-10sg;TIEm:Rt ehIydak;DIsGg;TIb‘Íy:UTikmin[elIsBI 6-7 eLIyenAkñúgcannIimYy². ebIsinCamanDIsGg;TIb‘Íy:UTikeRcInRtUv)aneKeRbIR)as;edIm,IeFVIetsþ eKRtUvdak;canBIr epSgKña b¤dak;canEdlmanTMhMviC¢maRt 14 sg;TIEm:Rt. CakarBitNas; tMbn;EdlK μanemeraKduH FMxusBIFm μtaekIt manenAelIfñalbNþúHEdlesþIg ehIyCakarBitvapÞúÞúyeTAvij enAeBlEdlkMras;énfñalbNþúHRkas;. karpøas;bþÚr bnþicbnþÜcénkMras;rbs;fñalbNþúHGacTat;ecal)an. kardak;cenøaHBIDIsGg;TIb‘Íy:UTikmYyeTADIsmYyeTotman

172

sar³sMxan; edIm,IkMu[tMbn;K μanemeraKduHénGg;TIb‘Íy:UTiknimYy²Can;Kña b¤naM[xUcrUbragenAtamCayfñalbNþúH ¬emIlrUbPaBTI 15¦ .

rUbPaBTI 15³ xñatKMrUénkardak;DIsGg;TIb‘ÍUTikenAkñúgRbGb;EdlmanviC¢maRt 90 mIlIEm:Rt

kMlaMgDIsGg;TIb‘Íy:UTik viC¢maRténtMbn;K μanemeraKduH R)aRs½yTak;TgeTAnwgbrimaNénfñaMEdlmanenAkñúgDIs. ebIsinCakMlaMgrbs;fñaMfy cuHbNþalBIkarxUcxatenAeBlEdlrkSaTuktMbn;K μanemeraKduHnwgbgðajnUvTMhMfycuHEdr RsbKñaenaHEdr. smasFatupSMénfñalbNþúH fñalbNþúHma\T§BlenAelIviC¢maRténtMbn;K μanemeraKduH edaysarEt\T§iBlrbs;vaeTAelIkarduHlUtlas;rbs; emeraK GRtaénkarsayPayrbs;Gg;TIb‘Íy:UTik nig\T§iBlrbs;fñalbNþúH. vamansar³sMxan;xøaMgNas;EdleyIg RtUveRbIR)as;fñalbNþúH[RtUv nigsmRsbCamYynwgbec©keTsNamYy. ktþaCaeRcInEdlman\T§iBlelIviC¢maRtrbs;tMbn;KμanemeraK GacRtUv)aneKBinitüeXIjenAelIbec©keTs enAelI )ak;etrIdEdleqøIytbnwg\T§iBlenHeTIbeKRtUvkarnUvbec©keTssþg;darmYyén Disc-diffision. karpøas;bþÚrktþa epSg²b:HBal;elIetsþGac[CalT§plminRtwmRtUvmYydl;RKUeBTüBüa)al. PaBCak;lak; nigRtwmRtUvrbs;bec©keTs KYrRtUv)aneKtamdanedaymanbegáItCakmμviFIRtYtBinitüKuNPaB dUc)an erobrab;xageRkam. karERbRbYlNamYyGacRtUv)aneKesIubGegátPøam² nigEkERbCabnÞan;edIm,IlubbM)at;.

173

karRtYtBinitüKuNPaB tRmUvkarcMeBaHkarRtYtBinitüKuNPaBenAelIetsþGg;TIb‘Íy:URkam lT§plcugeRkayénetsþGg;TIb‘Íy:URkamtamry³bec©keTs Disc-diffusion TTYlrgnUv\T§iBlBIktþaepSg². manktþaxøH²dUcCa kMhab;emeraKEdldak;bNþúH nigsItuNðPaB CaktþaEdlgayRsYlkñúgkarBinitütamdan b:uEnþmnÞIr BiesaFn_TUeTAkRmnwgdwgGMBIFatupSMBitR)akdénfñalbNþúHEdleKplitlk; b¤karpøas;bþÚrKuNPaBBILÚmYyeTALÚmYy Nas; ehIyeKminGacFanaGMBIcMNuHfñaMenAkñúgDIsenaHEdr. dUcenHlT§plénkareFVIetsþ KYrEtRtUv)aneKBinitütam dan[Cab;lab;tamry³kmμviFIRtYtBiinitüKuNPaBEdlRtUv)aneKKitfaCaEpñkmYyénbec©keTskñúgkarGnuvtþkargar PaBCak;lak; nigRtwmRtUvrbs;etsþ RtUv)aneKRtYtBinitüedayeRbIR)as;Qutrbs;BBYk)ak;etrIEdleRbIsMrab;RtYt BinitüEdleK)andwgGMBIPaBsg;sIubrbs;vaeTAnwgGg;TIb‘Íy:UTikrYceTAehIy. )ak;etrIEdleRbIR)as;kñúgkarRtYtBinitü enHRtUv)aneKGnuvtþtambec©keTsdUcKñaebHbiTeTAnwgkareFVIetsþelIGtisuxumR)aNTUeTA. tMbn;KμanemeraKduHEdl )anbgðajeday)ak;etrIRtYtBinitü KYrEtsßitenAkñúgcenøaHviC¢maRtEdl)anbgðajenAkñúgtarag 24. enAeBlEdl lT§pletsþR)as;cakGMBIviC¢maRtkñúgtarag 24 ehIyenaH eKGacKitfaenHCaPsþútagEdlbgðajGMBIkMhusqÁgEpñk bec©keTskñúgkareFVIetsþenH b¤k¾Gacsnñidæanfa sMPar³epSg²eTotxUcKuNPaB. sMPar³nimYy²EdlykmkeRbI nigkarGnuvtþkargareFVIetsþmYytMNak;mþg² KYrEtRtUv)aneKtamdanrhUtdl;eKrkmUlehtukMhusqÁgenHRtUv)aneK rkeXIj nigbM)at;ecal . nItiviFIsþg;darkñúgetsþRtYtBinitüKuNPaB km μviFIRtYtBinitüKuNPaB KYrEtRtUv)aneKeFVIenAelI)ak;etrIKMrUNamYyEdldUcKñaeTAnwg)ak;etrINamYy Edlcg;eFVI etsþ. etsþTaMgGs;enH KYrEtRtUv)aneKeFVIerogral;s)þah_ b¤erogral;R)aMLÚetsþ nigCabEnßmKWenAerogral;eBlEdl eKeRbILÚ Mueller-Hinton fμ I b¤LÚfμIrbs; Disc . BBYk)ak;etrIsþg;darsMrab;RtYtBinitüKuNPaB Staphylococcus aureus (ATCC 25923) Escheriachia coli (ATCC 25922) Pseudomonas aeruginosa (ATCC 27853) )ak;etrITaMgGs;enHGacrk)anBImCÄmNÐlRbmUlpþúM)ak;etrIfñak;CatimYy b¤BYkvaGacRtUv)aneKdak;lk;kñúg TRmg;Ca RKab;dMutUc b¤CaemSAs¶ÜtbNþúHsuT§ . bNþúHsMrab;eRbIBImYyéf¶eTAmYyéf¶ KYrEtRtUv)aneKdak;bNþúHenAkñúgGNþatrbs;fñalbNþúHEdlsMbUrcMNIGahar (Tryptic soy agar manPaBgayRsYl) nigrkSaenAkñúgTUrTwkkk. BYkvaKYrEtRtUv)aneKbNþúHbnþenAelIGNþatén fñalbNþúHenAerogral;BIrs)þah_ .

174

kaerobcMfñalbNþúH )ak;etrIKYrEtRtUv)aneKdak;bNþúHenAkñúgfñalbNþúHrav nigbNþúHrhUtdl;fñalbNþúHenaHeLIgl¥k;. emeraKEdlduHBI fñalravnImYy² KYrEtRtUv)aneKykeTAeFVIkarbNþúHenAelIcanfñalbNþúHkñúgry³eBl 1 yb;. eKKYrEtqáwHykkBa©úM emeraKEtmYy ehIydak;eFVIetsþGg;TIb‘Íy:URkamdUcEdl)anerobrab;.

rUbPaB 16³ taragRtYtBinitüKuNPaBelIkareFVIetsþGg;TIb‘Íy:URkam

kardak;DIsGg;TIb‘Íy:UTik bnÞab;GMBIeKdak;)ak;etrIbNþúHenAelIfñalbNþúHrYcehIy DIsGg;TIb‘Íy:UTik EdlsmRsbKYrEtRtUv)aneKdak;. DIs EdlRtUv)aneKeRCIserIssMrab;eRbIeTAelI)ak;etrIsMrab;etsþRtYtBinitüKuNPaB RtUv)aneKerobrab;enAkñúgtarag 24. karBinitüemIlfñalbNþúH bnÞab;BIdak;bNþúH)an 16-18em:ag TMhMviC¢maRtrbs;tMbn;EdlKμanemeraKduH KYrEtRtUv)aneKvas;edaybnÞat; nigpþl;Car)aykarN_edaymanP¢ab;CamYyedayéf¶ Ex énkareFVIetsþenAkñúgtaragetsþRtYtBinitüKuNPaBCaBiess mYy. taragenHKYrEtbgðaj[Gs;nUvral;Tinñ½yTaMgLayEdlTak;Tgnwg)ak;etrI nigDIsGg;TIb‘Íy:UTik . taragén Gg;TIb‘Íy:URkamKYrEtRtUv)aneKkt;RtaCamIlIEm:RtnUvviC¢maRtrbs;tMbn;KμanemeraKduH. ]TahrN_mYyéntaragenaH RtUv)aneKbgðajenAkñúgtarag 16 . enAeBlEdllT§plEdlTTYl)an sßitenAeRkArgVg;EdnkMNt;éntMbn;K μan emeraKenaH dEdlCadEdl enaHeKRtUvEtEkéxnUvKuNPaBénetsþenaH . lT§plEdlPan;RcLMEdlFMbMputEdlminEmnCakMhusqÁgEpñkbec©keTsenaH KWGacRtUv)aneKbgðaj tamry³kar qøgcUlGMBIsMNak;)ak;etrIepSg nigkarpøas;bþÚrCayfaehtuenAkñúgetsþGg;TIb‘Íy:URkam b¤karpøas;bþÚrlkçN³énkarduH lUtlas;rbs;)ak;etrIEdleKeRbIsMrab;RtYtBinitüKuNPaB. ebIsinCamankrNIenHekIteLIg eKKYrEtyk)ak;etrI EdleKeTIbEtrkSaTukf μ IGMBIRbPBEdlKYr[eCOCak;)an.

175

etsþesr:UmsaRsþ esckáIepþIm etsþesr:UmsaRsþ vamindUckarRsavRCavtamkarbNþúH nigkarsegátBinitüedaymIRkÚTsSn_eT etsþTaMgenHpþl;Et PsþútagRbeyalbu:eNÑaHrbs;karbgáeraK edayrkeXIjGg;TIEhSn b¤GgÁbdibkçEdlbegáIteLIg edIm,IeqøIytbnwg Gg;TIEhSnTaMgenHenAkñúgvtßúviPaKKøInik. etsþrebobenH \LÚvRtÚv)aneKeRbIR)as;y:agTUlMTUlayenAkñúgvis½yGti-suxumCIvsaRsþ edaysarEtlkçN³ Specificity nig Sensitivity x<s;rbs;va. bnÞab;GMBImankarbgáeraKedaysarGtisuxumR)aNNamYymkGñkCMgWPaKeRcIn nwgbegáItTaMgGgÁbdibkç IgM nig IgG. enABIreTAbIGaTitüeRkaymkekasikaEdlbegáItGgÁbdibkç IgM )anpøas;bþÚreTAbegáItCa IgG vij ehIybnþ bnÞab;mkeTot manEtGgÁbdibkç IgG b:ueNÑaHEdlmanvtþmanenAkñúgesr:Umrbs;GñkCMgW. kñúgkrNImankarbgáCMgW ekItmaneLIgedayPñak;garbgáeraKdEdlenaHeyIgeXIjmankarbeBa©jEt IgG mYymuxb:ueNÑaH edIm,ITb;Tl;nwg Pñak;garenaH. edaysarEt GgÁbdibkçEdlbegáItecjmk)ancgcaM b¤sÁal;nUvPñak;garbgáCMgWTaMgenaHehIy eTIbkar Tb;Tl;mansPaBelOn nigxøaMgkøaCagkarTb;Tl;RbqaMgenAdMNak;kaldMbUgTaMgenHehIy EdleKehAfa CakarTb; Tl;nwgPñak;garbgáeraKEdlFøab;bgáCMgW (Anamnestic Response). kMriténGgÁbdibkçRtÚv)aneKkMNt;CaTUeTAtamry³ “Titre”. eraKvinicä½y Titre EdlRtÚvraykarN¾KWCatMélRbvas; énkMritravrbs;esr:Umrbs;GñkCMgWx<s;bMput EdlkñúgenaHmanbrimaNGgÁbdibkç enAEteKGacrkeXIj. ]TahrN_³ ebIsinCaGgÁbdibkçenAEteKGacrkeXIjenAkñúgl,ay !³!0@$ EtminGacenAkñúgBRgavelIsBIenH enaH Titre rbs; esr:UmKW 1024. esr:UmEdleKRbmUl)anBIGñkCMgWEdlsßitenAkñúgdMNak;kalRsÜcRsavénkarbgáeraK b¤enAeBl EdlCMgWenaHRtÚv)aneKsgS½yCaelIkTImYy enaHeKehAfaCaesr:UmRsÜcRsav (Acute Serum) . cMeBaHesr:UmEdl eKykBIGñkCMgWEdleTIbEtegIbBIQW CaTUeTAKWBIrGaTitüeRkayeBlFUres,IyeKehAfa esr:UmeRkayeBlQW (Con-

valescent Serum). RbtikmμCamYynwgGg;TIEhSnnwgekIteLIgenAeBldMNak;kalbgáCMgW eTaHbICaeBlxøHvanwgmankarERbRbÜlk¾eday. vtþman rbs;GgÁbdibkç IgG kñúgvtßúviPaKCaesr:UmmYy cg¥úlbgðajGMBIkarRbQmmuxeTAnwgPñak;garbgáeraKknøgmk dUcenHeKminGaceRbIR)as;vaedIm,IeFVIeraKvinicä½ykarbgáCMgWnaeBlbc©úb,nñeT. vtþmanGg;TIEhSnGacrMejac[man karbegáItCaGgÁbdibkçehIyEdlTb;Tl;RbqaMgCamYyGg;TIEhSnepSg²eTot. edaysarEtGgÁbdibkçTaMgenHmin Cak;lak;(Non specific) dUecñaHkareFVIetsþenAesr:UmEtmþgGacpþl;nUvlT§plminRtwmRtÚv. sMrab;etsþesr:UmsaRsþ PaKeRcIn TaMgesr:UmRsÜcRsavTaMgesr:UmeRkayeBlQWKYrEtRtÚv)aneK eFVICamYyKñaenAelIetsþdMNalKña nigenAelI ma:sIunrt;etsþEtmYy edIm,ITb;Tl;bMErbMrYlnanaenAkñúgkareFVIetsþ. karbegáInGgÁbdibkç Titre énBRgavBIrdg

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(]TahrN_³ BIl,ay !³* eTACal,ay!³#@) CaTUeTARtÚv)aneKykmkGnuvtþkñúgkarrkeraKvinicä½yénkarbgáCMgWEdl kMBugman. TaMgenHeKehAfakMeNInl,aymYyCabYn. kareFVIetsþenAelIsMNakesr:UmEtmYyelIk GacRtÚv)aneK eRbIR)as;EtenA kñúgkrNIBiessmYycMnYndUcCa karrkeraKvinicä½y karbgáCMgWrbs; Mycoplasma pneumonia enA eBlEdl Titre x<s;bBa¢ak;fa CakarQWf μ I² b¤enAeBletsþbgðajfa manvtßúmanGgÁbdibkç IgG ehIyniglT§pl GacRtÚv)aneKykCaPsþútagfamankarbgáCMgWenAeBlenH. RbePTénRbtikm μGg;TIEhSnnigGgÁbdibkç GaRs½yeTA elIsPaBrbs;Gg;TIEhSn. karvas;EvgkarRtÜtBinitüKuNPaB PaBGaceCOCak;)an nig PaBGacplit)annUvlT§pldEdl rbs;etsþesr:UmsaRsþ KWBwgEp¥kTaMgRsúgeTAelIviFan karRtÜtBinitüKuNPaB EdlRtÚv)aneKeFVIeLIgenAmuneBleFVIetsþ enAeBlkMBugeFVIetsþ nigeRkayeBletsþnImYy². viFankarénkarRtÜtBinitüKuNPaB BitCamansar³sMxan;xøaMgNas; eRBaHfalT§plviC¢manb¤GviC¢man-xus GaceFVI[ RKÚeBTüBüa)alsMerccitþ b¤k¾eFVIkarBüa)alEdlminRtwmRtÚv EdlnaM[maneRKaHfñak;dl;GñkCMgW. manktþaCaeRcIn EdlGacman\T§iBlelIKuNPaBénkareFVIetsþesr:UmsaRsþ dUcCabTBiesaFn_énbuKÁlikmnÞIrBiesaFn_ KuNPaB Rbtikr nig]bkrN¾ lkçxNÐ½vtßúviPaK karRtYtBinitüEdl)aneRbIenAeBletsþdMeNIrkar nigkarbkRsaylT§pl nigr)aykarN_. enAeBlEdletsþRtÚv)aneFVIrYcral;ehIy cUre)aHecalsMPar³Edl)aneRbIR)as;rYceTA kñúgFugEdl mansarFatusMlab;emeraK rYclagédnigTIkEnøgEdlGnuvtþn_etsþedaysarFatusMlab;emeraK. eRKOg]bkrN¾

