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Laboratory Manual of Microbiology For Medical Students Department of Microbiology Gannan medical Univerisity 2002 General Rules for Microbiology Laboratory The laboratory work of microbiological course involves handing cultures and materials, which are infectious in nature, for safety in the laboratory, please observe the following precautions: 1. Wear a laboratory coat before entering the laboratory. 2. No eating, smoking and drinking in the laboratory. 3. Dispose of infectious materials and cultures carefully to avoid endangering your health. Put the contaminated glassware into the large cylinder with lysol solution, and the materials to be sterilized or disposed at the indicated area. 4. Be very careful to avoid spilling out any kinds of contaminated materials. If the infectious materials contaminated the desk, hands, laboratory coat or floor notifies your instructor at once. 5. Take care of the glassware and instruments you used, in case of any breakage, report to your instructor. 6. Do not remove specimens, cultures or equipment out of the laboratory under any circumstances. 7. Keep personal items in the places designated and away from working area. 8. After finishing the experiment, scrub the laboratory tables with cleaning agent, wash your hands thoroughly, close the windows, and turn off the electric light and tap water before leaving the laboratory. Experiment 1 Use and Care of Microscope One of the most useful tools for Microbiology study is the microscope. It is assumed that this instrument has been used and is generally familiar with the parts of lt. For this reason, discussion of the instrument will be restricted to the use and care of oil immersion lens. Oil-immersion lens in size is smaller than other lens. The rays of light undergo refraction by air and pass into the lens very little. The space between the lens and object is occupied by immersion oil, which has the same refractive index as the glass; so light pass through the lens is brighter. The objects can be seen clearly. A.Materials light microscope small bottle of immersion oil (cedal oil) xylene lens paper prepared practice slides of bacteria B. Procedure 1. Place microscope in proper working position of the table at convenient height. Be sure you are comfortably seated and look into the microscope. 2. Adjust the mirror or the illumination, so that you can find the brightest microscopic field. 3. Put the slide on the stage and place a drop of immersion oil on the slide. 4. Lower the oil immersion objective with the coarse adjustment into the drop of oil until the objective almost touches the slide but does not touch it. 5. Focus upward with the coarse adjustment knob very slowly until the image appears while looking into eyepiece. 6. Complete focus with fine adjustment. C. Care of Microscope 1. When the experiment is over, clean the microscope. Be sure to remove oil from the oil immersion objective with lens paper moistened with xylene, then use dry lens paper to remove the xylene on lens. 2. Because the microscope is an expensive and fine instrument, especially the oil-immersion lens. It is necessary to take care of it. Do not drop and lay it on the wrong place and be sure to place it in the case. Experiment 2 Basic Shapes and Special Structures of Bacteria 1.Materials Smears of Staphylococcus aureus, Escherichia coli and Vibrio cholera, which are stained by Gram stain. Smears of Streptococcus pneumoniae , Proteus vulgaris and Clostridium tetani , which are stained by special stain. 2.Procedure Observe these sears on the microscope, and pay attention to the morphology, the arrangement and the staining properties. 3. Result Coccus: Staphylococcus.aureus Basic shapes: Bacillus: Escherichia coli Vibrio: Vibrio cholera Special structures: Capsule: Streptococcus pneumoniae Flagella: Proteus vulgaris Spore: Vibrio cholera Experiment 3 Preparation of Culture Media In order to cultivate the bacteria artificially, it is necessary to provide suitable nutrients for their growth. Medium is the material prepared artificially in which or on which the bacteria are grown. The media used for the cultivation of the bacteria may be liquid, semisolid, or solid. The media that support the growth of a large number of bacteria are called general-purpose media. Selective media contain some chemical substances, which can prevent the growth of one, or more groups of bacteria without inhibiting the growth of desired one. Differentiate media contain certain chemicals which permit the observer to differentiate the bacteria. The basic components of media consist of peptone, amino acids, sugars, salts and water. Besides, the media should be adjusted to optimal pH (usually 7.4-7.6) and be sterilized. A. Broth Medium 1. Materials Finely ground beef Peptone NaCl K2HPO4 Distilled water 2. Procedure a. Add 1000ml of distilled water to 500g finely ground lean beef (fascia and fat are completely removed). Put in the refrigerator over night; let the nutrients in fuse out from the beef. Remove all the fat on the surface of the infusion liquid. b. Boil the infusion for 30 min, filter through a piece of cloth, squeeze out all the liquid from the beef residues. c. Add distilled water to restore the volume up to 1000ml. Put 10g of peptone and 5g of NaCl to the infusion. d. Cool to 40-50℃,adjust pH to 7.8 with NaOH, boil for 10 min and restore the volume with distilled water, filter through absorbent cotton. e. Dispense into tubes or flasks, and stopped with cotton plugs. f. Sterilize in autoclave at 15 lbs (121℃) for 20 min. Note If there are not any fresh beef available, we can use the meat extract (meat infusion) 3g. B. Solid Medium Agar is usually used to prepare the solid media. Agar itself doesn’t posses any nutritive value for the growth of bacteria, but it is used in the media to alter the physical properties of broth , for it can melt at 100℃ and solidify around 40℃. Add 2% agar to the broth, we will get a solid medium. If 0.5% agar is added, a semisolid medium will be formed. 