{"id":10158,"date":"2020-04-23T03:58:16","date_gmt":"2020-04-23T00:58:16","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/cultura-secretie-nazala-cu-antibiograma-dupa-caz\/"},"modified":"2026-02-18T23:29:07","modified_gmt":"2026-02-18T21:29:07","slug":"cultura-secretie-nazala-cu-antibiograma-dupa-caz","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/cultura-secretie-nazala-cu-antibiograma-dupa-caz\/","title":{"rendered":"\u0411\u0430\u043a \u043f\u043e\u0441\u0435\u0432 \u0438\u0437 \u043d\u043e\u0441\u0430( \u0441 \u0430\u043d\u0442\u0438\u0431\u0438\u043e\u0442\u0438\u043a\u043e\u0433\u0440\u0430\u043c\u043c\u043e\u0439)"},"content":{"rendered":"<p><strong><em>\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f<\/em><\/strong><\/p>\n<p>Rinita este cauzata cel mai adesea de virusuri (rhinovirusuri, adenovirusuri, virusuri gripale, paragripale, Coxsackie A) si rareori de bacterii.<\/p>\n<p>Exista microorganisme patogene care se gasesc la nivelul narinelor atat in stare de boala cat si in starea de purtator sanatos.<\/p>\n<p>Examenul microbiologic al exsudatului nazofaringian este indicat pentru <em><span style=\"text-decoration: underline;\">depistarea portajului<\/span><\/em> de germeni patogeni in caile respiratorii superioare, depistare solicitata si indicata in scopuri epidemiologice (e.g., stabilirea sursei de infectie, carantinarea purtatorilor sanatosi, evaluarea lucratorilor din industria alimentara)<sup>1<\/sup><sup>;2;4;7<\/sup>.<\/p>\n<p>Astfel, informatiile privind diagnosticul clinic si suspiciunea asupra florei implicate in infectie sunt utile personalului din laborator in alegerea mediilor de cultura folosite<sup>3;4<\/sup>.<\/p>\n<p style=\"padding-left: 30px;\">\u2022 <em>Staphylococcus aureus<\/em> \u2013 rata portajului nazal este de cca. 30% in colectivitatea generala, ajungand la 70% la personalul medical. In focarul epidemic prelevarea tamponului nazal trebuie repetata de 1-2 ori la interval de o saptamana pentru a diferentia portajul de durata de cel tranzitor<sup>2<\/sup>.<\/p>\n<p style=\"padding-left: 30px;\">\u2022 <em>Streptococcus pyogenes<\/em> \u2013 purtatorii nazali au potential epidemic mai mare decat cei faringieni<sup>2<\/sup>.<\/p>\n<p style=\"padding-left: 30px;\">\u2022 <em>Streptococcus pneumoniae<\/em> \u2013 rata portajului este de 40-60% din populatia generala<sup>2<\/sup><sup>;4<\/sup>.<\/p>\n<p style=\"padding-left: 30px;\">\u2022 <em>Haemophilus influenzae<\/em> \u2013 la 25-80% dintre persoanele sanatoase se evidentiaza tulpini necapsulate, la 5-10% tulpini capsulate si la 1- 5% tulpini de tip b<sup>5<\/sup>.<\/p>\n<p style=\"padding-left: 30px;\">\u2022 <em>Moraxella catarrhalis<\/em> \u2013 datorita colonizarii tractului respirator superior poate determina otita medie sau sinuzita prin contiguitate; rata portajului este variabila, fiind influentata atat de factorii de mediu cat si genetici<sup>7<\/sup>.<\/p>\n<p style=\"padding-left: 30px;\">\u2022 <em>Klebsiella rhinoscleromatis<\/em> \u2013 determina aparitia rhinoscleromului, forma rara de infectie granulomatoasa cronica a submucoasei nasului si sinusurilor, faringelui si laringelui, rar a traheei<sup>2;5<\/sup>.<\/p>\n<p style=\"padding-left: 30px;\">\u2022 <em>Klebsiella ozenae<\/em> \u2013 poate fi izolata si ea de la nivelul tractului respirator superior. Este agentul etiologic al ozenei, afectiune cronica, caracterizata prin atrofia mucoasei nazale, abundenta secretie mucopurulenta, adesea cu miros fetid<sup>2;5<\/sup>.