1 Searching for microbes Part II. Microscopical diagnostics II Gram staining + capsulla Author of the slideshow: Ondřej Zahradníček To practical education of VLLM0421c Contact to myself:
2 Contents of presentation Survey of methods of clinical microbiology Microscopy: review Gram stain: principle Gram stain: procedure Capsule. Burri staining After having studied this slideshow, try to answer these questions. After finding the answers, fill in the ROPOT questionaire. 1. How do the chemicals in Gram staining follow one after another? 2. What bacteria do not Gram stain or stain poorly? 3. What is the color of various microorganisms in Gram staining? 4. What are other staining methods commonly used in microbiology? 5. How epithelial cells and white blood cells stain in Gram staining?
3 A Tale (based on real story, but still more fiction than truth ) There was a man from Denmark, named Christian Gram. He stained bacteria and was angry. Sometimes he stained a pacient s sample, but beside bacteria, epitheliae were also stained. Awful epitheliae, they hide my bacteria!, said he. So he started a research. He wanted to find something that would stain him bacteria, but not epitheliae To be continued
4 Tale continues He found, that when the sample is stained by gentiane or crystaline violet, and then binding of the dye to the cell wall is supported by Lugol Solution, bacteria do not decolorize even by alcohol. Epitheliae, on the other hand, decolorize. Great! But soon he saw, that with epitheliae, part of bacteria decolorize, too. Stupid staining, said he, drunk remaining decolorizing alcohol, and throught his work into the corner of the room.
5 And end of the tale Some twenty years later, one young researcher found in a corner of a laboratory the dusty work of Mr. Christian Gram. As he read it, he thougt it is not bad, it only needs a bit more to be added. And so, to the end of the processus, he added counterstain of safranin (or Gabbet = carbolfuchsin). Not only bacteria, but also epitheliae stained red, but he said why not? To know, if epitheliae are present, may be quite usefull! And so Gram staining of today was developped.
6 Survey of methods in medical microbiology
7 Survey of methods Direct methods: We search for a microbe, its part or its product (e. g. a bacterial toxin) Direct detection in specimen we use the whole specimen (blood, urine, CSF etc.) Strain identification isolate determination Indirect methods: We search for antibodies. An antibody is neither a part nor a product of a microbe it is a macroorganism product, after being challenged by a microbe
8 Survey of direct methods Method Specimen examination Microscopy yes yes Cultivation yes yes Biochemical identificat. no Identification yes Antigen detection yes yes Animal experiment yes usually not Molecular methody yes usually not* *but in molecular epidemiology detection of simillarity of strains - yes
9 Microbiological laboratory Foto O. Z.
10 Microscopy: review
11 What we can see in a microscope When we work with a strain, we can see one type of microbial cells When we work with a specimen, we can see microbes sometimes no microbes, sometimes more than ten various species of organisms cells of host organism usually epitheliae, WBCs, sometimes RBCs and other cells other structures, e. g. fibrin fibers, cellullar detritus etc.
12 Types of microscopy Electron microscopy in viruses, rather research than routine diagnostics Optical microscopy Wet mount large and/or motile organisms Wet mount dark field (mostly spirochets) Fixated and stained preparations, e. g. Gram staining most important bacteriological stain Ziehl-Neelsen staining e. g. for TB bacilli Giemsa staining to some protozoa Fluorescent staining for better visualisation
13 What we allready know Microbes have various size. Yeasts are larger than bacteria, and bacteria than viruses Bacteria have various shape (cocci, coccobacilli, bacilli of various shapes, spirochets) Bacteria have various arrangement (clusters, chains, couples); cocci in chains should not be named streptococci, because they could be for example enterococci. Some bacteria form endospores, that do not stain
14 Comparison of size: yeast of genus Candida and bacterium Staphylococcus Photo: archive of the institute, from
15 Gram stain: principle
16 Bacterial cell wall There are bacteria, that are mechanically strong, their cell wall is thick and simple. They are called gram-positive bacteria. There are other bacteria, that are rather chemically strong, their cell wall is thiner, thin, but more complex. They are called gram-negative bacteria. Besides these and those, there are also so named Gram non-staining bacteria.
17 Gram-positive cell wall
18 Gram-negative cell-wall
19 Gram staining principle 1 Gram -positive bacteria have a thick peptidoglycan layer in the cell wall. So, gentiane/crystallin violet binds more firmly to them, and after confirmation of this bound by Lugol iodine solution even alcohol is not able to decolorize them. Gram-negative bacteria are decolorized by alcohol and then stained pink by safranin.
