INHOUD
1. Pre-analytische fase ........................................................................................................................................ 6
1.1. Wat is pre analytische fase? .................................................................................................................. 6
1.2. Soorten afnames ................................................................................................................................... 6
Type 1 .............................................................................................................................................................. 6
TYPE 2 .............................................................................................................................................................. 7
TYPE 3 .............................................................................................................................................................. 7
1.3. Soorten stalen........................................................................................................................................ 8
Bloed ............................................................................................................................................................... 8
Punctievloeistoffen – empyeem type 1 .......................................................................................................... 8
Lumbaal vocht ................................................................................................................................................. 8
Weefselmateriaal ............................................................................................................................................ 9
Etter, wondvocht, klierpunctievocht ............................................................................................................... 9
Keel- en neusspecimens .................................................................................................................................. 9
Onderste luchtwegen ...................................................................................................................................... 9
Urine type 2................................................................................................................................................... 10
Faeces type 3................................................................................................................................................. 10
1.4. Overzicht van de mogelijke tools voor staalafname en staalbewaring ............................................... 11
Wattendrager ................................................................................................................................................ 11
E-swab ........................................................................................................................................................... 11
Spuit .............................................................................................................................................................. 11
1.5. Steriele afname van versch soorten microbiologische stalen en begeleidende documenten ............ 11
1.6. Transport van de stalen ....................................................................................................................... 12
Transport-omstandigheden: ......................................................................................................................... 13
1.7. Organisatie van de pre analytische fase in het labo ............................................................................ 13
Ontvangst en registratie van het specimen in het Laboratory Information System ..................................... 13
Sorteren van de stalen .................................................................................................................................. 13
Sneltesten ..................................................................................................................................................... 13
Microscopie (= rechtsreeks onderzoek) ........................................................................................................ 14
Inzetten van de kweek .................................................................................................................................. 16
1.8. Kwaliteitszorg ...................................................................................................................................... 16
2. Gram negatieve kokken ................................................................................................................................ 17
2.1. Neisseria species .................................................................................................................................. 17
Morfologie..................................................................................................................................................... 17
Species .......................................................................................................................................................... 17
Pathogeen vermogen meningokok ............................................................................................................... 17
1
, Pathogeen vermogen bij de gonokok (gonorroe) ......................................................................................... 17
Laboratorium diagnosa ................................................................................................................................. 18
Serotypes en vaccinatie ................................................................................................................................ 18
Gevoeligheidsbepaling .................................................................................................................................. 18
2.2. Moracella catarrhalis ........................................................................................................................... 19
Pathogeen vermogen .................................................................................................................................... 19
Laboratorium diagnose ................................................................................................................................. 19
3. Gram positieve kokken.................................................................................................................................. 20
3.1. STaphylococcus aureus ........................................................................................................................ 20
Morfologie..................................................................................................................................................... 20
Pathogeen vermogen .................................................................................................................................... 20
Laboratoriumdiagnostiek .............................................................................................................................. 20
Antibiogram .................................................................................................................................................. 21
Soorten MRSA ............................................................................................................................................... 22
3.2. Coagulase negatieve Stafylokokken (CNS)........................................................................................... 22
Pathogeen vermogen .................................................................................................................................... 22
3.3. Streptokokken ..................................................................................................................................... 22
Indeling op basis van hemolysepatroon ....................................................................................................... 22
Streptococcus pyogenes ............................................................................................................................... 23
Streptococcus agalctiae ................................................................................................................................ 23
3.4. Groep D streptokokken ....................................................................................................................... 25
Pathogeen vermogen .................................................................................................................................... 25
Laboratoriumdiagnostiek .............................................................................................................................. 25
3.5. Viridans streptokokken ........................................................................................................................ 25
Pathogeen vermogen .................................................................................................................................... 25
Laboratorium diagnostiek ............................................................................................................................. 25
3.6. Streptococcus pneumoniae ................................................................................................................. 26
Pathogeen vermogen .................................................................................................................................... 26
4. Gram negatieve bacillen ............................................................................................................................... 27
4.1. Belangrijkste geslachten ...................................................................................................................... 27
4.2. Anaerobiose......................................................................................................................................... 27
4.3. Algemene kernmerken van ifnecties bij anaerobe kiemen ................................................................. 27
Biofilmvorming (examen) .............................................................................................................................. 27
4.4. Morfologie (gramkleuring) .................................................................................................................. 28
Porphyromonas/prevotella ........................................................................................................................... 28
5. Anaerobe grampositieve bacillen.................................................................................................................. 29
5.1. Soorten ............................................................................................................................................... 29
2
, 5.2. Clostridium species .............................................................................................................................. 29
