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Low levels are risk factor. Primary target of therapy. HGB Normal metabolism of bilirubin. Protect sample from light.

Jendrassik-Grof method. Diazo reagent. Accelerator added so conjugated bilirubin reacts. Bilirubinometry for neonates only. Protect from light. No accelerator required. Total bili — direct bili. No Yes Present in urine? Diurnal variation: highest levels in early am, lowest in late afternoon. Collect on ice.

Store frozen. LH Maturation of follicles, ovulation, production of estrogen, progesterone, testosterone Regulated by GnRH from hypothalamus. Anterior pituitary ACTH continued Stored in posterior pituitary.

Uterine contractions during childbirth, lactation Produced in hypothalamus. Not clinically useful. Contains 4 atoms of I. Regulated by TSH.

Most bound to thyroxine-binding globulin TBG. Contains 3 atoms of I. If normal, no further testing. Usually not helpful in Dx of hypothyroidism because last test to become abnormal. Thyroid tests are immunoassays. Diurnal variation. Highest in am. Regulation of menstrual cycle. Maintenance of pregnancy Estradiol E2 is major estrogen produced by ovaries; most potent estrogen.

Also produced in adrenal cortex. Progesterone Preparation of uterus for ovum implantation, maintenance of pregnancy Also produced by placenta.

Metabolite is pregnanediol. Development of fetal gonads Used to detect pregnancy, gestational trophoblastic disease e. Development of mammary glands Used to assess placental function. Decreases plasma glucose levels. Glucagon Glycogenolysis, gluconeogenesis, lipolysis Produced in alpha cells of islets of Langerhans. Increases plasma glucose levels. Reached just before next scheduled dose. Drawn immediately on achievement of steady state.

Screening asymptomatic men is controversial. Antithyroglobulin antibodies should be measured at same time. Can interfere with assays. Most are not useful for screening. Some patients with cancer do not have elevated tumor markers. Serial testing is more useful than a single test.

Increasing levels following treatment might indicate a recurrence. All of the tumor markers above are measured by immunoassay. Proton donor. Minimizes changes in pH. Second largest fraction of anions. Proton acceptor or base. Regulated by kidneys Carbonic acid H2CO3. Proton donor or weak acid. Directly related to amount of dissolved CO2. Normal Measure of respiratory component inversely proportional to respiration PO2 Partial pressure of O2.

Measurement is potentiometric change in voltage indicates activity of analyte. Measurement is potentiometric. Oxygen saturation. Useful QC check. Direct measurements now available. Electrolytes contribute most. One of colligative properties. Used to Dx poisonings.

What is the glucose concentration of the patient? No special equipment. II Moderate Common human pathogens E. Personal protective equipment PPE. Autoclave must be available. Limited access. Most micro labs fall in this category.

III High Those that may cause serious or lethal disease via inhalation. IV Extreme Those that pose high risk of life-threatening disease. May be transmitted by aerosols. Unsterilized room air enters. Provides minimal personnel protection. Type most commonly used in hospital micro labs. III Completely enclosed. Negative pressure. Gloves are attached to front. Provides maximum protection. Used in labs that work with extremely hazardous organisms. Kills spores. Boiling Not reliable.

Spores may not be killed. Pasteurization Used in food industry to kill foodborne pathogens. Liquid is heated to Hot air sterilization Used when steam may damage or fail to penetrate. Filtration Used to sterilize liquids that are thermolabile e. Radiation UV light. Used in BSC. Chlorine Sodium hypochlorite household bleach. Prepare daily. Formalin Aqueous solution of formaldehyde.

Exposure must be monitored. Used for cold sterilization of items damaged by heat, e. Yes No Converted to toxoid? Collect before antibiotics are administered. Sample appropriate site. Aspirates or tissues are preferred to swabs. For anaerobes, aspirates preferred to swabs.

Use sterile, leak-proof container. Properly label container, not lid. Transport in secondary container plastic bag marked with biohazard symbol.

