What is microscopy in gynecology. Gynecological smear: interpretation of analysis in women
smear on flora- often prescribed by gynecologists for analysis. What wines show and how are pardons for yoga rahunok used?
Danish analysis can be called "hard". This is the first diagnostic, as it allows the doctor to confirm or to ask for the presence of an ignition process in the pelvic cavity, urethra, cervical canal, as well as to develop a visnovka lesion that could lead to menopause or menopausal changes in the patient.
What exactly is the name of the analysis:
- microscopic (bacterioscopic) follow-up of a smear made according to Gram - this is the official name;
- smear from state organs;
- bacterioscopy;
- microscopy.
Vikoristovuetsya for the diagnosis of infectious-inflammatory processes. Bacterioscopy allows detecting bacteria in the female organs: the simplest microorganism - gonococci, which provoke gonorrhea, trichomonads - trichomoniasis. Also fahivets in the microscope to sip bacteria, fungi (Candida), key cells (a sign of bacterial vaginosis). The type of microorganism is assigned to the form, rozmіrom, and also to that - they are farbuyutsya in barvnik chi nі, that is gram-positive or gram-negative.
In addition, in a smear from the skin point (taken from the penis, urethra, cervical canal), the number of leukocytes in the field of view is counted. Chim їх more - tim is stronger than the expressions of the ignition process. The quantity of epithelium and mucus is estimated. especially rich in women of reproductive age during ovulation - in the middle of the menstrual cycle.
Microscopic examination of the observation of the female organs - is it possible to evaluate the condition - a healthy gynecological woman can make one of the following diagnoses:
- vaginal candidiasis (thrush);
- bacterial vaginosis (previously called gardnerellosis);
- gonorrhea;
- trichomoniasis.
As a clear sign of one of the diseases, there is no smear, but a smear of filth, the destruction of the material is carried out - the bacterium is sown.
Reasons for visiting gynecology
- Even though the smear is more peaceful, or the number of leukocytes is large, but the infection is not common. So, with microscopy, there is a lower boundary between the manifestation of microorganisms: 10 in 4 - 10 in 5 steps.
- As a microbe of manifestations, to signify its sensitivity to antibiotics.
- These are signs of a fungal infection. To accurately identify the type of fungus and indicate an effective antimycotic drug.
Active fungi, for example, Candida albicans (Candida albicans - a diploid fungus), are not safe for future mothers and can provoke infection and early growth of fruit membranes.
Other types of mushrooms Candida can not be exulted, as there are no pathological symptoms.
There are also known key cells (signs of BV), but they are also present and other microbes. For identification.
Why is it possible to have a smear on the flora and a degree of cleanliness of the soil
In the follow-up method. In case of a smear, the material, applied on a skeltse, is stuffed with special barbers and marveled under a microscope. And if the bacteriological (bacterio-sowing, cultural, microbiological) follow-up is done, then one’s head “hangs” on the life-giving center. And then, after a few days, marvel under a microscope - colonies of some microorganism have grown.
Tobto, as a language about express analysis, you will be given a summary only about the number of leukocytes, epithelium and mucus. Posіv termіnovim not buvaє
Also, with microscopy, you can easily determine the degree of purity from pikhvi. Here, the doctor only evaluates the spivvіdnoshennia between normal, mentally pathogenic and pathogenic microflora.
A classic assessment of the purity of pikhvi.
updated table
| step | marks |
| I | Dederlein sticks, flat epithelium. |
| II | Non-pyogenic bacteria. Leukocytes are normal. Diagnosis: non-suppurative bacterial colpitis. |
| III | Pyogenic (staphylococci, streptococci, sinogniyna sticks, gonococci, etc.) Microorganisms. High rіven leukocytes. Putrid bacterial colpitis. |
| IV | Gonorrhea (indicated by gonococci). |
| V | Trichomoniasis (manifestations of Trichomonas). |
| VI | Vaginal candidiasis (infected fungi). |
What doctors do not swear at microscopy
- Vagity. For the sake of argument, a smear is not required and it does not matter what result you show. It is necessary to have a blood test for hCG, to undergo a gynecological examination by a doctor, or to perform an ultrasound scan of the uterus. You can determine chorionic gonadotropin in the community, but not in the sights of these state organs!
- Cancer of the uterus and cervix. To diagnose the evil degeneration of endometrium, the necessary histological material, moreover, in a large number. I take yoga directly from the uterus.
