Download Microscopic Examination Tyrosine Crystals Microscopic

Urinary Tract Infection
URINARY TRACT
INFECTION
 DEFINITION:
TISSUE RESPONSE
TO THE PRESENCE
OF SIGNIFICANT
AMOUNT OF
BACTERIA IN THE
URINE
Physical Composition and
Chemical Properties
Urine
 95% water
 5% waste products
 Other dissolved chemicals
Urea, uric acid, ammonia, calcium,
creatine, sodium, chloride, potassium,
sulfates, phosphates, bicarbonates,
hydrogen ions, urobilinogen
Specimens Types
Varies in method used and in time
frame in which to collect
specimen
Types of specimens:
 Random
 First morning
 Clean catch midstream
 24 hour
Specimens Types (cont.)
 Random – most common, taken anytime of day
 First morning – has a greater concentration of
substances, taken in morning
 Clean catch midstream – the urethral area is
cleaned, urine is tested for microorganisms or
presence of infection
 24 hour – used for quantitative and qualitative
analysis of substances. Some common 24-hour
preservatives are hydrochloric acid, boric acid, acetic
acid and thymol.
LABORATORY
EVALUATION
Other types of Urine sampling:
 Catheterization
 Suprapubic aspiration
 Pediatric Bag
Catheterization
 Urinary catheter –
plastic tube
inserted to provide
urinary drainage
Types Of Urine Collection
 Suprapubic Aspiration Specimen This
method is used when a bedridden patient cannot
be catheterized or a sterile specimen is required.
The urine specimen is collected by needle
aspiration through the abdominal wall into the
bladder.
Specimen Collection
Supra-pubic Needle Aspiration
Types Of Urine Collection
 Pediatric Specimen For infants and small
children, a special urine collection bag is adhered
to the skin surrounding the urethral area. Once
the collection is completed, the urine is poured
into a collection cup.
Urinalysis
Evaluation of urine to obtain
information about body health and
disease
Three types of testing:
 Physical
 Chemical
 Microscopic
Preservation and Storage
Changes that affect
the chemical or
microscopic
properties of urine
occur if urine is
kept at room
temperature for
more than 1 hour
Refrigeration – most
common method for
storing and preserving
urine
It prevents bacterial
growth for 24 hours.
After 24 hours use
chemical preservation
Physical Examination of Urine
Visual examination of
physical characteristics




Color and turbidity
Volume
Odor
Specific gravity
 The
refractometer or a
reagent strip is used to
measure specific gravity
Refractometer
Reagent Strips
Chemical Analysis
Urine Dipstick
Glucose
Bilirubin
Ketones
Specific Gravity
Blood
pH
Protein
Urobilinogen
Nitrite
Leukocyte Esterase
Chemical Analysis
Chemicals Found in Urine
 Ketone bodies – may indicate that patient is
following a low carbohydrate diet or that patient
has conditions such as starvation
 pH – provides information about metabolic
status, diet, medication or several conditions
 Blood (hematuria) – may indicate patient is
menstruating, have urinary tract infection or
trauma
Chemicals Found in Urine
(cont.)
Bilirubin or urobilinogen – first signs of liver
disease
Glucose – common in patients with diabetes
Protein – usually indicates renal disease
Nitrite – suggests bacterial infection
Leukocytes – urinary or renal infection
Microscopic Examination
of Urine
 Microscopic examination used to view elements
not visible without microscope
 Centrifuge spins urine to cause heavier
substances to settle to the bottom
•Cells
•Casts
•Crystals
•Yeasts
•Bacteria
•Parasites
Microscopic Examination
RBCs
Microscopic Examination
RBCs
Microscopic Examination
WBCs
Microscopic Examination
Squamous Cells
Microscopic Examination
Microscopic Examination
Yeasts
Microscopic Examination
Yeasts
Microscopic Examination
RBCs Cast
Microscopic Examination
WBCs Cast
Microscopic Examination
Hyaline Cast
Microscopic Examination
Waxy Cast
Urinary Crystals
 Classification