Protect requisition from contamination. Syringes with needles attached should never be transported. Deliver to lab within 30 min of collection. For prolonged transit, use special preservatives or holding media. Best to process without delay. Teichoic acid cross-links prevent decolorization in Gram stain. Primary stain crystal violet washes out. Group B strep will also grow. Lactose fermenters LF green-black or purple.

Non—lactose fermenters NLF colorless. LF pink. NLF colorless. Colorless colonies. Some labs have stopped using because non-O serotypes can be pathogens. Nonpathogens orange to salmon pink. NLF green to blue-green. H2S-pos colonies have black precipitate.

Some shigellae may be inhibited. Some salmonellae may not produce H2S. Salmonella produces H2S black center. Use of enrichment broths for stool cultures is decreasing. Some N. Inhibits yeast better. Genital mycoplasmas will grow. No need to transfer to culture plate. Others are light green. Some salmonellae may be inhibited. Novobiocin inhibits GPC. Subcultured to TCBS. Bordet-Gengou agar Selective enrichment medium for isolation of Bordetella pertussis Potato-glycerol-based medium enriched with blood.

Contaminants inhibited by methicillin. Regan-Lowe agar Selective for B. Charcoal absorbs toxic compounds. Colonies are beta hemolytic. May be narrow or wide. Partial lysis of RBCs Streptococcus pneumoniae, viridans streptococci, some enterococci Beta Clear zone around colony. Catalase pos. Resistant to bacitracin. Facultative anaerobe. Grows on most nonselective media. Salt tolerant. May be golden. Coagulase pos. Ferments mannitol yellow colonies on mannitol salt agar. Spread by direct contact.

Coagulase-negative staphylococci CNS Opportunistic pathogen. Coagulase neg. Sensitive to novobiocin. Often contaminant. Usually only speciated if from normally sterile site. Resistant to novobiocin. May ferment mannitol. Novobiocin only performed when CNS isolated from urine of female. Micrococcus Usually nonpathogenic. High-domed colonies. Susceptible to bacitracin. Not commonly isolated. Usually only grow aerobically. Immediate bubbling. Staphylococci pos. Catalase from RBCs in blood agar may produce weak bubbles.

Coagulase Enzyme coagulase causes coagulation tube test or agglutination slide test in plasma. Detects bound coagulase clumping factor. If neg, tube test should be performed. Detects free coagulase. Largely replaced by latex agglutination tests. Slide agglutination tests for S. Mannitol salt agar MSA Fermentation of mannitol results in color change from pink to yellow. All staph can grow on MSA. Rarely used for ID of S. Novobiocin susceptibility Organisms resistant to novobiocin grow to edge of disk.

Variable hemolysis. Catalase neg Facultative anaerobes. Require enriched media. Chaining best in broth cultures. Strep sore throat, rheumatic fever, glomerulonephritis, scarlet fever scarlatina , erysipelas, puerperal sepsis, impetigo Pinpoint. Grayish white.

Usually beta hemolytic wide zone. Sensitive to bacitracin. Resistant to SXT. PYR pos Most common is S. To detect species that produce streptolysin O only, stab into agar, place coverslip over inoculum, or incubate anaerobically. May be nonhemolytic. Sodium hippurate pos. CAMP pos S. Inoculated in selective broth, e. Group D streptococci, Normal in GI tract.

May be alpha hemolytic. Hydrolyzes esculin Most common is S. Rarely beta. Hydrolyzes esculin. Grows in 6. Normal in mouth, GI tract, female genital tract. Causes nosocomial UTI, wound infections, bacteremia continued Most common cause of communityacquired pneumonia. Major cause of otitis media, meningitis in adults. Infects sinuses, eyes Football-shaped lancet-shaped GPC.

Usually in pairs. May be single or in short chains. Frequently encapsulated Round, translucent, glistening, dome shaped when young. Central depression with age umbilicate due to autolysis. Alpha hemolytic. Encapsulated strains are mucoid Bile solubility pos. Opportunistic pathogens. Frequent cause of subacute bacterial endocarditis. Usually alpha heResistant to optochin. Infections associated with trauma or surgery.