CC and other pathologies (erosion, leukoplakia, atypical clitinitis, etc.) Set after the results of cytological follow-up. Danish analysis is taken directly from the cervix, from the transformation zone, according to the Pap test using the Pap test method. It is also called oncocytology.
- Chi does not show the same infection (ZPSSH) yak:
- herpes;
- chlamydia (chlamydia);
- mycoplasma (mycoplasmosis);
- ureaplasma (ureaplasmosis);
The first few infections are diagnosed by the PCR method. And it is impossible to determine the presence of immunodeficiency virus in a smear with high accuracy. It is necessary to have a blood test.
How to get ready for the task of analysis and if wine is necessary
A smear of the drug is taken from the patient on a gynecological chair (independently, because of that - the vagina is out of place) for the help of a special brush or a sterile Volkmann spoon. Tse zovsіm not hurt more and more quickly.
It is technically possible to achieve a garniture, to create an ideal smear, for example, to sanitize pihva with chlorhexidine or miramistin, for example. Ale, what kind of sense do you have?
To take a reliable smear result, 48 years before the first task is not possible:
- douche;
- have sex;
- vikoristovuvat be-like vaginal hygiene, intimate deodorant, as well as faces, like stinks were not recognized by the doctor;
- efficiency of ultrasound with the use of a vaginal probe;
- get a colposcopy.
- before seeing a gynecologist or laboratory, for 3 years, no trace of urination.
It is necessary to give smears after menstrual bleeding. Navit є just "mazanina" on the rest of the day of menstruation, more likely to be followed, so the result will be singly filthy - a large number of leukocytes will appear.
Chodo priyomu alcohol zaboron nemaє.
Can you take a smear while taking antibiotics or just after the treatment? It is necessary to spend 10 days after the appointment of a medical drug (vaginal) and one month after taking antibacterial drugs in the middle.
Microscopically determined to prescribe:
- in a planned manner with the supervision of a gynecologist;
- when entering the gynecological hospital;
- before ECO;
- under the hour of vagity (especially, as we often get a dirty smear);
- yakscho є skargi: unremarkable vision, sverbіzh, pelvic pain, etc.
Deciphering the results: what is the norm, and what is the pathology in the microflora
For the sake of the cob, I suggest your respect for the table, in order to show the signs of the so-called first degree of purity. She has no riddles of the urethra (if the material is collected and taken away), so we are talking about gynecological diseases. The flamboyant process in the sechіvnik is an exuberant urologist.
| ostentatious | pihvu | cervical canal |
| leukocytes | 0-10 in field of view | 0-30 in the field |
| epithelium | in zalezhnostі vіd fazimen. cycle | |
| slime | peacefully | |
| trichomonads | nothing | |
| gonococci | nothing | |
| Key cells | nothing | |
| candidi | nothing | |
| microflora |
gram-positive sticks |
Daily |
Epithelium - the number of epithelial cells is not taken into account, since it does not have diagnostic value. Ale too wretchedly small epithelium to talk about the atrophic type of smear - it happens in women during menopause.
Leukocytes - vvazhayutsya in the "field of dawn":
- no more than 10 - a small number;
- 10-15 - pomіrna kіlkіst;
- 30-50 - the number is large, the woman notices pathological symptoms, and the doctor, when looking around, diagnoses the ignition process in the uterus and (or) on the cervix.
Slime (heavy slime)- in the norm, it may be present, but there is a large number of times when it is inflamed. In the urethra, the mucus is not guilty.
Palichkova flora or gr lactomorphotypes- norm, tse zahist p_hvi v_d microbes.
Trichomonas, gonococcus and key clitin in a healthy woman, in the cervix of the uterus and in the womb, it is not guilty. Candida is normal and daily. At least in a significant amount, it appears when analyzing the flora.
The applicability of the smear is not great. And as soon as a woman enters a hospital, then right there, at the first glance at the armchair, she takes fresh.
Call the results for 7-14 days. Therefore, if you need to build it up before the operation, you need to do it 3 days before going to the hospital. Let's stop the recognition of analyses.
What to show in bakposeva
The gynecologist can decipher the result of the culture as best as possible. Ale and yourself, if you read the information below, you will sort it out in your analysis.
The number of microorganisms can be expressed in "crosses":
- "+" - small quantity;
- "++" - pomіrna kіlkіst;
- "+++" - great number;
- "++++" - ryasna flora.
And more often, a small number of representatives of microflora hang in the steps. For example: Klebsiella: 10 in 4 steps. Before speech, tse one of the representatives of enterobacteria. Gram-negative stick, aerobic microorganism. One of the most unsafe health workers, although it is less mentally pathogenic. Everything that Klebsiella is resistant (unacceptable) to the greatest extent of antibacterial infections.
