The Institute of Medical Microbiology and Hygiene supports clinical diagnosis through the direct detection of infectious agents (bacteria, fungi, protozoa), their antigens and the antibodies directed against them.
Individual tests that cannot be carried out on site are forwarded to specialised, qualified institutes.
Do you have any questions? We are here to help you.
Contact laboratory
Phone +49 731 500-65380
Fax +49 731 500-65304
You can reach us by telephone during our opening hours:
Monday to Friday: 07.30 - 17.00 - closing time for samples 16:00
Weekend/Public holiday: 07.30 - 12.00 - closing time for samples 11:30
Outside laboratory opening hours you can reach us in urgent cases
the microbiologiston duty
via the hospital switchboard in urgent cases.
The diagnostics team
General information and instructions for submitters
Below you will find information on the different materials as well as information on material transport and performance requirements. You can also find out more about the special examination and diagnostic procedures here.
Culture Report
- Culture report 03/2024: Discontinuation of Chlamydia pneumoniae serology (PDF)
- Culture Report 07-3/2023: Changes in blood culture diagnostics (PDF)
- Kulturreport 07-2/23: Changes in the diagnosis of Lues (PDF)
- Culture Report 07/2023: Innovations in the diagnosis of community-acquired meningitis/encephalitis (PDF)
- Culture report 07/2022: Diagnosis of urogenital chlamydial, gonococcal and trichomonas infections (PDF)
- Culture report 01/2021: Pneumococcal antigen rapid test and update on pneumonia diagnostics (PDF)
- Culture Report 04/2019: Changes in the resistance testing of bacteria (PDF)
- Culture report 05/2018: Innovations in enteritis diagnostics (PDF)
Online request
All test requests should be made online via the voucherless laboratory request. If you have any questions, please call us on 65368.
You can find an example page for voucherless requests here.
Subsequent requests for tests
- Subsequent requests for tests after the sample and the test request have arrived at the laboratory are generally possible. Please contact the laboratory by telephone (Tel. 65312).
- All diagnostic sample materials are stored in the laboratory refrigerator for 1 week and are therefore available for subsequent requests. However, please note that some pathogens are environmentally labile, sensitive to cold or not very tolerant to oxygen and that the detection of these pathogens is not promising after prolonged storage of the sample. If a test request you have made does not appear to make sense due to the growth requirements of the pathogens, the laboratory doctor responsible will advise you accordingly. For specific requests, please contact the laboratory doctor responsible for the respective laboratory directly.
- Follow-up requests for serological tests are possible at any time, as all serum samples are kept frozen in the laboratory for several years. The longer storage period does not usually have a negative effect on serological tests. Please contact the serology staff directly (Tel. 65327/65376) if you require additional serological tests, including those from earlier test materials.
Paper forms for requesting services in the event of system failure
Please only use the paper forms to request services in the event of system failures (IS-H*Med, Konas).
The required forms can also be stored locally on the PC.
Please print out paper forms (pdf file) on a laser printer.
The patient data can be labelled manually or with labels (if labels are required for labelling the collection material, label them manually or use pre-printed labels).
Request forms
Our laboratory offers laboratory services for both privately and statutorily insured patients.
For each examination of patients with statutory health insurance, we require a referral slip, which should be enclosed directly with the sample!
Request forms
Requisition forms
Instructions for completing the request forms
- Please send in one request form per test material!
- Please fill in the form carefully and completely. This is the only way we can carry out a quick and efficient diagnosis for you!
General microbiology request form
The request form for general microbiology contains the following sections:
Patient data/sender data: Please enter the surname, first name, date of birth and the sender's address, fax/telephone number etc. as accurately as possible.
Diagnostically relevant information/suspected diagnosis: Please enter the relevant clinical information here as precisely as possible, as the processing and assessment of the results will be based on the clinical information!
Examination material: Please mark exactly one type of material in this area! If no tick box is available for an individual material type, please tick "Other" and note the material type there. In the "Localisation" field, please enter any details about the collection site.
Examinationorder: A distinction is made here between a general examination order and special examination orders.
The general test order "Pathogen culture and resistance" is used to record the pathogens usually found in the respective test material.
However, for some pathogens that require, for example, special culture media, extended incubation times, etc., special test orders must be requested. These special pathogens are explicitly named on the request form. If you cannot find a specific pathogen on this list, please contact the laboratory doctor responsible by telephone.
Additional information on tuberculosis: Please note the clinical suspicion of open tuberculosis on the request form or contact the responsible microbiologist (Tel.: 65318/65368) so that a direct preparation can be prepared and assessed in advance.
Serology and molecular biology request form
The request form for serology and molecular biology contains the following sections:
Patient data/sender data: Please enter the surname, first name, date of birth and the sender's address, fax/telephone etc. as accurately as possible.
Test material: Please mark exactly one type of material in this area! If no tick box is available for an individual type of material, please tick "Other" and note the type of material as well as any details of the place of collection.
Diagnostically relevant information/suspected diagnosis: Please enter the relevant clinical information as precisely as possible here, as the processing and assessment of the results is based on the clinical information!
Examination request:
- Please tick here whether this is an initial examination or a follow-up examination . This information is very important for the interpretation of the findings!
- Mark the desired examinations or pathogens to be detected in this area.
- If you cannot find a specific pathogen in this list, please contact the laboratory doctor responsible by telephone.
Additional information: Please note any additional information that is important for the diagnosis in the field marked accordingly.
Subsequent requests for tests
Subsequent requests for tests after the sample and the test request have arrived at the laboratory are generally possible. Please contact the laboratory by telephone (Tel. 65380).
All diagnostic sample materials are stored in the laboratory refrigerator for 1 week and are therefore available for follow-up requests.
However, please note that some pathogens are environmentally unstable, sensitive to cold or not very tolerant to oxygen and the detection of these pathogens is not promising after prolonged storage of the sample. If a test request you have made does not appear to make sense due to the growth requirements of the pathogens, the laboratory doctor responsible will advise you accordingly. For specific requests, please contact the laboratory doctor responsible for the respective laboratory directly.
Follow-up requests for serological tests are possible at any time, as all serum samples are kept frozen in the laboratory for several years. The longer storage period does not usually have a negative effect on serological tests. Please contact the serology staff directly (Tel. 65327/65376) if you require additional serological tests, including those from earlier test materials.
The standard requirement "Pathogen culture and resistance" includes the cultural examination and preparation of antibiograms for obligate and facultative pathogens. For primarily sterile materials, such as cerebrospinal fluid, punctates and biopsies, the requirement also includes the preparation of a microscopic direct preparation.
The culture media, enrichment methods and further diagnostic procedures used represent a procedure that is optimally adapted to the respective test material and is based on the applicable national and international standards. Depending on the material, this also includes the search for anaerobically growing or fastidiously growing germs. For example, Nocardia, actinomycetes and anaerobes are always included in the "Pathogens and resistance" request from brain abscess materials.
However, for other test materials, especially those that are subject to a high degree of contamination with physiological flora, particular pathogens must be specifically requested by the sender by means of a special request.
General information on the collection and transport of test materials
Proper collection and transport of the test materials contributes significantly to the validity of the test results obtained in the microbiological laboratory.
The following general instructions apply to (almost) all test materials:
- Take specific samples while avoiding contamination (normal flora)!
- Avoid temperature extremes!
- Avoid drying out the samples!
- If possible, take samples before starting antimicrobial therapy!
- Label samples clearly: either online sticker or
(for requests that are not generated via the online system) Patient's first and last name, date of birth, sender/station, date of sample collection and test material - Send samples to the microbiological laboratory as quickly as possible, as shifts in pathogen quantities can occur during prolonged storage:
- Undemanding germs, such as staphylococci and enterobacteria, multiply
- fastidious germs, such as Haemophilus spp. pneumococci and meningococci, die off.
- Send the sample to the bacteriological laboratory as quickly as possible, as shifts in pathogen quantities occur after just a few hours.
- Always close sample containers securely!
- When transporting infectious materials, the relevant transport regulations must be observed! Information on this can be obtained from the Microbiological Diagnostics team.
- If the samples are not sent to the laboratory immediately, observe the storage conditions of the samples.
Sample containers
Test materials
Eye swab
| Sample container: Universal swabs with transport medium. Thinner swabs with transport medium (orange lid) are also available for swabbing newborns and children. |
Take the swab:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
Storage: A special PCR collection kit is required for PCR for Chlamydia trachomatis. |
| Sample container: Universal swab with transport medium. |
Collection:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. |
| Special features: For larger bubbles, you can also try to aspirate some liquid with a sterile syringe. |
| Sample container: Universal swab with transport medium. |
Removal:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. |
| Special features: Taking a skin swab is generally only advisable if there are open efflorescences on the skin. Contamination of the test sample with bacteria from the physiological skin flora is usually unavoidable. |
| Sample container: Universal swab with transport medium. |
Removal:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store the sample at room temperature until the next day. |
| Special features: Please be sure to specify the exact localisation and label "intraoperative" so that the findings can be interpreted correctly! |
| Sample container: Universal swab with transport medium. |
Removal:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate despatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. |
| Special features: Bacteria of the physiological oral flora are usually detected in oral swabs. A specific test order is required to detect yeasts(Candida spp.) in the case of oral thrush! |
| Sample container: Universal swab with transport medium. Thinner swabs with transport medium (orange lid) are also available. |
Removal:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate despatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. |
| Special features: When taking nasal swabs for MRSA testing, please swab both nasal cavities in succession with one swab! Also use universal swabs with transport medium for MRSA PCR as part of MRSA screening! |
| Sample container: Universal swab with transport medium. Thinner swabs with transport medium (orange lid) are also available. |
| Acceptance: For ear canal swabs, the pinna should be disinfected beforehand and crusts removed if necessary. The ear canal is then swabbed in rotation using a swab. For a deep ear canal swab, an ear funnel should be used to avoid contamination with germs from the outer ear. For middle ear punctures and paracentesis with the eardrum closed, first clean the ear canal with physiological NaCl solution. Then puncture or incise the eardrum and aseptically aspirate some fluid. If the eardrum is ruptured, the examination material can be obtained directly with a swab using a speculum. |
| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store the sample at room temperature until the next day. |
| Special features: For ear swabs, a selective culture medium is routinely used in the laboratory to detect mould fungi. |
| Sample container: Universal swab with transport medium. |
Removal:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. |
| Special features: If Angina Plaut-Vincent is suspected, "Microscopic preparation Gram" should also be requested! |
| Sample container: Universal swab with transport medium. |
Removal:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. in the case of overnight collection), store the sample at room temperature until the next day. |
| Special features: Rectal swabs are mainly taken as part of screening for multi-resistant pathogens (e.g. MRSA, VRE, MRGN). They are notsuitable for diagnosing gastroenteritis. Rectal swabs are also suitable for detecting chlamydial proctitis. Please use a special swab kit for this . |
| Sample container: Universal swab with transport medium. |
Removal:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. |
| Special features: If Angina Plaut-Vincent is suspected, "Microscopic Gram preparation" should also be requested! |
Sample container: Universal swab with transport medium |
Removal:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store the sample at room temperature until the next day. |
| Special features: PCR for Neisseria gonorrhoeae,Chlamydia trachomatis and Trichomonas vaginalis from swab or urine (preferably first stream urine) possible (special collection kit for PCR required). |
| Sample container: Universal swab with transport medium. |
Removal:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store the sample at room temperature until the next day. |
| Special features: PCR for Neisseria gonorrhoeae,Chlamydia trachomatis and Trichomonas vaginalis from swab or urine (preferably first stream urine) possible (special collection kit for PCR required). |
| Sample container: Universal swab with transport medium |
Take off :
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store the sample at room temperature until the next day. |
| Special features: When requesting the test, please differentiate between deep and superficial wounds and specify the wound localisation, as this information influences the microbiological assessment of the sample! |
| Sample container: Universal swab with transport medium. |
Take the swab:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store the sample at room temperature until the next day. |
| Special features: PCR for Neisseria gonorrhoeae,Chlamydia trachomatis and Trichomonas vaginalis from swab or urine (preferably first stream urine) possible (special collection kit for PCR required). |
| Sample container: Sterile tube with screw cap. |
| Collection: The material is obtained as part of a bronchoscopic examination. The BAL is a representative test material for infections of the alveolar space.
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature: |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store BAL at room temperature until the next day. If stored in the refrigerator, sensitive bacteria such as Haemophilus spp. or pneumococci may die! |
| Special features: BAL are prepared in the laboratory natively and after dilution quantitatively on culture media. Therefore, the bacterial count in bacteria per ml is indicated on the report. Each BAL is examined microscopically in the laboratory using Gram staining and Calcofluor-White staining (special staining for fungi). In addition, selective culture media for the detection of Legionella and anaerobic bacteria are routinely added to each BAL. A separate test request is required for the examination for Pneumocystis jiroveci! |
| Sample container: Sterile tube with screw cap. |
| Collection: The material is obtained as part of a bronchoscopic examination.
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store bronchial lavage at room temperature until the next day. If stored in the refrigerator, sensitive bacteria such as Haemophilus spp. or pneumococci may die! |
| Special features: Note: Bronchial secretion is a secretion that is aspirated directly from the bronchial system during a bronchoscopic examination without prior rinsing with saline solution. If saline solution is introduced into the bronchial tract in order to aspirate secretions (which is necessary in most cases), the sample is a bronchial lavage. Bronchial secretions are prepared in the laboratory natively and after dilution quantitatively on culture media. The bacterial count in bacteria per ml is therefore stated on the report. |
| Sample container: Sterile tube with screw cap. |
| Collection: The material is obtained as part of a bronchoscopic examination. The bronchial lavage is a representative test material for infections of the respiratory tract.
