感染症の診療支援−臨床検査医と微生物検査技師の役割−(2)

症例 1：急性化膿性髄膜炎
−臨床検査技師の立場から−

三　澤　成　毅*
　　　　　　　　　　　　　　　　　　　　　　
Medical Supports for the Diagnosis of Infectious Diseases ;
the Role and Responsibilities of Clinical Pathologist and Microbiology Technologist
Case 1 : Acute Purulent Meningitis ;
the Position of the Technologists in Microbiology Laboratory

Shigeki MISAWA*

The features and limitations of microbiology processes for the diagnosis of bacterial meningitis were summarized. Requests for physicians were also emphasized. The microbiology laboratory should be responsible for providing highly reliable and concordant data with a variety of clinical settings. Technologists in a microbiology laboratory should perform following subjects :
i)Direct smear examination : Presumptive identification by the observers with abundant experience and sufficient training.
ii)Rapid bacterial antigen detection tests : Active utilize alone in combination with the direct microscopy.
iii)Culture : Cost effective utilize for appropriate media and culture condition based on the bacteriological statistics. Report with bacteriological interpretations and with additional proper comments, if necessary.
iv)Antimicrobial susceptibility tests : Determination of penicillin resistance among the strains of penicillin-resistant or -intermediate Streptococcus pneumoniae (PI or PRSP) should be confirmed by MIC procedures ; Detection of β-lactamase producing Haemophilus influenzae (BLP) could detect by β-lactamase tests, but not clearly identify for β-lactamase-negative ampicillin-resistant isolates(BLNAR).
In addition, a laboratory should provide appropriate information by using the accumulated routine clinical microbiology data, which may help to physicians in selecting an empiric therapy and to the microbiology technologists in processing the routine microbiology.
In recent status, the most common organisms isolated from patients with bacterial meningitis continue to be S. pneumoniae and H. influenzae. Among S. pneumoniae strains, penicillin-intermediate(PISP) and -resistant(PRSP) strains had exceeded 50%, and the strains of β-lactamase producing H. influenzae (BLP) had decreased with less than 10% and β-lactamase negative ampicillin-resistant strains(BLNAR) have increasing.
To providing rapid and accurate results, a laboratory should require the clinical information, including patient's age, major presenting symptoms, and receive antimicrobials prior to specimen collection.
[Rinsho Byori 50 : 664〜671, 2002]

*Clinical Laboratory, Juntendo University Hospital, Bunkyo-ku, Tokyo 113-8431

*順天堂大学附属病院臨床検査部(〒113-8431 東京都文京区本郷3-1-3)

E-mail :misanet@mbd.sphere.ne.jp