1. Materials Agar Petri dish Pipet Broth Medium 2. Procedure a. Add 2-3 g of agar to 100ml broth in a flask; heat until agar is completely dissolved. b. Adjust pH to 7.4-7.6 with NaOH. c. Sterilize in autoclave at 15 lbs for 20 min. d. When the medium is still liquid, pour it to the sterile Petri dish, allow it to cool to 40℃ and agar plate is formed. 5. Pour 4-5ml of medium to sterile tube and let the tube slant, agar slant is formed. Note If add 0.5% agar to the broth, the medium becomes semisolid. Experiment 4 Examination of Bacterial Metabolic Products It is common for two bacterial cultures to be very similar in their morphologic and cultural characteristics, but strikingly different in their ability to use nutrients and form the end products. These characteristics of bacteria are indispensable in classifying and identifying the bacteria. A. Sugar fermentation of bacteria. Bacteria can utilize different sugars and produce different end products, for they possess different enzyme. The common method used is a routine qualitative test designed to permit to detect the sugar fermentation by noting the change in pH of culture medium. The medium usually consists of certain sugar and indicator, such as bromcresol-purple, which will change color from purple (pH 7) to yellow (pH 5.4), if the bacteria ferment the sugar and produce acid. If gases are produced, they will trap in the small inverted vial in the tube. 1. Materials Slant cultures of E. coli and S. Typhoid Wire loop Glucose and lactose fermentation tubes Alcohol lamp 2. Procedure a. Inoculate two bacterial cultures into fermentation tubes, respectively. Incubate at 37℃ for 18-24 h. b. After incubation, observe if the media change color and have any bubble in the vial. 3. Result E. coli S. Typhoid Glucose ⊕ + Lactose ⊕ _ B. Metyl Red Test (MR) and Voges-Proskaurer Test(VP) MR test and VP test used for the same general purpose: to distinguish between E. coli and E. aerogenes and to lessen extent among other species as well. 1. Materials Glucose-peptone water medium Methyl red reagent 5% alpha naphthol, in absolute ethy1 alcohol Slant cultures of E. coli and E. aerigenes 2. Procedure a. Inoculate E. coli and E. aerogenes into two tubes of glucose peptone media and incubate at 37℃ for 48 h. b. MR test: add 5 drops of methy1 red reagent to one tube, records the result: A red color means a positive test, showing that E. coli ferment glucose producing enough acid to effect pH change from 6.0 to 4.4 (at pH 6.0) methyl red is red. c. VP test: add 0.5ml of 5% alpha naphthol in absolute ethyl alcohol and 0.5ml of 40% potassium hydroxide into two tubes with E. coli and E. aerogenes, respectively, stand for 15-30 min. A red color is developed (positive), which indicate that the bacteria produce acelyl-methy1-carbiol by the fermentation of glucose in the media. 3. Result E. coli E. aerogenes MR test + ─ VP test ─ + C. Citrate Utilizing Test Some bacteria can utilize citrate as their carbon source to provide the energy to growth. The end production of this reaction is NH3, which makes the culture medium’s pH>7. The indicator BTB (bromothymol blue) change color from green to blue. 1. Materials Slant cultures of E. coli and E. aerigenes Citrate medium 2. Procedure a. Inoculated E. coli and E. aerogenes into two tubes of citrate medium, respectively, and incubate at 37℃ for 48 h. b. Observe the color of the slant. 3. Result Citrate Utilizing Test E. coli ─ E. aerogenes + D. Indole test Some bacteria produce tryptophanase, which can hydrolyze the tryptophan into indole. Indole is colorless and invisible, but may reacts with dimethyl aminobenzaluehyde to form rose indole. 1. Materials Slant cultures of E. coli and E. Aerogenes Peptone water medium Kovacs reagent: para-dimethylaminobenzaldehyde dissolved in pure amylalcohol and concentrated hydrochloric acid. 2. Procedure a. Inoculate the E. coli and E. aerogenes into peptone water media, respectively. b. Incubate at 37℃ for 18-24 h. c. Add several drops of Kovacs reagent to the media and shake the culture tubes. d. A deep red color indicates a positive reaction. 3. Result E. coli E. aerogenes Indole test + ─ E. Hydrogen sulfide production test Some bacteria possess the enzymes, which can split the sulfur containing amino acids to produce H2S. The combination of H2S with lead acetate or ferrous sulfate forms lead sulfide or ferrous sulfide, which is indicated by blackening the medium. 1. Materials Slant culture of E. coil and S. typhi. Lead acetate agar or ferrous sulfide Wire needle Alcohol lamp 2. Procedure a. Inoculate E. coli and S. typhi into the lead acetate agar with straight wire needle. b.Incubate at 37℃ for 24 h. c. Positive test is indicated by the appearance of the black precipitates along the stab track. 3. Result H2S test E. coli ─ F. S. typhi + Pigments Some bacteria can produce characteristically pigment, which give the colonies or media a color. 1. Materials 24 hours broth cultures of S. aureus, S.epidermidis and P. aeruginsa Agar slants or agar plates wire loop alcohol lamp 2. Procedure a. Inoculate S. aureus, S. epidermidis and P. aeruginsa in the slants or plates, respectively. b. Incubate at 37℃ for 24-48 h. 3. Observe the color of colonies and media. Experiment 5 Cultivation of Bacteria It is possible that the most frequently used technique in the microbiology involves the transfer of microbial growth from one environment to another. The main purpose of inoculation is to get a pure culture of bacteria. 1. Materials Agar plate, agar slant, semisolid agar, broth Alcohol lamp Agar slant cultures of S.epidermidis and E. coli wire loop A. Inoculating bacteria on the Petri dish Many clinical specimens, such as feces, sputum and pus, etc, usually contain various kinds of bacteria. The use of streak-plate method can often obtain discrete colonies of the pathogenic bacteria and the pathogens can be isolated in pure cultures. So the identification of the pathogens concerned becomes possible. Procedure 1. Place the slant of the bacteria in left hand, remove the plug, flame the wire loop and the mouth of the culture tube. 2. Insert the loop into the tube and pick the bacteria growth on the slant. 