Most common sites: abdomen, head, neck GPC in pairs, chains Colonies are half the size of other strep. Usually beta hemolytic but can be alpha hemolytic or nonhemolytic. Butterscotch or caramel odor. PYR neg. VP pos 3 species: S. In viridans group. Grow better anaerobically.

GAS susceptible. GBS resistant Also known as A disk. Performed on SBA. Requires overnight incubation. Disk test only takes minutes. Incubated in ambient air overnight. False pos in CO2.

Arrowhead hemolysis where inoculum lines meet. Only requires min incubation. Most labs only use for ID of beta hemolytic. Viridans strep resistant Also known as P disk. Contains ethylhydrocupreine hydrochloride. Placed on lawn of inoculum on SBA. Bile solubility Bile salts e. Results in 30 min or less. Group D strep neg Requires overnight incubation. Methicillin-resistant S. Yes Group A streptococci Universally susceptible to penicillin, cephalosporins, vancomycin. No Group B streptococci Susceptible to penicillin, cephalosporins, vancomycin.

Susceptible to vancomycin. Yes Group D streptococci Susceptible to penicillin, vancomycin. Most are susceptible to vancomycin, but vancomycin-resistant enterococci VRE are becoming more common in hospitals. See B. Large spreading betahemolytic colonies with irregular edges Medusa head. Whitish gray. May be pigmented. Most are motile.

Must rule out B. Bacillus anthracis One of most highly pathogenic microorganisms. Causes anthrax. Contracted from contaminated hides, wool, meat.

Rare in U. Large with square ends. May be in chains. Looks like bamboo. Spores may not be seen in direct smear. Stands up like beaten egg white when touched with loop. Beta hemolysis rules out. Potential bioterrorism organism. Handle in BSC. Bacillus cereus Often environmental contaminant. Same as B. Irregular, slightly curved, nonparallel sides, club-shaped ends. Chinese letter or picket fence formation palisades. Facultative anaerobes. Grow on most media. Called diphtheroids because resemble C.

Corynebacterium diphtheriae Diphtheria. Same as above. Gray-black colonies with brown halos on Tindale agar. Black colonies on cystine tellurite. Toxin producing. ID requires demonstration of toxin production. Same as other commensal corynebacteria. Rapid sucrose urea RSU neg.

Most commonly isolated diphtheroid. Highly resistant to antibiotics. Food poisoning. Parallel sides, rounded ends, coccobacillary. Singles, chains, or diphtheroid arrangement. Tiny colonies with narrow zone of indistinct beta hemolysis. Translucent, gray. Hippurate hydrolysis pos. Esculin pos. CAMP pos hemolysis looks like shovel, not arrowhead. Tumbling motility on wet mount. Grows from 0. Cold enrichment may be used.

Nocardia Immunocompetent: skin infections. Often beaded. On SBA wrinkled, dry, crumbly, chalky white to orange-tan, beta hemolytic. Partially acid fast. Sulfur granules. Pathogens are capnophilic. Oxidase pos. Diagnostic in urethral discharge from symptomatic males. Colonies are small, grayish white or tan. May look like mixed culture.

Carbohydrate utilization: glucose only. Superoxol pos. Can ID with monoclonal antibodies. Molecular methods for genital specimens. Colonies are bluish gray or tan. May be mucoid. ONPG neg. Serogrouping by slide agglutination. Bacterial antigen test available for detection but poor sensitivity. Vaccine available. Commensal Neisseria spp Normal in upper respiratory tract. Some grow on Neisseriaselective media. Varies with species. Not speciated if from respiratory specimens.

Rare in adults. Resembles N. ONPG pos. One of commensal Neisseria. May react with meningococcal typing sera.

