Eye Infection
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Transcript of Eye Infection
LABORATORY EXAMINATION IN
THE ETIOLOGICAL DIAGNOSIS OF
EYE FOR INFECTION
WINARTODEPT. of OPHTHALMOLOGY
FAC. of MEDICINE, DIPONEGORO UNIVERSITY /
DR KARIADI HOSPITAL S E M A R A N G
1. Sites with normal flora : a. Function : - part of innate immunity - contribute to body normal function b. If disturb dysfunction causes a diseases
e.g.: skin (palpebra), conjunctivae, cornea, lacrimal system.
2. Steril sites :e.g. COA, COP, vitreous, subcutaneous tissue,
subconjungtival tissue
Indogenous Microflora of Human Eye
INTRODUCTION
Site with normal flora
TIDAK MEMPENGARUHI
TAJAM PENGLIHATAN
Hordeolum eksternum Hordeolum internum
Kalazion
• Kalazion• Jaringan granuloma
pada tarsus inferior
Selulitis (anterior) palpebra
• Palpebra bengkak
• Tanda radang pada palpebra
EMERGENCY
DAPAT MEMPENGARUHI
TAJAM PENGLIHATAN
Trikiasis
• Silia atas tumbuh ke arah dalam : kornea atau konjungtiva
• Kornea atau konjungtiva teriritasi
• Akibatnya terjadi Keratitis atau Konjungtivitis
Konjungtivitis bakteri
• Konjungtivitis bakteri – Sekret
mukopururulen– Konjungtiva kemotik– Injeksi konjungtiva
Keratitis marginal
• Abses berbentuk cincin di tepi kornea
• Jernih antara keratitis dan limbus
Pemakai lensa kontak
KERATITIS
DECORATIVE / COSMETIC
Konjungitivitis purulenta
• Konjungtivitis purulenta gonorrhoe :– Konjungtiva
kemotik dan kasar– Sekret purulen
EMERGENCY
Konjungtivitis virus
• Konjungtivitis virus– Injeksi
konjungtival– Sekret sereous– Perdarahan
subkonjungtiva
( subakut )
Herpes zooster oftalmikus
• Herpes zoster
oftalmikus
• Stadium
penyembuhan
Keratitis dendritik
• Infiltrat dengan batas seperti cabang-cabang
• Disebabkan Herpes simpleks
Trakoma
• Konjungtivitis trakoma– Folikel pada
konjungtiva tarsal
– Panus
• Infiltrat limbus atas
• Neovaskularisasi di atas
Keratitis lagoftalmos
• Lagoftalmos pada penderita eksoftalmus goiter
• Keratitis di bagian bawah akibat mata tidak tertutup waktu tidur
Ulkus sentral
• Ulkus dengan neovaskularisasi dari limbus
EMERGENCY
Ulkus atau abses kornea + hipopion
• Kemotik + injeksi siliar
• Abses kornea• Hipopion di dalam
bilik mata depan
EMERGENCY
Endoftalmitis
• Injeksi siliar• Massa supuratif di
dalam bilik mata depan
EMERGENCY
Nebula kornea
• Kekeruhan tipis pada kornea
• Batas kabur• Tanda radang
negatif
Leukoma kornea
• Kekeruhan dengan
- Batas tegas
- Mata tenang
Infection ?
Inflammation ?