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store bronchial lavage at room temperature until the next day. If stored in the refrigerator, sensitive bacteria such as haemophilus spp. or pneumococci may die! |
| Special features: Bronchial lavages are prepared in the laboratory natively and after dilution quantitatively on culture media. The bacterial count in bacteria per ml is therefore stated on the report. |
| Sample container: Sterile sample container, e.g. universal sample tube with screw cap or Vanek beaker. |
Collection:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate despatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. |
| Special features: Induction with hypertonic saline solution is intended to increase coughing up of secretions from the lower respiratory tract. Induced sputum is particularly useful for diagnosing tuberculosis. For general information on sputum diagnostics, see "Sputum". |
| Sample container: Sterile gastric juice tube with sodium phosphate solution. |
| Collection: Hygienic hand disinfection and use of disposable gloves.
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| Transport: If possible, immediately on the day of collection at room temperature! The sample must be transported in sterile, leak-proof sample containers. |
| Storage: If immediate dispatch to the laboratory is not possible, store samples in the refrigerator at 2-8 °C for up to 24 hours. |
| Special features: The submission of gastric juice is generally used to diagnose tuberculosis. For this purpose, the gastric juice must be placed in a gastric juice tube in which sodium phosphate solution has already been placed to buffer the gastric acid (available from the Institute of Medical Microbiology and Hygiene tel.: 65318 ). Care must be taken to send in certain minimum quantities of sample material. To increase sensitivity, it is suggested that 3 samples be tested on 3 consecutive days. The NALC-NaOH enrichment procedure for decontamination, homogenisation and enrichment of samples for cultural, microscopic and molecular biological detection is carried out from Monday to Friday. (Samples must arrive at the laboratory before 8 a.m., otherwise they will be processed the following day). |
| Sample container: Sterile tube with screw cap |
Sampling:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample in the refrigerator at 2-8 °C room temperature until the next day. |
Sample container: Vanek cup |
Collection:
Note on mycobacterial diagnostics: Repeat coughing up 2-3 times to obtain the largest possible sample quantity. When testing for atypical mycobacteria, rinse the mouth with sterile saline solution before collecting the sputum to prevent contamination of the sample with mycobacteria from the tap water! |
| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. If only mycobacteria are required, the sputum should be stored at 2-8 °C in the refrigerator. |
| Special features: A separate request is required for PCR detection of atypical pneumonia pathogens(Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila). |
| Sample container: Tracheal suction set with collection container or sterile tube with screw cap. |
Take the sample:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store the sample at room temperature until the next day. If stored in the refrigerator, sensitive bacteria such as Haemophilus spp. or pneumococci may die! |
| Sample container: Sterile sample container, e.g. universal sample tube with screw cap or Vanek beaker |
Sampling:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate despatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. |
Special features: Place biopsies from the gastrointestinal tract in Portagerm pylori transport medium for testing for Helicobacter pylori and transport the samples to the laboratory as quickly as possible, as the pathogens are very sensitive to environmental influences. |
| Sample container: Sterile sample container, e.g. universal sample tube with screw cap or Vanek beaker |
Sampling:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store the sample at room temperature until the next day. |
| Special features: If a fungal infection of the skin is suspected, a specific test request for fungi (yeasts, moulds and/or dermatophytes) is required! |
| Sample container: Blood culture bottles, BD, BACTEC Plus Aerobic/F and BACTEC Anaerobic Lytic (to be inoculated with 5-10 ml blood each) For children: Children's blood culture bottle, BD BACTEC PEDS Plus/F (to be inoculated with 2-5 ml blood) |
| Collection: If possible, collect blood cultures before starting antibiotic therapy! If samples need to be taken during antibiotic therapy, the blood cultures should be taken immediately before the next dose of antibiotics is administered.
Taking blood cultures from peripheral venous catheters, e.g. Viggo, is not indicated! |
| Transport: Transport blood culture bottles to the laboratory immediately at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. in the case of overnight collection), store the sample at room temperature until the next day. Do not pre-incubate blood culture bottles! |
| Special features: A pair of (aerobic/anaerobic) bottles should always be taken in order to also optimally capture anaerobically growing bacteria. At least two to a maximum of four blood cultures should always be taken, which should be obtained by separate punctures . If acute infective endocarditis is suspected, three blood cultures should be taken by three different venipunctures within one hour before the start of therapy.If subacute endocarditis (endocarditis lenta) is suspected, up to 4 blood cultures should be taken within 24 hours. The detection rate increases with the number of blood cultures taken (usually 2-3). If a catheter infection is suspected, simultaneous collection of central and peripheral blood cultures (one pair each) is recommended. In addition, the time of the positive report can be determined in the automated blood culture device and the "differential time to positivity" can be determined if the cultures are taken simultaneously. If the central blood culture reports positive at least 2 hours earlier than the peripheral culture, this indicates a catheter infection. |
| Sample container: Citrate blood tube |
Sampling:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample in the refrigerator until the next day. |
| Special features: Citrated blood is required in particular for the culture of mycobacteria in cases of suspected tuberculosis septicaemia (e.g. Landouzy septicaemia). |
| Sample container: EDTA blood tube |
Sampling:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store the sample at room temperature until the next day. |
Special features: |
Please take EDTA blood (microscopic parasite detection) or citrate blood (cultural pathogen detection, e.g. mycobacteria)!
Sample container: Vacutainer: InTube plasma (contains 4 QuantiFERON®-TB Gold (QFT) plus blood collection tubes (zero control, Tb1 and Tb2 antigen, mitogen control tubes) |
Collection:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. The blood samples must arrive at the laboratory as quickly as possible (within 16 hours of blood collection). |
| Storage: Storage is not possible. No submission at weekends and before public holidays |
| Sample container: Sterile transport container, e.g. Vanek beaker or universal sample tube with screw cap |
Sampling:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store the sample at room temperature until the next day. |
| Special features: Routine microbiological examination of drainage tips is not recommended. If infection of a wound is suspected, wound secretions from the drainage should be sent for examination. |
| Sample container: Sterile transport container, e.g. Vanek beaker |
Take the sample:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. |
| Sample container: Sterile transport container, e.g. Vanek beaker. |
Sampling:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store the sample at room temperature until the next day. |
| Special features: If actinomycosis is clinically suspected, please request a test for Actinomyces spp. |
| Sample container: Sterile transport container, e.g. Vanek beaker. |
Removal:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store the sample at room temperature until the next day. |
| Special features: Catheter tips are cultivated in the laboratory according to the MAKI roll-off method. Colony counts of more than 15 colonies/catheter tip are considered significant for a catheter infection. |
| Sample container: Sterile transport container, e.g. Vanek cup, contact lens storage box if necessary |
Collection:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. |
| Special features: If acanthamoeba infection is suspected : specific test order required. Due to the great effort involved and the rarity of the disease, strict indication and consultation with a laboratory doctor . |
| Sample container: Sterile transport container, e.g. Vanek beaker. |
Take the sample:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store the pacemaker wire in sterile NaCl overnight at room temperature. |
see under the heading "Smears"
see under the heading "Biopsies"
| Sample container: Sterile transport container, e.g. Vanek beaker or universal transport container with screw cap. |
Acceptance:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. |
| Special features: A special test requirement is necessary for the examination for dermatophytes, so that a selective medium is inoculated and incubated for several weeks! |
| Sample container: Sterile transport container, e.g. Vanek beaker or universal transport container with screw cap. |
Acceptance:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. |
| Special features: A special test requirement is necessary for the examination for dermatophytes, so that a selective medium is inoculated and incubated for several weeks! |
| Sample container: Sterile transport container, e.g. Vanek beaker or universal transport container with screw cap. |
Acceptance:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. |
| Special features: A special test requirement is necessary for the examination for dermatophytes, so that a selective medium is inoculated and incubated for several weeks! |
Sample container: Sterile tube with screw cap |
Sampling: Lumbar puncture, only in exceptional cases suboccipital puncture, under strict adherence to sterile conditions! Performing the lumbar puncture:
Pull out needle, cover puncture site with sterile plaster, compress for a few minutes, leave patient lying flat on stomach for 1 hour, place sandbag on puncture site.
Immediate dispatch of the samples to the laboratory at room temperature! Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store the CSF at room temperature. Special features: In addition to sending native CSF, a portion (1-2 ml) can be placed in a blood culture bottle. Then request this as a CSF in blood culture bottle! The detection of Mcobacterium tuberculosis in CSF is only sufficiently sensitive if a high volume of CSF is sent in, i.e. approx. 3-5 ml of CSF. If tuberculous meningitis is clinically suspected, please also request PCR! If neuroborreliosis is suspected, send in a paired CSF/serum sample (see Borrelia burgdorferi pathogen information). |
| Sample container: Depending on the quantity, e.g. sterile syringe Universal sample tube with screw cap Universal sample beaker "Vanek beaker" |
Acceptance:
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| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. Sensitive bacteria may die if stored in the refrigerator! |
| Special features: Sample containersUse a syringe (without air inclusion) to detect anaerobic bacteria! For the detection of nocardia and actinomycetes, a specific test request is necessary. |
| Sample container: Depending on the quantity, e.g. sterile syringe Universal sample tube with screw cap Universal sample beaker "Vanek beaker" |
Sampling:
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| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. Sensitive bacteria may die if stored in the refrigerator |
| Special features: Use a syringe without air inclusion to detect anaerobic bacteria! In addition to sending in the punctate, a portion (approx. 5 ml) can be placed in a blood culture bottle. Then label this as a "punctate bottle"! |
| Sample container: Sterile syringe, Universal sample tube with screw cap Universal sample beaker "Vanek beaker" Paediatric blood culture bottle |
| Collection: Strictly aseptic procedure! Local anaesthesia not always necessary.
|
| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. Sensitive bacteria may die if stored in the refrigerator! |
Special features: In addition, or in the case of very little material (1-3 ml), a paediatric blood culture bottle (for small volumes) can be inoculated. Request as joint punctate in blood culture bottle. Serological examination requirements (arthritis screening) are necessary for the diagnosis of reactive arthritis. |
Sample container: |
Collection:
|
| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), enrichment broths are available in the operating theatre of the eye clinic. Add part of the sample to the broth and store the broth and the rest of the sample at room temperature until the next day. Sensitive bacteria may die if stored in the refrigerator! |
Sample container: |
Acceptance:
|
| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. |
Special features: |
Sample container: |
| Sampling: Strictly aseptic procedure!
|
| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. Sensitive bacteria may die if stored in the refrigerator! |
| Special features: Use a syringe without air inclusion to detect anaerobic bacteria! A specific test request is necessary for the detection of mycobacteria. |
| Sample container: Sterile syringe, Universal sample tube with screw cap |
Sampling:
|
| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. Sensitive bacteria may die if stored in the refrigerator! |
Special features:
|
| Sample container: Sterile syringe Universal sample tube with screw cap Universal sample beaker "Vanek beaker" |
Acceptance:
|
| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. If stored in the refrigerator, sensitive bacteria such as Haemophilus spp. or pneumococci may die! |
| Special features: For the detection of anaerobic bacteria, use a syringe without air inclusion! In addition to sending in the punctate, a portion (approx. 5 ml) can be placed in a blood culture bottle. Then label this as a"punctate bottle"! |
| Sample container: Universal sample beaker "Vanek beaker", sterile stool tube with spoon |
| Collection: Hygienic hand disinfection and use of disposable gloves.
|
| Transport: If possible, immediately on the day of collection at room temperature! Longer transport times may result in a falsification of the bacterial count. |
| Storage: If immediate dispatch to the laboratory is not possible, store the sample in the refrigerator at 2-8 °C for up to 24 hours. |
| Sample container: Sterile tube with screw cap. |
| Collection: The material is obtained as part of a bronchoscopic examination.
|
| Transport: Send the samples to the laboratory immediately at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store bronchial lavage at room temperature until the next day. If stored in the refrigerator, sensitive bacteria such as Haemophilus spp. or pneumococci may die! |
| Special features: Note: Bronchial secretion is a secretion that is aspirated directly from the bronchial system during a bronchoscopic examination without prior rinsing with saline solution. If saline solution is introduced into the bronchial tract in order to aspirate secretions (which is necessary in most cases), the sample is a bronchial lavage. Bronchial secretions are prepared in the laboratory natively and after dilution quantitatively on culture media. The bacterial count in bacteria per ml is therefore stated on the report. |
| Sample container: Sterile syringe Universal sample tube with screw cap Universal sample beaker "Vanek beaker" |
| Collection: Hygienic hand disinfection and use of disposable gloves.
|
| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next day. Sensitive bacteria may die if stored in the refrigerator! |
| Special features: Use a syringe without air inclusion to detect anaerobic bacteria ! |
| Sample container: sterile syringe, universal swab with transport medium. |
| Sampling: Hygienic hand disinfection and use of disposable gloves.
|
| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible, store the sample at room temperature for up to 24 hours. |
| Special features: The examination of drainage secretions can provide valuable information on the presence of an infection in the drainage area. However, there is always a risk that germs from the patient's own flora, which colonise the (plastic) drainage as a biofilm, will be detected. |
| Sample container: Universal sample beaker "Vanek beaker". |
Acceptance:
|
| Transport: If possible immediately on the day of collection at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible, store the sample at room temperature for up to 24 hours. |
If Neisseria gonorrhoeae is suspected, transport to the laboratory immediately. |
| Sample container: Universal sample tube with screw cap (blue cap). Universal swab with transport medium. |
Acceptance:
|
| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: If immediate despatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next morning. |
| Special features: Endoscopic collection harbours the risk of contamination with germs from the upper respiratory tract. |
| Sample container: Sterile gastric juice tube with sodium phosphate solution. |
| Collection: Hygienic hand disinfection and use of disposable gloves.
