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[New tests for laboratory diagnosis of spherocytosis].

The authors evaluated advantages of the glycerol lysis test (AGLT) and its modification the "pink" test in the laboratory diagnosis of hereditary spherocytosis (HS). Both tests were positive in all examined subjects with HS and in some patients with autoimmune haemolytic anaemia (AIHA) and were negative in controls and some other haemolytic diseases. As these tests are easy to perform and quick, they can be recommended as a supplementary or screening examination in hereditary spherocytosis. The "pink" test has, as compared with the ALGT test, the advantage that it is simpler.

Glycerol↗

[Laboratory diagnosis of human Mycoplasma infection].

The paper shows that aggregate hemagglutination reaction, enzyme immunoassays, and passive hemagglutination may be used in the laboratory diagnosis of Mycoplasma-induced infections. In patients with respiratory diseases of unknown origin, the M. pneumoniae antigen is easiest detected in the first days of the disease, then a long-term persistence of antigens as part of circulating immune complexes is frequently seen. An examination of patients with chronic rheumatoid arthritis has indicated that 26.7% exhibit M. arthritidis or M. fermentans antigens, 16.3% display associations of these two types of mycoplasma. The disease in immunocomplex: the mycoplasma antigens circulate as part of immune complexes long in 80%. In females with urogenital abnormality, serum tests have shown U. urealyticum and M. hominis in 83.6%, the patients having inflammatory diseases of unknown etiology.

Adult↗

Controversies in the laboratory diagnosis of community-acquired urinary tract infection.

Urine samples constitute the largest single category of specimens examined in most medical microbiology laboratories. The everyday nature and apparent simplicity of urinary tract infection belies the intense debate and controversy regarding the optimal methods of collection, transport and processing of urine specimens and reporting of results. There is considerable variation in the interpretation of quantitative culture results between laboratories and the etiology of abacterial cystitis remains unclear. Microscopy to detect pyuria provides information on an important indicator of inflammation and it has been proposed that detection of urinary antibody may provide similar information. Neither of these indices of host response is suitable for use in a screening test for urinary infection however, although they may usefully contribute to the interpretation of significance of culture results. The development of screening tests and automated systems continues, but at present microscopy and culture remain the most important techniques for laboratory diagnosis. However, these techniques have so far failed to provide an etiological diagnosis for abacterial cystitis and this remains a major area for research.

Adult↗

International external quality assessment scheme for the laboratory diagnosis of diphtheria.

An international external quality assessment (EQA) scheme has been established so as to evaluate the proficiency of specialist, national diphtheria reference laboratories in the laboratory diagnosis of diphtheria. Six simulated clinical specimens were freeze-dried and distributed to 23 participants in 20 countries. Participants were asked to isolate, identify and perform toxigenicity testing on any corynebacteria present and to complete a simple questionnaire describing the procedures and reagents used. Only three laboratories obtained correct biochemical and toxigenicity results for all six specimens. The majority of laboratories performed better with toxigenicity testing than with the biochemical identification. Of concern were the results from three laboratories that failed to isolate any corynebacteria from four or more of the specimens. In one centre this was shown to be due to lack of availability of 'in-date' media and, in the other two, was presumed to be due to lack of experience in primary laboratory diagnostics for this organism. It is essential that countries, globally, maintain awareness and laboratory capabilities in this specialised area of microbiology. EQA is an invaluable process, which enables laboratories to monitor, evaluate and improve their own performance in such areas.

Clinical Laboratory Techniques↗

Laboratory diagnosis of smallpox: role of the Virus Reference Laboratory, Colindale, 1947-70.

The Virus Reference Laboratory, Colindale, first embarked on laboratory investigations for smallpox early in 1947. From then, in conjunction with the Department of Bacteriology, University of Liverpool, it provided a complete diagnostic service throughout England and Wales until 1962, after which the service became available regionally until eradication was effected. Up to 1970 it had investigated 2696 specimens from suspected cases of smallpox and had recovered 108 strains of variola and 248 of vaccinia virus. These last were from persons suffering the complications of vaccination. Some outbreaks following smallpox importation are discussed but infection among laboratory staff during this period was not demonstrated.

England↗

Clinical manifestations, epidemiology, and laboratory diagnosis of human monocytotropic ehrlichiosis in a commercial laboratory setting.