<\/p>\n<p>O serie de factori ce determina scaderea rezistentei atat locale (mucoasa nazala), cat si generale a organismului (infectii virale ce determina acumulari anormale de mucus si lezarea epiteliului respirator, alcoolismul, circulatia sangvina pulmonara anormala, malnutritia si toate afectiunile ce contribuie la scaderea importanta a imunitatii) favorizeaza infectia locala cu microorganismele amintite anterior si propagarea acesteia pe cale limfatica, cu dezvoltarea unor afectiuni grave: otita, meningita, pneumonie, endocardita, artrita septica<sup>7<\/sup>.<\/p>\n<p><strong><em>Recoltarea si transportul probelor<\/em><\/strong><\/p>\n<p>Produsul patologic de la acest nivel este usor de obtinut (metoda neinvaziva) dar are dezavantajul de a fi contaminat cu microbiota saprofita rezidenta.<\/p>\n<p><span style=\"text-decoration: underline;\">Tehnica de recoltare<\/span><\/p>\n<p style=\"padding-left: 30px;\">\u2013 se aseaza pacientul pe scaun cu fata spre sursa de lumina, gatul in usoara extensie si ceafa sprijinita de spatar sau perete;<\/p>\n<p style=\"padding-left: 30px;\">\u2013 se introduce bland tamponul printr-o nara de-a lungul planseului nazal, pana atinge peretele posterior al nazofaringelui;<\/p>\n<p style=\"padding-left: 30px;\">\u2013 se lasa tamponul pe loc cateva secunde, apoi se roteste usor si se retrage;<\/p>\n<p style=\"padding-left: 30px;\">\u2013 se introduce tamponul in tubul protector prevazut cu mediu de transport (Amies sau Stuart), se eticheteaza si se trimite la laborator.<\/p>\n<p>Recoltarea exsudatului nazofaringian in contextul suspiciunii de sinuzita nu este recomandata, in aceasta afectiune produsul patologic de electie fiind punctia sinusala<sup>4<\/sup>.<\/p>\n<p>Se recomanda recoltarea produsului patologic pe 2 tampoane:<\/p>\n<ul>\n<li>un tampon simplu din care se va efectua extemporaneu un frotiu ce va fi colorat Giemsa pentru diagnosticul rinitei alergice.<\/li>\n<li>un tampon prevazut cu mediu de transport pentru efectuarea culturii.<\/li>\n<\/ul>\n<p>Transportul probelor catre laborator se face in maximum 2 ore de la prelevare. Desi probele prelevate pe tampoane in tuburi ce contin mediu de transport pot fi pastrate pana la 24 h, este recomandat ca insamantarile pe mediile de cultura sa se faca imediat ce probele ajung la laborator, pentru o mai sigura recuperare a microorganismelor urmarite<sup>3<\/sup>.<sup>.<\/sup><\/p>\n<p><strong><em>Diagnostic de laborator<\/em><\/strong><\/p>\n<p>Proba se insamanteaza pe mediu agar Columbia cu 5% sange de berbec si, la cerere (cand medicul clinician solicita si flora) pe agar Chocolate; se incubeaza aerob in atmosfera cu 5% CO<sub>2<\/sub>, 24 h la 37\u00b0C, cu prelungire pana la 48 h daca la prima citire a placilor nu se observa coloniile caracteristice germenului urmarit. Coloniile caracteristice se repica in vederea obtinerii culturii pure pentru identificare si antibiograma.<\/p>\n<p>Examenul microscopic pentru diagnosticul rinitei alergice \u2013 se numara polimorfonuclearele eozinofile si se raporteaza procentual la 100 de elemente albe<sup>3<\/sup>.