|
| Transport: If possible, immediately on the day of collection at room temperature! The sample must be transported in sterile, leak-proof sample containers. |
| Storage: If immediate dispatch to the laboratory is not possible, store samples in the refrigerator at 2-8 °C for up to 24 hours. |
| Special features: The submission of gastric juice is generally used to diagnose tuberculosis. For this purpose, the gastric juice must be placed in a gastric juice tube in which sodium phosphate solution has already been placed to buffer the gastric acid (available from the Institute of Medical Microbiology and Hygiene tel.: 65318 ). It is important to ensure that certain minimum quantities of sample material are sent in. To increase sensitivity, it is suggested that 3 samples be tested on 3 consecutive days. The NALC-NaOH enrichment procedure for decontamination, homogenisation and enrichment of samples for cultural, microscopic and molecular biological detection is carried out from Monday to Friday. (Samples must arrive at the laboratory before 8 a.m., otherwise they will be processed the following day). |
Sample container: |
Acceptance:
|
Transport: If possible, refrigerate immediately on the day of collection! |
| Storage: If immediate dispatch to the laboratory is not possible, store samples in the refrigerator at 2-8 °C for up to 24 hours. |
| Sample container: Universal sample cup "Vanek cup", Universal swab with transport medium Thinner swabs with transport medium (orange lid) are also available. |
Acceptance:
|
| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible, store the sample at room temperature for up to 24 hours. |
Special features: |
| Sample container: Sterile syringe Universal sample tube with screw cap, |
Sampling:
|
| Transport: In order to avoid the death of sensitive pathogens (e.g. pneumococci, anaerobes), the sample should be transported and the material should be set up as quickly as possible after the secretion has been removed. If transport times exceed 24 hours, the significance of the resulting microbiological findings is limited. |
| Storage: If immediate dispatch to the laboratory is not possible, store the sample at room temperature for up to 24 hours. |
| Special features: For an adequate microbiological examination of sinus secretions, material is required that is obtained either by puncturing the nasal cavity or intraoperatively during a surgical opening of the nasal cavity. Nasal lavage fluids or nasal swabs drained openly through the nose are not suitable for sinusitis diagnostics as they are contaminated with physiological nasal flora. |
| Sample container: Tracheal suction set with collection container or sterile tube with screw cap. |
Sampling:
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| Transport: Immediate dispatch of the samples to the laboratory at room temperature. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if samples are taken at night), store the sample at room temperature until the next day. If stored in the refrigerator, sensitive bacteria such as Haemophilus spp. or pneumococci may die! |
| Sample container: Universal swab with transport medium Thinner swabs with transport medium (orange lid) are also available. |
Collection:
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| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible, store the sample at room temperature for up to 24 hours. |
Special features: In case of V. a. Neisseria gonorrhoeaeimmediate transport to the laboratory. ZPCR for Neisseria gonorrhoeae,Chlamydia trachomatis and Trichomonas vaginalis from smear or urine (preferably first stream urine) possible (special collection kit for PCR required). |
| Sample container: Serum tube. |
| Collection: Hygienic hand disinfection and use of disposable gloves. Puncture usually in the crook of the elbow.
|
| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample at room temperature until the next morning. |
| Sample container: Universal sample tube with screw cap (blue lid). Universal sample beaker "Vanek beaker". |
| Acceptance: Hygienic hand disinfection and use of disposable gloves.
|
| Transport: If possible, immediately on the day of collection within one hour at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible, store the sample at room temperature. |
| Special features: Duodenal secretions should be analysed natively or as sediment for Giardia duodenalis (formerly lamblia) if there is persistent suspicion of infection in negative stool samples. |
| Sample container: Sterile stool tube with spoon |
| Collection: Hygienic hand disinfection and use of disposable gloves.
|
Transport: The sample should be transported at room temperature (2°C-25°C) on the day the sample is taken. If, in exceptional cases or at weekends, it is not possible to process the material within 24 hours of sampling, the material should be stored in a refrigerator at 2-8°C. |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. if the sample is taken at night), store the sample in a refrigerator at 2-8 °C for up to 24 hours. |
Special features: |
| Sample container: Universal sample cup "Vanek cup", Boric acid tube |
| Collection: Suprapubic bladder puncture e.g. as part of a Cystofix system under strict adherence to sterile conditions!
|
| Sample container: Universal sample beaker "Vanek beaker", Boric acid tubes, |
Acceptance:
Transfer 10 ml of the urine into a sterile boric acid tube. |
| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: Store urine in the boric acid tube for up to 24 hours at room temperature. |
| Special features: When collecting permanent catheter urine, it is essential to ensure that the urine is freshly collected. Urine that has already been in the bag for some time should not be collected, as germs multiply in the urine bag! |
| Sample container: Universal sample beaker (Vanek beaker) Boric acid tubes |
| Collection: There are various catheter systems. As a rule, sizes of 14-18 Charierre are used.
|
| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: Store the urine in the boric acid tube for up to 24 hours at room temperature. |
Special features: |
Sample vessel: Boric acid tube Universal sample cup "Vanek cup" |
Collection:
|
| Transport: If possible immediately at room temperature! |
| Storage: Store urine samples in boric acid tubes for up to 24 hours at room temperature . |
Special features: |
| Sample container: Boric acid tubes Universal sample beaker "Vanek beaker" |
Acceptance:
|
| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: Store urine in the boric acid tube for up to 24 hours at room temperature . |
| Special features: In the case of leucocyturia without significant bacteriuria, atypical pathogens such as Mycobacterium tuberculosis should be considered. |
Sample container: |
Collection:
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| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: Store urine in the boric acid tube for up to 24 hours at room temperature. |
Special features: PCR for Neisseria gonorrhoeae,Chlamydia trachomatis and Trichomonas vaginalis from smear or urine (preferably first stream urine) possible (special collection kit for PCR required). |
| Sample container: Universal sample cup "Vanek cup" Boric acid tubes |
| Collection: Collection best in the morning, before urination or 4 hours after the last micturition:
|
| Transport: If possible, immediately on the day of collection at room temperature! |
Storage: Store urine in the boric acid tube for up to 24 hours at room temperature. |
Special features: For the detection of Schistosoma haematobium, freshly collected single urine (activity urine) or 24-hour urine collection. At least 10 ml of urine should be collected. The best results The best results are obtained if the urine is collected between 12 noon and 2 p.m. and after major physical exertion (patients climbing stairs). PCR for Neisseria gonorrhoeae,Chlamydia trachomatis and Trichomonas vaginalis from smear or urine (preferably first stream urine) possible (special collection kit for PCR required) |
| Sample container: Universal sample beaker "Vanek beaker", or Uricult |
| Collection: Collection best in the morning
|
| Transport: If possible, immediately on the day of collection at room temperature! |
| Storage: If immediate dispatch to the laboratory is not possible (e.g. in the case of nocturnal collection), store the urine at room temperature. |
| Special features: In the case of leucocyturia without significant bacteriuria, urethritis or atypical pathogens, such as Mycobacterium tuberculosis, should be considered. |
| Incidence and pathogen spectrum: Brucellosis is an anthropozoonosis. Brucella are found in particular in the urogenital tract of cattle(B. abortus), pigs(B. suis), goats and sheep(B. melitensis). There they cause inflammation of the placenta, resulting in abortion and sterility. A chronic infection can develop with lifelong persistence of the pathogens with long-lasting excretion in the milk. Around 500,000 Brucella infections in humans are recorded worldwide every year. Infections caused by B. abortus have almost disappeared in Germany thanks to effective control measures. In Germany, infections mainly occur through the consumption of imported and non-pasteurised dairy products from countries where brucellosis is still endemic (Mediterranean region). These are mostly "imported" diseases from migrant workers and holiday travellers. Due to exposure, endemic brucellosis is mainly found in farmers, butchers, veterinarians, dairy and slaughterhouse workers. Brucella are excreted from infected animals in milk (the most important transmission route for humans), urine, faeces or with the placenta during birth or abortion. There is no transmission from person to person. The incubation period is 1 week to several months. After prodromal symptoms such as fatigue, moderate fever, headache and aching limbs, infections with B. melitensis lead to a rapid rise in temperature of up to 40 °C (typically an undulating fever with profuse sweating). In the organ manifestation stage, hepatosplenomegaly, icterus and lymphadenopathy occur. The symptoms can recur over a period of months. Relatively frequent complications are arthritis and spondylitis (affecting the thoracic and lumbar vertebrae), manifestations in the urogenital tract (orchitis, epididymitis), neurological deficits (peripheral neuritis, meningoencephalitis) and manifestations in the heart. The lethality of untreated disease is approx. 2 %. Human infections with B. abortus are often mild or inapparent. |
| Test material: Blood cultures Serum Biopsies (lymph nodes) Punctates (bone marrow) |
| Basic diagnostics: A cultural and serological pathogen detection is performed. For the examination for Brucella spp. a specific examination request should be made in case of clinical suspicion, as the blood cultures and other culture media must be incubated longer than usual! |
| Further diagnostics: There is no standard procedure or specific limit values for susceptibility testing of Brucella spp. For this reason and due to the high infectivity of the pathogen, resistance testing in our laboratory is not carried out. |
| Miscellaneous B. melitensis is categorised as a safety level 3 pathogen in accordance with the German Ordinance on Biological Agents. Due to the risk of laboratory infections, please make a corresponding note on the request if there is a clinical indication of brucellosis (food, occupational, travel history)! Obligation to report illness and death. |
| Incidence and pathogen spectrum: Malaria is widespread in tropical countries worldwide, although the distribution areas of the individual malaria pathogens differ. Every year, around 0.5 to 2 million people die from malaria, 80-90% of them in tropical Africa. Around 1000 cases are imported to Germany every year, of which around 30 are fatal. Clinically, malaria is a febrile illness with chills. It has an incubation period of at least 5 days. Malaria tropica is often very severe and is often accompanied by complications such as anaemia, jaundice, kidney failure, CNS involvement and pulmonary oedema. Malaria tertiana and malaria quartana are milder diseases that are mainly characterised by recurrent fever attacks. In malaria tertiana, the pathogens can persist in the liver for decades and lead to frequently recurring fever attacks. All forms of malaria are caused by protozoa of the genus Plasmodium. There are four human pathogenic species: Plasmodium falciparum (causative agent of malaria tropica), P. malariae (causative agent of malaria quartana), P. ovale and P. vivax (causative agent of malaria tertiana). In Southeast Asia, malaria caused by Plasmodium knowlesi can occur in rare cases. The plasmodia are transmitted to humans via the bite of infected mosquitoes of the genus Anopheles. They multiply in humans first in the liver and later in the erythrocytes after release from the liver. They form rings in the erythrocytes. These develop via trophozoites into multinucleated schizonts, which are released again when the erythrocytes burst (this leads clinically to anaemia). They develop further in the blood into sexual forms(gametocytes) or can infect new erythrocytes. During a mosquito bite, the gametocytes are again ingested by Anopheles mosquitoes, and the cycle is completed by further development in the mosquito's intestine. The different Plasmodium species can be differentiated morphologically in the blood smear. It is particularly important to recognise P. falciparum, as the immediate treatment of malaria tropica can be life-saving. |
Test material: |
Basic diagnostics: In addition, microscopic detection of the plasmodia is always carried out in the blood smear and in the thick drop (after Giemsa staining). The different types of plasmodia are also differentiated and, in the case of malaria tropica, the parasitaemia is quantified. |
Other: Outside laboratory opening hours , the rapid test is carried out in the Clinical Chemistry Department. For microscopic detection, the test material is forwarded promptly (the following day) to the microbiology department. |
Incidence and pathogen spectrum Sepsis is defined as a systemic inflammatory reaction to an infection, whereby microorganisms usually enter the bloodstream from a focus, either constantly or periodically, and cause metastases or damage to other organs. | ||||||||||||||||
Test material: Blood culture bottles should be transported to the laboratory within 24 hours.