Normal and Abnormal



Normal Acidic crystals
Normal Alkaline crystals
Abnormal crystals - metabolic origin
Amorphous Urates and Phosphates
Microscopic Examination
Calcium Oxalate Crystals
Microscopic Examination
Calcium Oxalate Crystals
Dumbbell Shape
Microscopic Examination
Triple Phosphate Crystals
Ammonium
Biurate
Uric acid crystal
leucine crystal
Microscopic Examination
Tyrosine Crystals
Microscopic Examination
Cystine Crystals
Cystine crystals in urine
Cystine, an amino acid, is an abnormal finding in urine.
Rarely seen, these crystals are found in acid urine and
are seen as thin, colorless, hexagonal plates.
LABORATORY
EVALUATION
Urine culture
 Midstream clean catch  10⁵ colony forming
units
 Cathterization  10.000 CFU
 Suprapubic aspiration any growth
Culturing Procedure
Mix the urine sample to re-suspend microorganism present.
Dip a 1 μl or 10 μl calibrated loop in vertical position in the urine and remove
the loop and use the collected fluid to inoculate Blood and MacConkey agars
respectively.
Culturing Procedure
Colony counting
CFU
# colonies counted
in original sample 
ml
(dilution) (volume plated, in ml)
 A plate count of 100,000 CFU/ml of pure culture should be considered positive
and isolated organism should be identified and sensitivity test will be performed.
 A plate count between 10,000 – 100,000 CFU/ml is considered suspected .
A plate count less than 10,000 CFU/ml is considered negative.
Inoculation of Urine
 Inoculation of urine for quantitative
culture (colony forming units→cfu’s)
performed with a calibrated 0.001 mL and
0.01 mL plastic or wire loop
 Sheep blood agar (SBA) utilized for
quantitative urine culture
 With 0.001 ml loop, 1 colony on SBA
equivalent to 1,000 cfu’s per mL of urine
 With 0.01 ml loop, 1 colony on SBA
equivalent to 100 cfu’s per mL of urine
Infecting organisms
E.coli
Klebsiella
Staphylococci
Proteus
Pseudomonas
Enterococci
E.coli
 IMViC reaction of E.
coli:

+ + - -
KIA A/A
Klebsiella species

Significant biochemical reactions



Lactose positive
Most are urease positive
Non-motile
Klebsiella species
 IMViC reaction of K.
pneumoniae:
- - + +
Proteus spp .
 KIA: G+, K/A
SIM: H2S+, I variabil,
M+
Urea: +
Simmons: +
Proteus spp.
 Proteus - Members of
the genus Proteus will
swarm at certain
intervals and produce a
pattern of rings due to
their motility.
Pseudomonas aeruginosa
 Greenish discoloration
of media due to
production of pyocyanin
by Pseudomonas
aeruginosa
Pseudomonas spp.
Pseudomonas aeruginosa
 Results of oxidase test
Staphylococcus aureus
 G-positive cocci in
clusters,
 typical of
Staphylococcus aureus
 Catalase test used to
differentiate
Staphylococci
 from Streptococci
 Coagulase test used to
differentiate S. aureus
 from other
Staphylococcus spp.
Staphylococcus saprophyticus
 Coagulase-negative
staphylococci
 Novobiocin Resistant:
Zone is less than or
equal to 16mm
Schistosomiasis
 Females are slender and delicate, whereas
males are much bigger and have a spiny
trough or groove into which the female fits
and locks in.
 The male consumes blood and feeds the
female most of it, which she turns into eggs,
which pass out of the host and can begin the
life cycle again.
Blood fluke is a special kind of flukes because of
following characters:
(1) The adult worms look like nematodes, elongated
cylindrical in shape.
(2) Two sexes are separate.
(3) egg without operculum, but with a terminal spine.
(4) only one intermediate host required.
(5) The infective stage is cercaria.
(6) The infective route is by skin.
(7) The eggs are main pathogenic stage.
Paired male and female adult worms. The female is the darker,
curled worm within the male's gynacophoric canal.
Mature egg is oval in shape, slight yellow in color, shell is
thin without an operculum but with a terminal spine. The
content is a miracidium.
Cercaria is infective stage. It is composed of the body and
forked tail (including tail stem and fork) and has 5 pairs
of penetrating glands in the body.
oval in shape, slight
yellow in color, shell
is thin without an
operculum but with a
terminal spine.
A Comparison of Schistosome Eggs
S. mansoni
Lateral spine
S. haematobium
Terminal spine
S. japonicum
No spine
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