3. Remove the cover of the plate and hold the bottom in upright position with left hand. Rub the inoculum on the top surface of the plate with the lip of the wire loop, gently and continuously streak the inoculum back and forth until obtained the streaking pattern you desired. 4. Replace the cover, flame-sterilize the wire loop and put it on the desk. 5. Label the plate, invert the Petri dish and incubate at 37℃ for 18-24 hours. B. Inoculating bacteria on the slant 1. Flame-sterilize the wire needle. 2. Place a sterile agar slant in your left hand, remove the cotton plug, and pass the mouth of the tube over the flame. 3. Touch the tip of wire needle very carefully to the surface of the bacterial given in the slant. 4. Insert the wire needle containing a small amount of bacterial growth into the slant culture tube. 5. Inoculate the bacteria on the surface of the slant by passing the tip of the needle across the surface area in short swinging strokes, beginning near the end of tube and coursing to the top of the slant, cover as much of the surface area as possible. 6. Pass the mouth of the tube over the flame and replace the cotton plug, flame-sterilize the wire needle. 7. Incubate at 37℃ for 18-24 h. C. Inoculating bacteria on the semisolid agar In addition to the direct microscopic examination of bacterial culture for motility, another method in common used for determining this characteristic is the inoculation and subsequent observation of the motility of bacteria in semisolid media. Motility of bacteria is indicated by a diffuse growth of bacteria from the line of inoculation. 1. Flame-sterilize the wire needle. 2. Place a semisolid agar tube in your left hand, remove the cotton plug and pass the mouth of the tube over the flame. 3. Touch the tip of the wire needle to surface of the growth of bacteria and pick a little. 4. Insert the wire needle into the semisolid agar straightly and return the needle by the same way. 5. Pass the mouth of the tube over the flame and replace the cotton plug, flame-sterilize the needle. 6. Incubate at 37℃ for 18-24 h. Note: 1. Be careful to keep sterile technique to prevent contamination during the laboratory periods. Do not speak and laugh. 2. Be careful not to cut the agar when streaking on the agar surface. 3. Do not pick up too much growth in inoculation, for there may be several million organisms while your loop just touches to the growth. So, very small (barely visible) quantities adhering to the wire loop are sufficient to affect a successful transfer. Experiment 6 Observation of Bacteria Growth A. Observation of bacterial colony on the plate agar Colony is made up of millions of bacterial cell derived from a single bacterium. It is very regular (round) in shape and does not touch any others on the plate agar. The colonies of different types of bacteria show different characteristics, which can be used to identify the bacteria. The characteristics of colony: 1. Size: small colony: 1mm; medium colony: 2-3mm; large colony: 3mm. 2. Form: circular or irregular. 3. Edge: entire or irregular. 4. Surface: convex, flat smooth, rough, dry or moist. 5. Transparency: transparent or opaque. 6. Color: some bacteria produce lipid-soluble pigments, which confined to the colonies, others produce water-soluble pigments that diffuse into the medium. B. Observation of bacterial growth in the broth Bacterial growth in the broth may appear turbid, membrane-like growth or sediment growth, according to the different types of bacteria. C. Observation of bacterial growth in semisolid agar Semi-solid agar is used to test the motility of bacteria. The growth of non-motile bacteria is restricted to the inoculation line, and the medium keeps clean. The motile bacteria spread throughout the whole medium while growing, so the inoculation line is not visible and the medium appears turbid. Experiment 7 Staining of Bacteria Bacteria are small, almost colorless and difficult to observe even with the aid of microscope. Fortunately, most bacteria readily react with various dyes, which allow the morphology of bacteria cells to be distinguishing from extraneous materials present in the stained smear. There are many methods to be used to stain the bacteria, such as, simple stains, differential stains, special stains, and so on. A. Gram's stain The Gram's stain is a differential stain devised by Christian Gram in 1884. This staining procedure is the most widely used which can differentiate the bacteria into two groups, i. e. Gram-positive (G+), and Gram-negative (C-). 1. Materials Slide Staining rack Wire loop Normal saline A set of Gram's stains (Gram's crystal violet, Gram's iodine, 95% alcohol, and diluted Safranin solution) Slant cultures of Escherichia coli and Staphylococuse epidermidis. 2. Procedure 2.1. Preparation of bacterial smear a. Flame the wire loop to red-hot and cool it for a few seconds, do not touch it to anything. b. Place two small Drops of normal saline with the sterile loop on the slide. c. Hold the culture tube with the left hand, flame the wire loop again. d. Remove the plug from the culture tube with the right hand. Hold the plug and do not let it touch anything else. e. Pass the mouth of the culture tube through the flame, and remove a very little bacterial growth from the agar slant with the sterilized loop. Do not dig into the agar. f. Pass the mouth of the culture tube through the flame again and replace the plug. g. Emulsify the growth with saline as figure and make a thin smear. h. Do not forget to flame the wire loop again before lay it aside. i. Allow the smear to dry in air or over flame. j. Fix smear by passing the slide through the flame several times. 2.2 Gram's Stain a. Cover the smear prepared on the slide with Gram's crystal Violet for l min fist stain. b. Wash with tap water and shake off excess. c. Cover with Gram s iodine (mordant) for l min. d. Wash with tap water and shake off excess. e. Cover the smear with 95% ethyl alcohol (decolorize) for 30 seconds, wash with tap water. f. Cover the smear with safranin (counter-stain) for 1 min. g. Wash with tap water and shake off excess. h. Dry in air or with a fresh piece of hygroscopic paper. i. Use the oil immersion lens to examine the smear. 