If there is no evidence of a source of infection, urine and, if possible, sputum should always be analysed due to the frequency of urinary tract infections. Test material from primarily sterile body compartments (e.g. punctates) can be inoculated into a blood culture bottle for diagnosis; other swabs, drainage and secretions from the respiratory or gastrointestinal tract should be sent to the laboratory in their native state in an appropriate transport container as quickly as possible. | ||||||||||||||||
| Basic diagnostics: As part of basic diagnostics, the request "Pathogens and resistance" on the request form is sufficient. The blood cultures are incubated in the automated incubator for 5 days. If the device gives a positive signal, the grown bacteria are first differentiated microscopically and then cultivated on enrichment and selective culture media for species differentiation and resistance testing. An antibiotic resistance test is usually available at the latest 48 hours after notification of the microscopic findings. In the case of the growth of fast-growing bacteria such as enterobacteria and S. aureus, a resistance test is usually available after 24 hours. If there are already indications of an infection with difficult-to-cultivate, very slow-growing bacteria (e.g. brucella) in the medical history or clinic, this should be checked for the presence of antibiotics. Brucella), this should be noted on the request form so that the blood cultures are incubated for longer than 5 days and, if necessary, special culture media are used for pathogen cultivation. The examination of materials from sepsis samples should be carried out according to the usual diagnostic standards. For urine, punctates, tracheal secretions etc., the requirement "pathogen and resistance" is usually sufficient. | ||||||||||||||||
| Further diagnostics: If no sepsis pathogens can be isolated in the usual blood culture and focal examination, rarer pathogens or pathogens that can only be cultivated under special conditions should also be included in the diagnostics, depending on the patient history and clinical picture. This applies in particular to patients with immunosuppression and a history of travelling abroad or to tropical countries. If sepsis caused by fungi is suspected, antigen detection in serum for Candida, Aspergillus and Cryptococcus can also be carried out in addition to culture on special fungal culture plates. With these antigen tests, however, it should be noted that some of the commercially available tests only have a sensitivity of 60-90% and therefore a negative test does not rule out fungaemia. A urine antigen test is also recommended to clarify septicaemia induced by Legionella or pneumococci. If a so-called Landouzy septicaemia caused by Mycobacterium tuberculosis complex is suspected, culture citrated blood. If the microscopic preparation in respiratory secretions is positive, nucleic acid detection by PCR can also be attempted. In the case of previous stays in the tropics, septic diseases such as malaria (request thick drops and smear), typhoid fever (blood culture) etc. should also be considered. | ||||||||||||||||
| Other: The interpretation of blood culture results in the clinical context plays a special role in clarifying the question of significant bacteraemia. The following in particular indicates contamination of the blood culture during collection:
| ||||||||||||||||
Table 1: Pathogen spectrum depending on the form of sepsis (examples):
| ||||||||||||||||
Incidence and pathogen spectrum: Incidence and pathogen spectrum: Campylobacter Salmonella Yersinia Shigella. E. coli (e.g. EHEC) Other important enteritis pathogens and their characteristics are listed below (see table). The most common cause of nosocomial or antibiotic-associated colitis is Clostridioides difficile (formerly Clostridium difficile). | ||||||||||||||||||||||||||||||
| Examination material: The amount of stool sent in should be about the size of a hazelnut. Parasites are not evenly distributed in the intestine, but sit in nests in the intervillous spaces or in diverticula of the large intestine. It is therefore advisable to stir the stool with the collection spoon before taking the sample. The stool sample should then be taken from different places. | ||||||||||||||||||||||||||||||
Basic diagnostics requirement for bacterial gastroenteritis pathogens A multiplex PCR is carried out, which includes the following pathogens: Salmonella, Shigella, Yersinia Campylobacter and EHEC If received by 11 a.m., the test is carried out on the same day; if the result is positive, the culture is followed by a resistance test. | ||||||||||||||||||||||||||||||
Further diagnostics:
|
Incidence and spectrum of pathogens:
S. aureus, KNS, streptococci, pseudomonads, Acinetobacter and enterobacteria, moulds, Propionibacterium (if the course is protracted).
Bacillus spp, Clostridia, KNS, gram-negative rods, moulds (injuries with plant material), streptococci (especially in children).
S. aureus, Candida spp. Aspergillus spp. Enterobacteriaceae, pneumococci, Haemophilus spp, Neisseria meningitidis, Mucorales (derived from ENT area). |
Material collection and dispatch:
|
| Basic diagnostics: Pathogens and resistance |
| Targeted diagnostics: If there is a clinical indication of failed microorganisms (actinomycetes, mycobacteria, Aspergillus spp. and other hyaline moulds, Mucor spp. and other zygomycetes), a targeted request should be made. |
Notification of findings:
|
| Incidence and pathogen spectrum: Conjunctivitis is an inflammation of the conjunctiva due to infectious, physical or allergic causes. Typical bacterial pathogens of conjunctivitis with and without blepharitis as well as dacryoadenitis and dacryocystitis are: S. aureus, ß-hemolytic streptococci, S. pneumoniae, H. influenzae, M. catarrhalis, P. aeruginosa, various enterobacteriaceae and Chlamydia trachomatis. Rarely, Neisseria gonorrhoeae, N. meningitidis, S. epidermidis, L. monocytogenes, Actinomyces spp,M. tuberculosis and others. Keratitis is an inflammation of the cornea usually triggered by local injury and consecutive infection. The spectrum of pathogens also includes fungi (Candida, Aspergillus). Other pathogens to be considered are viruses (mostly adenoviruses, HSV, VZV, rarely also CMV, measles and rubella virus) and, more rarely, protozoa (microsporidia, acanthamoeba). Tests for acanthamoeba are generally only useful for contact lens keratitis, but not for non-specific eye inflammation. |
| Examination material: Eye swab Corneal swab Corneal scraping |
| Basic diagnostics: Pathogens are detected by culture. In the case of slow-growing and/or rare pathogens (e.g. Actinomyces spp., mycobacteria, fungi), a specific examination request should be made, as the culture media must be incubated for longer than usual! |
| Further diagnostics: Virological diagnostics (e.g. in cases of herpes simplex keratitis, zoster ophthalmicus, adenoviruses in keratoconjunctivitis epidemica) are carried out in the virology department. Serological detection methods are required to detect or exclude an infection caused by Toxoplasma gondii or Toxocara canis (external examination). |
Miscellaneous: For DNA detection of N. gonorrhoeae and/or Chlamydia trachomatis using PCR, a special swab kit is required, which can be ordered from the hospital pharmacy. Due to the rarity of acanthamoeba keratitis, a bacterial or viral infection should be ruled out prior to acanthamoeba diagnostics. |
| Incidence and pathogen spectrum: The most common pathogens in catheter-associated infections are CNS (coagulase-negative staphylococci), S. aureus, enterococci, gram-negative rod bacteria (e.g. E. coli) and Candida spp. Rarer pathogens (e.g. atypical mycobacteria or anaerobes) are increasingly found in immunocompromised patients. The diagnosis of "catheter-associated sepsis" requires not only pathogen detection at the catheter tip and a blood culture, but also clinically manifest symptoms of infection (fever, chills or hypotension). Otherwise, one only speaks of colonisation/colonisation of the catheter. A distinction is made between vascular catheters for short-term use (single or multi-lumen silicone or polyurethane catheters) and those for longer-term use (usually surgically implanted, tunneled, such as port, hickman catheters). Short-term catheters are usually colonised by skin microorganisms that grow along the puncture site on the outside of the catheter towards the tip, while long-term catheters are more likely to be primarily contaminated by the catheter hub. In all patients with vascular catheters, but especially in surgically implanted catheters or in patients in whom removal of the catheter is almost impossible (e.g. coagulation problems in CMT patients, no further vascular accesses), the determination of the DTTP (differential time to positivity) can provide information as to whether a catheter-associated infection is likely. This involves determining the time difference between the positive blood cultures taken peripherally and centrally from the catheter. The prerequisite for this is the simultaneous collection of peripheral and central blood cultures from the same amount of blood. There is also the option of antibiotic lock therapy. |
Test material: Falcon tube Blood cultures (central and peripheral) |
| Basic diagnostics: The most common method is the semi-quantitative method according to Maki, whereby the catheter tip is rolled over a blood agar plate. The number of colony forming units (CFU) is counted. If > 15 colonies are detected, the pathogen is considered significant. |
| Further diagnostics: As catheter-associated infections are usually accompanied by bacteraemia, blood cultures should always be taken at the same time as the catheter tip. The detection of an identical pathogen from both the catheter tip and a blood culture taken from the periphery is considered evidence of a catheter-associated infection or bacteraemia as opposed to catheter colonisation alone. |
| Miscellaneous: To determine the DTTP (differential time to positivity), it is necessary to note the exact time of collection of the blood cultures. Provided that the samples were taken at the same time, patients with catheter-associated infections show a positive result in cultures taken centrally from the catheter > 2 hours earlier than in the peripherally taken culture. |
| Incidence and pathogen spectrum: Wound infections can occur as a result of trauma (outpatient) or nosocomial. S. aureus is the most common pathogen of community-acquired wound infections. Enterobacteriaceae (especially after penetrating trauma), Clostridium spp. and Bacteroides fragilis and Bacillus spp. are also found in contaminated wounds. Mixed infections involving Gram-negative rods and anaerobes are frequently found in ulcerating wounds due to circulatory disorders. In rare cases, contamination with brackish water leads to wound infection with Aeromonas hydrophila or Vibrio vulnificus after exposure to salt water. Rapidly progressive courses with accompanying cellulitis and myositis are observed. Occasionally, severe chronic courses due to fungal infestation (Zygomycetes or Aspergillus spp.) or ubiquitous mycobacteria are also observed, particularly in immunocompromised patients. Due to the particularities of the pathogen spectrum, the type of bite injury (human bite, dog bite, cat bite, etc.) and risk factors should be reported to the microbiologist.etc.) and risk factors for certain infections (immunosuppression, diabetes mellitus, hepatopathies, post-splenectomy, transplants, steroid therapy and stays abroad) should be reported to the microbiologist. The following table summarises some characteristic pathogens in typical wound localisation:
Primarily "clean" nosocomial wound infections are often caused by staphylococci or streptococci. Escherichia coli, Proteus mirabilis, enterococci and anaerobes are also found after gastrointestinal and genitourethral procedures. In immunocompromised patients, especially after a transplant, the wound may be colonised by rarer pathogens in addition to staphylococci and enterobacteriaceae. These include in particular viruses (HSV, VZV, papilloma virus), fungi(Candida spp., dermatophytes) and Mycobacterium chelonae. A wound inspection can provide additional information about the causative pathogens. A putrid odour is found, for example, in anaerobes or enterococci, while Pseudomonas spp. often has a sweet odour. | ||||||||||||||||||
Test material - basic diagnostics: | ||||||||||||||||||
Test material - further diagnostics:
Chronic and/or ulcerating wound infection: If this is suspected, specific tests for mycobacteria, Nocardia, Actinomyces or dermatophytes, for example, should also be sought (specific test request required).
suspected gas gangrene ( spp.) or request a Gram preparation from a wound swab or punctate in addition to the basic diagnosis . |
| Incidence and pathogen spectrum: Humans are the only reservoir of C. diphtheriae. Human infection is usually aerogenic, in the case of skin infections also by smear infection. However, up to 5 % of those exposed become asymptomatic carriers (especially on the skin) without falling ill and thus become a reservoir in non-epidemic times. The incidence of diphtheria has become rare in Germany due to the recommended active immunisation (< 10 cases per year). Due to a certain vaccination fatigue and decline in vaccination protection, there are repeated warnings of the risk of epidemic occurrence of the disease. Diphtheria is caused by Corynebacterium diphtheriae. Four biotypes are known: gravis, intermedius, mitis and belfanti. Closely related to C. diphtheriae are C. ulcerans and C. pseudotuberculosis, which can also cause a diphtheria-like illness. C. diphtheriae causes an infection of the upper respiratory tract and also toxic symptoms of the heart, nerves and kidneys due to transmission of the toxin (a phage-encoded A-B toxin). In the case of pharyngeal diphtheria, the formation of pseudomembranous clots, which lead to bleeding when detached and have a sweet odour, is typical, while in the case of nasal diphtheria a bloody-serous rhinitis predominates. Toxic symptoms can occur either in the early stages of the disease (primary toxic course) or only after a few weeks (secondary toxic course) in the form of myocarditis, cranial nerve palsies, peripheral neuritis, etc. Skin diphtheria is usually clinically characterised by a necrotising skin lesion. The lethality of the disease is high due to the toxic effects. In addition to the typical diphtheria disease described above, invasive diseases (endocarditis, osteomyelitis, septic arthritis, etc.) caused by non-toxigenic C. diphtheriae strains occur, particularly in drug and alcohol abusers. |
| Test material: Throat swab, nasal swab, tonsil swab, skin swab, other swabs from infected areas (several swabs if possible, before administering antibiotics or antitoxin!); throat and tonsil swabs are best taken from under the pseudomembranes by holding them up with tweezers. A piece of the pseudomembranes should also be sent in a sterile container for diagnosis. If skin diphtheria is suspected, a nasal and throat swab should always be taken in order to determine the pathogen carrier status. The pathogen can only be cultivated from blood cultures in rare invasive diseases. In typical diphtheria, the systemic effects are based solely on the spread of the toxin and not on bacterial invasion. It is advisable to take a serum sample at the same time to determine the patient's vaccination status. |
| Basic diagnostics: A suspected case of diphtheria should always be documented on the request form and the microbiologist on duty should always be informed by telephone before the sample is received! As corynebacteria are part of the physiological flora of the skin and mucous membranes, special selective and special nutrient media must be inoculated in the laboratory in addition to universal nutrient media. It is therefore essential to specifically test for Corynebacterium diphtheriae! |
| Further diagnostics: A PCR test to detect the diphtheria toxin gene is carried out in our laboratory from microscopically conspicuous primary materials and when suspicious colonies grow on the culture media. PCR-positive isolates are sent to the diphtheria cosiliary laboratory for detection of toxin production using the Elek test. These further tests do not require a separate request from the sender, but are carried out automatically as part of the diagnostic procedure in suspected cases of diphtheria. |
Other: |
| Incidence and spectrum of pathogens: Ear infections include acute and chronic otitis media (inflammation of the middle ear) and otitis externa (inflammation of the outer ear and auditory canal).
1) Acute localised otitis externa: clinically impressive as a pustule, boil or erysipelas, 2) Acute diffuse otitis externa (= Swimmer's ear): Diffuse inflammation, occurs particularly in humid, warm climates/environments, pathogens: 3) Chronic otitis externa: Mostly caused by drainage of secretions from the middle ear with a damaged eardru m, o f otitis media (see below), rare pathogens: P. aerugino sa, other Gram-negative rods . M. tuberculosis, M. leprae, Treponema pallidum 4) Malignant (invasive) otitis externa: Necrotising infection of the auditory canal, frequently occurring in diabetes mellitus.
