For medical & Health science

1. Body Effusions (Synovial,
Pleural, Pericardial, ascitic, Bone
marrow and Hydrocele Fluids ),
Dr.Abdelhakam Hassan Aldigeal
Assistant professor of Molecular
Microbiology
Aldigeal007@gmail.com

2. OriginFluid
JointFromSynovial
From the pleural cavity (space
between the lungs and the inner
chest wall)
Pleural
From the pericardial sac (
Membranous surrounding the heart)
pericardial
cavityFrom the peritoneal (
abdominal)
Ascitic ( peritoneal)
Usually from the sacHydrocele

3. Introduction
• The human body is divided into five main body
cavities: cranial, spinal, thoracic, abdominal, and
pelvic.
• Each cavity is lined with membranes, and within the
body wall and these membranes, or between the
membranes and organs, are small spaces filled with
minute amounts of fluid.

4. Introduction
• The purpose of this fluid is to bathe the organs and
membranes, reducing the friction between organs.
• Bacteria, fungi, virus, or parasite can invade any body
tissue or sterile body fluid site.
• All these fluids are considered normally sterile.
Therefore, even one colony of a potentially
pathogenic microorganism may be significant.

5. SPECIMENS FROM STERILE
BODY SITES
• FLUIDS
• In response to infection, fluid may accumulate
in any body cavity.
• Infected solid tissue often presents as cellulitis
or with abscess formation.

6. Pleural Fluid
• Lining the entire thoracic cavity of the body is a
serous membrane called the parietal pleura.
• Covering the outer surface of the lung is another
membrane called the visceral pleura.
• Within the pleural space between the lung and chest
wall is a small amount of fluid called pleural fluid.
• that lubricates the surfaces of the pleura (the
membranes surrounding the lungs and lining the chest
cavity).

8. Fluid accumulates in the pleural
space by three mechanisms:
increased drainage of fluid into the space
increased production of fluid by cells in the
space
decreased drainage of fluid from the space

9. CLINICAL FEATURES
• History:
 Small pleural effusion: asymptomatic
 Large pleural effusion: pleuritic chest pain,
abdominal pain, pain during inspiration or
coughing
 The child may prefer to lie on the affected side (to
decrease respiratory excursions)
 Cough
 Fever
 Respiratory distress, dyspnea.

10. TREATMENT
Thoracentesis
 Diagnostic thoracentesis
 A needle is inserted into
the chest wall to remove the
collection of fluid
 50-100ml of fluid is sent
for analysis; Determines the type of fluid (transudate or
exudate)
 temporarily relieve symptoms

13. Lab investigations
• Normal pleural fluid contains few or no cells
and has a consistency similar to serum, but
with a lower protein count.
• Pleural fluid containing numerous white blood
cells is indicative of infections.
• The fluid, or effusion, can then be analyzed for
cell count, total protein, glucose, lactate
dehydrogenase, amylase, cytology, and culture.

14. EMPYEMA
• When effusions are extremely purulent or full of pus,
the effusion is referred to as an empyema.
• Empyema often arises as a complication of:
• Pneumonia.
• other infections near the lung (e.g. subdiaphragmatic
infection) may seed microorganisms into the pleural
cavity.
• It has been estimated that 50% to 60% of patients
develop empyema as a complication of pneumonia.

15. Peritoneal Fluid
• The peritoneum is a large, moist, continuous
sheet of membrane lining the walls of the
abdominal pelvic cavity and the outer coat of
the organs contained within the cavity.
• Within the healthy human peritoneal cavity is
a small amount of fluid that maintains the
surface moisture of the peritoneum.

16. Peritoneal Fluid
• In the abdomen, these two membrane linings are
separated by a space called the peritoneal cavity, which
contains or abuts the
• liver,
• pancreas,
• spleen,
• stomach and intestinal tract,
• bladder,
• and fallopian tubes and ovaries.
• The kidneys occupy a retroperitoneal (behind the
peritoneum) position.

17. ASCITES
• During an infectious or inflammatory process,
increased
• amounts of fluid accumulate in the peritoneal
cavity, a condition called ascites.
• Most cases of ascites are due to liver disease,
and in severe cases, the abdomen is often
distended.

18. Lab Diagnosis
• The fluid can be collected for testing by paracentesis
• (the insertion of a needle into the abdomen and
removal of fluid).
• The peritoneal or ascites fluid can then be analyzed
for amylase, protein, albumin, cell count, culture, and
cytology.
• Often ascitic fluid contains an increased number of
inflammatory cells and an elevated protein level.

19. Pathogenicity
• Agents of infection gain access to the peritoneum
• through a perforation of the bowel,
• through infection within abdominal viscera, by way
of the bloodstream, or by external inoculation (as in
surgery or trauma).
• On occasion, as in pelvic inflammatory disease
(PID),
• organisms travel through the natural channels of the
fallopian tubes into the peritoneal cavity.

20. Clinical features
• 1- Primary peritonitis
• is rare and results when infection spreads from the blood
and lymph nodes with no apparent evidence of infection.
• Causative organisms:
• In children Streptococcus pneumoniae and group A
streptococci, Enterobacteriaceae, other gram-negative
bacilli, and staphylococci.
• In adults, Escherichia coli , S. pneumoniae and group A
streptococci.
• Among sexually active young women, Neisseria
gonorrhoeae and Chlamydia trachomatis
• Fungal as Candida spp. may be recovered from
immunosuppressed patients

21. Clinical features
• 2- Secondary peritonitis is a complication
• of a perforated viscus (organ),
• surgery
• traumatic injury
• loss of bowel wall integrity following a destructive
disease (e.g., ulcerative colitis, ruptured appendix,
carcinoma),
• obstruction, or a preceding infection
(liver abscess, salpingitis, septicemia).