3. Results: Bacteria that retain the dye complex after washing and appear bluish-purple are termed Gram-positive organism; those can not retain primary stain and appear red after counter-staining are Gram-negative organism. Note: a. Decolorization is the most critical step in Gram’s stain. If you decolorize too vigorously, all cells will lose their primary dye and appear red, on the other hand, if you decolorize too gently, Gram negative bacteria will appear bluish-purple. b. Gram's stain is also affected by the incubating time of bacteria. It is important for you to remember that Gram's stain, as a differential method, is valid only with the cultures of 18-24 h. Experiment 8 Distribution of Bacteria in the Environment and Human Body Bacteria distribute in every place of the environment including air, soil, water, food, and the surface structures of human and animal body. Therefore, it is important to understand the natural distribution of bacteria in order to establish the aseptic concepts in medical practice and certain scientific experiments. A. Bacteria in the air 1. Materials Nutrient agar plate 2. Procedure a. Put the agar plates at different places in the laboratory. b. Remove the lid of the Petri dish. c. Let the Petri dish to expose to the air for 10 min. d. Replace the cover to the Petri dish, invert position, label and place in the incubator for 18-24 h. e. Count the number of colonies on the plate and observe their characteristics. B. Bacteria in running water and the pool water 1. Materials Nutrient agar plate Sterile cotton swabs 2. Procedure a. Moisten a dry sterile cotton swab with water from tap water and pool water, respectively. b. Rub the surface of the agar plate with the cotton swab. c. Replace the cover on the Petri dish, invert, and incubate at 37℃ for 18-24 h. d. Count the number of colonies of bacteria on the plate and observe their characteristics. C. Bacteria on the finger tip 1. Materials: Nutrient agar plate Sterile cotton swabs 2. Procedure a. Divide the plate with wax pencil into two equal squares. b. Rub on the surface of the plate with the fingertip on one square before disinfection. Disinfect the fingertip with 75% alcohol, and then rub on another square. c. Incubate at 37℃ for 18-24 h. d. Count the number of colonies on the plate and observe their characteristics. Observe the effect of disinfection with 75% alcohol. D. Bacteria in the throat 1. Materials: Blood agar plate 2. Procedure a. Remove the lid on the blood agar plate. b. Hold the plate at 30 cm from your mouth and cough violently to the surface of the agar plate. c. Replace the cover, invert and incubate at 37℃ for 18-24 h. d. Count the number of the colonies and observe the characteristics. E. Bacteria in the soil 1. Materials: Chopped meat broth Sterile pipet Vaseline 2. Procedure a. Add 0.5ml of 1/10 diluted soil (with water) to chopped meat broth by sterile pipet. b. Place the culture tube at 80℃ hot water for 30 min. c. Add melting vaseline (about 1ml) to the surface of broth. d. Incubate at 37℃ for 24-48 h. e. Observe the color of chopped meat. Experiment 9 Variation of Bacteria Bacteria, like other living things, posses the traits of heredity and variation, i.e. the resemblance and difference between parents and their progeny. In this laboratory period, we shall observe the phenomenon of variation in some bacteria. A. Smooth-rough variation A change in the cell surface composition in certain species of bacteria may occur, in which the bacteria may form colonies, which differ from those of the original strain in the appearance. If the colony is mucous with glow glossy surface on agar plate, we can call smooth colony; on the contrary, rough colony is dull and matt. Usually, encapsulated bacteria form smooth colony, while non-encapsulated cells produce rough colony. In general, the change in colony from smooth to rough may involve some or all of followings: 1. The appearance of colony has altered. 2. The specific smooth-strain antigens are lost. 3. The susceptibility to certain bacteriophages has changed. 4. A reduction in virulence. With varying the components of medium, the variation from S to R may be reversible, i.e. from S to R, or vice versa. B. H-O variation Many strains of bacteria have flagella on the surface, The flagella may loss, when the conditions which the bacteria need for their growth are changed, this phenomena in termed the variation from H (Hauch ) to O (Ohne Hauch). Proteus has peritrichous flagella distributed on the surface of bacterial body. The bacteria spread rapidly over the plate when inoculation on the agar plate, we can called swimming growth, but the swarming growth is inhibited if the bacteria grown on the 0.1% phenylethy1 agar plate. Experiment 10 Pathogenicity of Bacteria The pathogenicity of bacteria includes invasiveness and toxin. Invasiveness is a kind of capacity of bacteria to invade host tissues, which depends on the function of enzymes and the formation of bacterial surface structure. There are many enzymes produced by different bacteria species, for example, coagulase, hyaluronidase, etc. The bacterial toxin are usually grouped as exotoxins and endotoxins. A. Hyaluronidase test 1. Materials Rabbits hyaluronidase Needle Alcohol Indian ink Syringes 2. Procedure a. Shave the hairs on the both sides of skin in the back of rabbit for inoculation. b. Sterilize skin with 75% alcohol. c. Dilute the hyaluronidase with normal saline to 1:100 and mix equal volume of Indian ink. d. Inoculate intradermally the above mixture 0.5ml to one side of the back and the mixture of ink and equal volume normal saline .S 0.5ml to the other side as the control. e. Examine the results 1 hour later, compare the diameter of infiltration of ink on the both sides of rabbit. B. Tetanus toxin test 1. Materials Tetanus exotoxin Mice Syringe Needle 2. Procedure a. Inject intramuscularly