1. Acute otitis media
S. aureus, coagulase-negative staphylococci and enterobacteria are more common in newborns! 2. Chronic otitis media:
Chlamydia pneumoniae, Mycoplasma pneumoniae, Corynebacterium diphtheriae, Mycobacterium tuberculosis, MOTT and Nocardia are also described as rare pathogens. Moulds(Aspergillus spp. etc.) also play an important pathogenetic role. Expected contamination germs The normal flora of the external ear and auditory canal corresponds to the normal flora of the skin. In particular, Staphylococcus epidermidis, Corynebacterium spp., propionibacteria, greening streptococci and Candida (especially C. parapsilosis) are present. S. aureus can also be part of the normal flora, but it is always differentiated and tested in our laboratory as it is also a significant pathogenic germ. The middle ear is physiologically sterile or minimally colonised by flora from the upper respiratory tract (by migration through the Eustachian tube) | |||||
| Examination material: Ear swabs (including ear canal swabs and tympanic membrane swabs) Also aspirates, punctates and biopsies from the middle ear | |||||
| Basic diagnostics: The aim should always be to detect pathogens by culture, as this usually also enables the bacteria to be tested for resistance. The standard examination requirement "pathogen culture and resistance" is sufficient as a basic diagnostic test in cases of otitis media and otitis externa and includes the detection of the pathogens described above. A selective medium for the detection of fungi (in particular Aspergillus spp. and Candida spp.) is also routinely used. | |||||
| Further diagnostics: If infection is suspected but the culture results are negative, further swabs should be taken and, if necessary, invasive test material should be taken. If otitis is present but there is no evidence of bacterial or fungal pathogens, a viral origin of the otitis should be considered and appropriate diagnostics carried out. Viral pathogens include, in particular, herpes simplex virus and varicella zoster virus. | |||||
| Other: --- |
| Incidence and spectrum of pathogens: Throat infections as inflammatory reactions in the oropharynx include pharyngitis and tonsillitis, which usually present together as tonsillopharyngitis. There are also rarer special forms, such as angina Plaut-Vincent, which is caused by anaerobes, in particular fusobacteria and spirochaetes. Fusobacteria and spirochaetes, retropharyngeal abscesses and diphtheria. Tonsillopharyngitis is one of the most common reasons for consulting a general practitioner or ENT specialist, especially in childhood. It peaks at the age of 4-7 years and usually occurs seasonally in the colder months of the year. Table 1 (see below) provides an overview of the most common pathogens causing tonsillopharyngitis. The most common bacterial pathogens include beta-hemolytic streptococci of groups A, C or G, Arcanobacterium haemolyticum (a gram-positive rod bacterium) and Mycoplasma pneumoniae. In rarer cases, Bordetella spp., Corynebacterium diphtheriae/ulcerans, N. gonorrhoeae, Treponema, Chlamydia, Yersinia and anaerobes can also occur as pathogens. | ||||||||||||||||||||||
| Test material: Tonsil swab Throat swab | ||||||||||||||||||||||
| Basic diagnostics: Cultural pathogen detection should always be sought, as this usually also enables resistance testing of the bacteria. The standard examination requirement "pathogen culture and resistance" is sufficient as basic diagnostics for suspected bacterial tonsillopharyngitis and includes the detection of beta-hemolytic streptococci, Arcanobacterium haemolyticum and corynebacteria. | ||||||||||||||||||||||
| Further diagnostics: If angina Plaut-Vincent is suspected (foul odour, purulent tonsillitis), a microscopic Gram preparation should always be requested, as the typical pathogens (fusobacteria, spirochaetes) are usually only detected microscopically and do not grow culturally! The suspected diagnosis should always be stated on the request form so that an optimal diagnosis can be made and additional anaerobic cultures can be prepared! If the basic diagnosis is negative, the rarer pathogens of tonsillopharyngitis should also be considered: Mycoplasma pneumoniae and Chlamydia pneumoniae are difficult to culture. PCR diagnostics are available for the | ||||||||||||||||||||||
| Other: Table 1 (MiQ 13 2010):
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Incidence and pathogen spectrum: Prosthetic joint infections are categorised according to the spectrum of pathogens into early infection/late infection - florid infection and late infection - suspected infection. Stapylococcus aureus, streptococci and E. coli are most frequently detected in early and florid infections. In the case of late infections (so-called low-grade infections), coagulase-negative staphylococci, enterococci or propionibacteria are more likely to be detected. It is often difficult to differentiate between skin contamination/relevant pathogens; correct material collection and microbiological diagnostics are crucial (see below) |
Test material: Biopsies 1-2 cm3 in size in a sterile Vanek cup (1 biopsy per cup) Intraoperative swabs, e.g. for prosthesis replacement |
Basic diagnostics: Joint prosthesis infection: For joint punctures, it is recommended to send 1-3 ml in a blood culture ped bottle and, if possible, 2-3 ml of native punctate in a syringe. If a surgical revision is performed, 4-6 tissue samples approx. 1-2 cm3 in size from different localisations should be sent in. Superficial fistulas and ulcerations are always contaminated with skin flora and are not suitable for the diagnosis of a prosthesis infection. |
Other: In the case of bacterial/septic arthritis, consider blood culture diagnostics. In the case of chronic arthritis that does not regress under antibacterial therapy, please consult a microbiologist if necessary. |
| Incidence and pathogen spectrum: Osteomyelitis describes an inflammation of the bone that can affect not only the bone marrow but all structural elements such as cancellous bone, cortical bone and periosteum. A distinction is made between haematogenous osteomyelitis, which is caused by haematogenous spread of the pathogens, and exogenous osteomyelitis, in which the pathogens directly infect the bone from outside, e.g. after trauma. Haematogenous osteomyelitis occurs most frequently in prepubertal and late adulthood and preferentially affects the metaphysis of long tubular bones. The most common pathogens of haematogenous osteomyelitis include Staphylococcus aureus and beta-hemolytic streptococci. Haemophilus influenzae capsular type B is also found in children with no vaccination protection and enteritic salmonella in children with sickle cell anaemia. In adults, other pathogens include enterobacteria such as E. coli, Serratia marcescens and Pseudomonas aeruginosa. Rare pathogens of osteomyelitis include Mycobacterium tuberculosis and atypical mycobacteria (usually affecting the vertebral bodies), Brucella (usually affecting the vertebral bodies and the sacroiliac joint) and actinomycetes (usually affecting the jaw bones or ribs). |
| Examination material: Blood cultures Punctates, biopsies of the affected bone |
| Basic diagnostics: A suspected case of osteomyelitis should always be stated on the request form so that an optimal diagnosis can be made! Blood cultures are positive in over half of cases and therefore contribute significantly to the diagnosis. The cultural detection of pathogens from a joint puncture or needle aspiration or from tissue from the immediate vicinity should be sought wherever possible so that an effective specific therapy can be carried out after resistance testing of the bacteria. The standard examination requirement "pathogen culture and resistance" is usually initially sufficient as a basic diagnosis in cases of suspected osteomyelitis of the long tubular bones. However, if the vertebral bodies or other bones are affected (see above), special examinations should always be requested due to the epidemiology of the specific pathogens (see "Further diagnostics"). |
| Further diagnostics: If the pathogen is not detected in the standard culture procedures or if the vertebral bodies or other bones are affected in atypical localisations, the following pathogens should be specifically requested:
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| Other: In chronic osteomyelitis that has already been treated with antibiotics for some time, so-called small-colony variants of staphylococci (in particular S. aureus) can occur as pathogens. These are variants of the pathogen in which the otherwise typical species characteristics (coagulase reaction, pigmentation, haemolysis properties) are not or only slightly pronounced and which, due to specific electron transport defects, exhibit increased intracellular pathogen persistence and thus a reduced response rate to targeted antimicrobial therapy. The aim is to detect these small-colony variants in the laboratory if the suspected diagnosis of "osteomyelitis" is recognisable on the request! |
| Incidence and spectrum of pathogens: Cystic fib rosis is an autosomal recessive inherited disease that leads to a generalised disorder of the secretory epithelium of all exocrine glands. It is usually caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, which is necessary for salt and water transport processes in cells. This leads to severe changes, particularly in the pancreas, intestine and respiratory tract. A very viscous mucus is produced in the respiratory tract, which impairs the self-cleaning function of the alveoli. Bacteria colonise, leading to chronic inflammation and remodelling of the lung tissue. Pulmonary insufficiency is the main cause of reduced average life expectancy. The pathogen spectrum in respiratory tract infections develops quite characteristically with age: Staphylococcus aureus and Haemophilus influenzae dominate in infancy and early childhood. From school age onwards, chronic colonisation with Pseudomonas aeruginosa follows, often in a mucoid variant. 1-5 % of older patients are colonised with Burkholderia cepacia, which is associated with an unfavourable prognosis. There are other typical pathogens of the respiratory tract of cystic fibrosis patients, although their pathogenetic significance is still unclear(Pseudomonas spp., Stenotrophomonas maltophilia, Achromobacter xylosoxidans, Ralstonia pickettii, atypical mycobacteria (MOTT)). In addition, Aspergillus fumigatus and Candida spp. are frequently detected in cystic fibrosis patients, with approx. 5 % of patients showing allergic bronchopulmonary aspergillosis. |
| Test material: sputum, bronchial secretions, BAL (at least 500 µl) throat swab |
| Basic diagnostics: The pathogen is detected by cultural cultivation on universal and selective media and subsequent differentiation and resistance testing. Selective culture media are also used for the detection of pseudomonads, fungi and Burkholderia. |
| Miscellaneous: The special spectrum of pathogens, which is characterised by otherwise rather rare germs and by pathogens that are sometimes slow-growing and difficult to differentiate, requires special methods of cultivation and differentiation as well as personal experience. A special "cystic fibrosis workstation" has therefore been set up in our laboratory. |
Incidence and pathogen spectrum: In outpatient pneumonia, the outstanding importance of Streptococcus pneumoniae was confirmed for Germany based on the CAPNETZ data. Infections caused by Mycoplasma pneumoniae, Haemophilus influenzae, Enterobacteriaceae, Legionella, S. aureus or respiratory viruses are much rarer. Occasionally, however, pathogens such as Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae can also be detected in the physiological respiratory flora of healthy individuals. | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Test material:
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| Further diagnostics: Table 2 (see below) provides an overview of the diagnostics for various pneumonias. Invasive diagnostics should be carried out at an early stage in high-risk patients and suspected rare pathogens (BAL) Serological and molecular biological diagnostics(M. pneumoniae, Legionella spp, C. pneumoniae, C. psittaci, Coxiella burnetii, etc.) and antigen detection in urine(L. pneumophila; S. pneumoniae) are reserved for special suspected diagnoses. In cases of suspected pulmonary tuberculosis, the mycobacteria of the Mycobacterium tuberculosis complexcan be detected by polymerase chain reaction (PCR) from respiratory secretions or pleural punctate in addition to the microscopy and culture mentioned above. However, due to its sensitivity and the possibility of false positive results, PCR is only useful in the case of a positive direct preparation or very strong suspicion of pulmonary TB. The detection of Pneumocystis jiroveci from materials obtained by bronchoscopy is more conclusive than from sputum. The pathogen is detected microscopically using fluorescence microscopy. If microscopy is negative and there is a high degree of clinical suspicion, DNA detection from the BAL can be attempted (only after consultation by telephone). Pleural punctate: Various pathogens can cause parapneumonic pleuritis with pleural effusion. The most common microbial pathogens are S . pneumoniae, Legionella spp, M. pneumoniae, H. influenzae, Klebsiella spp, Pneumocystis jiroveci. The aim is to detect pathogens by aerobic and anaerobic cultivation. | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Table 1: Common pathogens causing deep respiratory tract infections in different age groups
Table 2: Diagnosis of various pneumonias
With risk factor for multidrug-resistant pathogens: maltophilia |
| Incidence and pathogen spectrum: In Germany, human tuberculosis (TB) is most commonly caused by Mycobacterium tuberculosis. M. bovis (reservoir in cattle) and M. africanum (in Africa) are rare pathogens. In immunocompromised individuals, the tuberculosis vaccine strain M. bovis BCG can cause vaccine tuberculosis ("BCGitis"). Infection by M. microti, a rodent pathogen, is a rarity in immunocompromised individuals. Due to their close genotypic and phenotypic relationship, M. tuberculosis, M. bovis, M. bovis BCG, M. africanum and M. microti are grouped together to form the Mycobacterium tuberculosis complex. |
Test material:
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Basic diagnostics: (control required): 1 - 9 acid-fast rods per 100 visual fields, |
Further diagnostics: The QuantiFERON® test is an indirect test for the detection of M. tuberculosis infection. It is an alternative to the Mendel-Mantoux tuberculin skin test. In contrast, the QuantiFERON® test shows no cross-reaction with the tuberculosis vaccine strain (BCG). The results of the QuantiFERON® test must be considered in combination with the epidemiological history of the individual patient, their current state of health and other diagnostic examinations. A positive test result cannot distinguish between acute tuberculosis requiring treatment and latent tuberculosis. Further diagnostics to rule out active tuberculosis (see above) may need to be carried out. |
| Other: A resistance test is carried out for detected M. tuberculosis complexisolates. This usually takes approx. 2 weeks. |
| Incidence and pathogen spectrum: Urinary tract infections are the most common nosocomial infection. They are divided into
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Test material: With catheter urine, germs can already multiply in the catheter bag. It should therefore always be obtained from the designated puncture site on the catheter. | |||||
| Basic diagnostics: Transfer native urine into a boric acid tube. If native urine is sent in a Vanek beaker, rapid sample transport is necessary to prevent the growth of contaminants in the urine. It may be stored at room temperature for a maximum of 30 minutes until it arrives at the laboratory, otherwise it must be refrigerated at 2-8 °C. | |||||
| Further diagnostics: If there is a discrepancy between the clinical and bacteriological findings, it is advisable to resend a urine sample. Infectious pathogens that are not detected during basic diagnostics and are necessary for special requirements include
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Interpretation of findings: | |||||
| Further diagnostic measures: Knowledge of leukocyturia can also be useful for the assessment of bacteriological urine findings. Leucocyturia is usually present in a urinary tract infection. If leucocyturia is absent in the presence of significant bacteriuria, this indicates collection errors. If there is leucocyturia without significant bacteriuria, urethritis or atypical pathogens, such as Mycobacterium tuberculosis, should be considered.