Below we will describe other parts of the term, which appear in the results of the follow-up, or you can feel like a doctor.
Soor - ce candidiasis, or in other words - thrush. Enjoy antimycotic (antifungal) drugs.
Blastospores and pseudomycelium of yeast-like fungi- candidiasis or else fungal infection, sound like thrush.
Difteroides are mentally pathogenic microorganism, according to the results of studies, in most women, close to 10% of the microflora is formed by the stink itself, as well as streptococci, staphylococci, intestinal stick, gardnerella. As the flora is destroyed, their number is increasing.
Zmishana flora is a variant of the norm, although there are no symptoms of illness, often leukocytes or a strong increase (40-60-100). 15-20 - a variant of the norm, especially during the hour of vaginess.
Enterococci (Enterococcus)- representatives of the intestinal microflora, yakі іnоdі drank і in pіkhvі. Koki. About enterococcus faecalis (Enterococcus faecalis) mi. Є esche enterococcus coli - intestinal stick. Call out the unacceptable symptoms at a concentration of more than 10 in 4 steps.
sign fire stick- gram bacterium. Often attacks people with low immunity. May have good resistance to antibiotics, which complicates the treatment process.
polymorphic wand- a typical representative of the biocenosis of pikhvi. Although the number of leukocytes is normal and there is no scarg, it is not guilty of turbulence.
Erythrocytes - can be in a small amount in a smear, especially if they took it for an hour of the ignition process, or if there were small bloody visions.
coccal or coccobacillary flora- ring out when you have an infectious process in the womb or on the cervix of the uterus. As a woman has a scar, it is necessary to have an antibacterial treatment - sanitation of the penis.
Diplococci are a variety of bacteria (cocci). Do not bring shkodi to a small number. For a vine of gonococci - gonorrhea vigilantes. Її rejoice forever.
And at the end, we will introduce parts of the short period, which should be written on the forms of the results of the analyses:
- L - leukocytes;
- En - epithelium;
- Pl. ep. - flat epithelium;
- Gn (gn) - gonococcus, gonorrhea alarm clock;
- Trich - trichomonas, trichomoniasis alarm.
Leukocytes in a smear in the most important form of depression are a sign of the ignition process in the organs of the urogenital tract, moreover, both female and human. However, a rare person, especially in a young person, can “boast” that they took a smear from a new one, as if everything is in order with the sechostat system. For people, smears should not lie down until obov'yazykovyh analyziv during clinical examination. The lady on the right is women. Without a doubt, there are no such people, like, at least once a year, such manipulations are not performed. If there are any pathologies, but if there are problems, then smears are taken in the world of need.
Norm and pathology
The material from the urethra of a person at the norm is not sufficient. Single leukocytes, transitional epithelium in a smear, single sticks - the axis and everything that can give us a healthy person. The appearance of a large number of leukocytes in a smear of a strong state, as a rule, is accompanied by the presence of inflammation(, Drіzhdzhodzhopodіbіbіbіbіbіbіbіbіbіbіbіv genus i іn), yak rejoice, and then take the analysis anew, schob to reconsider in the success of their visits.
As women stand, then the number of leukocytes is promoted before menstruation and is considered an absolutely natural phenomenon. Until then, the very advancement in the field (the norm is up to 30 cells in the field of view) to reliable indications is not considered, the morphological signs of these cells are taken into account for the comparison of the norms of leukocytes. The stench is “calm”, not ruminated (saving nuclei), signs of phagocytosis daily. Of course, sometimes the reason for the pardon of the doctor-diagnostic may be the wrong taking of the material. The butt is a “thick” smear, which is practically not visible when looking at those who are overlapping the entire field of seedlings one on one clitin (including leukocytes). Chi not rizikuyuchi have mercy, in similar vipadkas women pronounce the building of the analysis again.
Table: normal smear results for women
V - material from pikhvi, C - cervical canal (uterine cervix), U - urethra
Flora and cytology - why are they important?
Just as people take only urethral samples for analysis, women have more objects: urethra, pihva, cervix, cervical canal. True, sometimes take an aspirate from an empty uterus and also test smears, the sample is taken into account by biopsy material, which is looked at by a cytologist. Vіn same zrobiv vysnovok about those. Aspirates are not taken during prophylactic examinations, whose analysis is victorious only with a diagnostic method for the detection of cancerous and precancerous diseases of the head reproductive organ in women. In addition, if you fill the aspirate with formalin, and then apply yoga to the warehouse and infuse, then we will form a histological preparation, which in the diagnosis of evil neoplasm is important for the rest of the instance.