the diluted Tetanus exotoxin 0.2 ml to one of the hind legs of mouse. b. Examine the results on next day. The inoculated leg shows spasimc paralysis and the animal dies within 2/3 days. C. Lecithinase test 1. Materials C. perfringens Fresh-egg-yolk plate Anaerobic jar Inoculating loop 2. Procedure a. Inoculate C.erfringens on nutrient agar containing 10% sterilized fresh-egg-yolk. b. Put the plate in the anaerobic jar to culture anaerobic. Culture at 37℃ for 18-24 h. c. Examine the result: the presence of turbid precipitation over the inoculated area means positive. Which is due to the lecithinase, produced by C. Perfringens, decomposes the lecithin of egg-yolk into glacerine and fatty acid, the latter precipice on the inoculated area. D. Plasma coagulase test The production of coagulase is one of the major criteria employed to differeciate S. aureus from S. epidermidis, because 90% S,aureus associated with pathogenic processes. So, coagulase-positive Staphylococcus is considered as pathogenic coccus. 1. Materials The cultures of S. epidermidis and S. aureus. Two tubes with 0.5ml rabbit plasma in it. 2. Procedure a. Inoculate S. epidermidis and S. aureus into the rabbit plasma, respectively. b. Incubate at 37℃ for 0.5h. c. Examine the result: The rabbit plasma in which the S. aureus inoculated coagulated, that means the coagulase-positive. The rabbit plasma in which the S. epidermidis inoculated didn’t coagulated, that means the coagulase-negative. Experiment 11 Isolation and Identification of Pyogenic Cocci Pyogenic cocci are most frequently encountered pathogenic bacteria. These cocci commonly include four well-known genera, namely, Staphylococcus, Streptococcus, Neisseria and Pneumococcus, which can be isolated from patients with pyogenic cocci infection and healthy carries. Although Gram stain of an isolate is helpful in identification of cocci, it is not sufficient to differentiate pathogenic cocci from non-pathogenic. So the bacteria must be isolated in pure culture and further identify according to antigenic structure and biochemical test. A technique commonly used in isolation of pathogenic cocci is the procurable of microbial specimens on a swab, streaking the plate with swab, which is very useful to get isolation of pure colonies. 1. Materials Blood plates, pus specimen, wire loop, alcohol lamp 2. Procedure It needs 3-4 days to complete the procedure for isolation of the pathogen from the pus specimen given. Directly make smear and Gram's stain (Arrangement, Pus swab morphology, and stain characteristics) Inoculate on blood plate 37C growth character 18h A. first day 1. Streak with cotton swab on one edge of blood plate, with a back and forth motion. 2. Cover the plate with cover and throw the swab into the cylinder with lysol solution. 3. Sterilized the loop and drag it through the sector streaked with swab to pick up bacteria deposited there. 4. Streak into the uninoculated area in a fashion similar to that performed in the streak-plate technique. 5. Close the plate with the cover and inverted the plate. 6. Incubate the plate at 37℃ for 24 h. B. Second day 1. Materials Blood plate, rabbit plasma, slide, saline. 2. Procedure a. Observation of the cultures: note colonial morphology and growth character of bacteria. If the colonies are medium size, smooth, hemolytic and golden yellow, Gram stain shows G+ and arranged in irregular clusters, the isolates may be S. aureus. If the colonies are small in size, smooth, G+, and arranged in chains, the isolate may be Streptococcus. b. Plasma coagulase test The production of coagulase is one of the major criteria employed to difference S. aureus from S. epidermidis, because 90% S, aureus associated with pathogen processes. So, coagulase-positive Staphylococcus is considered as pathogenic coccus. a. Place two loops of saline to the two area on the slide respectively. b. Remove enough bacteria from a colony on the plate to prepare a heavy suspension of bacteria. c. Add one drop (or one loop) of rabbit plasma to the one of the suspensions, quickly mix with the wire loop. d. In few seconds, a positive result is visible clumping, and the control is still homogenous liquid. 3. Sub-inoculate one colony of bacteria into fluid broth for antibiotics sensitivity test. C. Third day 1. Materials Sterile cotton swab, blood plate, several paper discs containing different antibiotics 2. Procedure a. Immerse the cotton swab with the broth cultures. b. Spread with cotton swab over the surface of the blood plate. c. Place the paper discs containing antibiotics on it and incubate the plate at 37℃ for 18 h. d. Measure the inhibitory zone to determine the drug sensitivity of the bacteria. Experiment12 Effect of anti-microbial agent on bacteria (Anti-microbial susceptibility tests) Substances produced by one kind of microorganism can kill or inhibit others are known as antibiotics or anti-microbial agents. There are many ways to evaluating the effect of antibiotics on bacteria, including the dilution tests, such as the broth tube and agar plate dilution procedures, and the disc agar diffusion test, utilizing antibiotics impregnated discs. However, the most useful and practical method for antibiotics susceptibility is the disc agar diffusion procedure. It is very helpful for doctor to select the most effective drugs to render the infectious diseases. 