]bkrN¾enAkñúgmnÞIrBiesaFn_esr:UmsaRsþedaymanrab;bBa©Úl epIgTwk m:asuInbNþúH TUrTwkkk m:asuIneFVI[kk ]bkrN_sMrab;vas; CBa¢Ig m:asuInbgVil mIRkÚTsSn_nigm:asuInGRgÜn. kartamdan nigkarCYsCul]bkrN¾TaMgenaHCa RbcaM CakarTTYlxusRtÚvnigCakarFananUvKuNPaBénmnÞIrBiesaFn_esr:Umsa®sþenaH. esvaEfTaMCaRbcaM KYrEtRtÚv )aneKbegáIteLIgedaymankarGPi)altameBlevlaeTAelIRKb;]bkrN_TaMgGs; edIm,IkarEktMrUvtUctac. r)aykarN¾RtUvmancuHéf¶-ExGPi)al karEfTaM nigkarCYlCul KYrRtUvrkSaTuksMrab;]bkrN¾nImYy². FugTwkKYrEt RtÚv)aneKrkSa[enAdac;BIsMPar³epSg² ehIybgðÚrniglagsMGatCaRbcaMerogral;Ex. sItuNðPaBenAkñúgsItuNðPaB rbs;FugTwkkMedAKYrEtRtYtBinitü[)anhμt;ct; ehIyeFVIy:agNakuM[ERbRbÜlelIsBI 1± GgSar. sItuNðPaBnigFug TwkenHKYrEtBinitünigkt;Rtaerogral;éf¶ nigenAkñúgGMLuúgeBleRbIR)as;. eKRtÚveRbIR)as;KMrbénFugTwkkMedAenH edIm,IkarBarkuM[sItuNðPaBenAépÞxagelIcuHRtCak;CagépÞTwkxageRkam. eKminRtÚvdak;l,ayrbs;Gg;TIEhSn nig GgÁbdibkçenAkñúgFugkMedArhUtdl;sItuNðPaBEdleKcg;)anelIsBImYyem:ageT. kMriténépÞ TwkkñúgFugkMedA nig sarFatusMrab;eFVIetsþEdlrkSaenAkñúgbMBg;EkvKYrEtdUcKña.

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mIRkÚTsSn_ KWCasMPar³d¾sMxan;mYysMrab;eFVIetsþkñúgmnÞIrBiesaFn_RsavRCavrkeraKsgÁm (VDRL) nigetsþ Fluo-

rescent Treponemal Antigen Absorption (FTA-Abs). eKRtÚvEfrkSava[)anx¢ab;x¢Ün nigmanrebob erobry. eRkayeBleRbIrYc Rtg;kEnøgdak;EPñkemIlEkvBRgIk nig Condenser rbs;mIRkÚTsSn_KYrEtRtÚv)aneKCUt sMGateRbgnigkMeTckMTICamYynwgRkdasEdlmineFVI[swk. enAeBlEdlmin)aneRbIR)as; mIRkÚTsSn_KYrEtRtÚv)an eKRKb nigkarBarkuM[b:HnwgsMeNIm. GaMgtg;suIeténGMBUlcegáóg)artrbs;mIRkÚTsSn_ Fluorescent KYrEtRtÚv )aneKBinitünig vas;CaRbcaMedayeRbIR)as;]bkrN_vas;BnøW. m:asuInsMrab;GRgÜnEdlbMerIkñúgkareFVIetsþ VDRL nigetsþ RPR KYrEtRtÚv)aneKBinitüel,Ónrbs;vaenAeBl eRbIR)as;ehIytMrUvenAerogral;eBlbþÚrel,ÓnkñúgeBleFVIetsþ Agglutination. bEnßmBIelIenaHeKRtÚvdak;eRbg rMGilCab;CaRbcaMedIm,I[m:asuInenHdMeNIrkar)anRtwmRtÚv. sMPar³ eRKÓgEkv nigm¢úlEdleKeRbIR)as;kñúgkareFVIetsþesr:Umsa®sþRtÚvEtbMeBjtamtMrUvkarCak;lak;EdleKENnaM enAkñúg kareFVIVIetsþenaH. ral;eRKOgEkv can nigbnÞHkBa©k;EdlEqb b¤ekas KYrEtRtÚv)aneKRkvat;ecal. kareRbIR)as;eRKOgEkvkxVk; b¤ sMGatminRtwmRtUvEdlGacmankMeTcemeraKenAelIenaH KWCamUlehtucMbgEdlnaMeTArkkarpþl;lT§plxus. esckþI ENnaMGMBIbec©keTsénkarlagsMGatbnÞHkBa©k;b¤]bkrN_eFVIGMBIEkvKYrEtRtÚv)anENnaM[)anRtwmRtÚv edayman sresrCalaylkçN_GkSr nigbiTenAkEnøgEdleKlagbnÞHkBa©k;nigsMPar³eFVIGMBIEkvTaMgenaH. CMhanCamUldæan nanarYmman)aj;TwksMGatCamun lagsMGatCamYynwgemSAsab‘UsMrab;mnÞIrBiesaFn¾EdlsmRsb rYclagsMGat edayTwkk,alma:sIun rYcTwkbit sMgYt nigBinitüCacugeRkayedIm,IFanafa RCHsab‘UGs;. RKb;bMBg;bWt (Pipettes) KYrEtRtÚv)aneKRtaMbBaÄrenAkñúgTwksab‘U dUcenHTwksab‘UGaccUleBjxagkñúgbMBg;bWt. bnÞab;mkeKRtÚvlagbMBg;bWtTaMgenaH[)any:agtic30naTICamYynwgTwkr:Ub‘ÍeN rYcbnþlagCamYynwgTwkbit. can EkvEdleKeRbIR)as;sMrab;eFVIetsþ VDRL KYrEtRtÚv)aneKsMGateday h μt;ct;rhUtdl;sab‘Unig sMNl;eRbgRtÚv )anykecjGs;. eCosvagkarRtaMsMPar³enAkñúgTwksab‘UyUreRBaHvaGacnaM[xUcxat]bkrN_TaMgenaH edayvaGac bMpøajRsTab;esr:amikEdl)a:tBIxageRkA]bkrN_TaMgenH. canEkvEdleRsabeday)a:r:ahVIn KYrEtRtÚv)aneKlag sMGatedaysarFatusirIragÁEdlsmRsb (]TahrN_dUcCa eGETrCaedIm). edIm,IbMerIkñúgetsþ RPR nig VDRL m¢úlEdlmanRkitRtÚv)aneKeRbIedIm,Ilayl,ayGg;TIEhSn. ]bkrN_sMrab; eFVIetsþ RPR EdlrYmmanm¢úlsMrab;lay ehIym¢úlTaMgenHKYrEtRtÚv)aneKBinitüenAmuneBleRbIR)as;. BinitüemIl m¢úledaykMNt;cMnYntMNk;kñúgmYymIlIlIRt³ m¢úl 20RkitmYyedIm bnþk;)an 90tMNk;kñúgmYymIlIlIRt. m¢úlsMrab;

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eFVIetsþ RPR EdlmintMeNIrkarRtwmRtÚv KYrEt)aneKRKvat;ecal. cUrlagm¢úledayTwksuT§ enAeRkayeBleRbI. kñúgkarerobcMm¢úlTaMgBIrsMrab;eFVIetsþ VDRL eKeRbIdgáab;edIm,Ikat;cugm¢úlenaH. eFVIkarRtÜtBinitüemIlm¢úlenaH[ )anRtwmRtÚvtamkarkMNt;cMnYntMNk;enAkñúgmYymIlIlIRt³ m¢úlEdlman18Rkit RtÚvEtbnþk;)an 60 tMNk;kñúgmYy mIlIlIRt ehIym¢úlEdlman21b¤22RkitRtÚvEtman100tMNk;kñúgmYymIlIlIRt. m¢úlTaMgLayNa EdleKeRbIR)as;Ca]bkrN_sMrab;eFVIetsþ VDRL Edlminpþl;cMnYntMNk;BitR)akd KYrEtRtÚv)aneKRkvat;ecal b¤EktMrUvvaedaysgát;b¤ ecaHBRgIkrn§enAxagcugm¢úl. lagm¢úlCamYynwgTwk edayeGtaNul70° nig acetone

enAeRkayeBl eRbIR)as;. Rbtikr sarFatuKImIEdleRbIR)as;kñúgesr:UmsaRsþRtÚvEtCaRbtikrEdlmanKuNPaB nigRtwmRtÚveTAtamkarkMNt;Cak;lak; énrebobeFVIetsþ. RbtikrTaMgGs;enaHKYrEtRtÚv)aneKrkSaTukenAkñúg sItuNðPaBb¤kEnøgEdleKtMrUv[dak;. TwkbitEdlmanKuNPaBx<s;Edlman pH=7,0 KYrEtRtÚv)aneKeRbIR)as;edIm,IerobcMRbtikrTaMgenaH. TwkbitKYrEt RtÚv)aneKrkSaTukenAkñúgEkvEdlFn;nwgkMedA b¤db)aøsÞikEdlmanKMrbbiTCit)anl¥EdlGac[eKbiTpøaknigcuHkal briecäT)any:agRsÜl. esr:UméRbRtÚveKeRbIpgEdredayedIrtYCaesr:UmxøÜnvapÞal;pg nigCasUluysüúgsMrab;laypgdUcCa Phosphate

buffered saline CaedIm. enAkñúgtMbn;EdlGakasFatumansMeNIm sUdüÚmkørIdKYrEtRtÚv)aneKsMgYtenAkñúgm:asuIn kMedAEdlmanxül;ekþA160-180GgSarcMnYn30naTIedIm,IykecjnUvsMeNImTaMgLay. GMbilenHKYrEtRtÚv)an layCamYynwgTwkbit b¤TwkK μanCatiEr: ehIyrkSaTukenAkñúgdbEdlFn;nwgkMedA b¤kñúgdb)aøsÞikEdlmanKMrbbiTCit l¥edaymanbiTsøaknigcuHkalbriecäT)anRtwmRtÚv. enAeBlEdlerobcMsUluysüúgGMbilenH eKRtÚvkMNt; pH

rbs;va enAmuneBleRbI. esr:UmTaMgLayEdlmankMeTckMTIenAkñúgenaHKYrEtRtÚv)aneKbgVil[)an 3000g kñúgry³eBl 10naTI rYcyk EpñkføaxagelIrbs;vaedIm,IykmkeFVIetsþ.esr:UmEdlmanlayRKab;QamEbknigesr:UmEdlqøgemeraKBIIeRkAKYrEt RtÚvRKvat;ecal. ebIsinNaCaeKtMrUvykesr:UmEdlminskm μmkeFVIetsþ eKRtÚvEtkMedAesr:UmenHenAsItuNðPaB 56GgSarry³eBl 30naTIsin. ebIsinCaesr:UmenaHenAEtmin)aneRbIR)as;enAry³eBl 4em:ageKRtÚvEtkMedAesr:Um enHsarCaf μ IedayeRbIkMedA 56GgSar nigry³eBl10naTI munnwgeRbIR)as;. RtÚvykesr:UmEdlerobcMrYc eTAdak;enA eRkamsItuNðPaBmnÞIr BiesaFn_.

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kalbriyaylMGitsþIGMBIeKalkarN_énkareFVIetsþesr:Umsa®sþRbcaMéf¶mYycMnYn EdleKGnuvtþenAkñúgmnÞIrBiesaFn_ KøIniknwgRtÚv)anelIkykBiPakSaenAkñúgCMBUkenH. TaMgGs;enHnwgmanrab;bBa©ÚlkareFVIetsþesr:UmsaRsþ edIm,I RsavRCavrkCMgWsVayetsþ Wright sMrab;rkeraKvinicä½yénCMgW Brucellosis nigetsþ Antistreptolysin O sMrab; rkeraKvinicä½yCMgWEdlekIteLIgeRkayeBlbgáeraKedayBYk Streptococci. ral;karbriyayTaMgLayenAkñúgCMBUkenH eRcInEtsMedAeTArkkareRbIR)as;kBa©b;etsþEdlmandak;lk;enATIpSar. edaysarkBa©b;etsþTaMgenH eKGacrk)anenAtamTIpSar nig)anmkBIGñkplitCaeRcIn dUecñaHmunnwgeRbIR)as;eKRtÚv emIlkarENnaMlMGitEdleK)andak;P¢ab;enAkñúgkBa©b;enaH. RbtikmμenAkñúgetsþesr:UmsaRsþ RbtikmμCakkr nigkkCaduM (Flucculation or Precipitin reactions) enAetsþeFVI[kkr Rbtikm μrvagGg;TIEhSnEdlmanenAkñúgsUluysüúg nigGgÁbdibkçnwgbgðajCalT§plCakkr Edl[eKGacemIleXIjtamry³EPñkTeT b¤mIRkÚTsSn_. enAeBlEdlRbtikrRtÚv)aneKlaybBa¢Úll,ayrbs; Gg;TIEhSnnigGgÁbdibkçcab;epþImbegáIt[manCaRbtikm μPøam²mYyrMeBc. eTaHCay:agNak¾eday karbegáItCakMNk FM²EdleyIgGacemIleXIjGacmanry³eBlrhUteTAdl;mYyem:ag b¤eRcInCagenHeRkamsItuNðPaBEdleKcg;)an mYy. RbtikmμRbRBwtþeTAy:agelOnbMputenAeBl enAkñúgtMbn;esμ IKñaénGg;TIEhSnnigGgÁbdibkçkñúgl,ayenHman kMritx<s;. bMBg;EdlekItmankkrya:gelOnbMputenaHKWCasBaØad¾l¥énsmmUl. etsþEdlbegáItCakkrEdleK Gnuvtþya:gTUlMTUlayenaHKWetsþ VDRL nig RPR. etsþTaMgBIrRtÚv)aneKeRbIedIm,IeFVIeraKvinicä½yCMgWsVay (bNþalmkBI Treponema pellidum) nigkarbgáeraKedayBYk Treponema d¾éTeTot. etsþeFVI[kkrenHpþl;[eyIgnUvPsþútagKuNPaBGMBIRbtikmμrvagGg;TIEhSn nigGgÁbdibkç EtminbgðajGMBIfa etI Gg;TIEhSn b¤GgÁbdibkçmYyRbePT b¤eRcInRbePTEdlcUlrYmenAkñúgRbtikmμenHeT. ebIeTaHbICaRbtikmμenHRtÚv )aneKGegátedayeRbIR)as;sarFatuesÞIrxab;esÞIrravGn§ilk¾eday k¾Gg;TIEhSnnigGgÁbdibkçemIleTAdUcCa mankar sayPayenAkñúgGRtaxusKña ehIyvaGaceGayeKEbgEckRbtikmμepSg²)an. Rbtikmμ Agglutination enAkñúgetsþ Agglutination (Rbtikmμ[kkr) RbtikrEdleKeRbIR)as;GacCaGg;TIEhSnb¤GgÁbdibkç ehIyRtÚv)an eKP¢ab;b¤RsÚbcUleTAnwgkMeTcl¥it². kMeTcl¥it²epSg²GacRtUveKeRbIR)as; sMrab;CaGñkdwknaMRbtikr ]TahrN_³ dUcCakMeTckMTIC½reQI (Latex particles) kMeTckMTIcahYy (Gelatin particles) RKab;GgáaMtUc² (Microbeads) )ak;etrIb¤ekasikaQamRkhm. bec©keTsTaMgGs;enHRtÚv)aneKehAfa Passive agglutination (etsþ[kkr Gkm μ). enAeBlEdleKeRbIR)as;eKalikaRkhm KWCaGñkTTYlrab;rgénkareFVI[kkr b¤kkenaHeKehAetsþenaHfa

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etsþeFVI[kk (Coagulation test). enAeBlEdleKdak;layCamYynwg Antiserum ekasikab¤sarFatul¥it² TaMgenaH )ankkCaduMehIybnSl;TuknUvTwkføaEpñkxagelI. ebIsinCa Antiserum EdleKdwgBI Specificity mYy RtÚv)aneKeRbIR)as;etsþedIm,IrkemeraKEdleKminsÁal; b¤k¾Gg;TIEhSnrbs;vanwgGaceFVI)an. etsþenHGacRtUv)an eKeFVIenAelIbnÞHkBa©k; ehIyeKGacbkRsaylT§pltamry³karBinitüedaymIRkÚTsSn_. Rbtikm μ[kk b¤kkrenH RtÚv)aneKeRbIpgEdredIm,I)a:n;RbmaNbrimaNénGgÁbdibkçEdlRbqaMgnwg)ak;etrIenAkñúgesr:Um EdleFVI[etsþenaH eLIgkkrbs;GñkCMgWEdlminsÁal;GMBIRbePTCMgWBitR)akdmYy. karekIneLIgénbrimaNénkkrEdleXIjenAkñúg eBlEdlGñkCMgWkMBugEtQW bgðajGMBIPaBF¶n;F¶rénCMgWenaHEdr.