It is sing-song, richly expressive: "smear for flora", "smear for cytology". What does it all mean? Why are stinks similar and why are they special?
On the right, in the fact that in a smear on the flora on a large scale with immersion, the drug can infect cells, reveal trichomonads, yeasts, diplococci, gardnerella and other microorganism, which represent a rich biocenosis of the female state sphere. Ale vin cannot be used to identify morphological changes in the epithelium, oscillators of the direct laboratory diagnostics, decytology occupies a niche. Doslіdzhennya kіtinnogo warehouse kakogos material vmagає, krіm sevnyh znan, shch y spetsialї podgotovki. Treatment of pathological changes in the clitin and nucleus theoretically gives even a little, here, as it seems, an eye is needed.
The deciphering of the analysis in both types (flora and cytology) is handled by the doctor, we should not be easily familiarized with certain understandings, so that, having stumbled upon a similar problem, do not lie and do not panic.
cytological follow-up
The tasks and functions of cytology are significantly wider, narrower, wider and more possible. Likar, what dosledzhuє material, the main respect attaches to the epithelial clitin with the method of revealing pathological processes (inflammation, dysplasia, malignant neoplasms) and immediately revealing the flora. The most commonly used portion of the vaginal portion of the cervix is represented by the squamous (chotirishar) squamous epithelium (MPE) and the cervical canal. With a correctly taken smear from the cervical canal, in a cytological preparation, at a normal rate, a prismatic (cylindrical) epithelium is clearly visible, leukocytes are single and the microflora is affected, yak could be consumed from the lower veins (for example).
It should be respected that the cytological preparation is more informative, and the way of preparation (for Romanovsky-Gimsa, Pappenheim or Papanicolaou) gives a greater clear picture. Clitini are looked at on the small scale, to evaluate the burning camp of the preparation, and then on the great one (with immersion), to look not only at the epithelium itself, but also at the core, with another illness. In a word, the cytologist should saturate the flora, inflame, and in most cases, change the cause and change, as if causing the igniting process. And so are the orienting signs of infections, which are especially difficult in diagnosis, pre-swelling and puffy will become the epithelium.
Video: about a smear for oncocytology
Indirect signs of active IPSS in cytology
If you need a smear for IPSS, then it should be considered as a cytological preparation. Taking on the flora and using a methylene blue smear, which is the first, affordable and cheap, and the most widely used diagnostic method in gynecology. However, unfortunately, the wines do not give the necessary picture for the diagnostic investigation of ZPSSh and their findings.
Crime of all possible bags, yak if infected or damaged biocoenosis can be seen in a smear on the flora (Trichomonas, yeast, leptotriksom), in the additional material (cytology) it is possible to show indirect signs of the presence of problematic microorganism, yak yakichno velychіchіmіvitim for additional microscopic examination: 
- The appearance of giant meganuclear clitin MPE, for an hour to complete the chimeric form, often shows signs of parakeratosis and hyperkeratosis (cornea), indicating a possible lesion;
- Clitini in looking "owl eyes" with coarse-grained cytoplasm are typical for;
- When possible, koilocytic atypia can be detected (MPE cells with large nuclei and a zone of enlightenment near the nucleus);
- Orienting є і іltsya Provacek in clitin metaplastic epithelium, power for and play the role in screening studies.
Obviously, it is not possible to make a diagnosis of herpetic, cytomegalovirus, or papillomavirus infection with cytological analysis, however, it is possible to admit it, but it is also a substitute for a lower, more engulfed infection in a specific direction (, і ін.). In this way, cytology allows you to ring out a diagnostic request, avoid unnecessary analyses, save an hour, and also promptly come in often.
How to properly prepare for analysis?
Let’s make the stones ourselves simple and accessible by the method of revealing the ignition processes of the urogenital tract, like in people, so in women, and a smear on the flora, then you need to give more respect and learn to read the troubles in the records entered to the form.