22. Secondary peritonitis
• Causative organisms:
• gonococci, anaerobes, or chlamydiae are isolated.
• Enterobacteriaceae and enterococci
• streptococci, Staphylococcus aureus
• The organisms likely to be recovered include
• E.coli,
• the Bacteroides fragilis group,
• Bilophila spp.,
• other anaerobic gram negative bacilli,
• anaerobic gram-positive cocci, and clostridia.

23.  Most severe
cases associated
with
 cirrhosis of the
liver
 intra-abdominal
malignancy

25. Pericardial Fluid
• The area between the epicardium, which is the
membrane surrounding the heart muscle, and the
pericardium is called the pericardial space.
• normally contains 15 to 20 mL of clear fluid.
• During infection pericardium may become distended
• and tight, and eventually tamponade (interference with
• cardiac function and circulation) can ensue.
• Up to 500 mL of fluid can accumulate during infection.
• Myocarditis (inflammation of the heart muscle itself)
• may accompany or follow pericarditis.

27. Causative organisms
• Agents of pericarditis (inflammation of the
pericardium) are usually viruses, especially
Coxsackie virus.
• Patients who develop pericarditis resulting from
agents other than viruses (Parasites, bacteria, certain
fungi)
• are often immunocompromised or suffering from a
chronic disease.
• An example is infective endocarditis.

28. Common Etiologic Agents of Pericarditis
and Myocarditis
• Viruses
• Enteroviruses (primary Coxsackie A and B and, less
• frequently, echoviruses)
• Adenoviruses
• Influenza viruses
• Bacteria (relatively uncommon)
• Mycoplasma pneumoniae
• Chlamydia trachomatis
• Mycobacterium tuberculosis
• Staphylococcus aureus
• Streptococcus pneumoniae
• Enterobacteriaceae and other gram-negative bacilli

29. Common Etiologic Agents of Pericarditis
and Myocarditis
• Fungi (relatively uncommon)
• Coccidioides immitis
• Aspergillus spp.
• Candida spp.
• Cryptococcus neoformans
• Histoplasma capsulatum
• Parasites (relatively uncommon)
• Entamoeba histolytica
• Toxoplasma gondii

30. Joint Fluid
• Arthritis is an inflammation in a joint space.
• Infection usually occurs secondary to
hematogenous spread of bacteria
• or, less often, fungi.
• It may also occur after injection of material,
especially corticosteroids, into joints
• or after insertion of prosthetic material (e.g.,
total hip replacement).

31. Joint Fluid
• Usually occurs at a single site (monoarticular)
• but a preexisting bacteremia or fungemia may seed
more than one joint to establish polyarticular
infection.
• In bacterial arthritis, the knees and hips are the most
commonly affected joints.

32. Joint Fluid
• self-limited arthritis caused by antigen-antibody
interactions may follow an episode of infection, such
as meningococcal meningitis.
• When an etiologic agent cannot be isolated either the
absence of viable agents or inadequate transport or
culturing procedures may be the cause.
• Borrelia burgdorferi is isolated from the joints of
fewer than 20% of patients with Lyme disease.

33. Most Frequently Encountered Etiologic Agents
of Infectious Arthritis
• Staphylococcus aureus
• Beta-hemolytic streptococci
• Streptococci (other)
• Haemophilus influenzae
• Haemophilus spp. (other)
• Bacteroides spp.
• Fusobacterium spp.
• Neisseria gonorrhoeae
• Pseudomonas spp.
• Salmonella spp.
• Pasteurella multocida
• Moraxella osloensis
• Kingella kingae
• Moraxella catarrhalis
• Capnocytophaga spp.
• Corynebacterium spp.
• Clostridium spp.
• Peptostreptococcus spp.
• Eikenella corrodens
• Actinomyces spp.
• Mycobacterium spp.
• Mycoplasma spp.
• Ureaplasma urealyticum
• Borrelia burgdorferi
Bacterial

34. Most Frequently Encountered Etiologic Agents
of Infectious Arthritis
• Fungal
• Candida spp.
• Cryptococcus neoformans
• Coccidioides immitis
• Sporothrix schenckii
• Viral
• Hepatitis B
• Mumps
• Rubella
• Other viruses (rarely)

35. Diagnosis
• Diagnosis of joint infections requires an aspiration of
• joint fluid for culture and microscopic examination.
• Inoculating the fluid directly into blood culture bottles
• may prevent the fluid from clotting.
• Some of the fluid may be Gram stained
• and inoculated onto blood as well as chocolate and
anaerobic media.
• The use of AFB (acid fast bacteria) and fungal media
must also be considered.

37. Bone marrow
• Bone marrow is typically aspirated from the
interstitium of the iliac crest.
• Usually, this material is not processed for routine
bacteria, because blood cultures are equally
useful,
• and false-positive cultures for skin bacteria
(Staphylococcus epidermidis) are frequent.
• Bone removed at surgery or by percutaneous biopsy
is sent to the laboratory in a
• sterile container.

38. Occasionaly Wuchereria bancrofti microfilariae
and rarely Brugia spp can be found.
Hydrocele Fluid

39. Hydrocele Fluid
examination
• The fluid is placed on a slide
• And air-dried to prevent distortion of the parasite.
• The specimen should be stained with Giemsa, Wright’s, or
hematoxylin stain and examined microscopically.
• Polymerase chain reaction (PCR) amplification is available
• for the rapid diagnosis of blood microfilariae including
• W. bancrofti
• and Brugia spp.
• Serologic assays that measure antibody response have
• limited utility in the diagnosis of infections with microfilariae.

40. Microfilaria of Wuchereria bancrofti in thick
blood film.