Rbtikmμ Agglution enHGacRtÚv)aneKBenøÓnedayeRbIR)as;sItuNðPaBx<s; (35-5GgSar) nigbEnßmedayclna (]TahrN_GRgÜn kUrb¤bgVil) EdlskmμPaBTaMgGs;enHGacbegáInlT§PaBcab;P¢ab;rvagGg;TIEhSnnigGgÁbdibkç. dMeNIrkarén Agglutination tMrUv[manvtþmanrbs;GMbil. bBaðacMbgkñúgetsþ Agglutination enHKWCaRbtikmμ EdlekItmaneLIgedaysarPaBF¶n;mçag² ]TahrN_³ ebIsinCaGgÁbdibkçmancMnYneRcInelIslb;elIscMnYnsarFatu l¥it²BuMGacekItmanehIyRbtikmμ Agglutination nigminGacRbRBwtþeTA)aneLIy. RbtikmμrebobenHnwgpþl;[eK KitfaGvtþmanGgÁbdibkç. PaBlMeGogenHeTaHCay:agNak¾edayGacRtÚv)aneCosvag tamry³kareFVIetsþlay l,ayesr:UmCaes‘rI.

manetsþ Agglutination mYyEdleKeRbIjwkjab;KWCaetsþEdleKeRbIR)as; Staphylococcus aureus Edlman pÞúkRbÚetGuIn A enAelIépÞrbs;va. RbÚetGuInenH)anP¢ab;CamYykMNat; Fc rbs;GgÁbdibkç IgG. GgÁbdibkç IgG

EdleRsab Staphylococci begáIt)anCa Agglutination EdleKGacemIleXIjenAeBlEdlmanvtþman Gg;TIEhSnCak;lak;mYy. etsþenHRtÚv)aneKeRbICacm,gedIm,IviPaKrk)ak;etrIEdlbNþúHrYc b¤rkGg;TIEhSnenAkñúg TwksrIragÁrbs;GñkCMgW (TwkxYrq¥wgxñgkñúgkrNImanCMgWrlakeRsamxYr) . etsþ Agglutination RtÚv)aneRbIpgEdredIm,IrkeraKvinic½äyrbs;vIrus Epstein-Barr (Infection mononucle-

osis), Rotavirus, Rubella nigedIm,IrkGgÁTIEhSnrbs;)ak;etrIepSg²eTot (Haemophilus nig Streptoco-

ccus A nig B kñúgcMeNamepSg²eTot). etsþrkGgÁbdibkç Fluorescent enAkñúgetsþ Immunofluorescneu RbtikrCaPaBsuMa (Immunoreagent) (Gg;TIEhSnb¤GgÁbdibkç) RtÚv)aneK P¢ab;eTAnwgfñaMRClk; Fluorescense dUcCa Fluorescein b¤ Rhodamine ehIyRbtikmμrvagGg;TIEhSn nig GgÁbdibkç RtÚv)aneKrkeXIjtamry³karBinitüedaymIRkÚTsSn_ Fluorescense. cMeBaHetsþrkGg;TIEhSneday pÞal;vij GgÁbdibkç Fluorescein-conjugated RtÚveKeRbIR)as;edIm,IrkvtþmanGg;TIEhSnBiessNamYy. etsþ

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rebobenHpþl;CMnYyy:agsMxan;kñúgkarviPaKrk Chlamydia trachomatis C.psittaci Rickettsia spp. Streptococcus pyogenes Bordettella pertusis Corynebacterium diphtheriae Legionella pneumophila nigemeraKepSgeTotEdlmanenAkñúgvtßúviPaKKøInik. cMeBaHetsþGgÁbdibkç Fluorescent minpÞal;vij (IFA) karerobcMCal,ayCaes‘rIrbs;esr:UmGñkCMgWRtÚv)aneKyk eTA[manRbtikmμCamYynwgGg;TIEhSnBiessNamYynigGgÁbdibkç IgG rbs;mnusS b¤k¾GgÁbdibkç IgM EdleK P¢ab;CamYy Fluorescein rYcCaeRscedIm,ICaRbeyaCn_edIm,I[eKeXIjRbtikmμenH. ]TahrN_³ enAkñúgetsþrk eraKvinic½äyelIesr:Umrbs;GñkekItCMgWsVay Gg;TIEhSnrbs; Treponema pallidum RtUvP¢ab;eTAnwgbnÞHkBa©k;lab BIelIedayesrU:mrbs;GñkCMgW ehIybnÞab;mklagTwk. bnÞab;mkyk Fluorescein-labelled Antihuman

Immunoglobulin dak;elIbnÞHkBa©k;EdlerobcMrYcehIyenH ehIylagTwkecj nigcugbBa©b;ykeTABinitüeday mIRkÚTsSn_ Fluorescence. ebIsinCaesr:UmGñkCMgWmanpÞúkGgÁbdibkçBiesscMeBaH Treponema pallidum enaH eKnwgeXIjBN’ Fluorescent PøWc,as;CaragruWs½r. ebIsinNaCa)ak;etrIEdlmanragCaruws½renH minbgðajCaBN’ Fluorescence eTenaH eKGacniyayfaBuMman vtþmanGgÁbdibkçRbqaMgnwg treponema pallidum BiessenAkñúg esr:Umrbs;GñkCMgWeT. etsþ IFA enHGacRtÚv)aneKeRbIpgEdredIm,IviPaKrk)ak;etrIepSg²eTot edaymanrab;bBa¢Úl TaMg Mycobacteria ehIybec©keTsenHCajwkjymanPaBsg;suIbCagetsþ Immnofluorescence edaypÞal; eTAeToteRBaHfaGgÁbdibkç Fluorescein-labelled nwgP¢ab;eTAnwgkEnøgnImYy²rbs;Gg;TIEhSn. etsþesr:UmsaRsþsMrab; Syphilis etsþesr:UmsaRsþsMrab;rkeraKvinic½äyCMgWsVaymanrab;bBa¢ÚlTaMgetsþelIBYkminEmn Treponema nigTaMgBYk Tre-

ponema. etsþEdlminEmnCaetsþ Treponema enaHmanetsþ VDRL nig RPR. Gg;TIEhSnEdleRbIR)as; enAkñúgetsþTaMgGs;enHRtÚv)aneKerobcMecjBIGg;TIEhSnrbs;BBYkminEmnCa Treponema dUcCa Cardiolipin-

lecithin ehIyvanwgrksarFatu Reagin EdldUcGgÁbdibkç EdlmanvtþmanenAkñúgesr:Umrbs;GñkCMgWsVayCaeRcIn nak; ehIymþgmáaleKGacrkvaeXIjenAkñúgesr:Umrbs;GñkCMgWruaMér:nigRsYcRsav . etsþTaMgGs;enHCaetsþEdleK niymeRbI tMélefak nigKYr[eCOCak;)an eTaHbICaetsþenHminBiessNas;Nak¾eday. etsþenHGacRtÚv)aneRbICa RbeyaCn_kñúgkarepÞógpÞat;rkeraKvinic½äyéneraKsBaØarbs;CMgWsVaydMbUgb¤CitCasHes,Iy b¤pþl;nUvPsþútagénCMgW sVayRkab. etsþenHGacRtÚv)aneKeRbIR)as;pgEdr edIm,ItamdanemIlsPaBCMgWenAeRkayeBleFVIkarBüal)al rYcral;. elIsBIenaHeTAeTotetsþ VDRL KWCaetsþEdlmanRbsiT§PaBmYy kñúgkarRsavRCaveGBIedmIsaRsþénCMgW sVaynigCMgWbNþalmkBIBYk Treponema d¾éTeTot. etsþ treponema eRbIGg;TIEhSn Treponema pallidum edIm,IrkGgÁbdibkçBiessEdlekIteLIgenAkñúgesr:Um EdlCalT§plénkarRbqaMgTb;Tl;nwgkarbgáCMgWsVay. bec©keTsenHRtÚv)aneKeRbIpgEdrkñúgkarepÞógpÞat;elI RbtikmμviC¢man enAkñúgetsþminEmnCa Treponema pgEdr. rIÉetsþ Fluorescent Treponemal Antibody

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Absorption (FTA-Abs) nigetsþ Treponema Pallidum Haemagglutination (TPHA) KWCaetsþEdl Specific nig Sensitive x<s; EteKminGaceFVIkarEbgEck[dac; rvagCMgWsVayEdlkMBugskmμ b¤ekItkñúgeBl GtItkaleT. ehIyk¾eKminGaceRbIedIm,IeFVIkarvaytMélkareqøIytbelIkarBüa)alpgeT.

etsþ VDRL etsþ VDRL CaetsþeKeRbIkMeTcl¥it²én Cholesterol cardiolipi-lecithin-coated. esr:UmGskm μPaB b¤k¾ TwkxYrq¥wgxñg nig Gg;TIEhSnmanenAkñúg VDRL RtUv)aneKlaybBa¢ÚlKñaedayeRbIma:sIunRkLúkkñúgry³eBlkMNt; mYy. kMeTcl¥itEdlmanenAkñúgetsþ VDRL nwgeTACakkb¤kkr ebIsinCamanvtþmanrbs;GgÁbdibkçenAkñúgesr:Um b¤TwkxYrq¥wgxñg. etsþ VRDL bgðaj[eXIjnUvRbtikmμy:agxøaMgenAkñúgCMgWsVaydMNak;kaldMbUg. bnÞab;BIkarBüa)alEdlRtwmRtUv ehIy brimaNénGgÁbdibkçenHnwgfycuHbnþicmþg² ehIyrhUtdl;BuMeXIjmanenA1-2qñaMeRkaymk. enAkñúgdMNak; kalcugeRkayénCMgWesr:Umrbs;GñkCMgWGacenAmanRbtikmμenAkñúgl,ay ¬]TahrN_ 1³8 b¤ticCagenH¦ Gs;ryH eBlCaeRcInqñaM eTaHbICamankarBüa)al)anRtwmRtUvk¾eday. RbtikmμenHGacbBaÆb;edayÉg²RbEhl 20-30° énGñkCMgWEdlmin)anTTYlkarBüa)alenAkñúgdMNak;kalsVayRkab b¤Cajwkjab;enAkñúgGMLúgdMNak;kalcug eRkayénCMgW. lT§plviC¢man-xusGacRtUv)aneKBinitüeXIjpgEdrBIeRBaHEtmanPaBRsedogKñaénGg;TIEhSnEdlmanenAkñúg VDRL CamYynwgekasikarrbs;GñkCMgWFm μta. eTaHbICakrNIRbtikm μviC¢man-xus CYnkalGacRtUv)aneKrkeXIj enAkñúgesrU:mrbs;mnusSFm μtak¾eday k¾Cajwkjab;Rbtikm μTaMgenH vaCab;Tak;TgCamYynwgCMgWBiessNamYy b¤ eRkayeBlcak;va:k;saMg. RbtikmμviC¢man-xuskñúgCm¶WRsYcRsavCaerOy²mankMritl,ayTab¬1³8 b¤ticCagenH¦ ehIyCaTUeTAeKrkvaeXIjCamYynwgGñkCm¶WEdlmanCm¶WbgáeLIgedayvIrus b¤)ak;etrI ¬CMgWrlaksYtminCak;lak; Psittacosis karbgáeraK Mononucleosis nigrlakeføIm¦ enAeBlmanépÞeBaHb¤eRkayeBlTTYlva:k;saMgfμ I². RbtikmμviC¢man-xusEdlyUr CaTUeTAman Titre x<s;EdlekIteLIgedaysarGgÁbdibkçxøÜnÉg¬Autoantibodies¦ ¬ktþa Rheumatoids¦ enAkñúgGñkCm¶WXøg; rebg nigRbB½n§karBarcuHexSay ¬]TahrN_ Lupus erythematosus ,

Collagenosis, Cm¶Wrlaksnøak; Sjögren Syndrome, Dysgammaglobulinaemia¦ nig mþgmáalenAelIGñk CMgWRKuncaj; b¤GñkeRbIR)as;eRKOgejÓnehr:UGIun. eTaHCaRbtikm μskm μ b¤Rbtikm μya:gexSayk¾eday k¾lT§plén etsþ VDRL minRtUv)aneKKitfaCaPsþútagdac;xat rbs;Cm¶WsVayEdr ehIyetsþ VDRL minRbtikm μxøÜnva k¾min RtUvTat;ecalCMgWsVayEdr. RKb;vtßúviPaKTaMgLayEdlpþl;nUvlT§plskmμ b¤Rbtikm μskm μexSay kñúgxN³Edl GvtþmanPsþútagKøInikénCMgWsVay enaHeKKYrEtykvaeTAeFVIetsþepSgeTotdUcCa FTA-Abs b¤ TPHA.

183

smÖar³ nigRbtikrEdlmanenAkñúgkBa©b;etsþ VDRL sUluysüúg Buffered saline

Qutesr:UmsMrab; etsþRtYtBinitü ¬BMumanRbtikmμ Rbtikm μexSay nig Rbtikm μxøaMg¦ Gg;TIEhSn VDRL

smÖar³nigRbtikrbEnßmEdleKtRmUvenAkñúgkareFVIetsþ VDRL Gal;kulsuT§ nig GaestUn bnÞHkBa©k;sMrab;eFVI Agglutination EdlmanTMhMRbEhl 5,75× s>m edaymanxUgGgát;p©it16m>m nigCMerA 1/75 m>m. eKeRbIbnÞHkBa©k;enHsMrab;eFVIetsþTwkeRsamxYrq¥wgxñg. kUndbmanRkwt Twkbitb¤TwkdkCatiGIuy:ug canEkvedayman)a:ra:hVIncMnYn12 b¤kgesra:micmanGgát;p©itRbEhl14m>m sMrab;eFVIetsþesr:Um KRmbesIm m¢úlsMrab;cak;eRkamEs,kedaykat;bBaäitxagcugecj³ elx18sMrab;eFVIetsþesrU:m nig elx21 b¤ 22 sMrab;eFVI etsþTwkxYrq¥wgxñg naLikarkMNt;ema:g mIRkUTsSn_mYyEdlmanEkvBRgIkRtg;EPñkemIl x10 nig EkvBRgIkRtg;bnÞHkBa©k; x10 m:asIunbgVilEdlpþl;[CargVg;manGgát;p©it 2s>m nigmanel,Ón 180rev/naTI. Edldak;elITMrepþkl¥nigmanP¢ab; edaynaLikarkMNt;sV½yRbvtþipg. ]bkrN_sMrab;vas; pH

bMBg;BIEb:tesr:Um³ 5/0m>l 1/0m>l nig 0/2m>l sUluysüúgesr:UméRbs¥atKμanemeraK ¬0/85° nig 10°¦ sWrauMgRbePT Luer EdlmancMnuH 1b¤2m>l dbGg;TIEhSn VDRL EdlrlaycMnYn30m>l manragmUl manKMrbEkv manmat;tUc nigman)atxagkñúg rabesμ I Edlman Ggát;p©itRbEhl35m>m FugTwk ¬kMedA56GgSar¦

karbRgÁb;CatiTwkénGg;TIEhSn VDRL nigesr:UmRtYtBinitü Gg;TIEhSn VDRL KWCaRbePTsUluysüúgGakulénlIBIt ¬Cardiolipin nig Lecithin¦ nig Cholesterol. sarFatuTaMgGs;enHminrlayenAkñúgTwkeT. Gg;TIEhSn VDRL minesßreT ehIyl,ayKYrEteFVIeLIgenAéf¶

184

eRbIR)as;Etmþg. cak;Gg;TIEhSnEdlmanenAkñúgGMBUleTAkñúgkUndbtUc. [c,as;fadbEdlykmkdak;enHCa dbEdlbiT KMrbCitl¥ ehIydak;enAkñúgTIkEnøgggwtkñúgkMedA15-30GgSar. bUmykGg;TIEhSntamtRmUvkar. bnÞab;GMBIdb Buffered saline RtUv)aneKebIk vaKYrEtrkSaenAkñúgTUrTwkkk. cak; Buffered saline Edlman kkrecal. karbRgÁb;CatiTwkesr:UmRtYtBinitüCamYynwgTwkbitb¤TwkdkCatiGuIy:ugcMnYn 3m>l. EckesrU:mEdl)anbRgÁb;CatiTwk ehIyeTAtambrimaNkMNt;EdlRtUveRbIRbcaMéf¶rYcrkSaenAsItuNðPaB-20GgSar. eKGacrkSaesr:UmEdlerobcMrYc enHrhUtdl;eTAmYyEx. minRtUveFVIeGayrlayrYceFVIeGaykkmþgeToteLIy. rkSaesr:UmEdlRtUveRbIR)as;enAkñúg TUrTwkkkenAsItuNðPaB-20GgSar.

karerobcMl,ayGg;TIEhSn VDRL 1> TukeGayGg;TIEhSnnig Buffered saline eLIgdl;sItuNðPaBmnÞIrBiesaFn_. RtYtBinitü pH én Buffered

saline nig cak;ecalebIsinCavaman pH sßitenAeRkArgVg; pH=6,0 ± 0,1. 2> bWtyk Buffered saline cMnYn 0/4m>l eTAkñúgdbl,ayGg;TIEhSnrYcRkLúkdbfñm² eFVIdUecñaHeTIbeKeXIj

Buffered saline RKbdNþb;)atdb. 3> bUmyksUluysüúgGg;TIEhSn 0/5m>l edayeRbIbMBg;bWtmanRkit 1m>l rYcrkSaTukenAnwgcugbMBg;bWtenaH.

bEnßmGg;TIEhSndUcxageRkamenH³ • rkSabMBg;bWtenARbEhl 1 PaK 3xagelIéndb. minRtUv[bMBg;bWtb:Hnwgdbesr:UméRbeT. • enAeBlEdlbgVildbedayéd ragCargVg;EdlmanGgát;p©itRbEhl 5s>m bEnßmGg;TIEhSnmþgmYytMNk;

eTAelI Buffered saline. • cMNayeBlRbEhl 6 vinaTIkñúgkarbEnßmGg;TIEhSn rYc)aj;Gg;TIEhSnEdlenAesssl;Cab;nwgbMBg;bWt

[Gs;eTAkñúgdb. • bnþbgVildbenaHry³eBl 10 vinaTI.