However, the first thing to do is pay a visit to the doctor, patients are guilty of knowing deeds simple rules:
- A couple of days before the test, it is necessary to include not only state contacts (sometimes in a woman’s smear, spermatozoa can be smeared), but also any other type of douching, medical treatment of a breast indication (candles, creams, tablets);
- Do not follow the rule on a similar date before the hour of the month, but the menstrual blood will be responsible for reviewing the drug, de lіkar will be bachiti, basically, її;
- On the day of obstezhennya, it is necessary to loosen up an hour so that the last time you urinate in 2-3 years, so that you can cut through all the “information”;
- 7-10 days before the analysis, take pharmaceutical preparations, especially antibacterial drugs, or give a smear only after a week after the end of the treatment;
- There is one more rule that women often ignore: don't beat yourself up for intimate hygiene. Zvichayno, it’s already easy to get used to similar procedures, how to recommend fahivts, but if you want to be surrounded by clean warm water, you can. The people and the rest of the toilet of the state bodies of the state will be in the evening before seeing the doctor.
Take care of the data, the person is sent to the reception, for you to take a smear, cook and marvel under the microscope. The doctor will take care of deciphering, and the patient will take the visnovok on his hands, and you, mabut, you will find out what all the numbers and words mean.
Video: preparation for a smear
What can be used in a smear from the urethra in people?
Chantly, the reader guessed that it is unlikely that the analysis of the people’s parkan will be deprived of the reception, even if the object they have not reached is available, then it’s really possible to matimute the place of the unacceptable, if it’s possible, not to leave the people for a year. Sometimes, in order to avoid this, the doctor prescribes prostate massage to patients, which takes place a few days before the procedure per rectum, then through the rectum.
However, even though liver and soreness in the state member continue to think about a few days, and until these phenomena have come to be similar to - the trip to the doctor is inevitable. But if everything went well, then maybe, people can calm down the fact that in their smear, taken from the urethra, everything looks richly simpler, like, splendidly, normal analysis:
- The norm of leukocytes is up to 5 cells per field;
- Flora to become single sticks;
- Zagalny background dilutes the epithelium of the urethra (mostly transitional) - approximately 5-7 (up to 10) cells;
- A small amount of mucus, which does not play any role;
- For the first time in a smear, there may be a presence of mentally pathogenic flora in single specimens (streptococci, staphylococci, enterococci), however, in order to differentiate, it is necessary to take a smear after Gram.
At the time of the ignition process, the smear is changed:
- There is a large number of leukocytes in a smear, sometimes they do not show a puff;
- The coccal or cocco-bacilyar flora of the viticious rods;
- The preparation has microbes that caused inflammation (trichomonads, gonococci, yeasts and others);
- Microorganisms like chlamydia, urea- and mycoplasmas under a microscope can hardly be treated, in the same way, as well as pathogenic diplococci, which call gonorrhea, in pairs of lying enterococci, or Enterococcus faecalis (enterococci) the mind of the worker should be supplemented by the cultural method, or by the practically universal and popular in our time PLR (polymerase Lantzug reaction);
- For a rare vinnyak in a human smear, you can reveal an intestinal stick (screamingly violated the hygiene rules!), Like bringing measles in the intestines, ale screaming cystitis, dragging a person into the sewer canal. For її differentiation also necessary additional laboratory methods of investigation.
Similarly, to swear and with female smears, the shards of the found diplococci can appear similar to Neisser and not to gonorrhea. Before speech, intestinal coli (Escherichia coli), enterococcus (Enterococcus faecalis), staphylococci and streptococci and other microorganism in female smears are significantly more frequent, which is associated with the female organs.
Ecosystem of the female urogenital tract
Leukocytes in a smear taken in gynecology, even for flora, even for cytology, not a single cell, present in the preparation. In addition, the stinks appear less like a last resort, or a reaction to what occurs in the ecosystem under the skin (hormonal levels, inflammation). For example, their progress in the different phases of the cycle is associated with hormonal injections, so when taking the material, the date of the remaining months is indicated in the referral form.
The diagnostic criterion for the ignition process is not only the large number of Le, "into" on the field of "Viyskian activities", but the number of their nuclei. If the leukocytes enter into a reaction, the stinks are smothered by the "heap", they phagocytize, and then they themselves begin to collapse. Zruynovanny cells are called neutrophilic leukocytes, but this phenomenon is not shown in deciphering analysis. There is a large number of neutrophilic leukocytes, mixed with bright cocco-bacilar and coccal flora, to serve as a basis for confirming the obviousness of the ignition process.
The ecosystem of female organs includes micro-organisms that occupy several niches, such as: epithelium of the pelvis, cervix, cervical canal, rich endocervical folds. Tsі anatomical arrangements are safe for the mind for the life of other micro-organisms. Deyakі z meshkantsіv є obov'yazkovymi (obligatnymi), and іnshі spoorplyayut zzovnі owing to the songs of the environment and call different fuse reactions of the epithelium.