1. Materials Nutrient agar plate 24 h broth culture of S. epidemidis Sterile cotton swab forceps alcohol lamp paper discs in filtrated with following; penicillin 10 units streptomycin 10 ug gentamicin 10 ug sulfadiazine 1 mg tetracycline 30 ug 2. Procedure a. Inoculate the S. epidermidis on the plate with sterile swab, make the inoculation very heavy. b. Remove antibiotics discs from vials and place on the surface of inoculated agar plate with sterile forceps. c. Invert the plate and incubate at 37℃ for 18-24 h. d. Measure the diameters of inhibiting zones around the paper discs. The susceptibility of bacteria is determined on the basis of Table 12-1. Table 12-1 The susceptibility of bacteria to antibiotics Antibiotics penicillin streptomycin tetracycline gentamicin sulfadiaine R: resistant MS: moderately sensitive HS: highly sensitive Inhibitory zone of Antibiotics discs(mm) 10 10-20 20 10 10-14 15 10 10-14 15 10 10-18 19 10 10-15 15 Susceptibility R MS HS R MS HS R MS HS R MS HS R MS HS Experiment 13 Isolation and Identification of Enteropathogen Bacilli A. Specimen collection Stool should be fresh. Pick up the mucous or mucobloody portion of stool and inoculated on the medium. If the stool can't be got, rectal swab can be used. Besides, stool specimen should be immediately sent to the laboratory and inoculated, or preserve in glycerol-saline. A. Isolation and identification It needs 3-4 days to complete the isolation procedure of enteropathogenic bacilli from the stool specimen. Stool swab Direct inoculate S-S agar plate 37℃, 24h Pick up small, transparent and colorless colonies Double sugar iron agar 37℃,18-24 h Gram's stain Semisolid agar 37℃, 24h Observation of bacterial biochemical test slide agglutination test with known antiserum 1. Materials: S-S agar plate, stool swabs, double sugar iron agar, semisolid agar wire loop, alcohol lamp 3. Procedure First day a. Inoculate the stool specimen on the S-S agar plate with stool swab. b. Incubate the plate at 37℃ for 24 h. Second day: Observation of the growing character of bacteria and sub-inoculation. a. Observation of character of the bacteria on the S-S agar. S-S agar is a kind of selective and differential medium, for it contains some substances, such as bile salt, brilliant green, sodium thiosulfate, sodium citrate and so on, besides nutrients. These substances can inhibit the growth of non-pathogenic enteric bacteria; salt can promote the growth of Salmonella and Shigella, lactose and neutral red in the medium act as indicators. Generally, on the S-S agar, E.coli ferment lactose and produce acid, so the colonies appear red color, and the enteropathogenic bacteria can't ferment lactose, the colonies appear small, colorless. b. Sub-inoculation ①. Pick up the small colorless colonies and inoculate into the double sugar iron agar and semisolid medium. ②. Incubate the agar at 37℃ for 18-24 h. Third day: Examination of the results and sub-inoculation a. Observation of the results of double sugar iron and semisolid agar, Double sugar iron agar contains lactose and glucose (lactose is much more than glucose) and ferrous sulfate, sodium thiosulfate, phenol red acts as an indicator. When acid i.e. pH<7 and gas, the medium shows yellow; alkaline pH>7, appear red. E.coli ferment lactose and glucose and produce much acid. So the slant appears yellow and there is gas in the culture. Some enteropathogenic bacteria ferment glucose but not lactose, so the top of slant is still red (little acid has been volatilized), the bottom of the slant appears yellow. If the bacteria produce hydrogen sulfide, the slant appears black, because FeS is formed. b. Slide agglutination test: with known antibody (such anti-salmonella or anti-shigella serum), do slide agglutination test as usually fashion. 3. Sub-inoculation: pick up the bacteria from the surface of slant and inoculate into sugar fermenting tube, and incubate at 37℃ for 18-24 h. Fourth day: Examination of results of sugar fermentation tubes, and final identification can be determined. Experiment 14 Acid-Fast Stain and Albert’s Stain Acid-Fast Stain Some bacteria, such as mycobacteria, do not readily stain under normal staining procedures, but they can retain dyes with the aid of heating and resist decolorization with diluted acid or acid alcohol. So these bacteria are termed acid-fast bacteria. 1. Materials Phenolized sputum sample from a patient Carbol-fuchsion, acid alcohol, methylene blue Staining rack Slide Wire loop 2. Procedure a. Prepare the sputum smear, dry in air or over flame. b. Cover the smear with carbol-fuchsion and gently steam over flame (do not boil) for 3-5 min. Add the stain on the smear from time to time, do not allow the smear to dry. c. Allow the slide to cool, and wash with tap water. d. Decolorize by dropping acid-alcohol on the smear until all the red color is removed from the smear. e. Wash with tap water. f. Counter stain with methylene blue for l min. g. Wash with tap water. h. Allow the smear to dry and examine microscopically under oil immersion lens. 3. Result Acid-fact bacteria appear red; Nonacid-fast bacteria appear blue. Albert’s Stain Some bacteria, such as Corynebacterium, have metachromatic granules in their cell. These granules are composed of polymerized inorganic phosphates, which represent a stored form of these elements widely used in various metabolic processes of bacteria. The granules have a strong affinity for basic dyes. So, using a basic dye, the granules are stained much more intensely than the remainder of the bacterial cell. 1. Materials Slant cultures of Corynebacterium diphtheria Albert’s staining solution Slide Lugol’s iodine solution Staining rack Wire loop 2. Procedure a. Prepare the smear of C.diphtheriticum. b. Fix the smear with very gently heat. c. Cover the smear with Albert’s staining solution for 5 min. d. Pass the slide over flame back and forth, do not allow the stain to steam or boil. e. Drain the slide to remove excess dyes but do not wash with tap water. f. Place Lugol’s iodine solution on the smear for l min. g. Wash with tap water. h. Allow drying and examining microscopically under oil immersion lens. 3. Results Metachromatic granules appear very intense blue round dot within a pale green stained cytoplasm. Experiment 15 Toxigenic Properties of Corynebacterium Diphtheria (Elek test) Toxin production is one of the principal criteria for identifying C. Diphtherias and for separating it from the non-pathogenic diphtheria. The test may be performed in vivo using live animals or it may be performed in vitro (Elek test). 1. Materials Filter strips containing diphtheria antitoxin (500 units), agar medium, Toxigenic and non-toxigenic strains of C. Diphtheria. 