20 Gram staining principle 2 Chemical Gram-positive Gram-negative Crystal. violet Staining violet Staining violet Lugol iodine Confirmation Less confirm. Alkohol Not decolorized Decolorized Safranin Remain violet Stain to red Gram non staining bacteria do not stain in the first step, because of lack of any cell wall (Mycoplasma) or a very hydrophobic type of the cell wall (Mycobacterium). Spirochetes would stain gram-negative, but they are very thin, so they, too, use to be often considered to be Gram non-staining and Gram staining is not used in diagnostic.
21 Other structures than bacteria: how do they stain? Yeasts mostly stain violet like G+ bacteria. They have a cell wall of their own type, but in Gram staining it works similarly like that of Gram positive bacteria Human cells stain mostly red, although nuclei may be partially blue Do not forget, that preparations of specimens might contain various fibers, cell detritus etc., and all preparations may contain staining artifacts, too. Sometimes they are very confusing and may be mistaken for bacteria by a non-experienced observer!
22 Gram stained preparation Streptococci, genus Enterococcus
23 Gram stain: procedure
24 Part One: fixated preparation 1.We make a small saline drop 2.We sterilize your loop and wait until it stops to be too hot 3.We take some mass of microbes by your loop (stains A to E) 4.We mix in the drop 5.We sterilize your loop again and place back 6.We let the drop dry, or dry AROUND your burner 7.We fixate the slide by passing it THOUGH the flame of the burner 8.We move the slide to the sink for staining
25 Part Two: proper Gram staining Gentian/crystaline violet (20 ) 30 sec. (rinse by tap water not necessary) Lugol (20 ) 30 sec. (rinse by tap water not ncessary) Alkohol 15 ( 20) sec. rinse by tap water!!! imporant! Safranin sec. rinse by tap water dry by filtration paper microscopy as in Task One
26 Mixture of gram-positive and gramnegative bacteria G+ G
27 Strain microscopy (Gram positive bacilli) Foto O. Z.
28 Specimen microscopy (WBCs, G cocci) Foto O. Z.
29 Capsule. Burri staining
30 Capsule and biofilm Capsule surrounds an individual bacterium or a couple of bacteria. It is not an integral part of a bacterial cell, rather a layer of molecules (mostly polysaccharides) that protect the cell. Usually negative staining is used (capsule is an unstained place on a stained background) Biofilm is a complex layer, composed of bacteria, their capsullae and other material. Biofilm is much stronger than individual bacteria, living in so named planctonic form.
31 Burri capsular staining In Burri staining, bacteria were stained red and the bacground by black ink. Capsule is the unstained place between the red bacterium and the black ink. pathmicro.med.sc.edu
32 The End de.wikipedia.org
33 Lugol iodine = mixed I 2 + KI Jean Guillaume Auguste Lugol (18 August September 1851) was a French physician. He was born in Montauban. He studied medicine in Paris and graduated MD in In 1819 he was appointed acting physician at the Hôpital Saint-Louis a post he held until he retired. Lugol was interested in tuberculosis and presented a paper to the Royal Academy of Science in Paris in which he advocated the use of fresh air, exercise, cold bathing and drugs. He also published four books on scrofulous diseases and their treatment (1829, 1830, 1831, 1834). He suggested that his iodine solution could be used to treat tuberculosis. This assertion attracted much attention at the time. Although not efficacious in treating tuberculosis, Lugol's iodine was successfully used to treat thyrotoxicosis by Plummer. Back
34 Prof. Christian Gram Hans Christian Joachim Gram (September 13, November 14, 1938) was a Danish bacteriologist. Gram studied botany at the University of Copenhagen and and was an assistant in botany to the zoologist Japetus Steenstrup. He entered medical school in 1878 and graduated in In Berlin, in 1884, he developed a method for distinguishing between two major classes of bacteria. In 1891, Gram became a lecturer in pharmacology, and later that year was appointed professor at the University of Copenhagen. In 1900 he his Chair in Pharmacology to become Professor of Medicine. en.wikipedia.org/wiki/hans_christian_gram. Back
35 Lipopolysacharide of G cell wall It contains lipid A. This lipid is also called endotoxin. It is released when the cell is broken. It is an important factor of virulence. In also contains the polysaccharide part. It is a virulence factor; it also contains body antigens (called also O-antigens). These antigens are often important in diagnostics (especially in enterobacteria like Escherichia coli or Salmonella) Back
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