Clostridium perfringens (soldaat) ................................................................................................................. 29
Clostridium botulinum (zwemmen,lopen, fietsen) ....................................................................................... 30
Clostridium tetani (tetanus) .......................................................................................................................... 30
Clostridium ramosum en septicum ............................................................................................................... 30
!! Clostridium difficile !! ............................................................................................................................... 30
5.3. Actinomyces ........................................................................................................................................ 31
5.4. Propionibacterium ............................................................................................................................... 31
6. Aerobe grampositieve staven ....................................................................................................................... 32
6.0. Bacillus species .................................................................................................................................... 32
Bacillus cereus ............................................................................................................................................... 32
Bacillus anthracis ........................................................................................................................................... 32
Laboratoriumdiagnostiek .............................................................................................................................. 32
Behandeling .................................................................................................................................................. 33
6.2. Corynebacterium species .................................................................................................................... 33
C. diphtheriae ................................................................................................................................................ 33
Andere corynebacteriën ............................................................................................................................... 33
Laboratoriumdiagnostiek .............................................................................................................................. 34
6.3. Erysipelothrix ....................................................................................................................................... 34
Laboratoriumdiagnostiek .............................................................................................................................. 34
6.4. Lactobaccilus ....................................................................................................................................... 34
Laboratoriumdiagnostiek .............................................................................................................................. 34
Gardnerella ....................................................................................................................................................... 35
Gardnerella vaginalis ..................................................................................................................................... 35
Diagnostiek.................................................................................................................................................... 35
6.5. Listeria ................................................................................................................................................. 36
Laboratoriumdiagnostiek ...................................................................................................................................... 36
6.6. Nocardia .............................................................................................................................................. 37
Pathogeen vermogen .................................................................................................................................... 37
Laboratoriumdiagnostiek .............................................................................................................................. 37
Behandeling .................................................................................................................................................. 37
6.7. Rhodococcus equi ................................................................................................................................ 38
6.8. A. haemolyticum .................................................................................................................................. 38
Vragen ............................................................................................................................................................... 38
7. Spirochaetales (speciale celwand!) .............................................................................................................. 39
Treponema Pallidum ......................................................................................................................................... 39
Laboratoriumdiagnostiek .............................................................................................................................. 40
3
, Treponema pallidum haemagglutination assay (TPHA) ................................................................................ 42
Fluorescent treponemal antibody absorption test (FTA-ABS) ...................................................................... 42
Venereal disease research laboratory test (VDRL) ........................................................................................ 42
Behandeling .................................................................................................................................................. 42
Borrelia burgdorferi .......................................................................................................................................... 42
8. Mycobacterium (speciale celwand!) ............................................................................................................. 43
8.1. Situering............................................................................................................................................... 43
8.2. Algemene kernmerken ........................................................................................................................ 43
Celwandstructuur .......................................................................................................................................... 43
8.3. Mycobacterium indeling ...................................................................................................................... 44
8.4. Pathogene myobacterium ................................................................................................................... 44
Myobacterium tuberculosis .......................................................................................................................... 44
Mycobacterium Leprae ................................................................................................................................. 45
8.5. Microscopisch onderzoek van myobacterium ..................................................................................... 45
Kweek: voorbehandeling............................................................................................................................... 45
Kweek: automaten ........................................................................................................................................ 45
IGRA: Interferon gamma release assay !!!!! .................................................................................................. 45
Behandeling .................................................................................................................................................. 45
9. Mycoplasma en Chlamydia (speciale celwand) ............................................................................................. 46
9.1. Mycoplasmata ............................................................................................................................................ 46
Mycoplasma pneumoniae ............................................................................................................................. 46
M. hominis, M. genitalium& Ureaplasma urealyticum ................................................................................. 46
Kleinste prokaryoten die kunnen groeien op bodems .................................................................................. 47
Diagnostiek.................................................................................................................................................... 47
9.2. Chlamydiae .......................................................................................................................................... 47
unieke groeicyclus ......................................................................................................................................... 47
Belangrijke ziekteverwekkers ........................................................................................................................ 48
Diagnostiek.................................................................................................................................................... 48
10. Keuze van cultuurbodems voor diverse specimens ................................................................................. 49
10.2. Neus – keel – oren ............................................................................................................................... 49
Commensale microbiota ............................................................................................................................... 49
Acute keelontsteking..................................................................................................................................... 49
Pathogenen hogere luchtwegen: keel .......................................................................................................... 49
Keel bij gehospitaliseerde patiënten = intubatiebuis .................................................................................... 49
Commensalen neus ....................................................................................................................................... 50
Pathogenen neus .......................................................................................................................................... 50
Middenoorontsteking ................................................................................................................................... 50