Clinical, epidemiological, and laboratory diagnostic issues of human monocytotropic ehrlichiosis (HME) were investigated in a retrospective case study conducted at a national reference laboratory (Focus Technologies, formerly MRL Reference Laboratory), and at the University of Texas Medical Branch at Galveston, Texas, during 1997 and 1998. Standard questionnaires were sent to physicians for each laboratory-diagnosed patient 2 days to 2 weeks after immunofluorescent antibody assay results were available. Among the 41 cases for which data were obtained, 32 (78%) were definite cases of HME, and 9 (22%) were probable cases of HME. Tick bite or exposure to ticks was recorded in more than 97% of cases. The most prominent clinical findings were fever, abdominal tenderness, and regional lymphadenopathy. There was an association between age and severity of illness. The main laboratory findings included leukopenia, thrombocytopenia, and elevated aspartate aminotransferase and alanine aminotransferase. Clinical and laboratory findings were nonspecific and were not good predictors of the severity of illness. The 90% of patients who received doxycycline treatment underwent rapid clinical improvement with a favorable outcome. The usual duration of effective treatment with doxycycline was 7 to 10 days. This retrospective study is unique because it was based in a commercial reference laboratory setting that receives specimens from different geographic locations. The clinical and laboratory information from 41 patients provides insight into the epidemiological, clinical, and laboratory characteristics of HME.

Adolescent↗

Laboratory diagnosis of latent human papillomavirus infection.

The etiologic association of human papillomavirus (HPV) with uterine cervical cancer has prompted the need for improved laboratory diagnosis of this virus. The application of conventional hybridization technology, including filter in situ hybridization (FISH) and Southern-blot analysis, has revealed that the detection and typing of the virus is inconsistent between sequential specimens from the same individual. To determine whether the polymerase chain reaction (PCR) can be used to provide a more accurate assessment of infection status, two exfoliated cervical cell specimens obtained sequentially from a cohort of 30 women without clinical evidence of cervical abnormalities were analyzed in parallel by FISH and PCR at 6-month intervals. Neither of the procedures provided consistent findings with two sequential specimens suggesting that multiple analyses are necessary to assess infection accurately. However, PCR was less subjective in interpretation and demonstrated greater specificity than did FISH. With the increased sensitivity inherent to PCR, our findings indicated that PCR is more likely to identify latent HPV infection with a single specimen.

Base Sequence↗

[Medium with amikacin for laboratory diagnosis of beta-haemolytic streptococci].

Beta-haemolytic streptococci are implicated in the etiology of secondary wound infection, ulcerations and decubitus ulcers. Laboratory diagnosis of these causative agents is complicated by the fact that other less fastidious bacteria (Staphylococcus aureus, pseudomonads and enterobacteria) may also be involved in the infection. On blood agar, these bacteria overgrow colonies of beta-haemolytic streptococci. Detectability of beta-haemolytic streptococci on blood agar and selective blood agar added with, amikacin (36 microg/ml) was compared. A total of 836 specimens from 782 patients were examined. Eighty-six isolates of beta-haemolytic streptococci were detected. Coinfection with other bacterial species, most frequently identified as Staphylococcus aureus and Pseudomonas aeruginosa, was observed in 73 specimens. Forty-six isolates of beta-hemolytic streptococci involved in coinfection were detected on both blood agar and blood agar with amikacin. Twenty-seven additional isolates were only recovered on blood agar with amikacin. Without the use of selective medium, 37 % of isolates of beta-haemolytic streptococci from skin lesion specimens would escape detection.

Amikacin↗

A newer approach for the laboratory diagnosis of tuberculous meningitis.

In this prospective study, a simple method was standardized for measuring circulating mycobacterial antigen in the cerebrospinal fluid (CSF) for the laboratory diagnosis of tuberculous meningitis (TBM). The heat-inactivated CSF specimens from tuberculous and non-tuberculous patients were subjected to sodium dodecyl sulfate (SDS) - polyacrylamide gel electrophoresis (PAGE) (SDS-PAGE) and they were subsequently transferred onto nitrocellulose membrane (NCM) Using a rabbit polyvalent antibody to M tuberculosis, a heat stable 82 kDa mycobacterial antigen was demonstrated in the CSFs of patients with TBM. This antigen was conspicuous by its absence in the CSFs of non-tuberculous subjects. Due to inactivation of CSF specimens, there is a minimal risk of handling of infectious material in the laboratory. Besides, this newer approach is simple, inexpensive and can be readily applied in any routine clinical laboratory and it is particularly suited to developing countries.

Animals↗

Laboratory diagnosis and investigation of anaemia.

Anaemia is one of the most common conditions encountered in clinical practice. This article outlines the methods used to investigate anaemia and discusses the significance of laboratory diagnosis in treating this condition.

Anemia↗

Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA).

These evidence-based guidelines have been produced after a literature review of the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA). We have considered the detection of MRSA in screening samples and the detection of reduced susceptibility to glycopeptides in S. aureus. Recommendations are given for the identification of S. aureus and for suitable methods of susceptibility testing and screening for MRSA and for S. aureus with reduced susceptibility to glycopeptides. These guidelines indicate what tests should be used but not when the tests are applicable, as aspects of this are dealt with in guidelines on control of MRSA. There are currently several developments in screening media and molecular methods. It is likely that some of our recommendations will require modification as the new methods become available.

Anti-Bacterial Agents↗