Anthropometrics in Obesity Robert Kushner, MD Northwestern University Feinberg School of Medicine.
REVIEW OF THE BASICSTHE GRAM STAIN ADVANCED INTERPRETATIONS Richard (Tom) Thomson, Jr., Ph.D....
Transcript of REVIEW OF THE BASICSTHE GRAM STAIN ADVANCED INTERPRETATIONS Richard (Tom) Thomson, Jr., Ph.D....
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THE GRAM STAINADVANCED INTERPRETATIONS
Richard (Tom) Thomson, Jr., Ph.D.Northwestern University Feinberg School
of MedicineEvanston Northwestern Healthcare
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REVIEW OF THE BASICS
• Procedural highlights– Select area of specimen– Prepare smear– Low and high power scanning– Quantitate cells and microorganisms– Interpret by specimen source– Slides for review
• Interpret bacterial morphologies– Minimum competency– Advanced competency
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EXTRA GRAM STAIN MORPHOLOGIESINDICATORS OF PATHOLOGY
• White blood cells (polymorphonuclear leukocytes)
• Alveolar macrophages• Squamous/columnar epithelial
cells• Elastin/collagen fibers• Curschmann’s spirals• Corpora amylacea
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EXTRA GRAM STAIN MORPHOLOGIESINDICATORS OF PATHOLOGY
• Cell necrosis • Intracellular bacteria/yeasts• “Antibiotic” treated bacteria• Crystals• Respiratory therapy• Other oddities
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GRAM STAIN: PATTERN RECOGNITION
• Respiratory tract– Pneumonia/bronchitis– Aspiration pneumonia– Cystic fibrosis– Chronic lung disease/COPD
• Urinary tract– UTI– Vesicocolonic fistual
• Meningitis
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GRAM STAIN: PATTERN RECOGNITION
• Abscess– Staphylococcal– Mixed aerobic/anaerobic– Streptococcus milleri/anginosis– Nocardia
• Toxemia– Streptococcal necortizing fasciitis– Clostridium gas gangrene
• Miscellaneous– BV (bacterial vaginosis)– Lemierre’s disease (jugular vein thrombosis)– Gonococcal urethritis– Crystalline joint disease
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AFTER ALL THIS TRAINING
• Can you identify the pathogen in the following case?– Newborn sepsis– Mother appears at hospital in labor
• no pre-natal care
– Peri-partum fever– Child delivered vaginally
• Blood and CSF specimens for stain/culture
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CONCLUSIONSMicrobiology Model
• Standardize Gram stain procedure• Minimum competency for laboratory personnel• Gram stain review procedure• Advanced interpretation
– Indicators of pathology– Pattern recognition (diseases)
• Use Gram stain results in culture work-up• Train physicians to use the Gram stain• Future?
– Provide images of diagnostic Gram stains (high resolution monitors)
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