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| Incidence and pathogen spectrum: Lues or syphilis is caused by the spirochete Treponema pallidum ssp. Syphilis is transmitted almost exclusively through sexual contact. Clinicians categorise syphilis into different stages. Primary stage:T. pallidum usually penetrates the skin and mucous membranes through micro-injuries. The incubation period depends on the inoculum density of the transmitted pathogens. A lesion usually forms at the site of infection after 5-90 days. Typical is a single, painless, indurated ulceration with a clean surface (ulcus durum, hard chancre, primary effect). The regional lymph nodes enlarge approximately one week after the appearance of the ulcus durum. The complex of ulcus durum and lymph node swelling is called the primary complex. The ulcus durum heals 3-6 weeks after onset with scarring, while the swelling of the local lymph nodes can persist for months. Secondary stage: Secondary syphilis develops due to haematogenous spread of the pathogens and occurs 3-6 weeks after the primary effect. This stage is characterised by variable manifestations on the skin and mucous membranes. It is characterised by maculo-papular exanthema (also palmar and plantar!), plaques muqueuses of the tongue and condylomata lata genital and perianal. The lymph nodes are generally swollen, there may be a slight fever, as well as inflammation in the throat and arthralgia. Co-illnesses of internal organs are possible. The secondary stage of syphilis lasts weeks to months. If the disease remains untreated, it can relapse. Latency: Latency is the period after the primary stage has healed when there are no clinical symptoms. The pathogen is also present in the body during latency. Latency can last for less than a year or for life. It is divided into early latency, i.e. the symptom-free period in the first four years after the onset of the disease, and late latency, i.e. the symptom-free period thereafter. Tertiary stage: Up to 35 % of all untreated syphilis cases enter the tertiary stage. After a latency period of 1-20 years and longer, the various manifestations of tertiary syphilis can occur. The symptoms are extremely varied. Tuberous changes (lues tuberosa) and the now very rare lues gummatosa can occur on the skin and mucous membranes. Gumma formation can affect all layers between skin and bone, but also the heart, brain or parenchymatous organs. Other organ manifestations of tertiary syphilis are optic atrophy, sensorineural hearing loss (usually in congenital syphilis) and syphilitic aneurysm of the aorta. A variety of neurological symptom complexes are possible in the CNS. The classic forms of neurosyphilis, progressive paralysis and tabes dorsalis, which are also known as quaternary syphilis, are relatively rare today. Syphilis and pregnancy: Untreated syphilis can have a decisive influence on the course of pregnancy. Spontaneous abortion, stillbirth, premature birth or perinatal death are possible. Premature birth and low birth weight are found in 10-40% of children born to untreated mothers. The vertical transmission rate of untreated pregnant women is 70-100 % for primary syphilis, 40 % in early latency and 10 % in late latency. In principle, the longer the time interval between infection and pregnancy, the lower the risk for the child. Infection of the foetus can occur as early as the first trimester. However, the illness of the child is probably not a direct result of the treponema infestation, but is the result of inflammatory reactions that can only occur after the immune system has sufficiently matured. A risk to the foetus from syphilis is therefore only to be expected from the 4th-5th month of pregnancy. Syphilis connata: The infected newborn can be asymptomatic or show very different symptoms ranging from discrete symptoms to a multi-organ infestation. The postnatal clinical symptoms are divided into an early stage (onset of symptoms within the first 2 years of life) and a late stage (onset of symptoms after the second year of life). Symptoms of the early stage are persistent rhinitis, hepato- and splenomegaly, glomerulonephritis, generalised lymphadenopathy, skin changes and abnormal findings in the cerebrospinal fluid. Bone lesions usually occur within 8 months of birth in early congenital syphilis. A typical feature of the late stage is the Hutchinson triad, consisting of barrel teeth, keratitis parenchymatosa and sensorineural hearing loss. Numerous changes to the skeleton can also be found as a result of chronic inflammatory processes. A mostly asymptomatic neurosyphilis is also detectable in up to a third of patients older than 2 years. To avoid pregnancy complications and Lues connata, a T. pallidum antibody screening test is prescribed in the maternity guidelines for all pregnant women within the 1st trimester. |
Test material:
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| Basic diagnostics: Syphilis diagnostics are based on serological step-by-step diagnostics (see also explanations under "Other"). The ELISA is used as a screening test. |
| Further diagnostics: Further serological tests are carried out independently by the laboratory according to the constellation of findings and the clinical information. |
| Miscellaneous: Notes on the serological test procedures: As part of the initial diagnosis of Lues, the FTA-Abs test, IgM-recome line blot and VDRL test are performed if the ELISA is positive. In follow-up examinations, only the ELISA and the VDRL test (both quantitative) are routinely performed.
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| Special features for the diagnosis of neurosyphilis: Neurosyphilis is the result of a systemic infection with T. pallidum. As the pathogen reaches the organs via the bloodstream and it is therefore never an isolated infection of the CNS, serum testing is sufficient in the first instance even if neurosyphilis is clinically suspected. If the basic diagnosis is positive, a parallel examination of serum and cerebrospinal fluid samples taken on the same day is then required (external examination).
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| Incidence and pathogen spectrum: The leading pathogen in acute and chronic prostatitis is Escherichia coli, followed by other species from the enterobacteria family. The role of Chlamydiatrachomatis and Ureaplasma spp. in chronic bacterial prostatitis is controversial. Unusual or particularly challenging prostatitis pathogens include:
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| Test material: Infectious agents in prostatitis are detected from prostate secretions and/or a urine sample. Fast-growing, undemanding infectious agents are detected during the routine examination. Only in individual cases must the detection spectrum be extended to specific examinations and examination requirements (see above). For better localisation of the infection, it is recommended to determine the pathogen count in different urine samples. The so-called 4- or 2-glass sample (only 2nd and 4th) has proven itself:
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| Basic diagnostics: Pathogens and resistance. Detects fast-growing, undemanding pathogens. |
| Further diagnostics: A specific request is required for the detection of Haemophilus influenzae and/or obligate anaerobes. For cultural detection of Neisseria gonorrhoeae, specific request and immediate transport to the laboratory, for nucleic acid detection send urine sample. If C. trachomatis is suspected, send urine sample (first stream urine in TPM) for nucleic acid detection. Mycobacterium tuberculosis: specific request for culture and microscopy; significance of nucleic acid amplification for the detection of M. tuberculosis from prostate secretions unclear. Ureaplasma spp. is detected by culture from prostate secretions, use of special transport media and specific request required. |
| Evaluation: A bacterial count in the urine sample that is at least 10 times higher after prostate massage indicates that the infectious agent is localised in the prostate. |
| Incidence and pathogen spectrum: The pathogen spectrum includes:
Chlamydia trachomatis is the most common urethritis pathogen with approx. 50 %, presumably followed by mycoplasma and trichomonads. |
| Test material: The first portion of a urine sample or a urethral swab should be used to detect Chlamydia trachomatis, Neisseria gonorrhoeae and/or Trichomonas vaginalis using nucleic acid amplification. The sensitivity and specificity of this test are over 95%. Ureaplasma/mycoplasma is detected by culture from the urethral swab. Molecular biological detection (PCR) of Ureaplasma spp. can also be performed. Gonococci are detected by culture from a urethral swab; the sample is transported to the laboratory without delay. |
Basic diagnostics: |
| Other: The cultural detection of chlamydia is very complex and therefore not routinely available. There is no reliable serological method for the detection of uropathogenic mycoplasmas. Antibody detection for the diagnosis of urethritis caused by chlamydia and gonococci is unreliable. |
| Incidence and pathogen spectrum: In bacterial vaginosis, the normal local flora of the vagina, in particular the group of lactobacilli ("Döderlei bacteria"), is suppressed. The resulting alkalisation of the pH value promotes the growth of Gardnerella vaginalis and anaerobic bacteria. This often leads to the occurrence of symptoms. In practice, bacterial vaginosis is diagnosed using the following four criteria (Amsel's method), at least three of which must be positive:
Detection of Gardnerella vaginalis alone in the vaginal swab is not indicative of bacterial vaginosis, as Gardnerella can also be found in the vaginal flora of healthy women! |
| Test material: Vaginal swab |
| Basic diagnostics: Assessment of a Gram-stained preparation with semi-quantitative detection of lactobacilli, gardnerella and obligate anaerobes. This allows a statement to be made about the balance of pathogens in the vaginal secretions. |
| Further diagnostics: Cultural pathogen detection with subsequent resistance testing is not useful for the question of "bacterial vaginosis". |
| Miscellaneous: The sample should be placed on a sterile slide and air-dried immediately after collection by the examining physician. For dispatch, the dabbed slide is sent in a break-proof plastic container provided for this purpose after the sample has dried. The plastic containers are provided to the sender by the Department of Medical Microbiology and Hygiene (please request by calling 65380). |
Days to weeks after infection, erythema migrans develops at the site of entry. The skin symptoms can persist for weeks(erythema chronicum migrans). In addition to multiple erythema, another manifestation is lymphadenitis benigna cutis (Borrelia lymphocytoma). Disseminated early manifestation: Late manifestations: |
| Test material: Serum (at least 500 µl) Cerebrospinal fluid (at least 1 ml) |
| Basic diagnostics: The microbiological diagnosis of Lyme disease is carried out by serology (antibody detection). A step-by-step diagnosis is carried out for this purpose, which includes a screening test (ELISA) in the first step and a confirmation test (immunoblot) in the second step. |
| Further diagnostics: Diagnosis of neuroborreliosis requires the detection of intrathecally synthesised antibodies. The CSF/serum index is therefore determined by measuring the specific antibodies in the blood and CSF. The total IgG concentration of serum and CSF as well as the concentration of serum albumin and CSF albumin are determined in the Clinical Chemistry Department, which must be arranged by the sender (if necessary, telephone consultation + information)! |
| Miscellaneous: Clinical criteria (medical history, symptoms, findings) are decisive for the diagnosis and for the diagnostic evaluation of the microbiological laboratory findings. Follow-up examinations are useful if the initial examination produced a borderline result or the initial examination was negative and there is a clinical suspicion of early Lyme disease. |
| Incidence and pathogen spectrum: The incidence of bacterial meningitis in Germany is around 1 case per 100,000 inhabitants. The most common pathogens are
are present. The incidence of invasive meningococcal disease is 0.55/100,00 inhabitants. H. influenzae has become rare as a meningitis pathogen following the inclusion of active vaccination in the vaccination schedule for children. ). E. coli-K1(in infants), coagulase-negative staphylococci, Staph. aureus, streptococci and anaerobes (after neurosurgical procedures) and Brucella (especially in Mediterranean countries). |
| Test material: The primary aim should be to detect the pathogen from the cerebrospinal fluid. This should be obtained before antibiotics are administered, as antibiotic therapy reduces the number of bacteria in the cerebrospinal fluid bya factor of102 to106. 1-2 ml of cerebrospinal fluid is usually sufficient for microscopic or cultural detection of the pathogens mentioned above, but the probability of detecting the pathogens increases with increasing cerebrospinal fluid volume. If tuberculous meningitis is to be excluded, at least 3-5 ml of CSF is also required. The pathogen concentration in the CSF may be as low as 10 CFU/ml in the case of meningitis. The CSF should be sent to the microbiological laboratory for processing as quickly as possible. If this is not possible due to collection outside working hours, it should be stored at room temperature until transport and a children's blood culture bottle should also be inoculated with 1-5 ml of CSF. After inoculation, it should be stored at room temperature until transport to the laboratory. In addition to CSF diagnostics, the submission of blood cultures is recommended, as the meningeal invasion of bacteria usually occurs from the blood. Blood cultures are the only way to identify and cultivate the pathogens in the case of signs of intracranial pressure. |
| Basic diagnostics: As part of basic diagnostics, the requirement "pathogen and resistance" is sufficient. A few drops of cerebrospinal fluid are enriched using cytocentrifugation and stained according to Gram and with methylene blue. The number and type of cells (neutrophil granulocytes, mononuclear cells, erythrocytes) and bacteria are determined semi-quantitatively. The Gram stain allows identification of the bacteria in 60-90 % of meningitis cases. However, the sensitivity depends directly on the concentration of bacteria in the cerebrospinal fluid: at concentrations of
The number of neutrophils can be reduced by 50 % after just 2 hours of storage. A cell count should therefore be performed as soon as possible after CSF collection. The remainder of the CSF is used to inoculate special culture media and liquid media to cultivate and identify the pathogens. A resistance test is carried out on all bacteria isolated from the cerebrospinal fluid and is usually available after 48 hours at the latest. |
Further diagnostics: Multiplex PCR for the most common meningitis pathogens is available for special suspected cases. |
Miscellaneous: If the pathogen is detected as negative and meningococcal disease is still suspected, the cerebrospinal fluid is sent to the meningococcal reference laboratory for PCR. |
| Incidence and pathogen spectrum: The parasite Toxoplasma gondii causes toxoplasmosis, a mostly benign infectious disease that can be very serious in immunocompromised patients and prenatal infections. Toxoplasma gondii, a single-celled, obligate intracellular parasite, occurs worldwide and causes toxoplasmosis in humans. Cats are the most common end hosts in Europe. They excrete millions of infectious oocysts of T. gondii a few days after infection. The oocysts are very environmentally resistant and can remain in the soil for a long time. They can then also be ingested by farm animals, e.g. pigs, and persist in them. Human infection usually occurs through peroral ingestion of oocysts (contact with cat faeces, contaminated food, consumption of insufficiently heated meat containing cysts, etc.). The infection is usually asymptomatic in humans, with only 5% of acutely infected immunocompetent patients developing fever, swelling of the lymph nodes, headaches as a sign of encephalitis or chorioretinitis after an incubation period of 2-3 weeks. After primary infection, the pathogen usually persists for life in the lymph nodes and CNS without causing clinical symptoms. In young adults, the infection rate in Germany is 25-55 %. In immunocompromised patients, reactivation of the pathogen can occur, usually clinically associated with encephalitis. In immunocompetent patients, reactivation can be accompanied by chorioretinitis. Toxoplasmosis is of particular importance during pregnancy, as it can cause serious damage to the foetus, even if the mother is asymptomatic. Only the first infection during pregnancy leads to prenatal toxoplasmosis infection of the child. The risk of infection for the child varies depending on the time of infection during pregnancy: Infection of the mother in the first trimester of pregnancy rarely (4-15%) leads to diaplacental transmission of the parasite, but infection of the embryo is then not infrequently associated with miscarriage or severe clinical symptoms in the newborn. In contrast, infection of the mother during the last trimester often (60 %) results in transmission of the parasite to the child, but the clinical symptoms in the newborn are then less pronounced and may even be completely absent. In contrast to other European countries, routine testing for toxoplasmosis during pregnancy is not currently planned because the test systems, which are limited to the detection of IgM and IgG antibodies, do not allow clear conclusions to be drawn about the infection status in some cases. | ||||||||