<\/p>\n<p><strong><em>Comunicarea si interpretarea rezultatelor<\/em><\/strong><\/p>\n<p>In laboratoarele Synevo se comunica prezenta urmatoarelor microorganisme in secretia nazala:<\/p>\n<ul>\n<li>Staphylococcus aureus MSSA \u2013 portaj, cu recomandarea tratamentului local in functie de contextul clinico-epidemiologic;<\/li>\n<li>Staphylococcus aureus MRSA \u2013 portaj cu recomandaresa tratamentul local sau sistemic conform antibiogramei, \u00a0in functie de contextul clinic;<\/li>\n<li>Streptococcus pyogenes<\/li>\n<li>Haemophilus influenzae, Streptococcus pneumoniae \u2013 in functie de contextul clinic, la solicitarea medicului clinician;<\/li>\n<li>Klebsiella rhinoscleromatis si Klebsiella ozenae \u2013 in functie de contextul clinic, la solicitarea medicului clinician.<\/li>\n<\/ul>\n<p><span style=\"font-size: small;\">\u00a0<\/span><\/p>\n<p><span style=\"font-size: small;\">\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/p>\n<p><span style=\"font-size: small;\">1. Betty A. Forbes, Daniel S. Sahm, Alice S. Weissfeld. Upper respiratory tract infections and other infections of the oral cavity and neck . In Diagnostic Microbiology, 12th ed, 2007, 54: 814\u2013821.<\/span><\/p>\n<p><span style=\"font-size: small;\">2. Dumitru Buiuc. Diagnosticul de laborator al infectiilor tractusului respirator superior si cavitatilor conecte. Dumitru Buiuc, Marian Negut in Tratat de Microbiologie Clinica, Edit. Medicala 2008, 12: 208\u2013224.<\/span><\/p>\n<p><span style=\"font-size: small;\">3. Laborator Synevo. Referintele specifice tehnologiei de lucru utilizate 2006. Ref Type: Catalog.<\/span><\/p>\n<p><span style=\"font-size: small;\">4. Lynne S. Garcia. Guidelines for Performance of Respiratory Tract Cultures. In Clinical Microbiology Procedures Handbook, American Society for Microbiology, 2007; 3.11.1.<\/span><\/p>\n<p><span style=\"font-size: small;\">5. Olga-Mihaela Dorobat. Familia Enterobacteriaceae. In Bacteriologie Medicala. Universitatea \u201cTitu Maiorescu\u201d, Romania ed. 2006; 17:276.<\/span><\/p>\n<p><span style=\"font-size: small;\">6. Olga Mihaela Dorobat. Bacteriologie Medicala, 2006, 12: 189, 19: 300- 303.<\/span><\/p>\n<p><span style=\"font-size: small;\">7. Richard B. Thomson, Jr. Specimen collection, transport and processing: Bacteriology. In: Patrick R. Murray et al. \u2013 \u201cManual of Clinical Microbiology, 9th ed. , 2007 , 20: 291-333.<\/span><\/p>","protected":false},"excerpt":{"rendered":"<p>\u041f\u043e\u0440\u0430\u0436\u0435\u043d\u0438\u0435 \u043d\u043e\u0441\u0430 (\u0440\u0438\u043d\u0438\u0442, \u0441\u0438\u043d\u0443\u0441\u0438\u0442), \u0441\u043b\u0438\u0437\u0438\u0441\u0442\u043e\u0439 \u043e\u0431\u043e\u043b\u043e\u0447\u043a\u0438 \u0433\u043b\u043e\u0442\u043a\u0438 (\u0444\u0430\u0440\u0438\u043d\u0433\u0438\u0442) \u043d\u0435\u0440\u0435\u0434\u043a\u043e \u043e\u0431\u0443\u0441\u043b\u043e\u0432\u043b\u0435\u043d\u044b \u0431\u0430\u043a\u0442\u0435\u0440\u0438\u0430\u043b\u044c\u043d\u043e\u0439 \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u0435\u0439, \u0432 \u043e\u0441\u043d\u043e\u0432\u043d\u043e\u043c \u043f\u043d\u0435\u0432\u043c\u043e\u043a\u043e\u043a\u043a\u043e\u043c, \u0441\u0442\u0430\u0444\u0438\u043b\u043e\u043a\u043e\u043a\u043e\u043c (\u0440\u0438\u043d\u0438\u0442), 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\u043f\u0435\u0440\u0438\u043e\u0434 \u043b\u0430\u043a\u0442\u0430\u0446\u0438\u0438. \u041f\u0440\u0438 \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u043e\u0441\u0442\u0438 \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u043e\u0432\u0430\u043d\u0438\u044f \u0431\u0430\u043a\u0442\u0435\u0440\u0438\u043e\u0444\u0430\u0433\u043e\u0432 \u0432 \u043b\u0435\u0447\u0435\u0431\u043d\u044b\u0445 \u0438\/\u0438\u043b\u0438 \u043f\u0440\u043e\u0444\u0438\u043b\u0430\u043a\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u0446\u0435\u043b\u044f\u0445 \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u043e \u043f\u0440\u043e\u0432\u043e\u0434\u0438\u0442\u044c \u043e\u0446\u0435\u043d\u043a\u0443 \u0447\u0443\u0432\u0441\u0442\u0432\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0441\u0442\u0438 \u043a \u043d\u0438\u043c \u0432\u043e\u0437\u0431\u0443\u0434\u0438\u0442\u0435\u043b\u044f.