Krym tsgogo, ryvnovag in the ecosystem of the building destroy the various factors that negatively affect the body of the woman (both internally and externally), as it causes microbes, yak to live in a small number, to stop the removal of natural flora, sacks, yak and occupy a panivne camp. An example of this is the colonization of the vaginal medium with gardnerella, as for a number of reasons, lactobacilli (Doderlein sticks) are vitiated. The result of such a “war” is wide publicity.
Norm in a gynecological smear
Microscopic facts that a woman lives in stately ways are considered different, however, the norms are nevertheless established, if you want to finish the decals on the cordon, it’s difficult to finish them, but we still try to work it out. In this way, in a smear taken in gynecology, you can show:
- Leukocytes, the norm of which in the urethra is up to 10 cells in the field of view, in the cervix of the uterus and canal - up to 30 cells. With vagity qi, the indications change in the direction of zbіlshennya;
- The type of epithelium in the smear should be deposited in the place of the material intake: the urethra neck, the urethra is lined with a rich spherical flat epithelium (MPE), which we take in the preparation. A smear from the cervical canal will be presented as a cylindrical (prismatic) epithelium. The number of clitins changes in different phases of the cycle, in general, it is accepted to take into account that at the norm їх zmist is not guilty of revisiting 10 ones. However, everything should be done mentally, the shards for accurate diagnostics need to be protected morphological changes in clitin structures(Nucleus, cytoplasm, presence of "bare nuclei"), then conduct a cytological analysis;
- The mucus in the preparation is used as an obov'yazkovym, aloe pomirnym, component, even in the cervical canal and pikhvi її see. The mucus looks like in the ovulatory phase of the menstrual cycle;
- A normal smear, as a rule, shows rod flora (lactobacilli) and single cocci.
Mentally pathogenic flora - do not set the norm
Crim lactobacillus - the main representatives of the normal microflora of the state pathways, on which the important function of "self-purification of the vaginal medium" is placed, in a smear you can see in small quantities and other, mentally pathogenic, microorganism:
All these representatives of the microflora can live without respecting anyone, or they will burn with singing minds. Before speech, instill lactobacilli in the supra-world abundance and in the great abundance of the bacterial flora of the building, provoke the ignition process - lactobacillus, which is manifested by sverbіny, liver, vision. The ailment, obviously, is not fatal, but it is even more painful.
Pathogenic "guests"
The presence of pathogenic micro-organisms, which are transmitted mainly through direct contact, is practically responsible for the severity of intolerance. Mіstseve zapalennya, vyklikane zbudnik, can expand to other organs and systems and (often) go chronically, but do not vibrate at times.
Such a phenomenon is especially unsafe in the period of vagity, the oskilki are rich in the health workers of the building, they put a negative pressure on the child, to that a filthy smear with vagity - tse ker_vnitstvo to di, to the same, negain. What kind of microorganism can threaten the reproductive system of a person, being transmitted by a path? Singingly, we don’t call anyone, having named them, prote zayviy times, you still can’t make guesses about the problem, as they carry microscopic facts.
gonococcus - gonorrhea alarm clock
In this rank, before the pathogenic microflora, one can see the following paths:
What is the level of purity?
A smear on the level of purity of the pikhvi is taken as an excellent smear on the flora, but it is assessed in a different way. In gynecology, the IV degree of purity is seen:
I step- the presence to finish the rіdkіsne, a clean smear, only palic flora, one by one leukocytes and squamous epithelium cells in optimal numbers;
II step- middle sticks can "jump" one by one coca or domicile other non-pathogenic microorganism also in single specimens, the feet of the widest among women who are healthy in the gynecological plan;
table: standards for evaluating the purity of pikhvi
III stage- it is characterized by mentally pathogenic flora and yeast-like fungi, showing a tendency to active reproduction. Tse mozhe evidence about the development of the ignition reaction to the presence of the supraworld number of mentally pathogenic microorganisms. Danish analysis of the transfer of the supplementary obstezhennia of the woman;
IV stage- signs of an obvious ignition process: coccal cassava or cocco-bacilyar (smishana) flora, it is possible to have trichomonads, gonococci or other pathogenic microorganisms. In such cases, supplementary laboratory tests (bacteriological, PLR and other) are assigned for the sake of a wake-up call and a distant glee.