2. Procedure a. Using a sterile forceps, press a filter paper strip containing diphtheria antitoxin below the surface of a molten but cooled agar medium in a Petri dish. b. Allow the plate to dry at 35℃. c. Streak a known non-toxigenic strain of C. diphtheria to the filter paper strip, also streak a toxigenic strain perpendicular to the filter strip. As many as four or five clinical isolates can be tested in this way on the same plate. d. Incubating the plate at 35℃ and observe it after 1 to 3 days, the line of growth will appear black or gray. Strains that are toxigenic will show a thin white line of precipitate at an angle of 45 degrees from the culture streak. The white lines are caused by the diffusion of the antitoxin and toxin in the agar medium; at the points of optimal concentration they interact to produce a visible precipitate. Experiment 16 Method of Virus Cultivation Growth of viruses requires susceptible host cells capable of replicating the virus. We are used to inoculate viruses with suitable cell cultures, animals, or embryonated eggs. Prior to the inoculation of the specimen, it may be necessary to eliminate bacteria from the specimen. A. Cell and Tissue Culture Technique Cell and tissue culture technique are the most widely used for the cultivation of viruses, because this method is proved to be more sensitive, accurate and cheap. The test conditions are easily managed, so the results are not affected by other factors in the whole body (such as antibody complement, immune cells, etc). The applications of cell and tissue culture method include: (1) routine isolation and identification of viruses. (2) multiplication of viruses in established strains of susceptible cells. (3) quantitative measurement of virus neutralizing antibodies. (4) multiplication in tissue culture in sufficient quantity for the large-scale preparation of virus vaccines. Cell and tissue cultures can be classified as following: Primary cell monolayer Monolayer cell culture diploid cell strains Continuous cell lines organ culture Example: The preparation of monolayer cell culture of human embryonic kidney. 1. Materials Fresh fetus (artificial abortion), sterile operating instrument, Hanks' solution, 0.25% trypsin solution, culture medium (Eagal, 199 or RPMI 1640 solution containing 10% FCS and antibiotics), 2. Procedure a. Sterilize the skin of the fetus with 2% iodine and take out the kidney. b. Remove the capsule from the kidney, cut the surface area of kidney thus to take off the cortex, discarding the medulla area, then place the cortex in a small culture vial and chopped into small pieces(1-3mm), washed several times with Hanks’ solution till the supernatant of the washing fluid to clear. c. Digestion: put the chopped pieces into flask, add 10ml of 0.25% trypsin solution with 0.1ml of antibiotics, adjust pH to 8.0 and digest in 37℃ water for 2 h or icebox for 18 h, then washing three times with Hanks solution to remove the remaining trypsin solution. d. Centrifuge at 800-1000 rpm for 15 min, discard the supernatant, add 10ml of culture medium and gently re-suspend the cells. e. Dilute the cell suspension in 1:10 ratio and count the cells in haemocytometer. Cell number/ml=cell number in 4 big squares/4 ×100000 f. The cells suspension is transferred into culture medium at a concentration of 300000-500000 cells per ml. Dispense into culture vials, 1ml being distributed into each vial. The vials are stopped with rubber stoppers and incubated at 37℃. Monolayer cells can be obtained in 3-7 days and could be used for the inoculation of viruses. B. Embryonated Egg Technique Embryonated eggs, which provide a sterile environment, are also used for the multiplication of certain viruses. 1. Structure of the embryonated egg. Immediately under the shell is the shell membrane, a tough fibrous material which lines the entire shell but is readily separable from it; at the blunt end of the shell membrane forms an air sac. The chorioallantois, a highly vascular membrane serving as the respiratory organ of the embryo, lies directly under the shell membrane throughout the entire egg. The chorioallantois is separated from the amnion by the allantoic cavity, which contains 5-10 ml of fluid. The amniotic membrane forms a sac, which encloses the embryo; the amniotic cavity within which the embryo lies, contains approximately 1 ml of fluid, Term the amniotic fluid. Attached to the emryo is the yolk sac, which contains nutrients for the developing embryo, 2. Method of egg incubation (example by inoculation of allantoic cavity) a. Clear fertile eggs and sterile the shell with 75% alcohol. b. Place the eggs on the egg rack with the air sac up wards, incubation in a humidified incubator at 38-39℃ for 10-12 days. After incubation for 3 days, turn the eggs, 1-2 times everyday. c. Candling eggs: discard infertile eggs, mark the position of the embryo and air space on the shell with a pencil. d. Inoculation of embryonated eggs, wipe surface with alcohol swab punch a small hole on the shell, inoculated 0.2 ml of virus suspension, sealed the puncture. Write your name and the name of the virus on the shell. e. Incubated at 35-36℃ in an upright position, candling eggs everyday, after 72 h, take out and place them at 4℃ in a refrigerator overnight. f. Harvesting of the allantic fluid: sterilize the upper part of the shell, withdraw the fluid with a capillary pipet or syringe, about 6-8 ml allantoic fluid may be obtained in one chick embryo. g. Allantoic fluid should be placed in refrigerator until use. 3. Embryo inoculation technique. a. Allantoic sac inoculation. 