<\/p>\n<p>\u0412\u044b\u0434\u0435\u043b\u044f\u0435\u043c\u044b\u0435 \u043c\u0438\u043a\u0440\u043e\u043e\u0440\u0433\u0430\u043d\u0438\u0437\u043c\u044b \u0438 \u0432\u043e\u0437\u0431\u0443\u0434\u0438\u0442\u0435\u043b\u0438:<\/p>\n<ul>\n<li>\u0443\u0441\u043b\u043e\u0432\u043d\u043e-\u043f\u0430\u0442\u043e\u0433\u0435\u043d\u043d\u044b\u0435 \u043c\u0438\u043a\u0440\u043e\u043e\u0440\u0433\u0430\u043d\u0438\u0437\u043c\u044b: Streptococcus pneumoniae, Haemophilus influenzae, Branchamella catarrhalis, Streptococcus pyogenes, Staphylococcus aureus;<\/li>\n<li>\u0433\u0440\u0430\u043c\u043e\u0442\u0440\u0438\u0446\u0430\u0442\u0435\u043b\u044c\u043d\u044b\u0435 \u0431\u0430\u043a\u0442\u0435\u0440\u0438\u0438 \u0441\u0435\u043c\u0435\u0439\u0441\u0442\u0432\u0430 \u044d\u043d\u0442\u0435\u0440\u043e\u0431\u0430\u043a\u0442\u0435\u0440\u0438\u0439;<\/li>\n<li>\u0433\u0440\u0438\u0431\u044b \u0440\u043e\u0434\u0430 \u043a\u0430\u043d\u0434\u0438\u0434\u0430 (Candida albicans \u0438 \u0434\u0440.);<\/li>\n<li>\u043f\u0440\u0435\u0434\u0441\u0442\u0430\u0432\u0438\u0442\u0435\u043b\u0438 \u043d\u043e\u0440\u043c\u0430\u043b\u044c\u043d\u043e\u0439 \u0444\u043b\u043e\u0440\u044b: \u0437\u0435\u043b\u0435\u043d\u044f\u0449\u0438\u0435 \u0441\u0442\u0440\u0435\u043f\u0442\u043e\u043a\u043e\u043a\u043a\u0438 (Streptococcus viridans group), \u043a\u043e\u0430\u0433\u0443\u043b\u0430\u0437\u043e\u043d\u0435\u0433\u0430\u0442\u0438\u0432\u043d\u044b\u0435 \u0441\u0442\u0430\u0444\u0438\u043b\u043e\u043a\u043e\u043a\u043a\u0438 (Staphylococcus \u0435pidermidis), \u043d\u0435\u043f\u0430\u0442\u043e\u0433\u0435\u043d\u043d\u044b\u0435 \u043d\u0435\u0439\u0441\u0441\u0435\u0440\u0438\u0438 (Neisseria sp\u0440.), \u043d\u0435\u043f\u0430\u0442\u043e\u0433\u0435\u043d\u043d\u044b\u0435 \u0434\u0438\u0444\u0442\u0435\u0440\u043e\u0438\u0434\u044b (Corynebacterium sp\u0440.), \u0438 \u043d\u0435\u043a\u043e\u0442\u043e\u0440\u044b\u0435 \u0434\u0440\u0443\u0433\u0438\u0435.<\/li>\n<\/ul>\n<p>\u041f\u043e\u0441\u0435\u0432 \u0431\u0438\u043e\u043c\u0430\u0442\u0435\u0440\u0438\u0430\u043b\u0430 \u043f\u0440\u043e\u0432\u043e\u0434\u044f\u0442 \u0441 \u0446\u0435\u043b\u044c\u044e \u0432\u044b\u0434\u0435\u043b\u0435\u043d\u0438\u044f \u0438 \u0438\u0434\u0435\u043d\u0442\u0438\u0444\u0438\u043a\u0430\u0446\u0438\u0438 \u044d\u0442\u0438\u043e\u043b\u043e\u0433\u0438\u0447\u0435\u0441\u043a\u0438 \u0437\u043d\u0430\u0447\u0438\u043c\u044b\u0445 \u043c\u0438\u043a\u0440\u043e\u043e\u0440\u0433\u0430\u043d\u0438\u0437\u043c\u043e\u0432 \u2212 \u0432\u043e\u0437\u0431\u0443\u0434\u0438\u0442\u0435\u043b\u0435\u0439 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0439 \u0432\u0435\u0440\u0445\u043d\u0438\u0445 \u0434\u044b\u0445\u0430\u0442\u0435\u043b\u044c\u043d\u044b\u0445 \u043f\u0443\u0442\u0435\u0439, \u0430 \u0442\u0430\u043a\u0436\u0435 \u0434\u043b\u044f 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