A smear on the flora, if you want to use simple methods, but there may be great possibilities. The first step in the laboratory diagnosis of infection of the urogenital tract, for an hour, immediately overcomes the problem and allows you to proceed negligently to the jubilant visits, even though the smear itself is always controllable, such a uniquely accessible procedure is not recommended. Vaughn doesn’t see rich vitrat, that one won’t be able to check for a long time.
Мікроскопічне дослідження мазків з цервікального каналу і виділень з піхви є необхідним методом в скринінгу та діагностики інфекційно-запальних захворювань жіночих статевих шляхів (цервіцит, вагініт), оскільки дозволяє оцінити ступінь запального процесу (лейкоцитарну реакцію) і стан мікрофлори, а також виявити елементи грибів роду Candida, trichomonads, intracellular diplococci.
In addition, today, bacterioscopy of a Gram-farmed smear from pichwitse is the “gold standard” for diagnosing bacterial vaginosis. Diagnosis of BV is based on the presence or presence of such signs:
Change in the number of or the appearance of lactobacilli - gram-positive sticks of various dozhina and tovshchina;
. an increase in the number of gram-variable (changed) cocco-bacilar microflora;
. the presence of key cells, as they represent the superficial cells of the epithelium of the pylorus with bacteria adhering to them, for which the epithelial cells look granular, and the edge of such cells looks fuzzy.
To evaluate the results of the study of drugs, otrimanih z see pikhvi and zabarvlenih Gram, vikoristovuetsya standard ten-point scale (Nugent's criteria), as was proponated in 1991 by Nugent R.P. and co-authors (Nugent's Diagnostic Criteria for Bacterial Vaginosis). It is based on a system of scores (points) of 0 to 4 and its combination for the diagnosis and assessment of the stage of bacterial vaginosis for the assessment of three bacterial morphotypes of phi:
- A - Lactobacilli - great gram-positive sticks (Lactobacillus acidophilus);
- B - Vaginal gardnerella and bacteroides - other gram-variable and gram-negative coca (Gardnerella vaginalis and Bacteroides species);
- C - mobiluncus - curved gram-variable sticks (Mobiluncus species).
Smear from pikhvi zabarvlyuyut according to Gram
and take into account the quantity of the revealed elements of the flora:
| bali | A Lactobacilli | B Gardnerella | C Mobiluncus |
|---|---|---|---|
| 0 | more than 30 morphotypes | no morphotypes | no morphotypes |
| 1 | 5 - 30 morphotypes | one morphotype | one morphotype |
| 2 | 1-4 morphotypes | 1-4 morphotypes | 1-4 morphotypes |
| 3 | one morphotype | 5 - 30 morphotypes | 5 - 30 morphotypes |
| 4 | no morphotypes | more than 30 morphotypes | more than 30 morphotypes |
The number of points taken away is summed up (A + B + C). Interpretation of the results on the Nugent scale:
7-10 points - bacterial vaginosis;
4-6 balls - intermediate type;
0-3 points - the presence of bacterial vaginosis.
Indication before recognition date:
- screening with prof. glances, vaginess, before operations;
- complex diagnostics of vision of pikhvi - Beley;
- control of the development of vaginitis, cervicitis, BV.
> Microscopic (bacterioscopic) follow-up of a smear obtained after Gram in the diagnosis of infectious-inflammatory processes
This information cannot be trumpeted in self-judgment!
Obov'yazkovo necessary consultation with the fahivtsy!
Microscopic examination (or bacterioscopy) - the identification of microorganism under a microscope. In order for the drug to smear some bacteria from others, a smear (applications on the subject of difficult biological material) is reserved for a special technique - for Gram.
Why conduct a bacterioscopic examination of smears?
This method is inexpensive and quick, therefore it is widely used in the diagnosis of infectious-inflammatory processes of various localization. For additional bacterioscopy, the doctor can detect bacteria, fungi, and the simplest organisms (for example, Trichomonas). If so, estimating their shape, expanding and setting them to barniki (microorganisms are gram-positive and gram-negative), fahivets can increase the appearance of a wake-up caller.
Crimson, when diagnosing ignition processes, the laboratory assistant evaluates the number of leukocytes in a smear (there are more signs of a pathological process), the presence of epithelial cells, elements of dead cells and other.
In this way, bacterioscopy gives the doctor the opportunity to conduct an early assessment of the presence of an infectious agent in the analyzed material and determine the need for a bacteriological culture.
What should be done to supplement this method?
Most often this method is used in gynecology. For additional help, smears are taken, taken from the pelvis, cervix and urethra of the woman, as I turned to the gynecologist when it was obvious that I had a scar or just for a preventive look around.