4
1. Pre-analytische fase ........................................................................................................................................ 6
1.1. Wat is pre analytische fase? .................................................................................................................. 6
1.2. Soorten afnames ................................................................................................................................... 6
Type 1 .............................................................................................................................................................. 6
TYPE 2 .............................................................................................................................................................. 7
TYPE 3 .............................................................................................................................................................. 7
1.3. Soorten stalen........................................................................................................................................ 8
Bloed ............................................................................................................................................................... 8
Punctievloeistoffen – empyeem type 1 .......................................................................................................... 8
Lumbaal vocht ................................................................................................................................................. 8
Weefselmateriaal ............................................................................................................................................ 9
Etter, wondvocht, klierpunctievocht ............................................................................................................... 9
Keel- en neusspecimens .................................................................................................................................. 9
Onderste luchtwegen ...................................................................................................................................... 9
Urine type 2................................................................................................................................................... 10
Faeces type 3................................................................................................................................................. 10
1.4. Overzicht van de mogelijke tools voor staalafname en staalbewaring ............................................... 11
Wattendrager ................................................................................................................................................ 11
E-swab ........................................................................................................................................................... 11
Spuit .............................................................................................................................................................. 11
1.5. Steriele afname van versch soorten microbiologische stalen en begeleidende documenten ............ 11
1.6. Transport van de stalen ....................................................................................................................... 12
Transport-omstandigheden: ......................................................................................................................... 13
1.7. Organisatie van de pre analytische fase in het labo ............................................................................ 13
Ontvangst en registratie van het specimen in het Laboratory Information System ..................................... 13
Sorteren van de stalen .................................................................................................................................. 13
Sneltesten ..................................................................................................................................................... 13
Microscopie (= rechtsreeks onderzoek) ........................................................................................................ 14
Inzetten van de kweek .................................................................................................................................. 16
1.8. Kwaliteitszorg ...................................................................................................................................... 16
2. Gram negatieve kokken ................................................................................................................................ 17
2.1. Neisseria species .................................................................................................................................. 17
Morfologie..................................................................................................................................................... 17
Species .......................................................................................................................................................... 17
Pathogeen vermogen meningokok ............................................................................................................... 17
1
, Pathogeen vermogen bij de gonokok (gonorroe) ......................................................................................... 17
Laboratorium diagnosa ................................................................................................................................. 18
Serotypes en vaccinatie ................................................................................................................................ 18
Gevoeligheidsbepaling .................................................................................................................................. 18
2.2. Moracella catarrhalis ........................................................................................................................... 19
Pathogeen vermogen .................................................................................................................................... 19
Laboratorium diagnose ................................................................................................................................. 19
3. Gram positieve kokken.................................................................................................................................. 20
3.1. STaphylococcus aureus ........................................................................................................................ 20
Morfologie..................................................................................................................................................... 20
Pathogeen vermogen .................................................................................................................................... 20
Laboratoriumdiagnostiek .............................................................................................................................. 20
Antibiogram .................................................................................................................................................. 21
Soorten MRSA ............................................................................................................................................... 22
3.2. Coagulase negatieve Stafylokokken (CNS)........................................................................................... 22
Pathogeen vermogen .................................................................................................................................... 22
3.3. Streptokokken ..................................................................................................................................... 22
Indeling op basis van hemolysepatroon ....................................................................................................... 22
Streptococcus pyogenes ............................................................................................................................... 23
Streptococcus agalctiae ................................................................................................................................ 23
3.4. Groep D streptokokken ....................................................................................................................... 25
Pathogeen vermogen .................................................................................................................................... 25
Laboratoriumdiagnostiek .............................................................................................................................. 25
3.5. Viridans streptokokken ........................................................................................................................ 25
Pathogeen vermogen .................................................................................................................................... 25
Laboratorium diagnostiek ............................................................................................................................. 25
3.6. Streptococcus pneumoniae ................................................................................................................. 26
Pathogeen vermogen .................................................................................................................................... 26
4. Gram negatieve bacillen ............................................................................................................................... 27
4.1. Belangrijkste geslachten ...................................................................................................................... 27
4.2. Anaerobiose......................................................................................................................................... 27
4.3. Algemene kernmerken van ifnecties bij anaerobe kiemen ................................................................. 27
Biofilmvorming (examen) .............................................................................................................................. 27
4.4. Morfologie (gramkleuring) .................................................................................................................. 28
Porphyromonas/prevotella ........................................................................................................................... 28
5. Anaerobe grampositieve bacillen.................................................................................................................. 29
5.1. Soorten ............................................................................................................................................... 29
2
, 5.2. Clostridium species .............................................................................................................................. 29