Clinical Diagnosis / Suspicion:
Infection
Clinical Diagnosis / Suspicion:
1. Bacteria
2. Fungus
3. Virus
Infection
Clinical Diagnosis / Suspicion:
1. Bacteria
2. Fungus
3. Virus
1. Isolation
2. Susceptibility test
3. Antigen detection
4. Immunologic respons
5. Molecular diagnosis
IMMUNOLOGIC RESPONS
HUMORAL
CELLULAR
IgG, IgM, IgA, IgE, IgD
Cytokines
DIAGNOSTICS
IMMUNOLOGIC (RESPONS) DETECTION
HUMORAL
IgG, IgM, IgA, IgE, IgD
DIAGNOSTICS
1. Paired sera: acute
and convalescence
2. Rises of titer
3. Endemic titer
INPUT OUTPUTPROCESS
GARBAGE IN GARBAGE OUT
MICROBIOLOGY PROCESSES
INPUT OUTPUTPROCESS
CLINICAL SPECIMEN
MICROBIOLOGY PROCESSES
INPUT OUTPUTPROCESS
OPHTHALMOLOGIST
SPECIMEN COLLECTION
MICROBIOLOGY PROCESSES
INPUT OUTPUTPROCESS
CLINICAL MICROBIOLOGIST
SPECIMEN PROCESSING & REPORTING
MICROBIOLOGY PROCESSES
INPUT OUTPUTPROCESS
OPHTHALMOLOGIST
CLINICAL MICROBIOLOGIST
SPECIMEN COLLECTION
SPECIMEN PROCESSING & REPORTING
MICROBIOLOGY PROCESSES
OPHTHALMOLOGIST
CLINICAL MICROBIOLOGIST
Request Form :
Microbiology lab. :
1. Administration
2. Specimen inspection
3. Lab. Examination
4. Report
Main objectives : to serve better to the patients
communication
Clinical Diagnosis
(Request form)
Sample
Staining
Isolation & identification
Susceptibility test
Preliminary report
Final report
Serology results
MICROBIOLOGY EXAMINATION
Serology detection
Morphology / microscopy
Species nameAntibiogram
IgM & IgG
Rapid & mol. diagnosis IF, PCR, RFLP, Blotting, etc
SPECIMEN COLLECTION
IS VERY IMPORTANT
PROPER SPECIMEN
AVOID CONTAMINATION
BEFORE ANTIBIOTICS TR/
Ulkus Kornea
X
LABORATORY EXAMINATION
Scrapping Staining: Gram, KOH, Calcuflor white
Culture & Sensitivity test
Fungus culture: SDA
Acanthamoeba culture: non nutrient medium
BA, Chocolate agar, Mc Conkey
TYPE OF SPECIMENS
SWAB: - Conjungtivitis
SCRAPPING: - Conjungtivitis to study
epithelial cells (inclusion bodies)
- Corneal ulcers:
- fungus
- viral (HSV1)
- acanthamoeba
PUS: hordeolum
SKIN SCRAPPING’S: HSV1, mycoses
CORNEAL ULCER SPECIMEN
Local Analgesics:
- suppressed bacteria
- get more specimens
Limited specimens:
- culture : direct inoculation
enrichment broth isolation
- staining
STAINING
1. GRAM
2. GIEMSA
Bacterial MorphologyGram (+) / (-) p.m.n. choose antibiotics
Inclusion bodiesCellular respons (pmn/lymphocyte) Viral / chlamydial infection Acute / chronicAllergy
3. KOH Filament, yeast, spores
4. Imm-Fluoresens HSV
Corneal scraping (Masson trichrome) cyst of Acanthamoeba (arrow). Dendritiform epithelial lesions of patient with Acanthamoeba keratitis.
ISOLATION & SENSITIVITY TEST
CULTURE
Minimal using 2 type of media: - non inhibitory media- inhibitory media
Isolated colony
Identification
Colony morphologyStainingBiochemical reaction, etc
Primary plating = isolation
Identification = Biochemistry reaction
Antibiotic Sensitivity Test
Sensitive
Intermediate sensitive
Resistant
MIC : minimum inhibitory concentration
MBC : minimum bacteri- cidal concentration
Disc diffusion method :
Dilution method :
Causative organismConjungtivitis :
S pneumoniae, S aureus
H influenzae
C trachomatis (inclusion & trachoma)
Others : neisseria
Viral : adenovirus.
Keratitis :
S pneumoniae, S aureus, S pyogenes
Pseudomonas, Enterobacteriaceae, others
Acanthamuba
Viral : HSV, Herpes zoozter.
Endophthalmitis :
S aureus, Pseudomonas, S pneumoniae
P acnes
N meningititids
Others :
Periorbital sellulitis :
S aureus, S pyogenes, S pneumoniae,
H influenzae
Clostridium
WHEN TAKING SPECIMEN FOR CULTURE ???
x
x
x
Immediate AB, culture if no respond
Immediate culture, AB wait culture
Immediate culture & AB
AB culture Bacteria die
Disease progress
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