Eye Infection
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Transcript of Eye Infection
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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
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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
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Site with normal flora
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TIDAK MEMPENGARUHI
TAJAM PENGLIHATAN
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Hordeolum eksternum Hordeolum internum
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Kalazion
• Kalazion• Jaringan granuloma
pada tarsus inferior
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Selulitis (anterior) palpebra
• Palpebra bengkak
• Tanda radang pada palpebra
EMERGENCY
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DAPAT MEMPENGARUHI
TAJAM PENGLIHATAN
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Trikiasis
• Silia atas tumbuh ke arah dalam : kornea atau konjungtiva
• Kornea atau konjungtiva teriritasi
• Akibatnya terjadi Keratitis atau Konjungtivitis
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Konjungtivitis bakteri
• Konjungtivitis bakteri – Sekret
mukopururulen– Konjungtiva kemotik– Injeksi konjungtiva
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Keratitis marginal
• Abses berbentuk cincin di tepi kornea
• Jernih antara keratitis dan limbus
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Pemakai lensa kontak
KERATITIS
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DECORATIVE / COSMETIC
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Konjungitivitis purulenta
• Konjungtivitis purulenta gonorrhoe :– Konjungtiva
kemotik dan kasar– Sekret purulen
EMERGENCY
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Konjungtivitis virus
• Konjungtivitis virus– Injeksi
konjungtival– Sekret sereous– Perdarahan
subkonjungtiva
( subakut )
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Herpes zooster oftalmikus
• Herpes zoster
oftalmikus
• Stadium
penyembuhan
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Keratitis dendritik
• Infiltrat dengan batas seperti cabang-cabang
• Disebabkan Herpes simpleks
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Trakoma
• Konjungtivitis trakoma– Folikel pada
konjungtiva tarsal
– Panus
• Infiltrat limbus atas
• Neovaskularisasi di atas
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Keratitis lagoftalmos
• Lagoftalmos pada penderita eksoftalmus goiter
• Keratitis di bagian bawah akibat mata tidak tertutup waktu tidur
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Ulkus sentral
• Ulkus dengan neovaskularisasi dari limbus
EMERGENCY
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Ulkus atau abses kornea + hipopion
• Kemotik + injeksi siliar
• Abses kornea• Hipopion di dalam
bilik mata depan
EMERGENCY
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Endoftalmitis
• Injeksi siliar• Massa supuratif di
dalam bilik mata depan
EMERGENCY
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Nebula kornea
• Kekeruhan tipis pada kornea
• Batas kabur• Tanda radang
negatif
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Leukoma kornea
• Kekeruhan dengan
- Batas tegas
- Mata tenang
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Infection ?
Inflammation ?
Clinical Diagnosis / Suspicion:
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Infection
Clinical Diagnosis / Suspicion:
1. Bacteria
2. Fungus
3. Virus
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Infection
Clinical Diagnosis / Suspicion:
1. Bacteria
2. Fungus
3. Virus
1. Isolation
2. Susceptibility test
3. Antigen detection
4. Immunologic respons
5. Molecular diagnosis
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IMMUNOLOGIC RESPONS
HUMORAL
CELLULAR
IgG, IgM, IgA, IgE, IgD
Cytokines
DIAGNOSTICS
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IMMUNOLOGIC (RESPONS) DETECTION
HUMORAL
IgG, IgM, IgA, IgE, IgD
DIAGNOSTICS
1. Paired sera: acute
and convalescence
2. Rises of titer
3. Endemic titer
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INPUT OUTPUTPROCESS
GARBAGE IN GARBAGE OUT
MICROBIOLOGY PROCESSES
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INPUT OUTPUTPROCESS
CLINICAL SPECIMEN
MICROBIOLOGY PROCESSES
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INPUT OUTPUTPROCESS
OPHTHALMOLOGIST
SPECIMEN COLLECTION
MICROBIOLOGY PROCESSES
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INPUT OUTPUTPROCESS
CLINICAL MICROBIOLOGIST
SPECIMEN PROCESSING & REPORTING
MICROBIOLOGY PROCESSES
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INPUT OUTPUTPROCESS
OPHTHALMOLOGIST
CLINICAL MICROBIOLOGIST
SPECIMEN COLLECTION
SPECIMEN PROCESSING & REPORTING
MICROBIOLOGY PROCESSES
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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
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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
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SPECIMEN COLLECTION
IS VERY IMPORTANT
PROPER SPECIMEN
AVOID CONTAMINATION
BEFORE ANTIBIOTICS TR/
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Ulkus Kornea
X
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LABORATORY EXAMINATION
Scrapping Staining: Gram, KOH, Calcuflor white
Culture & Sensitivity test
Fungus culture: SDA
Acanthamoeba culture: non nutrient medium
BA, Chocolate agar, Mc Conkey
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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
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CORNEAL ULCER SPECIMEN
Local Analgesics:
- suppressed bacteria
- get more specimens
Limited specimens:
- culture : direct inoculation
enrichment broth isolation
- staining
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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
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Corneal scraping (Masson trichrome) cyst of Acanthamoeba (arrow). Dendritiform epithelial lesions of patient with Acanthamoeba keratitis.
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ISOLATION & SENSITIVITY TEST
CULTURE
Minimal using 2 type of media: - non inhibitory media- inhibitory media
Isolated colony
Identification
Colony morphologyStainingBiochemical reaction, etc
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Primary plating = isolation
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Identification = Biochemistry reaction
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Antibiotic Sensitivity Test
Sensitive
Intermediate sensitive
Resistant
MIC : minimum inhibitory concentration
MBC : minimum bacteri- cidal concentration
Disc diffusion method :
Dilution method :
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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.
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Endophthalmitis :
S aureus, Pseudomonas, S pneumoniae
P acnes
N meningititids
Others :
Periorbital sellulitis :
S aureus, S pyogenes, S pneumoniae,
H influenzae
Clostridium
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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
Best choice
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