Moraxella catarrhalis Normal in upper respiratory tract. DNase pos. Butyrate esterase pos. False pos from ironcontaining wire. Use platinum wire or wooden stick. Reduces nitrates. Red color after zinc dust indicates presence of residual nitrates, i. No color after zinc dust means nitrates reduced to N2 or NO2, i. Carbohydrate fermentation When carbohydrate fermented, acidic end products cause color change in pH indicator. With phenol red indicator, change from red to yellow Frequently tested carbohydrates are glucose, lactose, sucrose, mannose, sorbitol, mannitol, xylose, adonitol, cellobiose, dulcitol, trehalose.

All Enterobacteriaceae ferment glucose. Leave cap slightly loose. Some record NC [no change] for pink butt. Indole produced. Spot indole test commercially available. Need source of tryptophan. Color change in pH indicator. False neg if cap not loose. Urease Urease breaks down urea. Phenylalanine deaminase PD Phenylalanine deaminase deaminates phenylalanine to phenylpyruvic acid, which reacts with ferric chloride to produce green color.

Proteus, Providencia, Morganella are pos. K antigen Capsular antigen Capsule Polysaccharide, heat labile, may mask O antigen. Removed by heating Role in preventing phagocytosis.

Vi antigen is K antigen produced by S. Most common cause of UTI. Green metallic sheen on EMB. Presumptive ID: lactose pos, dry colony on MacConkey, oxidase neg, indole pos.

Shigella Dysentery shigellosis. Most communicable of bacterial diarrheas. Found primarily in crowded or substandard conditions, e. Rarely disseminates. Fragile organism. Shigella sonnei most common in U. Serogrouped by O antigens. Serogroups A, B, C, D. Closely related to Escherichia on molecular basis. Edwardsiella tarda Opportunistic. Infections often involve aquatic environments.

May be transmitted by reptiles. Grouped by O antigens e. Colonies usually mucoid. Some strains hydrolyze urea slowly. Burned chocolate odor. Morganella morganii Mainly nosocomial infections. UTI, wound infections. Bipolar staining. CIN agar is selective. Incubate 48 hr.

Most common cause of renal failure in children in U. May be fatal, especially in young or elderly Undercooked meat, raw milk, apple cider Toxins vertoxins or Shiga toxins RBCs but usually no polys E. DNA probes can ID genes that code for toxins. Report to public health. DNA probes to detect toxins or toxin genes. Usually in young children in areas of poor sanitation. Most common in children in developing countries Little known about epidemiology Adherenceattachment Not well studied.

May be oxidizers or nonoxidizers asaccharolytic. Most grow on MAC. Appear as non—lactose fermenter. Most are oxidase pos. Resistant to variety of antibiotics. Long, thin, pale-staining Important cause of nosoco- GNR. Slightly pointed or mial infections, e. Usually beta hemolytic. Dull gray or blue-green. Metallic sheen.

Grapelike odor. Only nonfermenter to produce pyocyanin. Resistant to many antibiotics. Opportunistic pathogen. Nosocomial infections, e. Pleomorphic GNCB in singles, pairs, short chains. Can be confused with N. Can grow on most media, including MAC.

Some produce purplish colonies might be mistaken for lactose fermenter. Straight or slightly curved slender GNR in singles or pairs. On SBA: large, nonhemolytic. May be light yellow. Agar may have lavender-green discoloration in areas of heavy growth. Grows on MAC. Oxidase neg. Rapid oxidation of maltose, weaker oxidation of glucose.

Ammonia odor. Broth dilution recommended. Common in hospital. Sources of infection: chickens, raw milk, pets Curved, slender, GNR. Stain faintly. Slow growing. Hold plates 3 days. Darting corkscrew motility. Campylobacter coli Similar to C. Usually foodborne Same as above. Hippurate hydrolysis neg. Uncommon stool isolate Same as above. Most often isolated in blood cultures. Hold for 2 wk. Inhibited on Campy agar. Possible risk factor for gastric carcinoma Curved, slender, GNR.