Clostridium perfringens (soldaat) ................................................................................................................. 29
Clostridium botulinum (zwemmen,lopen, fietsen) ....................................................................................... 30
Clostridium tetani (tetanus) .......................................................................................................................... 30
Clostridium ramosum en septicum ............................................................................................................... 30
!! Clostridium difficile !! ............................................................................................................................... 30
5.3. Actinomyces ........................................................................................................................................ 31
5.4. Propionibacterium ............................................................................................................................... 31
6. Aerobe grampositieve staven ....................................................................................................................... 32
6.0. Bacillus species .................................................................................................................................... 32
Bacillus cereus ............................................................................................................................................... 32
Bacillus anthracis ........................................................................................................................................... 32
Laboratoriumdiagnostiek .............................................................................................................................. 32
Behandeling .................................................................................................................................................. 33
6.2. Corynebacterium species .................................................................................................................... 33
C. diphtheriae ................................................................................................................................................ 33
Andere corynebacteriën ............................................................................................................................... 33
Laboratoriumdiagnostiek .............................................................................................................................. 34
6.3. Erysipelothrix ....................................................................................................................................... 34
Laboratoriumdiagnostiek .............................................................................................................................. 34
6.4. Lactobaccilus ....................................................................................................................................... 34
Laboratoriumdiagnostiek .............................................................................................................................. 34
Gardnerella ....................................................................................................................................................... 35
Gardnerella vaginalis ..................................................................................................................................... 35
Diagnostiek.................................................................................................................................................... 35
6.5. Listeria ................................................................................................................................................. 36
Laboratoriumdiagnostiek ...................................................................................................................................... 36
6.6. Nocardia .............................................................................................................................................. 37
Pathogeen vermogen .................................................................................................................................... 37
Laboratoriumdiagnostiek .............................................................................................................................. 37
Behandeling .................................................................................................................................................. 37
6.7. Rhodococcus equi ................................................................................................................................ 38
6.8. A. haemolyticum .................................................................................................................................. 38
Vragen ............................................................................................................................................................... 38
7. Spirochaetales (speciale celwand!) .............................................................................................................. 39
Treponema Pallidum ......................................................................................................................................... 39
Laboratoriumdiagnostiek .............................................................................................................................. 40
3
, Treponema pallidum haemagglutination assay (TPHA) ................................................................................ 42
Fluorescent treponemal antibody absorption test (FTA-ABS) ...................................................................... 42
Venereal disease research laboratory test (VDRL) ........................................................................................ 42
Behandeling .................................................................................................................................................. 42
Borrelia burgdorferi .......................................................................................................................................... 42
8. Mycobacterium (speciale celwand!) ............................................................................................................. 43
8.1. Situering............................................................................................................................................... 43
8.2. Algemene kernmerken ........................................................................................................................ 43
Celwandstructuur .......................................................................................................................................... 43
8.3. Mycobacterium indeling ...................................................................................................................... 44
8.4. Pathogene myobacterium ................................................................................................................... 44
Myobacterium tuberculosis .......................................................................................................................... 44
Mycobacterium Leprae ................................................................................................................................. 45
8.5. Microscopisch onderzoek van myobacterium ..................................................................................... 45
Kweek: voorbehandeling............................................................................................................................... 45
Kweek: automaten ........................................................................................................................................ 45
IGRA: Interferon gamma release assay !!!!! .................................................................................................. 45
Behandeling .................................................................................................................................................. 45
9. Mycoplasma en Chlamydia (speciale celwand) ............................................................................................. 46
9.1. Mycoplasmata ............................................................................................................................................ 46
Mycoplasma pneumoniae ............................................................................................................................. 46
M. hominis, M. genitalium& Ureaplasma urealyticum ................................................................................. 46
Kleinste prokaryoten die kunnen groeien op bodems .................................................................................. 47
Diagnostiek.................................................................................................................................................... 47
9.2. Chlamydiae .......................................................................................................................................... 47
unieke groeicyclus ......................................................................................................................................... 47
Belangrijke ziekteverwekkers ........................................................................................................................ 48
Diagnostiek.................................................................................................................................................... 48
10. Keuze van cultuurbodems voor diverse specimens ................................................................................. 49
10.2. Neus – keel – oren ............................................................................................................................... 49
Commensale microbiota ............................................................................................................................... 49
Acute keelontsteking..................................................................................................................................... 49
Pathogenen hogere luchtwegen: keel .......................................................................................................... 49
Keel bij gehospitaliseerde patiënten = intubatiebuis .................................................................................... 49
Commensalen neus ....................................................................................................................................... 50
Pathogenen neus .......................................................................................................................................... 50
Middenoorontsteking ................................................................................................................................... 50
4
