感染症の診療支援−臨床検査医と微生物検査技師の役割−(1)

症例 1：臨床検査医の立場から

細　川　直　登*
　　　　　　　　　　　　　　　　　　　　　　
Laboratory Logistics for Infectious Diseases
−Case 1 : From Clinical Laboratory Physicians

Naoto HOSOKAWA, MD*

The diagnosis of bacterial meningitis rests on examination of the CSF. The gross appearance of the fluid may be cloudy or turbid if the white cell count is elevated. Gram's staining should always be used in examining CSF, as it permits rapid and accurate identification of the etiologic agent in approximately 60 to 90 percent of cases of bacterial meningitis. The CSF culture is positive in approximately 70 to 85 percent of patients with bacterial meningitis.
Many other rapid diagnostic tests have been developed to aid in the diagnosis of bacterial meningitis when Gram's staining gives negative results. Nevertheless, newer techniques are more rapid and sensitive, postgraduate training in laboratory medicine should include basic clinical skills(Communication skills, physical examination and common laboratory procedures such as Gram's stain, Wright-Giemsa stain, etc.) and 24 hours on-call service system by laboratory physicians.
It must not be focused solely on the sophistication of laboratory methods. We must notice that an in-creasing gap between the clinic and the laboratory. Current needs require us to make a major attempt to bridge this gap. We, laboratory physicians must modify our behavior effectively and accept the value and limitations of laboratory automation and information technology. We must work more closely with physicians and other health care professionals to establish a good collaborative partnership with them.
[Rinsho Byori 50 : 658〜663, 2002]

*Department of Clinical Pathology, Nihon University School of Medicine, Itabashi-ku, Tokyo 173-8610

【Key Words】On call service(On call サービス)，clinical pathologist(臨床検査専門医)，medical consulta-tion(医学的コンサルテーション)，bacterial meningitis(細菌性髄膜炎)，Gram's stain(グラム染色)

*日本大学医学部臨床検査医学(〒173-8610 東京都板橋区大谷口上町30-1)

E-mail :naoto@med.nihon-u.ac.jp