Rarely cultured. Rapid urease tests on gastric biopsy, urea breath test, histology, PCR, serology. Transmitted by contaminated water, seafood. Uncommon in U. Large yellow colonies on TCBS ferments sucrose. Alkaline peptone water APW can be used for enrichment. Serological ID with antisera to O ag. El Tor biotype causes most cases worldwide. Immunocompromised or individuals with liver disease: septicemia following consumption of raw oysters, water-associated wound infections.

Healthy individuals: gastroenteritis. Seen in U. Straight or curved GNR. Most are green on TCBS; some are yellow. May look like enteric on MAC because some are lactose pos.

Contaminated seafood. Waterassociated wound infections. Septicemia, meningitis. Grows on routine media. Plesiomonas shigelloides now included in Enterobacteriaceae Gastroenteritis from contaminated water or seafood. Causes sinusitis, otitis media, pneumonia, bronchitis, often in elderly or compromised. Capsules may be seen. Translucent, moist, tannish colonies.

Mousy or bleach-like odor. May demonstrate satellitism with staph on SBA. Should be serotyped. Characteristics are similar to H. Low incidence of pathogenicity. Causes chancroid sexually transmitted disease. Small GNCB, bipolar staining.

Multitest biochemical systems available for ID. Takes 9—40 days to grow. Dx usually by serological or molecular methods. Fluorescent antibody stain.

DTaP vaccine diphtheria, tetanus, pertussis. Brucella Brucellosis undulant fever. From unpasteurized milk or contact with infected goats, cows, hogs, dogs Tiny, faintly staining GNCB Most often isolated from blood cultures or biopsies of reticuloendothelial RE tissue. Culture not sensitive. Level 3 pathogen. Potential bioterrorism agent.

Reportable disease. Serological tests are primary means of Dx. Francisella Tularemia rabbit fever. Small, transparent colonies after 3 days. Serological tests. Found in water e. Pasteurella multocida Contracted by bite or scratch of cat or dog or contact with infected carcass. Musty odor. Colonies are yellow due to fermentation of fructose. Can be used as backup broth to detect organisms present in small numbers or anaerobes. Thioglycolate acts as reducing agent. Aerobes grow at top, strict anaerobes at bottom, facultative anaerobes throughout.

Store at RT. Most have indicator that changes color in presence of O2. Can maintain anaerobes for 24—72 hr. Lid creates airtight seal. Anaerobic generating systems Plates in bag or container. Packet or ampule added.

Chemical reaction removes O2. Workbench in gas-tight cabinet. Work done through gloved or gloveless openings. Oxygen analyzers More expensive. Real-time monitoring. Some GN anaerobes stain faintly with safranin. Recommended to extend time of counterstaining to 3—5 min or use 0. Some GP anaerobes, e. Disks placed on 1st quadrant of plate. After incubation, observe if organism is susceptible or resistant.

Rapid tests For presumptive ID, e. Rxn leads to change in pH. Largely replaced by multitest systems. Only contains codes for most commonly isolated anaerobes. Preformed enzyme-based systems Detect preexisting enzymes. Color changes are read in 4 hr. Nucleotide sequence compared with known sequences in database. GPC in singles, pairs, tetrads, clusters. Resembles staph. Small colonies. May take 48 hr to grow. Resistant to SPS. Mixed infections of skin, soft tissues, GI tract, female genital tract, bones, joints, lungs, brain.

Tiny GPC in chains. Resembles strep. Small gray-white colonies in hr. Sweet odor. Sensitive to SPS. GPC in pairs, short chains, tetrads, clusters. November 20, Perfect May. Margarita Babovnikova. Lauren Teo. Ivory Lee. Zek Zek. Community posts Interesting at the top. Sunday Times Sport - Nov 21 The New Review - Nov 21 Irina Gordeeva. Tomas Mora. Great Magazines - thx. The TLS - No.

It was first published in as a pull-out supplement in The Times newspaper. Such was its popularity that in , the supplement became a separate publication selling for one penny. TLS - November 19 Lora Zhao. Smithsonian Magazine - December Overview: Smithsonian Magazine takes you on a journey through history, science, world culture and technology with breathtaking images from around the world.

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