4> bEnßm Buffered saline 4,1 m>l eTAkñúgdbeday[vahUrFøak;cuHtamépÞdbxagkñúg. 5> dak;cñúkEkveTAkñúgdbenaHrYcGRgYnRtLb;cuHRtLb;eLIgRbEhl 30 dgedaycMNayeBl 10 vinaTI. 6> Tukl,ayGg;TIEhSnenHecaly:agtic 10naTImunnwgeRbIR)as;. RKElgsUluysüúgenHfñm²munnwgeRbIR)as;.

l,ayGg;TIEhSnenHKYRtUveRbIR)as;enA8em:agbnÞab;. 7> ebIsinCavtßúviPaKCaTwkxYrq¥wgxñg eKRtUvlayGg;TIEhSnenaHbEnßmeTotkñúgl,ay 1³2 CamYynwgl,ayesr:Um

éRb 10°. GRgYndbenaHfñm²ryHeBl 10naTI nigTukecaly:agtic 5naTInigy:agyUrRtwm 2 em:agmuneBl eRbIR)as;.

185

etsþ VDRL Qualitative 1> eRbIR)as;bMBg;bWt 1/0m>l layesr:UmEdlBMumanskmμPaBCaeRcIndg rYcbEnßm0/05m>l eTAkñúgRKlukTI 1

éncanEkvsMrab;eFVIetsþ. 2> )aj;esrU:mCaclnaragrgVg;edayeRbIbMBg;bWt dUecñaHesr:UmGacRKbdNþb;épÞxagkñúg énRKlukEkvenaH. RtUvcg

caMfa eRbIR)as;EtcanEdls¥atEdlGaceGayesr:UmRKbeBjépÞTaMgmUl rbs;RKlukesra:micb¤)a:ra:hVIn. 3> yksWraMugEdlmanm¢úlelx18 ehIykan;bBaÄrrYcdak;tMNk;Gg;TIEhSn ¬1¼60 m>l¦eTAkñúgesr:Um. minRtUv

[m¢úleTAb:Hnwgesr:UmeT. 4> dak;bnÞHetsþeTAelIma:sIunbgViledaymanKMrb ehIybgVilcMnYn 4 naTI . ebIsinCaBMumanm:asIunbgVileT

cUrbgVilbnÞHetsþedayeRbIédCargVg;ry³eBl 4 naTI Edr . 5> eFIVkarBinitübnÞHetsþPøam²bnÞab;BIbgVilrYcedayeRbImIRkUTsSn_EdlmanEkvBRgIkenAnwgEPñk X10 nigenAnwg

bnÞHetsþ X10 . 6> cUrGanRbtikmμdUcxageRkam ³

mankkrl μm b¤CadMuFM² R: manRbtikmμ mankkrtUc² W: Rbtikm μexSay BMumankkr b¤esÞIrEtBMumaneXIjkkrenaH N: BMumanRbtikmμ esr:UmEdlbegáIt[manRbtikmμexSay b¤BMumanRbtikmμ KYrEtRtUv)aneKsakl,geFVIetsþmþgeTot edayeRbIetsþ Semi-quantitative eRBaHfaeKGacrkeXIjyUr²mþgEdr . etsþ VDRL Semi-Quantitative 1- erobcMsUluysüúg CaesrI Two-fold sUluysSúg edayeRbIesrU:mEdlBMumanskmμPaBeTAkñúgesr:UméRb

0/85° ¬1³2/ 1³4/1³8/1³16/1³32¦ 2- eFVIetsþl,ayesr:UmnImYy²edayeRbIbec©keTs quantitative . 3- raykarN¾lT§plBIl,ayesr:UmBRgavx<s;CageK EdlbegáIteGaymanRbtikm μ ¬minEmnkñúgkrNIRbtikmμ

exSayenaHeT¦RsbdUcxageRkam ¬kñúgtarag¦ 4- ebIsinCalT§plRbtikmμviC¢manrhUtdl;elIsBIl,ay 1³32 cUrerobcMlayl,ayeTVdgbnþeTotCamYynwg

es:UméRb 0/85° ¬1³64 1³128 nig 1³256¦ rYceFVVIetsþmþgeTottambec©keTs Qualitative .

186

l,ay r)aykarN_

esr:UmminTan;rlay 1:2 1:4 1:8 1:16 1:32

W N N N N N RbtikmμexSay minTan;lay

R W N N N N RbtikmμminTan;lay

R R N N N N Rbtikmμl,ay 1³2

R R R W N N Rbtikmμl,ay 1³4

W W R R N Rbtikmμl,ay 1³8

N ¬enARKab;²¦ W R R R N Rbtikmμl,ay 1³16 W RbtikmμexSay R Rbtikmμ N KμanRbtikmμ etsþ RPR l,ayGg;TIEhSnenAkñúg RPR etsþpÞúkedaykMeTcFüÚgtUc²EdlGac[eKemIleXIjedayEPñkTeTenAeBlkk. PaBxusKñaCacm,grvag RPR nig VDRL KWkareRbIR)as;Gg;TIEhSnEdlminERbRbYl eRbIbnÞHRkdas;CMnYscanEkv eRbI)anTaMgesr:Um TaMg)øasμa nigmincaM)ac;kMedAesr:UmeT. edaysarEteKeRbIR)as;vtßúviPaKEtbnþicenaH eKGacyk )øasμab¤esr:UmecjBIsrésQamtUc²k¾)anEdr. b:uEnþetsþ RPRminGacRtUv)aneKeRbIR)as;CamYynwgTwkxYrq¥wgxñgeT enAkñúgetsþ RPR Gg;TIEhSnRtUveKeRtomrYcCaeRscedIm,IykeTAeRbIR)as;Pøam². ehIyvamincaM)ac;erobcMCamun b¤layl,ayenaHeT. RbtikrCaGg;TIEhSnEdlminTan;ebIkeRbIR)as; CaTUeTAmanRbsiT§PaBeRbIR)as;mYyqñaM. ehIyeKKYrEtrkSavaenAkñúgTUTwkkk. enAeBlEdleKebIkeRbIR)as;RbtikrCaGg;TIEhSnGacrkSaskmμPaBrbs;va )anbIExebITukenAkñúgTUTwkkkkñúgdb)øasÞikrbs;va. etsþ RPR man Sensivity Cagetsþ VDRL bnþic ehIy gayRsYleFVICag nigelOnCagetsþ VDRL. kBa©b;EdleKeFVIdak;lk;enAtamTIpSarmYycMnYntRmUv[eFVIkarbgVil edayma:sIunedIm,IlayRbtikrEtxøHbgViledayédk¾)an . smÖar³ nigRbtikrEdlpþl;[kñúgRbGb;etsþ RPR m¢úlsMrab;bUmykl,ayGg;TIEhSnEdlmancMNuH 60 tMNk;¼m>l esr:UmsMrab;RtYtBinitüetsþ³ esr:UmviC¢man nigesr:UmGviC¢man bMBg;bnþk;EdleRbIehIye)aHecal edIm,IbUmesr:Um b¤)øasμacMnYn 50 mIRkUlIt bnÞHBasC½r)øasÞiksMrab;eFVVIetsþ RPR . enAelIbnÞHnImYy²manBIrCYr kñúgmYyCYr²manRKlukR)aM l,ayGg;TIEhSn RPR EdlerobcMrYcCaeRsc Rbdab;sMrab;kUr

187

smÖar³bEnßm nigRbtikrcaM)ac;sMrab;eFVIetsþ RPR bMBg;bnþk;EdleRbIehIy Rkvat;ecal exμAéd KRmbesIm m:asuInbgVilEdlmankMritrgVg;manviC¢maRt 2 s>m nigmanel,Ón 180 rev¼naTI ehIyEdldak;enAelIépÞ rabes μ I edayP¢ab;CamYynwgnaLikarkMNt;eBlevlaCasV½yRbvtþi esr:UméRbs¥atKμanemeraK ¬0/ 85°¦ etsþ RPR quantitative 1- ykkBa©b;RbtikrecjBITUTwkkk ehIyTukRbtikr[mansItuNðPaBesμ IrnwgsItuNðPaBmnÞIBiesaFn_ 2- pSMesr:UmRtYtBinitüedaybEnßmbrimaNTwkbiteTAtamkarENnaM 3- biTsøak b¤biTelxenAelIRKlukénbnÞHetsþ RPR edayeyaleTAtamelxrbs;mnÞIrBiesan¾énvtßúviPaK

EdlRtUveFVIetsþ edaymanrab;bBa©ÚlTaMgRKluksMrab;RbtikmμviC¢man viC¢manexSay nigGviC¢manrbs;etsþ RtYtBinitü .

4- eRbIR)as;bMBg;bnþk;mþgRkvat;ecal bEnßm 50 mIRkUlIRténesr:Um b¤)øasμaEdlminmandak;kMedAeTAkñúgRKluk enAelIbnÞHetsþenaH . cUreRbIR)as;bMBg;bnþk;fμ IenAerogral;vtßúviPaKnImYy² .

5- GRgYnfμm²énl,ayGg;TIEhSn rYcbUmykmYytMNk;eTAbEnßmelIRKlukenaH edayeRbIm¢úlsMrab;bUm Edl manenAkñúgRbGb;etsþenaH. layl,ayGg;TIEhSnCamYynwgesr:Umfμm². cUreRbIR)as;eQIkUrf μ IsMrab; sMNaknImYy². BRgayeGayvaRKbdNþb;eBjkñúgépÞRKluuk.

6- dak;bnÞH)øasÞikenAelIma:sIunbgViledaymanKRmbmansMeNImpg nigbgVilkñúgry³eBl 8 naTI. ebIsinCa BMumanma:sIunbgVileT eKGacbgVilbnÞH)øasÞikedayédCamYynwgclnaragCargVg; manry³eBl 2 naTIrYcdak; vaenAkñúgbMBg;mansMeNImEdlmanRkdasepSImTwk b¤RkdaseRcaHEdlmanepSImTwkTukecal 6 naTIeTot. dkykbnÞH)øasÞikecj rYcbgVilmþgeTotedIm,IBinitüemIllT§plcugeRkay. cUreFIVIkargaredayRbugRby½tñ edIm,IkMu[qøgemeraKBIxageRkAcUlkñúgvtßúviPaK.

7- dkykbnÞHecjBIm:asIunbgVil rYcBinitünwgEPñkTeTeRkamTItaMgEdlmanBnøWRKb;RKan;. esrU:mRtYtBinitü EdlviC¢manRtUvEtbgðaj[eyIgeXIjc,as;las;nUv Agglutatination. rIÉesr:UmRtYtBinitüetsþGviC¢man RtUvEtbgðajfaBMueXIjman Agglutatination GVITaMgGs;. karbgVil nigkarep¥ógp¥gelIkcugeRkayeday eRbIédGac[eyIgeFVIkarEbgEckrvagRbtikm μexSay nigminmanRbtikmμ.

188

8- eFVIr)aykarN_nUvlT§plrbs;etsþ³

karkkBItUceTAFM ¬xøaMg¦ ³manRbtikmμ manCakkrrbs;sarFatul¥itkñúgl,ay ³ BMumanRbtikmμ

9- erobcMeFVIl,aybnþKña cMeBaHesr:UmEdlviC¢manTaMgLayedIm,IeFVIkar)a:n;sμan TitreGgÁbdibkç . etsþ RPR Semi-quantitative 1- ykkBa©b;RbtikrecjBIkñúgTUTwkkk nigdak;RbtikrTaMgenaHeGayekþAenAkñúgsItuNðPaBmnÞIrBiesaFn_ . 2- biTelx b¤kt;RtasMKal;CYrEdlmanRKlukR)aMEdlmanenAelIbnÞH RPR eTAtamelxkñúgbBa¢Irbs;mnÞIr

BiesaFn_sMrab;vtßúviPaKnImYy² . 3- eRbIR)as;bMBg;sMrab;bnþk;EdleRbIehIye)aHecaledIm,IbEnßmsUluysüúgesr:UméRb 0/ 85° mYytMNk;eTA

elIRKluknImYy² b:uEnþminRtUvkUreT . 4- eRbIR)as;bMBg;bnþk;fμI bUmykesr:Umrbs;vtßúviPaKmYytMNk;eTAbEnßmBIelIRKlukTImYy. Rcbl;edayclna

TajbMBg;bnþk;eTAelIcuHeRkamcMnYn 5-6 dg ¬cUreCogvagkarbegáItCaBBuH¦ . 5- epÞr 50 mIRkUlIRtBIRKlukTImYyEdllayrYc ¬l,ay 1³2¦ eTAkan;RKlukbnÞab;mkeTot. eFIVdUcKñadEdl

enHrhUtdl;RKlukTIR)aM ¬l,ay 1³32¦. rYcbUmecalcMnYn 50 mIRkUlIRtecjBIl,aycugeRkay. 6- BRgayvtßúviPaKEdllayehIyenH [eBjRKlukénbnÞH)øasÞikedaycab;BIRKlukeEdlmanl,ayx<s;.

cUrcgcaMfa eRbIeQIkUrfμ IenAeBleFVIelIvtßúviPaKf μ I . 7- GRgYnGg;TIEhSnf μm² rYcbUmykmYytMNk; ehIydak;elIRKluknImYy²edayeRbIm¢úlsMrab;bUmyk

Gg;TIEhSnenaH. layl,ayGg;TIEhSnCamYynwgesr:Umfñm². kUr[l,ayenHeBjépÞRKlukénbnÞH)øasÞik RtUvdUrC½rkUrenAral;eBlvtßúviPaKfμ I .

8- dak;bnÞH)øasÞikenAelIm:asIunbgViledaymanRKbKRmbBIxagelI nigeFVIy:agNa[mansMeNImpg. bgVil ry³eBl 8naTI . EtebIKμanma:sIunbgVileT eKGacbgVilvaedayédtamclnaCargVg;dEdlry³eBl 2naTI rYcdak;vaeTAkñúgtMbn;mansMeNIm EdlGacCaRkdasepSImTwk b¤RkdaseRcaHEdlepSImTwk nigTukecal ry³eBl 6naTI. dkykbnÞH)øasÞikecjBIma:sIunbgVil rYceFVIkarBinitülT§plcugeRkaytamry³karbgVil fμm². RtUveFIVkaredayRbugRby½tñedIm,IkMu[mankarqøgemeraK.

9- dkykbnÞH)øasÞikecjBIm:asIunbgVil rYcBinitünwgEPñkTeT eRkamTItaMgEdlmanBnøWc,as;las;. l,ayEdl x<s;bMputEdleKBinitüeXIjman Agglutinaton edaypÞal;EPñkKWCakarbgðajGMBIkMriténGgÁbdibkçEdl manenAkñúgvtßúviPaK.

10- ebIsinCalT§plbBa¢ak;faviC¢manenAl,ay 1³32 enaHeKKYrbnþeFVIl,aybnþKñaeTot. erobcMl,ay 1³16 kñúgesr:UméRb ¬0/85°¦ nigeFVICal,ayCabnþbnÞab;dUc)anerobrab;xagelI.