10-12 days embryos are used for production of myxoviruses. b. Amniotic sac inoculation: embryos 12-14 days old are used for primary isolation of influenza virus. A small part of the amniotic chorioallantois membrane is draw with a forceps so that the inoculum can be introduced directly into the amniotic sac. c. Yolk sac inoculation: embryos 6-8 days old are used for cultivation of chlamydiae, rickettsiae and arboviruses. At this age the yolk sac almost fills the entire egg. A hole is made in the air sac end. And the inoculum is introduced directly into the yolk sac. d. Chorioallantoic inoculation: embryos 11-13 days old are used for identification poxviruses. An area free of vessels is selected by candling and the air sac is located, and a artificial air sac is made by chipping the shell with a sharp-pointed instrument over the marked area. The intact shell membrane is exposed and slit by gently pressure. A second hole is made in the air sac end of the egg. When gentle suction is applied through this opening, the intact chorioallantois will drop away from the shell membrane beneath the first hole. The inoculum is placed later into the chorioallantois. Experiment 17 Serologic Tests of Viruses The basic principle of serologic test of virus is identical to serologic reaction of bacteria. We can apply it not only to detect unknown antigens with known antibodies; here we mainly introduce the easiest and least expensive tests, i.e. the non-serologic hemagglutination test and the serologic hemagglutination-inhibition test. A. Hemagglutination Test Some viruses possess hemagglutinins (e.g. orthomyxoviruses and paramyxoviruses), so the viruses may agglutinate erythrocytes. In vitro, it is called hemagglutination. Hemagglutinated red blood cells show a diffuse blanket covering the entire bottom of the well, whereas non-agglutinated cells, settle as a small compact button on the Bottom of the well. Chick red blood cells are generally the cells of choice for hemagglutination test of influenza viruses. 1. Materials Allantoic fluid containing influenza virus, 0.5% chick erythrocyte, normal saline, 1 ml pipet 2. Procedure a. Set up 11 tubes on the rack, label the tube with pencil. b. Add the materials into the tube as listed in the following table. c. Shack the rack for a while and allow the tubes to stand in room temperature for 45 min, don’t disturb them. d. Observe and record the results as follow: B. - no evidence of hemagglutination ++ 50% hemagglutination +++ 75% hemagglutination ++++ 100% hemagglutination Hemagglutination-inhibition Test Many viruses agglutinate erythrocytes, and this reaction may be specifically inhibited by specific antiviral antibody. This principle is used to quantify the levels of antibody, in order to diagnose the viral infection or to identify the serotype of the virus. Diagnostic significance must be based on a rise in titer between acute and convalescent sera, a 4-fold or greater titer increase is considered proof of active virus infection. For most viruses, HI micromethod tests are now employed. 1. Materials Allantoic fluid of influenza virus containing 4 HA unis/0.25ml, 0.5% chick red cell suspension, inactivated patient's serum, normal saline, test tubes, rack, 1ml pipet 2. Procedure a. Put 11 tubes in a row in the rack and mark each tube with pencil. b. Add various materials into the tubes as listed in the following table. c. Read hemagglutination degree of each tube as the method used in hemagglutination test. The highest dilution of serum to inhibit hemagglutination completely is the HI titer of the serum (i. e. can inhibit 50% hemagglutination). Table 20-1 Hemagglutination Test Saline discard 1 2 3 0.9 0.25 0.1 0.25 0.25 4 5 6 7 0.25 0.25 0.25 0.25 0.25 8 unit: ml 9 10 0.25 0.25 11 0.25 0.5 viral suspension 0.25 0.25 0.25 0.25 0.25 0.25 saline add 0.25 ml to each tube 0.5% chick RBC Add 0.5 ml to each tube Viral dilution 1/10 1/20 1/40 1/80 1/160 1/320 discard 1/640 1/1280 Shake and place the tube rack at room temperature for 45 min before reading Results 0.25 the highest dilution of virus in the tube which shows”++” hemagglutination degree is used to express 1 HA unit 1/2560 Control Table 20-2 Hemagglutination -inbibition test 1 Saline 0.9 Patient serum 2 3 4 5 7 8 0.25 0.25 0.25 0.25 0.25 0.25 0.25 0.25 0.25 0.1 0.25 0.25 0.25 0.25 0.25 Viral suspend 6 unit: ml Contorl tubes 1 2 3 0.25 0.25 0.25(1:10) 0.25 - - - sion(4u/0.25ml) Add 0.25 to each tube 0.5% chick RBC Add 0.5 to each tube - 0.25 - 0.5 0.5 0.5 Serum dilution 1/10 1/20 1/40 1/80 1/160 1/320 1/640 1/1280 Shake the rack vigorously and keep it stationary at room temperature for 60 min before reading Results Table 20-2 Hemagglutination -inbibition test Test tubes unit: ml Contorl tubes 1 2 3 4 5 6 7 8 1 2 3 Saline 0.9 0.25 0.25 0.25 0.25 0.25 0.25 0.25 0.25 0.25 0.25 Patient serum 0.1 0.25 0.25 0.25 0.25 0.25 0.25 0.25 0.25 - - Viralsuspension 0.25 0.25 0.25 0.25 0.25 0.25 0.25 0.25 - 0.25 - 0.5%chick RBC 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 Serum dilution 1/20 1/40 1/80 1/160 1/320 1/640 1/1280 (4u/0.25ml) 1/20 hake the rack vigorously and keep it stationary at room temperaturefor 60 min before reading Results Experiment 18 Pathogenic Fungi The fungi, comprised of a large group of microorganism, are divided into two groups, single cells and multiple cells; their nutrient requirement is not so high and usually grows on a simple solid medium (Sabourand’s medium). They grow slowly and require a certain extent of moisture in air; most of them require oxygen for growth. The optimal temperature for growth is about 22-28℃. The pathogenic fungi can be identified by their characteristics of morphology and structure. 1. Materials Prepared slides of Candida albicans, Prepared slides of Dermatophytes. Prepared slides of Crytococcus neoformans, Sabourand’s agar slant cultures of various fungi 2. Procedure a. Examine the prepared slides and observe the morphology and structure of fungi under the light microscope. b. Observe the cultures of fungi, notice the morphology of colonies. c. Germ tube test: in the clinical laboratory one test used to identify C. albicans is the germ tube test. ⑴. Remove a very small inoculum from the colony of C. albicans and transfer it to a small glass tube containing 0.5ml of human or sheep serum. ⑵. Incubate the culture at 35℃ for up to 3 h. Observation can be made after 1 hour. ⑶. With a Pasteur pipet remove a drop of sediment from the serum tube and transfer to a slide containing a drop of nigrosin. ⑷. Cover the lid with a cover slip and observe under high lens for the presence of small pseudo hyphae (germ tube ) forming from the originally spherical cells.