| Test material: Serum for antibody detection CSF [DNA detection using PCR (external examination)] In special cases EDTA blood, amniotic fluid, ocular chamber fluid [DNA detection (external examination)] Lymph node biopsies, brain biopsies [microscopy and DNA detection (external examination)] | ||||||||
| Basic diagnostics: The diagnosis of toxoplasmosis is made serologically as part of a step-by-step diagnosis, whereby only diagnostics approved by the Paul Ehrlich Institute may be used. The screening test consists of the VIDAS TOXO IgG and IgM test. If the IgM test is negative and IgG antibodies are negative, no further tests are carried out. Procedure if the screening test is positive:
If follow-up sera are received, IgM antibodies and IgG antibodies are compared in parallel. In the case of special constellations of findings, e.g. positive IgM and IgG antibodies in pregnant women, further tests are carried out in the 3rd stage (see also under "Further diagnostics") :
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Further diagnostics:
Diagnostics for suspected lymph node toxoplasmosis
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| Other: In the case of previous infection with T. gondii, reactivation of the pathogen can occur under immunosuppression, which most frequently occurs in the form of cerebral toxoplasmosis. As a rule, specific IgG antibodies are detected in the VIDAS. Reactivation is not usually accompanied by an increase in IgG antibodies. When Toxoplasma-specific IgM antibodies are detected, a possible IgM persistence must always be clarified. The examination of cerebrospinal fluid using PCR is controversial and the results vary in cases of cerebral toxoplasmosis. |
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Special features: Due to the great effort involved and the rarity of the disease, strict indication and consultation with a laboratory doctor. |
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Special features: For screening for multi-resistant Acinetobacter baumannii complex(see hygiene plan for risk group), a separate request for "MRGN screening" is required. |
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Clinical: Wound infections, sepsis, eye infections and meningitis, gastrointestinal infections: especially in immunocompromised patients |
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Special features: Antigen detection from serum is used for early detection of invasive aspergillosis in patients at risk. Antigen detection from cerebrospinal fluid is used to diagnose cerebral aspergillosis. Antigen detection from BAL is recommended for the diagnosis of pulmonary aspergillosis according to EORTC criteria Note: According to current studies (e.g. JAC) and congress contributions, there is currently NO restriction in the detection of Aspergillus antigen in patients with piperacillin/tazobactam therapy. |
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Special features: PCR diagnostics for atypical mycobacteria is only useful if there is microscopic evidence of acid-fast rods in the test material; this is carried out in a specialised laboratory after consultation with the sender. Do not use EDTA additives for the cultural detection of pathogens from blood/bone marrow. EDTA is bactericidal! |
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Special features: The individual Babesia species cannot be distinguished microscopically. PCR methods have been established for this purpose, which are only available in specialised laboratories. In the USA, babesiosis can also be detected serologically. Pathogen cultivation is not possible. Epidemiology: Occurs in the USA and Europe. Rare disease! |
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Special features: Serological detection of B. bacilliformis is not available (travel history!, occurrence in Peru, Ecuador, Colombia), detection can be attempted using a blood smear and Giemsa staining. Molecular biological (PCR) and cultural detection methods are only available in specialised laboratories. Furthermore, Warthin-Starry staining of tissue sections can be carried out in the pathology department. |
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Special features: To clarify the immune status against B.pertussis, the serum is sent to an external laboratory. |
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Special features: If neuroborrelliosis is suspected, a serum/cerebrospinal fluid antibody quotient can be determined. For this purpose, please take serum and cerebrospinal fluid in parallel and send part of the sample to the clinical chemistry department for |
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Clinic: GBS screening is used for the sensitive detection of colonisation between the 35th and 37th week of pregnancy and allows a good prediction of the colonisation status at birth. |
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Special features: The examination is only recommended between the 35th and 37th week of pregnancy. Specific examination order "B streptococcus screening" required. |
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Special features: Antibody detection is indicated if there is clinical evidence of secondary diseases (Guillain-Barre syndrome, arthritis) |
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Special features: The detection of Candida spp. from primarily non-sterile materials (tracheal secretions, sputum, wounds) is often difficult to interpret, as hospitalised patients often have clinically irrelevant colonisation of the mucous membranes. |
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Special features: For uncomplicated infections of the urogenital tract PCR detection from irradiated urine, vaginal, cervical or urethral swabs is the method of choice. Please use a special swab kit! For Chronic infections of the upper genital tract and secondary diseases (arthritis), request antibody detection of C. trachomatis. In case of suspected Chlamydia pneumoniae and Chlamydia psittaci infection Submission of respiratory test materials for PCR detection. |
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Special features: A test for Clostridium botulinum is only carried out on request. The gold standard for the detection of Clostridium botulinum intoxication is botulism toxin detection in the responsible consultant laboratory. Toxin detection from patient serum is rarely successful in infant and wound botulism, but is the first choice for food intoxication. Detection of the remaining Clostridium spp. is ensured by the "pathogen and resistance" test requirement. If gas gangrene is suspected, please note this in the clinical information: Emergency examination! As a general rule, materials that are to be analysed for strict anaerobes must either be hermetically sealed (e.g. in a sterile syringe) or transported in a transport medium suitable for anaerobes, e.g. universal swab with Amies transport medium. |
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Special features: Request Crytococcus neoformans antigen detection for rapid detection. |
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Special features: As the excretion of cysts is irregular, repeated faecal examinations are often necessary to make a diagnosis. |
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Special features: As the excretion of cysts is irregular, repeated faecal examinations are often necessary to make a diagnosis. |
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Special features: Due to the high infectivity of the cultivated pathogens, it is imperative that the laboratory is informed of the suspected diagnosis of "infection with dimorphic fungi" by the sending doctor! |
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Test method(s): PCR examination for echinococcal DNA (external examination) |
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Test method(s): Microscopy Antibody detection (external examination) |
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Special features: For targeted screening for multi-resistant pathogens, see section MRGN enterobacteria. |
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Examination material: Mainly swabs (according to hygiene plan), urine, all other swabs, body secretions, punctates, biopsies, cerebrospinal fluid, blood cultures, foreign bodies, etc. |
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Special features: A multiplex PCR is available for the detection of carbapenemases in 4MRGN enterobacteria. |
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Test method(s): Microscopy |
Special features: For the cultural examination for Francisella tularensis, a specific examination request must be made. In order to ensure the necessary safety precautions (L3 organism) and an optimal material system, the receipt of the sample should be announced by telephone. |
Duration of the test: Culture cultivation: at least 2 days Pathogen identification: approx. 2-3 days. |
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Test method(s): Microscopy (detection of cysts or trophozoites) |
Special features: In the case of negative results and persistent suspicion, duodenal aspirate (native/sediment) should be analysed for lamblia. Duodenal aspirate for the detection of trophozoites should be transported in a centrifuge tube in a beaker with 37°C warm water. The samples should be transported and analysed as quickly as possible. Analysing material that is older than two hours is generally not useful for the detection of vegetative forms |
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Special features: Gonococci die very quickly in the environment and are very sensitive to cold. Therefore the immediate transport of the sample to the laboratory is necessary, if possible always request PCR detection. |
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Special features: The HACEK pathogens all belong to the normal flora of the oral cavity or the upper respiratory tract of humans. They generally cause opportunistic infections or invasive infections when they are washed into the bloodstream through small wounds in the mouth, for example. |
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Test method(s): Antigen detection |
Special features: Multiplex PCR from cerebrospinal fluid is available for special indications (e.g. persistent suspicion without cultural growth). (only carried out after consultation with the laboratory doctor) |
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Special features: Indication for cultural pathogen detection: Resistance testing after treatment failure or before initial H. pylori treatment in children. Place biopsies in Portagerm pylori transport medium and transport the samples to the laboratory as quickly as possible, as the pathogens are very sensitive to environmental influences. Indication for antigen detection: Non-invasive method for monitoring the success of treatment or supplementary method for clarifying discrepant previous findings. Caution: For reliable Helicobacter pylori diagnostics, the following minimum time intervals should be observed without H. pylori suppressive therapy: 2 weeks after the end of proton pump inhibitor therapy and 4 weeks after previous eradication therapy or other antibiotic therapy. |
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see Cystoisospora (previously Isospora) belli
Clinic: In addition to L. pneumophila as the most important human pathogenic species, L. bozemanii, L. dumoffii and L. micdadei are recognised as moderately human pathogenic and L. anisa, L. ainthelensis, L. israelensis, L. birminghamensis, L. jordanis, L. oakridgensis, L. maceachernii, L. tusconensis, L. wadsworthii, L. feelei, L. gormanii, L. longbeachae and L. hackeliae are considered to be rarely pathogenic to humans. Numerous other Legionella species are found in the environment and, according to current knowledge, are not pathogenic to humans. |
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Special features: A specific L. pneumophila PCR is carried out from respiratory secretions, which detects all serogroups. If an infection with other Legionella species is suspected, a Legionella spp. PCR can be carried out on request by telephone. |
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Special features: Antibody detection is carried out at the National Reference Centre for Tropical Pathogens. |
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Test method(s): Multiplex PCR from cerebrospinal fluid |
Special features: A multiplex PCR from cerebrospinal fluid is available for special indications (e.g. persistent suspicion without cultural growth). (only carried out after consultation with the laboratory doctor) The examination of specific antibodies is not meaningful and is therefore not recommended! |
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Test method(s): Culture Multiplex PCR from cerebrospinal fluid |
Special features: Multiplex PCR from CSF is available for special indications (e.g. persistent suspicion without cultural growth). (only carried out after consultation with the laboratory doctor) |
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Special features: A specific test request is necessary for the examination for microfilariae, as special staining (Giemsa staining) and enrichment of the pathogens are carried out! Antibody detection is carried out at the National Reference Centre for Tropical Infectious Pathogens. |
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Special features: If the MRSA status is unknown, request PCR detection for rapid diagnostics. Suitable for intensive care units and contact patients. Positive PCR detection should always be confirmed by culture as part of a round of swabs (nose, throat, perianal, wound if necessary). Cultural detection is recommended for screening before elective surgery or planned admissions. |
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see Zygomycetes
Mycobacterium tuberculosis complex
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Test material: Sputum, tracheal secretion, bronchial secretion, gastric fasting secretion (in sodium phosphate solution, transport tubes are provided by the department to the wards/outpatient clinics on request): ( 2-5 ml), Cerebrospinal fluid (3-5 ml) Stool (indicated for immunocompromised patients, especially HIV-positive patients), Urine (morning urine ≥ 30 ml) Whole blood (InTube plasma) using Vacutainer for the QuantiFERON® test. 4 tubes per patient must be received! Tubes must be filled exactly up to the black line (1 ml)! |
Test method(s): Interferon-gamma release assay: QuantiFERON®-TB (ELISA) |
Special features: Do not use EDTA additives for the cultural detection of pathogens from blood/bone marrow. EDTA is bactericidal! Send blood or bone marrow in citrate or heparin. QuantiFERON® test: indirect test for the detection of M. tuberculosis infection. This test is an alternative to the Mendel-Mantoux tuberculin skin test. In contrast, the QuantiFERON® test shows no cross-reaction with the tuberculosis vaccine strain (BCG). A positive test result cannot distinguish between acute tuberculosis requiring treatment and latent tuberculosis. |
Duration of the examination: Microscopy: 4-5 hours |
see atypical mycobacteria
Clinic: Mycoplasma pneumoniae: Atypical pneumonia, tracheobronchitis, sinusitis, pharyngitis |
Test material: Please use urea-arginine broth as transport medium. M. pneumoniaeRespiratory secretions (throat rinse, gargle, tracheal secretions, sputum, BAL etc.), serum |
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Special features: If urogenital mycoplasma is suspected, a specific test for mycoplasma should be ordered. The submission of secretions is preferable to a smear. Resistance testing of the pathogens is not yet possible. |
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see gonococci
see meningococci
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Test method(s): Antigen detection (rapid test) is usually carried out with every examination for malaria. |
Special features: The rapid test primarily detects Plasmodium falciparum and Plasmodium vivax. |
Duration of the test: Microscopy: several hours |
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Special features: Other materials: The detection of Plesiomonas spp. is guaranteed by the test requirement "Pathogen and resistance". |
Duration of the test: Culture: 2-4 days |
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Special features: To screen for 3/4 MRGN pseudomonads, please request MRGN screening. |
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see Zygomycetes
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Special features: Other materials, e.g. blood culture: The detection of Salmonella spp. is guaranteed by the test requirement "Pathogen and resistance".