189

etsþ Fluorescent Treponemal Antibody Absorption (FTA-Abs) Gg;TIEhSnEdleRbIkñúgetsþ FTA-Abs manenAkñúg Treponema pallidum ¬BBYk Nichols¦EdleKP¢ab;CamYy nwg Acetone enAelIbnÞHkBa©k;. ekasikarbs; Treponema pallidum EdleKbnSúT§[eTACaemSARtUv)aneKeRbI pgEdr edayykmklaymþgeTotCamYynwgesr:UméRb. esr:UmGskm μrbs;GñkCMgWRtUv)aneKdak;bNþúHCamYyvtßúbWt CatiTwkEdlmanpÞúk Reiter treponemes sMrab;bWtykRkumGgÁbdibkçEdlminBiessrbs;Rkum Treponema. eRkayGMBIkareRCotcUlrYcmk eKRtUvykesr:UmGñkCmøWeTAdak;elIbnÞHkB©ak;. GgÁbkçdibkçEdlBiess enAkñúgesr:Um etagCab;CamYyépÞénekasikarrbs; Treponemes. bnÞab;BIlagTwkrYcdak;bEnßm Conjugate Antihuman

Antibodies edaymanP¢ab;rYcCaeRscnUvsarFatu Fluorescent (Fluorescein isothiocyanate) elI Trepo-

nemes. Conjugate enHnwgetagP¢ab;CamYynwgGgÁbdibkçEdl)anetagP¢ab;CamYy Treponemes rYcehIy nig GaceGayeKemIleXIjeday mIRkUTsSn_ Fluorescence . RbtikmμviC¢mannwgGacRtUv)aneKBinitüeXIjenAkñúgkMLúg3s)þah_ bnÞab;BIbgáCm¶W b¤k¾GacemIleXIjCaerogrhUteTA elIGñkCm¶WEdlmin)anTTYlnUvkarBüa)al. eKGacemIleXIjrhUteRkay 4 eTA 5 qñaM eRkayeBlEdleKBüa)al )aneCaKC½yenAkñúgtMNak;kaldMbUgénCm¶W nigGacemIleXIjrhUtcMeBaHGñkCm¶WTTYl)annUvkarBüa)alenAkñúg dMNak;kalcugeRkayénCm¶W . etsþ FTA-Abs EdlmanRbtikmμbgðajGMBIlkçN³bgáCm¶Wkan;EtxøaMgcMeBaHGñkCm¶WsVay. lT§pl viC¢man-xus CakrNIelIkElgmYyedaysarEtRbsiT§PaBénGg;TIEhSn. RbtikmμviC¢man-xus GacbNþalmkBImUlehtu Rkum GgÁbdibkç EdlminRtUv)aneKkMcat;Gs;enAkñúgdMNak;kaleFVI[RCab b¤bNþalmkBIRbtikrxUcKuNPaB. lT§pl viC¢man-xusGacRtUv)aneKpþl;lT§plcMeBaHGñkCm¶WRkineføIm Cm¶Wrlakk,allwgÁ Collagenosis Cm¶W Herpes

eBlmanKk’ Xøg; ehIymþgmáalekItmancMeBaHGñkCm¶WEdlmanépÞeBaH b¤GñkmansuxPaBFm μta edayBMudwgGMBI mUlehtuc,as;las;. RbtikmμExVgrvag T. pallidum nig Borrelia burgdorferi ¬Cm¶WkUnkNþúr¦RtUv)aneKrkeXIjpgEdr. enAkñúg vtßúviPaKmYycMnYnEdlmanbrimaN Titre GgÁbdibkçx<s;minsmamaRt enAkñúgetsþ FTA-Abs enH ebIeRbobeFob CamYynwgetsþesr:UmsaRsþd¾éTeTot eKKYreFVIetsþedIm,IrkGgÁbdibkçRbqaMgCamYynwg Borrelia . KuNsm,tþicm,génetsþ FTA-Abs KWvaman Sensitivity nig Specificity ehIyk¾manRbtikmμelOnpgEdr. rIÉlT§plEdlTTYl)an CalT§plKYr[eCOCak;)an ehIyCYnkaleKeRbIvasMrab;karsMerccitþenAkñúgkrNIsgS½y pgEdr . EteTaHCaya:gNak¾eday etsþ FTA-Abs sIueBleRcIn nigéf¶. vaRtUvkarbuKÁlikEdl)anTTYlkar bNþúHbNþalx<s; edIm,IeFVI nigGanlT§pl. dUcenHvaKYrEtRtUveKeRbIsMrab;EtbBa¢ak;eraKvinicä½yEdlmankarsgS½y Etb:ueNÑaH.

190

smÖar³ nigRbtikrEdlmanenAkñúgRbGb;etsþ FTA-Abs sUluysSúg Buffer esr:UmRtYtBinitü Edlmanesr:UmviC¢man nigGviC¢man Fluorescein-labelled antihuman immunoglobulin (Conjugate) Reiter troponemes EdleKerobcMCaemSAs¶Üt ¬Sorbent¦ Pñas T. pallidum EdleKerobcMP¢ab;elIbnÞHkBa©k;CaeRsc smÖar³bEnßm nigRbtikrcaM)ac;EdleRbIsMrab;eFVIetsþ FTA-Abs snøwkKMrb mIRkUTsSn_ Flurescence edaymanBnøW UV ¬EkvBRgIkenAnwgEPñk x 40¦ fñalbMBg; Mounting medium

Phosphate-buffered saline Edlman pH 7.2 (PBS) Tween 80 (2%)-PBS etsþ FTA-Abs 1- ykRbGb;RbtikrecjGMBITUTwkkk rYcdak;va[sßitenAkñúgsItuNðPaBmnÞIrBiesaFn_ . 2- ykcMnYnbnÞHkBa©k;EdlRtUvkardak;[sißtenAkñúgsItuNðPaBmnÞIrBiesaFn_ry³eBl 15 naTI . 3- layesr:UmcMnYn 50 mIRkUlIt CamYynwg Sorbent cMnYn 0/ 2 mIlIlIRt rYckUrbBa©ÚlKña. layesr:Umetsþ

RtYtBinitüviC¢man nigGviC¢man[manPaBdUcKñaKW 1³5 enAkñúgsUluysSúg Buffer (Conjugate) nig 1³5 enAkñúg Sorbent .

4- cak;sUluysSúg Buffer cMnYn 100 mIRkUlIt ¬Conjugate sMrab;RtYtBinitü¦ BIelIbnÞHkBa©k; EdlBas vtßúviPaKrYc nig Sorbent ¬Sorbent sMrab;RtYtBinitü¦ 10 mIRkUlIRt eTAelIbnÞHkBa©k;TIBIr .

5- enAelIbnÞHkBa©k;enAsl;epSgeTot eKdak;enAelIbnÞHkBa©k;nImYy²nUv 10 mIRkUlIRténl,ayesr:UmemeraK nigl,ayesr:UmRtYtBinitü .

6- dak;bnÞHkBa©k;enAkñúgmCÄdæanmansMeNImry³eBl 30naTIkñúgsItuNðPaB 37GgSar. lagsMGatbnÞHkBa©k; cMnYn 5naTIkñúgsUluysSúg Tween-PBS. lagmþgeTot. rYclagCamYynwgTwkbit rYcTukbnÞHkBa©k;[s¶Üt enAkñúgRbGb;dak;bnÞHkBa©k;.

7- dak;BasBIelIbnÞHkBa©k;TaMgGs;nUv 10mIRkUlIRténl,ay Antihuman Immunoglobulin EdleKlay enAkñúgsUluysSúg Buffer GaRs½yeTAtamesckþIENnaMrbs;GñkplitRbtikr .

191

8- dak;bnÞHkBa©k;enAkñúgmCÄdæanmansMeNImry³eBl 30naTI kñúgsItuNðPaB 37GgSar. lagbnÞHkBa©k;enaH

cMnYn 5 naTICamYynwg Tween-PBS. lagmþgeTot RKbbnÞHkB©ak;TaMgGs;. lagCamYynwgTwkbitrYcTuk [s¶ÜtenAkñúgRbGb;dak;bnÞHkBa©k; .

9- dak;BasBIelIbnÞHkBa©k;nImYy²cMnYn 2 tMNk;én Mounting Medium rYcRKbbnÞHkBa©k;. 10- BinitüemIl Conjugate rbs; Sorbent nigesr:UmRtYtBinitüGviC¢man[c,as;favaK μanBN’ Fluoresce eT.

• BMumanBN’ Fluorescence b¤man Treporemes BN’ébtgx©I³ RbtikmμGviC¢man • kMritBN’ Fluorescenceébtg³ Rbtikm μviC¢man

kMriténBN’ fluoresence GacRtYv)aneKcMNat;fñak;dUcCa ³ BMumanRbtikm μ minc,as;las; 1÷/ 2÷/ 3÷ manRbtikmμ 4÷ RbtikmμEdlmancab;BI 2÷ eLIgeTA RtUv)aneKcat;Tukfa mankarbgáCm¶Weday T.pallidum . etsþ Febrile agglutinins RKUeBTüEdlBüa)alGñkCm¶WEdlmanRKunekþAEdlminGacBnül;)an EtgEteFVIkaresñIsMukareFVIetsþesr:UmsaRsþ Caes‘rI EdleKsÁal;faCaetsþ Febrile agglutinins edIm,IrkemIlkarbgáCm¶WmYyEdlbgáeLIgeday Brucella

¬etsþ Wright¦ Salmonella typhi ¬eFVIetsþ Widal¦nigBBYk Rickettsias mYycMnYn¬Rbtikmμ Wei-Felix¦. etsþ)anvas;EvgnUv Agglutination EdlekIteLIgedaysarGgÁbdibkçRbqaMgnwgGg;TIEhSn O EdlsßitenAépÞxag eRkAén)akétrI b¤Gg;TIEhSn H EdlsßiteTAnwgRbemay b¤enAkñúgkrNIRbtikmμ Weil-Felex eKeXIjmanRbtikmμ ExVgmYyEdlekItmanpgEdrenAelIGg;TIEhSnrbs;BBYk Proteus vulgaris. etsþ Widdal nig Weil-Felix KWCaktþaEdleKmintRmUv[eRbIR)as;eToteT edaysaretsþTaMgenHpþl;nUvbBaðakñúg karbkRsay nigbBaðabec©keTs. Rbtikm μGviC¢mannwgminGacTat;ecal)anpgeTnUvkarbgáCm¶WdUcCa kñúgry³eBl sm¶M b¤GñkCm¶WBMuTan;begáItCaGgÁbdibkçRbqaMgnwgemeraK. )atuPUt Prozone k¾ekItmanEdrenAkñúgRbtikm μGviC¢man TaMgenHGacRtUv)aneKkarBar)anedaysarkareFVIl,ayCaes‘rI. lT§plviC¢manCamYynwgGg;TIEhSnNamYy Gac minEmnCaeraKvinic½äyeT edaysarEtGñkCm¶WGacnwgbgðaj[eXIjnUvkarelceLIgnUv Heterogenous aggluti-

nins enAkñúgkMLúgeBlkarvivtþn_énCm¶W. Rbtikm μTaMgGs;enaH RtUv)aneKsÁal;fa CaRbtikm μrMlwkminCak;lak; eRBaH EtGñkCm¶W)aneqøIytbeTAnwgrMejacGg;TIEhSn ehIybegáIt)anCa Agglutinins minBiessmYy ¬Nonspecific

agglutinins¦. TaMgGs;enH)aneFVI[etsþesr:UmsaRsþsMrab;eraKvinic½äyEdlBwgEp¥kelIbrimaNénGgÁbdibkç Titre

192

Edlx<s;enaHmanPaBminc,as;las; nigmanEtpøÚvm:üagKt; KWkareFVIesr:Um Conversion edaytMeLIg Titre 4dg b¤ FMCagenH enAelIl,ayes‘rIrbs;esr:UmnwgGacTTYl)anfa CaGaMgDIkaT½énkarbgáeraKfμ I². GñkCm¶WPaKeRcInEdlmanCm¶W Brucellosis RsYcRsavnwgman Agglutinin titre 1 ³ 320 b¤FMCagenH kñúgkMLúg cugs)þah_TIBIrénkarbgáCm¶W. eTaHbICasßitenAdMNak;kalmYyqñaM eRkayeBlBüa)alk¾eday k¾eKeXIjfa 20° én GñkCm¶WEdlTTYlrgnUvkarBüa)alnwgbnþmanCaRbtikmμ Agglutinins dEdl. Brucella agglutinin titres x<s; k¾mankt;RtaTukpgEdrenAelIGñkCMgWbgáedayBYk Francisella tularensis nig Yersinia entero-colitica nig enAelIGñkCMgWEdlknøgmkfμ I²manCMgW Brucella b¤k¾cak;va:k;saMgCMgWGasnñeraK b¤)aneFVIetsþCamYynwgetsþEs,k Brucellergin. Rbtikm μ Agglutination enHmþgmáalRtUv)aneKkt;RtaenAelIkmμkreFVIkarenATIstVXat. edaysarEtkarbNþúHQamGacnwgBMu)anrkeXIjnUvemeraK eTaHCaeKeFVIeRcIns)þah_k¾eday dUecñHkareFVIetsþ Agglutination GaceqøIytbeTAnwgkarrkeraKvinic½äyénCm¶W Brucellosis RsYcRsav. karrkemeraKenH eXIjenA kñúgkarbNþúHQam CaTUeTAKWCaGMNHGMNagd¾Cak;lak;mYyénkarbgáCm¶W. EteTaHCay:agNak¾eday enAkñúgkrNI EdlmankarsgS½y kñúgxN³eBlEdlkarbNþúHQamminGacbgðajBIeraKvinic½äyénkarbgáCm¶WeTenaH karbUmykxYr énq¥wgsnÞHRTUgGacnwgRtUv)aneKeFVIedIm,IykmkbNþúHrk)ak;etrIRbePTenH. GñkCm¶WEdlpÞúkCm¶W Brucllosis enA nwgkEnøgBMumanRKunekþAeT ehIyk¾GacnwgminmanRbtikm μ Brucellla agglutination titre Edr. enAkñúgkrNIenH karsgS½yCm¶WKWEp¥keTAelIsPaBeGBIedmIsaRsþ nigedaykarrkeXIjkUnkNþúreLIgCatikal;süÚm enAelI X-Ray b:uEnþeraKvinic½äyKYrEtRtUv)aneKepÞógpÞat;tamry³karbNþúH. kareFVIetsþelOnelIbnÞHkBa©k;KWCaetsþErgEdleKerobcMeLIgedIm,IrkemIl Agglutinin kñúgxN³Edletsþ enAkñúg bMBg;EkvKWCaetsþbBa¢ak;EdleKerobcMeLIgedIm,Ivas;brimaN Agglutinin. lT§plviC¢manTaMgLayEdleKTTYl )anCamYyetsþenAelIbnÞHkBa©k;enH KYrEtRtUv)aneKeKepÞógpÞat; CamYynwgetsþenAkñúgbMBg;TIb . smÖar³ nigRbtikrEdlmanenAkúñgRbGb;etsþ Febrile Agglutinins l,ayGg;TIEhSn ¬ B. abortus, B. melitensis ¦EdlrkSaenAkñúgdbedayP¢ab;mkCamYynUvbMBg;sMrab;bNþk; esr:UmsMrab;RtYtBinitüGviC¢man esr:UmsMrab;RtYtBinitüviC¢man smÖar³bEnßm nigRbtikrEdlcaM)ac;enAkñúvetsþ Fibrile Agglutinins eQIsMrab;kUr canEkv exμAéd

193

bMBg;bWt cMNuH 50-1000 mIRkUlIRt bnÞat; esr:UméRbKμanemeraK ¬0/ 85°¦ bMBg;EkvsMrab;eFVIetsþ nigTRm naLika FugTwksMrab;kMedA nig]bkrN_sMrab;RtYtBinitüsItuNðPaB etsþ Febrile Agglutinins elIbnÞHkBa©k; eKcUlcitþeFVIetsþenHenAkñúgbMBg;Ekv eRBaHvaBMusUvmanPaBs μ úKsμaj . 1- esr:UmEdleKykeTAeFVIetsþ RtUvEtCaesr:UmEdlføa nigBMumankñúgdMuxøaj; b¤BMuKYrmankarEbkRKab;Qam b¤man

karqøg)ak;etrIcUleT. eKBMuKYrkMedAesr:UmeTeRBaHvaGacbMpøaj Thermolabile Agglutinins. 2- erobcMbnÞHkBa©k;eFVIetsþedayKUrCataragragkaer:EdlmanRCug 2/5s>medayeRbIR)as;bnÞat; nigexμAéd. CYr

nimYy²Edlman 5karer:GacRKb;RKan;sMrab;eFVIetsþGg;TIEhSnmYyTl;nwgl,ayrhUtdl; 1³320. 3- eRbIR)as;bMBg;bWt 0/2m>l edIm,IbUmesr:UmcMnYn 0/08 0/04 0/02 0/01 nig0/005m>l eTAdak;bEnßm

enAcenøaHkarer:nImYy²enAelIbnÞHkBa©k;enaH. 4- dak;l,ayGg;TIEhSnEdllaysBVl¥mYytMNk;bEnßmelItMNk;esr:UmnImYy²eTAelIbnÞHkBa©k; . 5- lay[sBVénl,ayesr:Um nigGg;TIEhSnedayeQIkU epþImecjGMBIl,ayEdlmankMhab;x<s;. l,aycug

eRkayénbMBg;EkvsMrab;eFVIetsþKWl,ay 1³20 1³40 1³80 1³160 1³320 . 6- kan;bnÞHkBa©k;edayédTaMgsgxag rYcbgVilf μm² RbmaN 15-20dg. BinitüemIll,ayesr:UmGg;TIEhSn

edayEPñkTeT emIl Agglutination ry³eBl 1naTIeRkamBnøWRKb;RKan;. RbtikmμEdlekIteLIgeRkayBI eBlenHGacbNþalmkBIPaBs¶ÜtenAelIbnÞHkBa©k; ehIyKYrEtepÞogpÞat;CamYyetsþenAkñúgbMBg;Ekv.

7- kt;RtalT§pldUcxageRkam ³ kkTaMgGs; 4÷ RbEhl 75°énekasikakk 3÷ RbEhl 50°énekasikakk 2÷ RbEhl 25° énekasikakk 1÷ RBal² b¤K μan Agglutination ³ -

194

etsþ Febrile Agglutinins kñúgbMBg;Ekv erobcMesr:Umrbs;vtßúviPaK nigesr:UmRtYtBinitüdUcxageRkam ³ 1- erobcMbMBg;EkvcMnYn 8 kñúgTRmcMeBaHesrU:mnImYy²EdlRtUvykmkeFVIetsþ 2- bWtesr:UméRb ¬0/ 85°¦ cMnYn 1/9m>l dak;eTAkñúgbMBg;TIbTImYyénCYrnImYy² nig 0/5m>l eTAkñúgTIb

epSg²eTot . 3- bEnßm 0/1 m>l énesr:UmeTAkñúgbMBg;EkvTI 1 Edlmanesr:UméRb 1/9 m>l 4- layl,ay[sBV rYcepÞr 0/5m>l eTAkñúgbMBg;EkvTI2. layl,ayenH[sBV. 5- bnþeFVIdUcxagelI edaybEnßml,ayesr:UmmYytMNk;rhUtdl;TIbTI7. layl,ay[sBV. bUmykl,ay

0/5m>l ecjBIbMBg;TIbTI7 bnÞab;BIlayl,ay)ansBVl¥rYc. bMBg;TUbTI 8 KWCabMBg;TIbEdldak;Gg;TIEhSn sMrab;RtYtBinitsMrab;RtYtBinitü .

6- bEnßm 0/5m>l énGg;TIEhSneTAkñúgbMBg;TIbnImYy²TaMg8TUb. GRgYnTRmbMBg;TIblμm² edImI,laybBa©Úl KñarvagGg;TIEhSn nig Antiserum [sBV. lT§plénl,ay manBIl,ay 1³20 dl; 1³1280.

7- kMedAl,ayenHeTAkñúgFugTwkkMedAeRkamsItuNðPaB 37GgSarry³eBl 48em:ag GaRs½yeTAtamkarENnaM éneragcRkplit.

8- BinitüemIlbMBg;TIbedayEPñkTeT rkemIl Agglutination ry³eBl 1naTI enAeRkamBnøWRKb;RKan; nigépÞ BN’exμA. eKminRtUvGRgYnbMBg;EkvTaMgenaHeT. Rbtikm μviC¢manbgðaj[eyIgeXIjRbtikm μ Agglutination rIÉRbtikmμGviC¢manvij bgðaj[eyIgeXIjnUvl,ayRsemal²EtBMuman Agglutination eT. l,ayesr:Um Edlx<s;CageK ehIybgðajnUvRbtikmμ Agglutination KWCakMriténl,ayenaH .

cak;Gg;TIEhSnecal RbsinebIvaminman Agglutination CamYynwgetsþRtYtBinitüviC¢man EdleKdwgrYcehIy b¤ebIsinCavamanRbtikm μ Agglutination CamYynwgesr:UmRtYtBinitüGviC¢manEdleKdwgrYcehIy. Agglutination GacRtUv)aneKrkeXIjenAelImnusSEdlmansuxPaBFm μta nigCamYyl,ayesr:UmEtmYy eday man Titres ticCag 80KWCaRbtikmμEdlRtUvEtsgS½y. lT§plviC¢man-xusnwgekIteLIgCamYynwgesr:UmEdlyk ecjBIGñkCm¶WEdlbgáeLIgeday Francisella tularensis b¤GñkEdlcak;va:k;saMgkarBarnwg Vibrio cholerae. eKminGaceFVIkarEbgEck[xusKñarvagkarbgáCm¶WEdlbgáeLIgeday B.abortus nig B.melitensis edayeRbIR)as; etsþenHeT.

195

etsþ Antistreptolysin O (ASO) karbgáCm¶WedayBBYk Streptococci RtUv)aneKCYbRbTHeRcInCageKbMputelImnusSTUeTA ehIymnusSPaKeRcIn manGgÁbdibkçRbqaMgnwgBYk Streptococci enH. BYk Streptococci Rkum A RbePT β- haemolytic plit

haemolysins BIry:agKW ³ Oxygen-labile streptolysin O nig Oxygen-stable haemolysin S. manEt

Streptolysin O¬minmanGuksIutkmμ¦ EdleKykmkeFVIetsþ. etsþ Antistreptolysin O KWCaetsþEdlBwgEp¥k eTAelIfa GñkCMgWEdlmankarbgáeraKedayBYk Streptocioccus pyogenes ¬Rkum A¦ begáItCaGgÁbdibkç Edl Tb;sáat;skm μPaBbMpøajRKab;Qamrbs; Streptolysin O. GgÁbdibkç EdlCaTUeTAsßitenAyUrGEgVg nig Titre

EdlekIneLIgEtmYyeBl minEmnCakarbgðajGMBIkarbgáCm¶WkMBugEtmanenaHeT. manEtkarekIneLIg Titre 4dg b¤eRcInCagenH enAelIsMNakesrU:mbnþbnÞab; EdleKykcenøaHBIKña 10-14éf¶eTIbeKGacsnñidæanfa CakarbgáCm¶W fμ I². etsþenHRtUv)aneRbICacm,genAkñúgkarvinic½äyrkCm¶Wsnøak;RsYcRsav rlaktRmgenam nigenAelIGñkCm¶WEdl mankarbgáCm¶WedayBBYk Streptococcus rYc. eKeXIjmanetsþ antistreptolysin O BIRbePTEdllk;enATIpSar ³ • etsþ Agglutination elIbnÞHkBa©k; ³ ASO latex EdlCaetsþsMrab;BinitüemIlesr:UmedIm,IkMNt;rkBYkEdl

mankarekIneLIgén ASO Titre ¬200 IU b¤x<s;CagenH¦ . • etsþ ASO kñúgbMBg;TIb KWCaetsþTb;sáat;karbMpøajRKab;QamEdlRtUv)aneKeRbIedIm,IkMNt;GMBIcMnYnGgÁbdibkç

ASO titre EdlmanenAkñúgsMNakesr:Um EdlviC¢manenAelIetsþ Agglutination elIbnÞHkBa©k;. kñúgkrNI eKrkeXIj Titre 50 IU b¤ticCagenHeKminGacsnñidæanfa CaCm¶Wsnøak;RsYcRsaveT .

smÖar³ nigRbtikrEdlpþl;[enAkñúgRbGb;etsþ Agglutination elIbnÞHkBa©k; ASO latex bnÞHC½rEdleRbIehIyRkvat;ecal edaymanRKlukcMnYn 6 enAelIbnÞHnImYy² bMBg;bnþk;EdleRbIehIyRkvat;ecal esr:UmsMrab;BinitüetsþviC¢man nigGviC¢man Latex RbtikrEdleFVI sensitivity rYc ( edayman streptolysin O) smÖar³bEnßmEdlRtUvkareFVIetsþ Agglutination elIbnÞHkBa©k; ASO latex

xñÚr

196

etsþ Agglutination elIbnÞHkBa©k; ASO latex 1- eFVIl,ayesr:Um 1³20 . 2- dak;sUluysSúgesr:UmmYytMNk;eTAkñúgRKlukénbnÞHC½r)øasÞik . 3- eRbIR)as;bMBg;sMrab;bnþk;Edlf μ I rYcbUmykRbtikrmYytMNk;dak;EfmBIelIesr:Um . 4- eRbIxñÚredIm,IkUrtMNk;l,ayTaMgBIrtMNk;enH[sBV rYc[BaseBjépÞRKluk . 5- BinitüemIlRbtikm μ agglutination ry³eBl 2 naTI . RbtikmμviC¢mannwgbgðaj[eXIjnUvkMNkkkesþIg² ¬Agglutination¦ kñúgry³eBl 2naTI . rIÉRbtikmμGviC¢manvijBMumanbgðajGVITaMgGs; ebIsinCaetsþxagelIviC¢manenAkñúgry³eBl 2naTI esr:UmenHKYrEtRtUv)aneKeFVIetsþeTot tamry³etsþelIbMBg;TIb Antistreptolysin O. smÖar³ nigRbtikrEdleKpþl;[kñúgetsþenAkñúgbMBg;Ekv ASO esr:UmRtYtBinitüetsþviC¢man Gg;TIEhSn Streptolysin O EdlbnßyrYc ¬erobcM[s¶ÜtCaeRsc¦ ekasikarQamRkhmrbs;stVecom GgÁbdibkç Antistreptolysin O sþg;dar ¬erobcMs¶ÜtCaeRscEdlman 20 IU¼db¦ Streptolysin O buffer ¬sUluysSúgxab; 25x ¦ smÖar³bEnßmEdlRtUvkarkñúgkareFVIetsþ ASO kñúgbMBg;Ekv Twkbit bMBg;bWt ¬cMNuH 1 m>l nig 2 m>l¦ bMBg;EkvsMrab;eFVIetsþ FugTwksMrab;kMedA etsþ ASO kñúgbMBg;Ekv 1- erobcMBRgaveLIgvijnUvl,ayGg;TIEhSn Streptolysin O edaybEnßmbrimaNTwkbiteTAtamtRmUvkar

¬Edl mankarENnaMenAelIdb¦ edIm,I[)an 2 IU kñúgmYymIlIlIRt . l,ayEdlerobcMrYc KYrEtRtUv)an eKeRbIR)as;enAry³eBl 6 em:ageRkayBIlayrYc eRBaHvaminGacrkSaTuk)anyUeT .

197

2- erobcMl,ayGgÁbdibkç Antistreptolysin O sþg;darCamYynwg 10m>l én Streptolysin O buffer.

sUluysSúgenHeKGacrkSaTuk)anrhUtdl;eTA6ExenAkñúgsItuNðPaB 4GgSar edayminmankarqøgemreraKcUl 3- layl,ay Streptolysin O buffer¬layl,ay 25X¦CamYynwgTwkbit 480m>l muneBleRbIR)as;.

l,ay Buffer enHKYrEtRtUv)aneKRkvat;ecalenAeRkayry³eBlmYys)þah_eRkayBIkarlayrYc. 4- lag nigbgVilekasikarQamRkhmrbs;ecomcMnYn 1m>l [)anbIdgenAkñúg streptolysin O buffer nig

bWtTwkføaEpñkxagelIecj. bEnßm Streptolysin O buffer vijedIm,I[)anl,ayekasika 8°. 5- RtUvEtTuk[Rbtikr nigvtßúviPaKEdlCaesr:Um[mansItuNðPaBdUcsItuNðPaBenAkñúgmnÞIrBiesaFn_ . 6- eFVIl,ay 1³10énesr:Umrbs;GñkCm¶WenAkñúgbMBg;EkvsMrab;eFVIetsþ ¬0/1 m>l énesr:Um ÷0/9 m>lén Strep-

tolysin O buffer¦ . erobcMl,ayemBIrGMBIl,ay 1³10 dUc)anbgðajenAkñúgtaragxageRkam ³ esr:Um Buffer l,ay 0/2 m>l ¬1³10¦ 1/8 m>l 1³100 1/0 m>l ¬1³100¦ 0/5 m>l 1³150

7- erobcMl,ayCaesrICamYynwg Streptolysin O buffer sMrab;l,aysMxan;²dUcxageRkam³ bMBg;Ekv esr:Um Buffer l,ay Streptolysin O

1 0/2 m>l ¬1³10¦ 0/8 m>l 1³50 0/5 m>l 2 0/5 m>l ¬1³100¦ 0/5 m>l 1³200 0/5m>l 3 0/5 m>l ¬1³200¦ 0/5 m>l 1³400 0/5m>l 4 0/5 m>l ¬1³400¦ 0/5 m>l 1³800 0/5m>l 5 0/5 m>l ¬1³150¦ 0/5 m>l 1³300 0/5m>l 6 0/5 m>l ¬1³300¦ 0/5m>l 1³600 0/5m>l 7 0 1/5m>l 1³600 0 8 0 1/10m>l 1³600 0/5m>l 8- erobcMbMBg;enHeLIgvijtamry³l,ayCabnþbnÞab; 1³50 1³200 1³300 1³400 1³600 nig 1³800 9- bEnßm 1/5m>lén Buffer eTAkñúgbMBg;EkvRtYtBinitüetsþTI7 nig 1m>l eTAkñúgEkvRtYtBinitüetsþTI8. 10- bEnßm 0/5m>lén Streptolysin O buffer eTARKb;bMBg;etsþTaMgGs;elIkElgEtbMBg;TI7 ecj. 11- layl,ay[sBVrYcdak;cUleTAkñúgTUTwkkk 4 GgSary³eBl 2 em:ag edIm,I[RbtikmμrvagGg;TIEhSn-

GgÁbdibkçekItmaneLIg.

198

12- bEnßm 0/5m>l énl,ayekasikarQamRkhm 8° eTAkan;bMBg;EkvnImYy²edaymanrYmbBa©ÚlTaMgbMBg; EkvetsþRtYtBinitübMBg;TI7 nigTI8 layl,ay[sBV rYcdak;kMedAenAkñúgFugTwkkMedA 37GgSary³eBl 30naTI.

13- bgVilbMBg;Ekvkñúgel,Ón 1000g ry³eBl 2naTI nigBinitüemIlkarbMpøajRKab;QamRkhm. bMBg;Ekv TI7 KYrEtBMubgðaj[eXIjnUvkarbMpøajRKab;QamRkhm rIÉbMBg;TI8 KYrEtCabMBg;Edlbgðaj[eXIjnUv karbMpøajRKab;QamTaMgRsug .

14- ASO Titre RtUveKkMNt;faCal,ayx<s;bMput EdlminmanbgðajsBaØaNamYyénkarEbkRKab;Qam Rkhm ³ RbsinebImankarEbkRKab;QamRkhmenARKb;bMBg;TaMgGs; cUrraykarN¾lT§plfa : ASO Titre

manticCag 200 IU :. RbsinebI KμankarEbkRKab;QamRkhmenAkñúgbMBg;TIbEdlmanl,ayesr:Umx<s;Cag cUrraykarN¾

lT§plfa :ASO manRbtikmμCamYynwg titre :. etsþGg;TIEhSn)ak;etrI etsþEdleRbI Latex agglutination nigetsþeFVI[kk ¬Coaglutination¦ sMrab;Gg;TIEhSn)ak;etrIKWCaetsþ EdleKeRbIsRmab;viPaKrkemeraK b¤Gg;TIEhSnrbs;vaenAkñúgbNúþHb¤vtßúviPaKKøInik. etsþ Latex agglutination eRbIR)as;kMeTctUc²rbs; polymer CaeKal rIÉetsþeFVI[kk ¬Coaglutination¦ eRbIR)as;ekasikaQamRkhm KWCaeKal. etsþ Latex agglutination RtUv)aneKeRbIR)as;sMrab;rkGg;TIEhSnrbs;)ak;etrIEdlCa Polysacha-

ride epSg² EdlGacbNþal[manCaCm¶WrlakeRsamxYr dUcCa Haemophilus influenzae ¬RbePT b¦ S.

pneumonia ¬RKb;RbePTTaMgGs;¦ (Omnivalent) N. meningitidis ¬Rkum A, B, C, Y nig W 135) E.

coli ¬RbePT K1¦ nig S. agalactriae ¬Rkum B¦. etsþ Latex agglutination enHRtUv)aneKniymeRbIR)as; sMrab;viPaKrkBBYk Streptococci BI Lancefield Rkum A, B, C, D, F nig G. elIsBIenaHeTot esr:Um Latex

agglutination GacRtUv)aneKeRbIpgEdrkñúgetsþ Qualitative EdleFVI Agglutination elIbnÞHkBa©k; nig Quantitative EdleFVIenAkñúgbMBg;EkvsMrab;eFVIkarviPaKelI Streptococcus Rkum A-D N. meningititis, H.

influenzae, Salmonella Shigella, Vibrio cholerae CaedIm. cMNucEdnkMNt;rbs;Gg;TIEhSnRtUvkarcaM)ac; edIm,IEsVgrkGg;TIEhSn Polysacharide enAkñúgvtßúviPaKKøInik. kMrit EdnkMNt;enH CaTUeTARtUvelIs RbsinebIeKGacBinitüeXIj)ak;etrIelIbnÞHkBa©k;EdlbMBak;BN’ Gram ebIeTaHCava minEmnRKb;krNIk¾eday. cMnYnrbs;)ak;etrIEdleKrkeXIj enAkñúgTwkxYrq¥wgxμgEdlCa N.meningitidis CaTUeTA mancMnYnticCaRbePTepSg²d¾éTeTotén Neisseria spp. dUecñHehIyeTIbkMritEdnkMNt;énGg;TIEhSn Polysac-

charide Cajwkjab;minsUvQandl; .