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Special features: Cotrimoxazole is the drug of choice for treatment. Limit values for assessing the MIC are currently only available for this substance. |
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Test method(s): If necessary, identification by sequencing the SodA gene |
Special features: In cases of acute pneumonia, meningitis or sepsis, pneumococcal antigen detection from urine or For special indications (e.g. persistent suspicion without cultural growth), a multiplex PCR |
Duration of the test: Culture:1-3 days |
See B streptococcus screening in pregnant women
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Test material: If necessary, EDTA blood, cerebrospinal fluid, amniotic fluid, ocular fluid, lymph node biopsies, brain biopsies for DNA detection |
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Special features: If neurolues is suspected, a comparative analysis of serum and cerebrospinal fluid can be carried out (external examination). For this purpose, please take serum and CSF in parallel. |
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Test method(s): antibody detection (external examination) |
Special features: A specific test request is necessary for the examination for trypanosomes, as special staining (Giemsa staining) is carried out |
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Test material: Please use urea-arginine broth as transport medium In case of suspected pulmonary infection in newborns (≤ 6 months): respiratory secretions (for DNA detection) |
Test method(s): DNA detection (PCR) |
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Test method(s): Resistance testing |
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Test method(s): Resistance testing, Determination of the resistance gene using PCR (no separate requirement) |
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Special features: If plague is suspected, please contact the laboratory by telephone beforehand! This is a category S3 pathogen (risk of laboratory infections) and special culture media must be used. A specific test for Yersinia should always be ordered. |
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Services
Molecular biological diagnostics is a supplement to conventional cultural and serological pathogen diagnostics.
It is carried out in particular to detect pathogens thatcannot be cultured or are difficult to culture
grow very slowly
may have toxin genes that are associated with very high pathogenicity (e.g. Corynebacterium diphtheriae)
may have resistance genes that are of great clinical and clinical-hygienic relevance (e.g. detection of MRSA)
In molecular biological diagnostics, the nucleic acid of the respective pathogen or a gene specific to the respective pathogen is detected. Various methods are available for this purpose, such as the polymerase chain reaction and the use of gene probes. As the methods for detecting nucleic acids are very sensitive procedures that can detect even the smallest amounts of nucleic acid from the pathogen, special conditions must be observed when taking and transporting the material:
A special swab kit must be used to detect chlamydia (PCR swab kit with MicroTest M4RT medium, available from the hospital pharmacy). As C. trachomatis is an intracellular pathogen, swabs with as many cells as possible should be taken.
For PCR detection of M. tuberculosis from cerebrospinal fluid, send at least 2-5 ml!
Ensure clean, contamination-free material collection.
The molecular biological diagnosis of infectious agents is generally offered by our laboratory once or twice a week. Indications for immediate molecular biological diagnostics must be discussed with the laboratory physician responsible for molecular biology, taking into account the severity of the clinical picture as well as therapeutic and clinical hygiene consequences.
Please note that the examination methods and the selected spectrum of pathogens are subject to constant updating. If you have any questions, also with regard to the interpretation of findings, please contact our molecular biology staff on 65327. You will also be forwarded to the laboratory doctor responsible for molecular biology via this number.
Below you will find an overview of the pathogens that are detected using nucleic acid detection:
| Pathogens | Test materials | Method | Remarks |
| Acanthamoeba spp. | Corneal abrasion Contact lens cerebrospinal fluid | PCR | Please contact us by telephone on 65327. |
| Bordetella pertussis Bordetella parapertussis | Throat swab, tracheal secretion, bronchial secretion, BAL | LightCycler PCR | B. parapertussis only after consultation by telephone (65327) |
| Chlamydia pneumoniae | Throat swab, sputum, tracheal secretion, bronchial secretion, BAL, conjunctival swab, cerebrospinal fluid | LightCycler PCR | |
| Chlamydia psittaci | Throat swab, sputum, tracheal secretion, bronchial secretion, BAL, conjunctival swab, CSF | LightCycler PCR | Generally only indicated if there is anamnestic evidence of bird contact. |
| Chlamydia trachomatis | Throat swab, tracheal secretion, bronchial secretion, BAL | PCR | Caution! Only indicated in case of clinical suspicion of neonatal pneumonia (newborns and infants < 6 months), use Chlamydia trachomatis PCR swab set with MicroTest M4RT medium! |
| Chlamydia trachomatis | Conjunctival swab, urethral swab, cervical swab, vaginal swab, first stream urine | PCR | Use Chlamydia trachomatis PCR swab kit with MicroTest M4RT medium! |
| Gastroenteritis pathogens (Campylobacter, Salmonella, Shigella, EHEC) | Stool | Multiplex PCR | If received in the laboratory by 11am, the test will be performed on the same day. |
| Legionella pneumophila | Throat swab, tracheal secretion, bronchial secretion, BAL | LightCycler PCR | A PCR is also carried out to detect all Legionella species. |
| Methicillin-resistant S. aureus (MRSA) | Nasal swab, wound swab, throat swab; in special cases also anal swab | Real-time PCR | PCR is recommended for MRSA screening. |
| Mycobacterium tuberculosis | Tracheal secretions, bronchial secretions, BAL, induced sputum, cerebrospinal fluid (at least 2-5 ml), punctates and biopsies (after telephone consultation) | PCR | PCR is only standardised for materials from the respiratory tract. |
| Mycoplasma pneumoniae | Throat swab, tracheal secretion, bronchial secretion, BAL | LightCycler PCR | |
| Neisseria gonorrhoeae | Urethral swab, cervical swab, first stream urine | LightCycler PCR | |
| Toxoplasma gondii | Cerebrospinal fluid | PCR | External examination |
| Ureaplasma urealyticum | Throat swab, tracheal secretion, bronchial secretion, BAL | LightCycler PCR | only for newborns and infants < 6 months! |
| Eubacterial PCR (detects all relevant pathogenic bacteria) | Primarily sterile materials (cerebrospinal fluid, biopsies, etc.) | LightCycler PCR subsequent sequencing* | only after consultation by telephone on 65327. |
| panfungal PCR (detects all relevant pathogenic fungi) | primarily sterile materials (cerebrospinal fluid, biopsies, etc.) | LightCycler PCR subsequent sequencing* | only after consultation by telephone on 65327. |
In addition to the nucleic acid tests listed in the table, tests for culture confirmation or toxin detection of certain pathogens are available, which are used as part of the respective pathogen diagnostics:
- Bacillus anthracis (LightCycler PCR)
- Corynebacterium diphtheriae (LightCycler PCR)
- Escherichia coli (EHEC) (LightCycler PCR)
- Methicillin-resistant Staphylococcus aureus (MRSA) (LightCycler PCR)
- Non-tuberculous mycobacteria (NTM) (with genotype)
- Mycobacterium tuberculosis complex (with genotype)
- Vancomycin-resistant enterococci (VRE) (LightCycler PCR)
- Burkholderia cepacia genomovar I, IIIA (BlockCycler PCR)
- Burkholderia multivorans (BlockCycler PCR)
- Carbapenemase PCR (multiplex PCR)
In addition to the nucleic acid diagnostics described above, it is possible to identify pathogens (bacteria and fungi) that cannot be clearly determined biochemically by means of gene sequencing*. As this is a very time-consuming and cost-intensive specialised diagnostic procedure, sequencing is only carried out in the case of significant pathogen detection and after consultation with the sending doctor regarding the clinical relevance of the pathogen detection.
* Sequencing is subcontracted as part of the identification process to a specialised laboratory accredited for this procedure.
Infectious serology always involves special requirements for the detection of antigens or antibodies against certain pathogens. The only exception to this is the arthritis serology requirement, in which antibodies against a specific selection of infectious agents that can induce arthritis are analysed.
Which tests are offered?
The antigen and antibody tests include the bacterial and parasitic infectious agents listed in the table below as well as pathogenic fungi. In addition, special tests (only for inpatients) can be carried out, which are forwarded to external laboratories, e.g. the Bernhard Nocht Institute for Tropical Medicine. The external laboratories are exclusively national reference centres or special laboratories with a high quality standard. If you have any requirements that are not mentioned on the request form, please contact the Infection Serology Department (Tel. 65327 / 65376) before sending in the sample.
Which test material is suitable?
Patient serum is the most suitable test material for the vast majority of tests. No less than 2 ml of venous blood should be sent to the Department of Medical Microbiology and Hygiene in a serum monovette, avoiding haemolysis and without the addition of anticoagulants. If an acute infection is clinically suspected, it is always advisable to send in a paired serum sample approx. 2-4 weeks after the initial examination. This allows titer movements or antibody conversions to be recorded. For a few indications (e.g. suspected neuro-borreliosis, suspected neuro-syphilis), it is advisable to send a paired serum and CSF sample. In this case, a determination of total IgG and albumin in serum and cerebrospinal fluid must always be carried out in clinical chemistry so that a specific serum/cerebrospinal fluid antibody quotient can be calculated! Only this can confirm an infection of the central nervous system with a high degree of probability.
How often are the tests carried out?
The tests are carried out at least once a week, depending on the sample volume. Test materials for which the detection of Aspergillus antigen or cryptococcal antigen is requested are processed immediately on the day the laboratory receives them.
How can I reach the infectious serology laboratory?
Please note that the examination methods and the selected spectrum of pathogens are subject to constant updating. If you have any questions, also with regard to the interpretation of findings, please contact our infection serology staff on 65327 / 65376. This number will also put you through to the laboratory doctor responsible for infectious serology.
| Pathogen | Test materials | Method | Remarks |
| Aspergillus spp. | Serum bronchoalveolar lavage | ELISA (antigen detection) | Antigen detection is indicated if invasive systemic aspergillosis is suspected. |
| Bartonella henselae Bartonella quintana | Serum | Microimmunofluorescence test | |
| Bordetella pertussis | serum | IgG antibody detection* (ELISA) | Indication *external examination |
| Borrelia burgdorferi | Serum CSF | IgG/IgM ELISA | Screening test Confirmation test If neuroborreliosis is suspected, send in cerebrospinal fluid (at least 1 ml) and serum. For reliable detection of intrathecally synthesised Ac, the determination of albumin and total IgG from CSF and serum should be arranged at the central Klinsche Chemie facility. |
| Brucella spp. | Serum | IgG/IgM ELISA | |
| Campylobacter jejuni Campylobacter coli | serum | IgG immunoblot | |
| Chlamydia spp. C. pneumoniae C. trachomatis C. psittaci | Serum | IgG/IgM microimmunofluorescence test | Screening test Confirmation test and species differentiation |
| C. trachomatis | Vaginal swab Cervical swab Urethral swab Urine Conjunctival swab Serum | Nucleic acid detection (see"Molecular biology") IgG immunoblot * | Order the appropriate swab kit (PCR swab kit with MicroTest M4RT medium) from the hospital pharmacy. If possible, take a cell-rich swab. The examination of tracheal secretions and material from the respiratory tract is only useful if neonatal pneumonia is suspected. * Indication: tubal sterility, ascending infection, reactive arthritis |
| C. pneumoniae | Nasal swab Throat swab bronchoalveolar lavage, Tracheal secretion | Nucleic acid detection Pathogen cultivation using cell culture; (only after consultation in exceptional cases) | If possible, take a cell-rich smear.
|
| Coxiella burnetii (Q fever) | Serum | Microimmunofluorescence test (antibody detection) | |
| Cryptococcus neoformans | Serum CSF | Antigen detection by agglutination reaction | |
| Echinococcus spp. E. multilocularis | Serum | Detection of polyvalent Ac by agglutination reaction Detection of polyvalent Ac by ELISA | Screening test Species differentiation |
| Legionella spp. | urine respiratory secretions | Antigen detection from urine using ELISA, with regard to nucleic acid detection (see"Molecular biology") | |
| Leptospires | serum | IgM ELISA | Specific antibodies appear from the 6th to 10th day of illness. |
| Mycoplasma pneumoniae | Serum respiratory secretions | ELISA Nucleic acid detection, (see"Molecular biology") | |
| Streptococcus pyogenes | serum | Antibody detection | This test is carried out in the Clinical Chemistry Centre (ADNase B) |
| Toxopolasma gondii | Serum | IgG, IgM ELISA (Vidas) Immunoblot IIFT | Screening test IgM confirmation test Follow-up monitoring |
| Treponema pallidum (Lues) | Serum CSF | TPPA | Screening test Confirmatory test Clarification of need for treatment Follow-up If neurosyphilis is suspected, send in serum and CSF. For reliable detection of intrathecally synthesised Ac, arrange for the determination of albumin and total IgG from serum and CSF in the Clinical Chemistry Department. |
Yersinia spp. Yersinia pseudotuberculosis | Serum | IgA immunoblot | Indicated above all for non-enteritic, intestinal (pseudoappendicitis) and extraintestinal yersiniosis. |
Abbreviations:
Ag | antigen |
Ac | antibody |
ELISA | Enzyme linked immuno assay |
FTA-Abs | Fluorescence treponema antibody absorption test |
IIFT | Indirect immunofluorescence test |
PCR | polymerase chain reaction |
TPPA | Treponema pallidum particle agglutination test |
Downloads
- Microbiology requirement certificate (bacteriology, mycobacteriology, mycology and parasites) (PDF, 377 KB)
- Serology and molecular biology request form (PDF, 427 KB)
- Overview of storage conditions (PDF, 161 KB)
- List of services by diagnosis (PDF, 3 MB)
- List of services by pathogen (PDF, 1 MB)
- List of services by material (PDF, 2 MB)
- Listing of the sample containers (PDF, 3 MB)
Files for download (only available internally)
Suggestions / praise / complaints
You can use our online form to send queries, complaints or praise to our laboratory.
Once we have received your enquiry, we will find the appropriate contact person to deal with the matter. The processing will be independent and impartial.
Please understand that it may take several weeks to process your enquiry.