199

Serogroups rbs; N. meningitidis mYycMnYnbgá[manCaCm¶WrlakeRsamxYr. kñúgxN³eBlEdl Serogroups

A, C, Y nig W135 nImYy²manGg;TIEhSnefr EdlGac[eKviPaKrkeXIjedayesr:Um Polivalent Etmþgén Gg;TIEhSn Serogroups B KWBMusUvmanlMnwg ehIyRtUv)aneKsÁal;faBi)akkñúgkarviPaKrk. vaGacRtUveKEbgEck pgEdrecjBIBBYkGg;TIEhSn K1 Polisaccharide rbs; E. coli EdlCa)ak;etrIbgá[manCm¶WrlakeRsamxYr kñúg cMeNamBYk E. coli enAelITarkeTIbnwgekIt. EteTaHCay:agNak¾eday karerobcMbnÞH kBa©k;edIm,IeFVIkarbMBak;BN’ Gram Edlbgðaj[eXIjCa Diplococci Gram-negative RtUv)aneKKitfa CakarbgáCm¶WEdlbgáeLIgeday N. meningitidis Rkum B. ebIsinCabnÞHkBa©k; Gram bgðajfa Ca)asIu Gram-negative enaHkarbgáCm¶WRtUveK KitfakarbgáCm¶WedayBYk E. coli . kñúgkareFVIetsþ CYnkaleKcMraj;ykGg;TIEhSnEdlCa Polisaccharide ecjGMBI)ak;etrI muneBlykeTAeFVIetsþ. sarFatucMraj;enaH GacCasarFatuKImI b¤Gg;sIumNamYy. eKeXIjmanetsþ 4 y:ag xusKñaEdleKeRbIR)as;sMrab; EsVgrkGg;TIEhSnrbs;)ak;etrI ³ • enAkñúgetsþ Agglutination elIbnÞHkBa©k;³ eKbEnßmGg;TIEhSneTAelIkMeTc Latex b¤ekasikarbs;

Staphylococci EdleRsabedayGgÁbdibkçCak;lak;. l,ayénetsþRtUv)aneKbgViledayeRbIédbgVilefr tamclnaCargVg;ry³eBl 1-2 naTI ehIylT§plRtUv)aneKemIlRbtikmμ Agglutination edayEPñk.

• enAkñúgetsþ ELISA³ sUluuysSúgvtßúviPaKnigGg;TIEhSn CatMbUgRtUvBasBIelIedayRsTab;EdleRsabeday GgÁbdibkç ¬GgÁbdibkçenH CaTUeTA Monoclonal¦. bnÞab;mkRsTab;xageRkAenH RKbdNþb;edaysUluy-sSúgEdlCaGgÁbdibkç Conjugated CamYynwgGg;sIummYy. vtþmanGg;sIumsuaMjúaMénGg;TIEhSnGgÁbdibkç enAelIRsTab;ekasika RtUv)aneKrkeXIjedayRbtikmμrbs;vaCamYynwgsarFatu Chromogenic EdleK bEnßmenAkñúgsUluysSúg.

• enAkñúg Gold immunoassay ³ sUluysSúgvtßúviPaK nigGg;TIEhSnRtUv)aneKTuk[sayPayenAelIRsTab; mYy ehIybnÞab;mkeKykmkBiniitü.

• enAkñúg Optical immunoassay³ GgÁbdibkçRtUv)aneKdak;[P¢ab;CamYynwgbnÞH Silicone esIþg²Edlman lkçN³caMgepøk². enAeBlEdlGg;TIEhSnmanRbtikmμCamYynwgGgÁbdibkçenAelIbnÞHenaH eKeXIjmankar pøas;enAelIépÞxageRkAEdlnaMeTArkkarpøas;bþÚrénBnøWcaMgpøatmkvij .

bec©keTsBiessénetsþ Latex agglutination b¤ Coagglutination 1- cMeBaHGg;TIEhSnEdlP¢ab;eTAnwgekasika³ eRbIR)as; Loop s¥atKμanemeraKedIm,IqáwHykkBa©úMemeraKEdl)an

bnSúT§l¥eTAdak;enAkñúgTwkesr:UméRbEdleKdak;mYytMNk;enAelIbnÞHkBa©k; rYckUr[sBVedIm,I[)anl,ay eLIgl¥k;bnþic. ebIsinCal,ayemeraKCamYyesr:UméRbeLIgkkdMu CaTUeTAbBa¢ak;faCaBBYk)ak;etrIKeRKIm

200

¬R¦ minEmnrelag ¬S¦ ehIyekasikanwgminman Agglutination CamYynwgGgÁbdibkçeT. ebIsinCaBMu eXIjmankkr b¤dMukkekIteLIgeT bEnßmRbtikrnigbnþBIdMNak;kalTI 4 .

cMeBaHGg;TIEhSnEdlcMraj;rYc³ eRbIR)as; Loop Edls¥atKμanemeraK rYcqáwHykkBa©úMemeraKEdlbnSúT§rYc ehIydak;eTAkñúgbMBg;EkvEdlmanpÞúksUluysSúgsMrab;cMraj; nigeFVI[rlaysBV. kMedAsUluysSúgenHenA kMedA 35GgSa b¤eTAtamkarENnaMénplitplenaH. cMeBaHvtßúviPaKKøInik ¬CSF,Twkenam¦ kMedAvtßúviPaK rhUtdl;cMNucBuH b¤GaRs½yeTAtamesckþIENnaMrbs;plitpl. eFVI[RtCak; nigbgVilsUluysSúgkñúg el,Ón 2000g ry³eBl 5-10 naTI .

2- dak;sarFatul¥uit²EdleRsabedayGgÁbdibkçeTAelIbnÞHkBa©k; . 3- dak;mYytMNk;énl,ayGg;TIEhSn enAEk,r sarFatul¥it²EdleRsabGgÁbdibkç . 4- laytMNk;TaMgBIrenAelIbnÞHkBa©k;enHcUlKña ehIyBas[eBjépÞkarer: . 5- bgVilbnÞHkBa©k;edayéd tamclnaragCargVg;cMnYn 1naTI . RtUveFVIkarbgViledayRbugRby½tñ edayeFVIy:ag

NakMu[ehorecjGMBIRBMRbTl;énkaer:enaH. 6- BinitüemIlbnÞHkBa©k;rkemIl Agglutination edayEPñkTeTtamry³eBlkMNt;eTAtamkarENnaMrbs;

plitpl. edIm,I[BinitüemIleXIjc,as; RtUvBinitüemIllT§plRtg;kEnøgEdlmanBnøWc,as;las; nigépÞBI eRkayBN’exμA.

7- lT§plviC¢mannwgRtUv)aneKpþl;Car)aykarN_ enAeBlEdlGg;TIEhSnRtUv)aneKlaybBa©ÚlKñaCamYynwg GgÁbdibkçtamry³ Agglutination ]TahrN_ l,aybgðajGMBIkkrRKab;² b¤kkecjBIcMNucbgVil. Agglutination RtUv)aneKBinitüeXIjc,as;tamry³ep¥ógp¥gbnÞHkBa©k;yWt² .

201

PaK 2 fñalbNúþHCasarvnþ½ nig Rbtikr

202

esckþIepþIm CamYynwg]bkrN_sMrab;eFVIeraKvinicä½yEtb:un μanmuxb:ueNÑaH mnÞIrBiesaFn_GaccUlrYmcMENky:agsMxan;kñúgkarEfTaM GñkCMgWmñak;tamry³kareFVIeraKvinicä½yrkmUlehtuRtwmRtUvénkarbgáCMgW. enAkñúgRbeTskMBugGPivDÆn_PaKeRcIn karGnuvtþkargarenAkñúgmnÞIrBiesaFn_)ak;etrIsaRsþRtÚv)anrMxan edaysarEtkarxVHxatfñalbNþúHnigRbtikrRKwH nanaEdlmantMéléføhYsehtukñúgkarnaMcUl. EteTaHCay:agNak¾edaybrimaNrbs;fñalbNþúH nigRbtikrmYy cMnYnEdlRtÚvTijGacRtÚv)aneKkat;bnßyehIy eRCIserIsykEtrbs;EdlsMxan;caM)ac; tamry³CMerIsRbkbeday karBicarNax<s;dUcEdl)aneFVIkñúgkrNIbBa¢I»sfsarvn½þ. bEnßmBIelIenaHeTotmanfñalbNþúH nigRbtikrsamBaØ² mYycMnYnGacRtÚv)aneKplitb¤erobcMenAkñúgRsúk. GnuvtþtammeFüa)ayTaMgBIry:agxagelIenHGackat;bnßyPaB caM)ac;énkarnaMcUlsarFatuBIxageRkA nigeFVI[sMPar³sMxan;²eRtomrYcCaeRscsMrab;eRbIR)as;kñúgmnÞIrBiesaFn_cUl rYmkñúgkarEfTaMGñkCMgW nigkarsikSaeGBIedmIsaRsþ. CMBUkenHRtÚv)aneKerobcMeLIgedIm,I CaCMnYydl;GñkRKb;RKgmnÞIrBiesaFn_TaMgLay[ykcitþTukdak;eTAelIFnFan fñalbNþúH nigRbtikrEdlTak;TgbMput. CMBUkenHEbgEckCaBIrEpñkEdlEpñkTaMgBIrenHpSMeLIgGMBItaragCabnþ bnÞab;Kña .

203

emeraK fñalbNþúHnigRbtikrsMrab;rkeraKvinic½äy EdleKrMBwgfaCaemeraKbgá emeraKbgáCMgWRtÚv)aneKkMNt; GaRs½yeTAelIktþaepSg²³

- sgVak;énkarrkeXIj - sBaØaKøInikEdlTak;Tg - PaBF¶n;F¶rénCMgW - skþanuBlPaBénkarqøgratt,at - pleFob tMél-tbsñg énkarbNþúHrkemeraK nig/b£karviPaK.

karkMNt;enHK μanGVIEdlCadac;xatenaHeTehIyva nwgERbRbÜlBIRbeTsmYyeTARbeTsmYy b£BImnÞIrBiesaFn_mYyeTA mnÞIrBiesaFn_mYy GaRs½yelIrUbPaBCMgWenAtMbn;enaH smtßPaBénmnÞIrBiesaFn_ nigFnFanEdlman. cMNat;fñak;GaTiPaBénfñalbNþúHnigRbtikr kMritbt;EbnmYycMnYnRtÚv)aneKbUkbBa¢ÚlKña edaysMrbykcMNat;fñak;GaTiPaBsMrab;fñalbNþúH nigRbtikrsMrab;rk eraKvinicä½ydUcteTAenH³ kMritTI1³ GaTiPaBx<s; kMritTI2³ GaTiPaBkNþal kMritTI3³ GaTiPaBTab fñalbNþúHnigRbtikrsMrab;rkeraKvinicä½y RtUv)aneKkMNt;kMritGaTiPaBGaRs½yeTAelIkarcuHbBa¢IénemeraKbgá Edl eKRtUveRbIfñalnigRbtikrTaMgenH edIm,IrknigkMNt;GtþsBaØaN. EteTaHCay:agNak¾edayeKGaceXIjmanPaB xus²Kña. ebIsinNaCafñalbNþúHRtÚv)aneKeRbITUlMTUlayeRcInCagkarkMNt;emeraKbgáCMgWmYyRbePT vaGacCa fñalbNþúHEdlcaM)ac;CagfñalbNþúHEdleRbIsMrab;EtemeraKbgáCMgWEtmYymux. kMritTI1³ fñalbNþúHnigRbtikrsMrab;rkeraKvinicä½yEdlCaGaTiPaBTI1 KYrEtmanenARKb;mnÞIrBiesaFn_TaMgGs; Edl GnuvtþrkeraKvinicä½yelI)ak;etrIsaRsþ. BYkenHCajwkjab;bMputRtÚv)aneKeRbIkñúgeKalbMNgCaTUeTAgayRsÜlerobcM nigmancMnYnbnþicbnþÜc.

204

kMritTI2³ fñalbNþúHnigRbtikrsMrab;rkeraKvinicä½y CaGaTiPaBkNþalRtÚv)aneKcat;TukfaCasarFatu Edlman RbeyaCn¾CabEnßm edIm,I[mnÞIrBiesaFn_rkeraKvinicä½y[)aneBjelj nigmanRbeyaCn_kan;EteRcInkñúgkarsikSa eGBIedmIsaRsþ ebIeTaHbICaBYkenHminCasarvnþ½sMrab;karEfTaMGñkCMgWpÞal;k¾eday]TahrN¾ bNþúM Antisera for

meningococci. kMritTI3³ CafñalbNþúH nigRbtikrsMrab;rkeraKvinicä½yEdlmanGaTiPaBTab. KWCasarFatuTaMgLayEdlKuN RbeyaCn_rbs;vamantMélkñúgkarEfTaMGñkCMgWmþgmáal b:uEnþpþl;CaRbeyaCn_kñúgkarbeRgónsikSaRsavRCav nigkar GegátCaBiessNamYy edaymnÞIrBiesaFn_bEg¥kNamYy. BBYkenHRtÚv)aneKsMedAeTArkfñalbNþúH b£Rbtikr sMrab;rkeraKvinicä½yEdléføhYsehtukñúgkareRbIR)as;TUeTAb£eKRtÚvkaredIm,IbNþúH nigviPaKrkGtisuxumR)aNEdl Bi)akbNþúHnigTTYl)annUvplRbeyaCn_EdlminsmnwgkarcMNay. sMrab;karRsavRCavCarYmrbs;mnÞIrBiesaFn_ emeraKbgáEdleK)ancuHbBa¢I nigfñalbNþúHEdltMrUv nigRbtikrepSg² sMrab;eraKvinicä½y bUkrYmbBa©ÚlkMritGaTiPaBEdleK)anpþl;eyabl;enaH RtÚv)aneKrkeXIjdUcxageRkam. karcat; fñak;CaGaTiPaBKYrEtRtÚvsMrbykedaymnÞIrBiesaFn_nImYy² GaRs½yeTAelIkal³eTs³enAnwgkEnøg. Qam emeraKbgáCMgWEdleKKitTuk Bacteroides fragilis Brucella Burkholderia pseudomallei Candida albicans nig Cryptococcus neoformans Haemophilus influenzae Neisseria meningitidis BBYkmineRbIR)as;CatisárepSg²eToteRkABI Pseudomosnas aeruginosa

BBYk Enterobacteriaceae epSg²eTot Pseudomonas aeruginosa Salmonella typhi nig non-typhi Staphylococcus aureus Streptococci (S. phyogenes, S. pneumoniae, viridans streptococci) fñalbNþúHnigRbtikrsMrab;rkeraKvinicä½y fñalsMrab;bNþúHQam cMNat;fñak;GaTiPaB fñalbNþúH Tryptic soy (TSB) GacRtÚv)aneKCMnYsedayfñalEdlsMbUrGaharÉeTot ]TahrN_³ fñalbNþúH Brain-heart infusion EdlmanbEnßm Sodium

polyanethol sulfonate (SPS)cMnYn0,25Rkam/lIRt. 1

205

fñalbNþúHsMrab;)ak;etrI minRtÚvkarxül;dUcCa Thioglycollate b£fñalbNþúH Schaedler b¤fñalbNþúHsMrab;bNþúH

)ak;etrIminRtÚvkarxül; Wilkins-Chalgen. 2 fñalsMrab;bNþúH fñalsMrab;bNþúHbnþ enAelIfñalbNþúHQamRss; Qamq¥in nig MacConkey ! RbtikrsMrab;rkeraKvinicä½y cMNat;fñak;GaTiPaB Bacitracin disc 1 Coagulase plasma 1 RbtikrsMrab;eFVIetsþ β-lactamase 1 Optochin disc 1 RbtikrsMrab;eFVIetsþ oxydase 1 Salmonella agglutinating antisera 1 V and XV factors 2 Antiserum RbePT b rbs; H-influenzae 3 Neisseria meninggitidis agglutinating serum (polivalent and specific groups A,B,C) 3 TwkxYrq¥wgxñg emeraKbgáCMgWEdleKKitTuk Cryptococcus neoformans Enterobacteriaceae Haemophilus influenzae Listeria monocytogenes Mycobacterium tuberculosis Neisseria meningitidis Streptococcus agalactiae Streptococcus pneumoniae fñalbNþúHnigRbtikrsMrab;rkeraKvinicä½y fñalsMrab;bNþúH cMNat;fñak;CaGaTiPaB fñalbNþúH Blood (with streak of Staphylococcus) 1

fñalbNþúH Chocolate 1

fñalbNþúH MacConkey 1

fñalbNþúH Lowenstein-Jensen 2

fñalbNþúH Sabouraud dextrose 2

206

RbtikrsMrab;rkehtuvinicä½y cMNat;fñak;GaTiPaB

India ink 1 Rbtikretsþ β-lactamase 1 Optochin disc 1 RbtikrsMrab;rk Oxydase 1 V and XV factors 2 Haemophilus influenzae type be antiserum 3 Neisseria meninggitidis agglutinating serum (polivalent and specific groups A,B,C) 3 etsþrkeraKvinicä½yelOn RbGb;etsþEdleRbIR)as;sMrab;rkeraKvinicä½yrbs;)ak;etrInaM[manCaCMgWrlakeRsamxYr 3

Twkenam emeraKbgáCMgWEdleKKitTuk Candida aalbicans Enterococci Escherichia coli Mycobacterium tuberculosis BBYk Enterobacteriaceae epSg² BBYk staphylococci epSg² Pseudomonas nigBBYk non-fermenters epSgeTot Staphylococcus saprophyticus fñalbNþúHnigRbtikrsMrab;rkeraKvinic½äy fñalsMrab;bNþúHnigfñalsMrab;cMnYnemeraK

cMNat;fñak;GaTiPaB fñalbNþúHmanQamRss; 1

fñalbNþúH Brolacin (eKGacCMnYsedayfñal purple lactose fñalMacConkey

fñalKμan crystal violet b¤fñalbNþúH eosin methlene-blue) 1

fñalbNþúH CLED 1

207

fñalbNþúHsMrab;kMNt;GtþsBaØaN nigRbtikrsMrab;rkeraKvinicä½y cMNat;fñak;GaTiPaB β-Glucuronidase RKab; (PGUA) sMrab;viPaK E.coli 1

sMrab;)asuI Gram-negative

fñalbNþúH Kligler Iron (KIA) 1

Rbtikr Kovacs sMrab; indole 1

fñalbNþúH motility-indole-urease (MIU) 1

Rbtikr Oxydax 1

fñalbNþúH lysine-decarboxylase (Möller) 2

etsþ ONPG 2

fñalbNþúH Simmon citrate 2

sMrab;BYk Staphylococci nig enterococci

etsþ catalax(H2O2) 1 Coagulase plasma 1 fñalbNþúH bile-aesculin (sMrab;enterococci) 2

novobiocin (5mIRkÚRkam) disc sMrab;EbgEckBBYk negative-coagulase staphylocci 3 lamk

emeraKbgáCMgWEdleKKitTuk Aeromonas nig Plesiomonas Campylobacter spp. Escherichia coli (enteropathogenic, enterotoxigenic, enteroenvasive nig enterohaemo-

rrhagic) BBYk Salmonellae spp. minEmn Typhoid nig Edwardsiella

Salmonella typhi nig S.paratyphi Shigella Vibrio CholeraeRkúmesr:UmO1 nig BYk Vibrios minEmn cholerae

Yersinia enterocolitica

208

fñalbNþúHnigRbtikrsMrab;rkeraKvinicä½y fñalbNþúHsMrab;dwkCBa¢Ún

cMNat;fñak;GaTiPaB

fñalbNþúH Cary-Blair (sMrab;RKb;Pñak;garbgáCMgW) 1

Buffered glycerol saline (minEmnsMrab; Vibrio b£ Campylobacter) 2 fñalbNþúHsMbUrcMNIGahar cMNat;fñak;GaTiPaB fñalbNþúH Selenite F 1

Twk peptoneGal;kaLaMg 2 fñalbNþúHrkemeraK cMNat;fñak;GaTiPaB fñalbNþúH Deoxycholate-citrate (GacCMnYsedayfñal Salmonella-Shigella

fñal xylose-lysine-deoxycholate (XLD) ) 1

fñalbNþúH MacConkey (CamYynwgCrystalviolet) 1

fñalbNþúH TCBS 1

fñalbNþúH Campylobacter: manRKwHCafñal Columbia b£RKwHQamepSg²

edaymanRKab;QamEbknigbEnßm Gg;TIb‘Íy:UTik

b¤CafñalEdlRKwHpSMGMBIFüÚg 2 fñalbNþúHdMbUgnigRbtikrsMrab;rkeraKvinicä½y cMNat;fñak;GaTiPaB fñal Kligler iron (KIA) (GacCMnYs)anedayfñalbNþúH triple sugar iron (TSI) b:uEnþsMrab;Et)ak;etrIbgáCMgWkñúgeBaHevonb:ueNÑaH) 1

Rbtikr Kovacs for indole 1

fñalbNþúH Motility-indole-urease(MIU) (GacCMnYsedayfñalbNþúH motility test + fñalbNþúH peptone urea) 1

Rbtikr oxidase 1

209

fñalbNþúHBiessnigRbtikrsMrab;rkeraKvinic½äy cMNat;fñak;GaTiPaB Twk Andrade peptone (b¤fñalbNþúHRKwH Phenol Rkhm) 2

fñalbNþúH Lysine-decarboxylase (Möller) 2

etsþ ONPG 2

fñalbNþúH Simmons citrate 2

DIs Vibriostatic compound O:129 2 Agglutinating antisera cMNat;fñak;GaTiPaB

Salmonnella: O antiseraum polyvalent(A_I nig Vi) 1 O-factor antisera: O:2 (A), O:4 (B), O:9 (D), Vi 2 H-factor antisera: H:a, H:b, H:d, H:i, H:m, H:2 3 H-antisera Rtlb;vKÁ: H:b, H:i, H:1,2 3 Shigella: dysenteriae polyvalent, flexneri polyvalent, boydii polyvalent, sonne polyvalent 1 dysenteriaeRbePT1 (Shiga) 1 Vibrio cholerae: O1 antiserum polyvalent 1 subtypes B (Ogawa), C (Inaba), O:139 3 Haemophilus influenzae: Rkum b 3 Neisseria meningitidis: polyvalent 3 foctor EtmYy A, B, C 3 pøÚvdegðImxagelI emeraKbgáCMgWEdleKKitTuk Candidas albicans (oropharynx) Corynebacterium diphteriae (bMBg;k b£ RcmuH) Haemophilus influenzae (RtecoknigsuInus)

Moraxella catarrhalis (RtecoknigsuInus) Neisseria meninggitidis Pseudomonas Staphylococcus aureus (RtecoknigsuInus)

Streptococcus pneumoniae (RtecoknigsuInus)

Streptococcus pyogenes (Rkúm A) (bMBg;k)

210

fñalbNþúH nigRbtikrsMrab;rkeraKvinicä½y fñalsMrab;bNþúH cMNat;fñak;GaTiPaB fñalbNþúHmanQamRss; (erobcMGMBIfñalbNþúHRKwHK μan glucose) 1

fñalbNþúHmanQamq¥in 2

esr:Um Löfffer coagulated nigfñalbNþúH Dorset egg 2

fñalbNþúH Tellurite manQamRss; 2

fñalbNþúH Thayer-Martin EkERb (sMrab;BYk gonococci nig meningococci) 3 RbtikrsMrab;rkeraKvinicä½y cMNat;fñak;GaTiPaB DIs Bacitracin 1

Rbtikr Catalasenig coagulase 1

DIs Optochin 1

fñalbNþúH Carbohydrate degradation sMrab; Neiseeria spp. 2

Rbtikr Oxydase 2

factor V nig XV (CaDIsb£CabnÞHEvg) 2 Tributyrin 3 etsþsMrab;rkeraKvinicä½yPøam² kBa©b;bNþM sMrab; Haemolytic streptococci 3 pøÚvdegðImxageRkam emeraKbgáCMgWEdleKKitTuk Candidas albicans Enteriobacteriaceae Haemophilus influenzae Klebsiella pneumoniae Moraxella catarrhalis Mycobacterium tuberailoois Staphylococcus aureus Streptococcus pneumoniae

211

fñalbNþúH nigRbtikrsMrab;rkeraKvinicä½y fñalsMrab;bNþúH cMNat;fñak;GaTiPaB fñalbNþúHmanQamRss; 1

fñalbNþúHmanQamq¥in 1


fñalbNþúH Löwenstein-Jensen 2

fñalbNþúH Sabouraud dextrose 3

fñalbNþúHmanQamRss;CeRmIssMrab; Haemophilus (bacitracin b£ Vacomycin) 3 RbtikrsMrab;rkeraKvinicä½y )aøsμasMrab;eFVI Coagulase 1

DIs Optochin 1

Rbtikr Oxydase 2

factors V nig XV (CaDIsb£bnÞH) 2 Tributyrin 3 vtßúviPaKykecjBIRbdab;bnþBUCnigRbB½n§Twkenam BiesssMrab;CMgWqøgtampøÚvePT (STDi)

Pñak;garbgáCMgW Candidas albicans (BinitüedaymIRkÚTsSn_) Chlamydia trachomatis Gardnerella Vaginalis (BinitüedaymIRkÚTsSn_)1

Haemophilus ducreyi Neisseria gonorrhoeae Treponema pallidum (BinitüedaymIRkÚTsSn_man)atggwt) fñalbNþúHnigRbtikrsMrab;rkeraKvinicä½y fñalsMrab;dwkCBa¢Ún

cMNat;fñak;GaTiPaB fñaldwkCBa¢Ún Amie b£ Stuart 1

212

fñalsMrab;bNþúH cMNat;fñak;GaTiPaB fñalbNþúH Thayer-Martin(MTM) EkERbb¤fñalbNþúH New York City (NYC) 1

fñalbNþúH Mueller-Hinton manQamq¥inrbs;esH

+ Vancomycin + Iso Vitalex sMrab;bNþúHrk H.ducreyi 3 RbtikrsMrab;rkeraKvinicä½y etsþ Nitrocefinb£RbtikrsMrab;eFVI β-lactamase etsþ epSgeTot 1

RbtikrsMrab;rk Oxydase 1 xÞúHnigTwkrég Pñak;garbgáCMgW Bacillus anthracis Bacteroids nigBYk)ak;etrIminRtÚvkarxül;dac;xatepSgeTot Clostridium perfringens Enterobacterium tuberculosis, M. ulcerans BBYk Mycobacterium spp. epSg²eTot Pasteurella multocida Pseudomonas Staphylococcus aureus nigBBYkmineRbIR)as;CatisárepSgeTot Streptococcus pyogenes Streptococcus (nigBBYkepSg²eTot) fñalbNþúH nigRbtikrsMrab;rkeraKvinicä½y fñalsMrab;bNþúH

cMNat;fñak;GaTiPaB fñalbNþúH Blood 1


fñalbNþúHMannitol salt 2

fñalbNþúH Thioglycollate (eRbI indicator) (GacCMnYs)aneday fñal cooked meat fñal Schaedlerb¤fñalbNþúH Wilkins-Chalgren) 2

fñalbNþúH Tryptic soy (TSB) 2

213

RbtikrsMrab;rkeraKvinicä½y cMNat;fñak;GaTiPaB Catalase (H2O2) 1 Coagulase plasma 1 Oxidase reagent 1 ]bkrN_sMrab;begáItGIuRdUEsn sMrab;eRbIR)as;kñúgRbGb;K μanxül; 2 taragénfñalbNþúHEdlRtÚveRbI nigRbtikrsMrab;rkeraKvinicä½y sMrab;mnÞIrBiesaFn_ Gtisuxum- CIvsaRsþfñak;kNþal fñalbNþúH Recommended medium Alternatives Priority grading Bile-aesculin agar 1 Blood agar (see tryptic soy agar) 1 Brolacin agar Purple lactose agar, CLED agar 1 Kligler iron agar (KIA) 1 Löffler coagulated serum Dorset egg medium 1 Löwenstein-Jensen medium 1 MacConkey agar (with crystal violet) 1 MacConkey agar (without crystal violet)

1

Motility-indole-urease (MIU) Motility test medium + urea broth + peptone (tryptone) water

1

Mueller-Hinton agar 1 Sabouraud dextrose agar 1 Deoxycholate citrate agar Samonella-Shigella (SS) agar 1 Tryptic soy agar (TSA) Columbia agar 1 Tryptic soy broth (TSB) Brain-heart infusion broth 1 TCBS 1 Transport medium (Armies) Transport medium Stuart or Cary-

Blair) 1

Andrade peptone water Phenol red broth 2 Decarboxylase broth (Möller) 2 Mannitol salt agar (MSA) 2 Selenite F broth 2 Simmons citrate agar 2 Thioglycollate medium (with indicator)

Scaedler broth, Wilkens-Chalgren anaerobe broth, cooked meat medium

2

DNase agar

3

214

sarFatuTb;sáat;min[emeraKduHb£Gg;TIb‘Íy:UTikEdleRbIR)as;enAkñúgfñalbNþúHb¤eRbICaRbtikr cMNat;fñak;GaTiPaB Chloramphenicol (sMrab;bNþúHBBYkpSit) 1

Gg;TIb‘Íy:UTikbEnßmkñúgkarbNþúHrkBBYk Gonococci: Vancomycin colistin mystatin (trimethoprim): VCN (VCNT) 1 Gg;TIb‘Íy:UTikbEnßmkñúgkarbNþúHrk Campylobacter 2

sUluysüúg Tellurite (sMrab;bNþúHrk Corrynebacterium diphtheriae) 2

Bacitracin (sMrab;bNþúHrk Haemopfilus spp.) 3

Vancomycin (sMrab;bNþúHrk Haemophilus ducreyi b£ H. Influenzae) 3 cMNIGaharEdlbEnßmkñúgfñalbNþúH IsoVitalex (Polyvitex Vitox B, supplement B, supplement VX, sup. CVA) 2 Sodium polyanethol sulfonate (SPS) 3 DIsRKab;fñaMb¤bnÞHsMrab;rkeraKvinicä½y DIs bacitracin 1

DIs Nitrocefin 1

etsþ ONPG 1

DIs Optochin 1

RbtikrsMrab;rk Oxydase 1 PGUA (β-glucuronidase) 1 factors V nig XV 2

DIs Novobiocin(5mIRkÚRkam) 3

etsþ PYR 3 Tributyrin 3 DIs Vibriostatic compound O:129 3 kBa©b;sMrab;rkeraKvinicä½y sMPar³esr:UmsMrab;rkeraKvinicä½yPøam²sMrab;rk)ak;etrI EdlbNþalCaCMgWrlak eRsamxYr 3

sMPar³esr:UsMrab;rkRkúménBBYk Streptococci EdlbMpøajRKab;Qam 3

215

RbtikrsMrab;rkeraKvinicä½y bMrug

cMNat;fñak;GaTiPaB

Barium sulfate sþg;dar (sMrab; Kirby-Bauer) 1

RbtikrsMrab;BN’ Gram 1 Hydrogen peroxide (H2O2) (catalase) 1 Rbtikr Kovacs (sMrab;rk indole) 1

RbtikrsMrab;rk oxydase (dimethyl-p-phenylenediamine) 1

)aøsμa(sMrab;etsþ coagulase and germ-tube test) 1

RbtikrsMrab;BN’ Ziehl- Neelsen 1

Buffered glycerol-saline (sMrab;dwkCBa¢Únlamk) 2 Carbohydrates: glucose, lactose, maltose, mannitol, sucrose 2 ]bkrN_sMrab;begáIt hydrogen sMrab;RbGb;Kμanxül; 2

Twk\NÐa (sMrab;rk Capsule) 2

Lysine (sMrab;eFVIetsþ decarboxylase) 2 DIs Sentivity-testing

Gg;TIb‘Íy:UTiksMxan;²EdleKrab;bBa¢ÚlkñúgbBa¢I»sfsaravnþ½rbs; WHO (2002) amoxicillin ampicillin benzylpenicillin choloramphenicol ciprofloxazin co-trimoxazole (sulfamethoxazole-trimethoprim) cloxacillin erythromycin gentamicin kanamycin nalidixic acid nitrofurantoin sulfonamide tetracycline (b¤ doxycycline) trimethoprim Gg;TIb‘Íy:UTikEdlbMrugTuk amoxy-clav amikacin cefalotin

216

cefazolin cefotaxime ceftazidime ceftriaxone cefuroxime ciprofloxacin b£ fluoquinolones epSg²eTot clindamycin piperacillin vancomycin Agglutination Antisera cMNat;fñak;GaTiPaB Salmonella: O antiserum polyvalent (A-I nig Vi) 1

O-factor antisera : O:2 (A) O:4 (B) O:9 (D) nig Vi 2

H-factor antisera : H:a H:b H:m nig H:2 3

H-antisera : H:b H:i nig H:1,2 3 Shigelle: dysenterias polyvalent flexneri polyvalent boydi polyvalent sonnei polyvalent 1 dysenterias RbePT1 (Shiga) 1 Vibrio Cholerae: 01 antiserum polyvalent 1 subtybe B (Ogawa) C(Inaba) nig O:139 3

Haemophilus influenzae: RbePT b 3 Neisseria meningibidis: Polyvalent 3 factor EtmYy A, B, C 3

217

esovePACMerIsmYycMnYn sMrab;karGanbEnßmeTot August MJ et al. Quality control and quality assurance practices in clinical

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Basic Laboratory Procedures in Clinical Bacteriology

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