Krіm tsgogo, microscopically doslіdzhennya smears of vicorist for trimming sechostete paths in people. They dosledzhuvanim material - scribbles from the urethra, the secret of the anterior follicle, sperm.
Such a bacterioscope of the vivcels of the vivors of the same bibs -bummerіaliv: Spring and vidiral wounds, full -time visits, pus with Furunkuliv, Karbunkuli, sobs, siblis.
Where can you do an analysis?
Preparation before delivery of the material for bacterioscopic follow-up to lie down depending on the localization of the pathological process, that in the specific skin type of mind, the task is determined by the best doctor and given recommendations.
The material for the preparation of a smear is taken by a doctor (gynecologist, urologist, ENT, ophthalmologist, surgeon or other).
shortfalls in the method
Bacterioscopy is an orienting diagnostic method, which does not provide sufficient information for making a diagnosis. In addition, a lot of people just don’t visualize in smears, but it doesn’t mean that they aren’t there. Therefore, in more cases, it is necessary to keep the patient away from the patient, which includes bacteriological examination, as well as various specific analyses. Blame є zastosuvannya bacterioskopії in gynecology - for the help of tsgogo dolіdzhennya confirm the onset of the diagnosis: bacterial vaginosis, thrush, trichomoniasis, gonorrhea.
interpretation of results
У бланку результату мікроскопічного дослідження мазка лікар-лаборант указує наступні дані: наявність і вид епітеліальних клітин (це важливо для гінекологічних мазків), наявність слизу і зруйнованих клітин, кількість лейкоцитів в полі зору, кількість, морфологічні типи та ставлення до барвників виявлених бактерій, грибів , the simplest. I will further evaluate the results to carry out a jubilant doctor.
Мазок із статевих органів (мікроскопічне або бактеріоскопії) це дослідження біоматеріалу (виділень, зіскрібка) з статевих органів за допомогою світлового мікроскопа під різними збільшення з попередньої забарвленням матеріалу або без неї (нативний мазок) .В даний час широко впроваджується комбіноване застосування світлової мікроскопії та цифрової photographs for the help of various digital microscopes with the help of special computer programs, which significantly improves the efficiency of research
If there is a microscopic follow-up
Основними показаннями до проведення мікроскопічного дослідження є симптоми статевих інфекцій, в більшості випадків уретральні та вагінальні виділення .За допомогою мікроскопії досліджують секрет передміхурової залози при діагностики простатиту, осад сечі при загальному аналізі сечі, а також проводять цито-морфологічне дослідження по Папаніколау .Мікроскопія використовується при pіdrakhunka spermograms
Microscopic examination can be carried out not only from the view of the secretory organs, but also from the superficially unsafe and scratchy from the erosions and mucus of the mucous organs, from the rectum, the posterior wall of the pharynx and the conjunctiva of the eye.
How to carry out microscopic examination
Для отримання повноцінного мазка чоловікам рекомендовано утриматися від сечовипускання протягом декількох годин, жінкам не спрінцеваться.Матеріал забирається з осередків ураження спеціальними інструментами (наприклад ложкою Фолькмана) .Возможен забір матеріалу за допомогою предметних стекол і бактеріологічної петлей.Обично забір матеріалу проводять з сечовипускального каналу ( уретри ), pihvi, cervical canal, rectum, posterior pharyngeal wall, and other mucosal conjunctiva of the eye.
У лабораторії доставлені мазки досліджуваного матеріалу в залежності від завдань забарвлюють спеціальними барвниками і проводять мікроскопію під різними збільшеннями мікроскопа.Отмечают прояви запальної реакції: наявність лейкоцитів, слизу, фібрину, при виявленні мікроорганізмів відзначають ступінь обсіменіння, відношення до фарбування за Грамом та морфологічні особливості. Zocrema, in case of gram-negative diplococci, especially in case of intracellular rotting, should be carried out additionally for gonorrhea. Revealed in smears of the simplest (Trichomonas), mycelium or blastospores of the fungus can serve as a basis for a positive result of the manifestation of these microorganisms in the examined material
Basic methods of smear preparation for visualization of state organs
|
zabarvlennya method |
characteristic |
|
|
native drug |
Follow-up without staining of dyes. Apply more 2 different types - follow-up of salt staining (0.9% sodium chloride) and 10% solvent meadow (KOH). |
|
|
aniline barvniki |
The most commonly used are methylene blue and diamond green. |
|
|
Gram concentration * |
Fallow due to the chemical structure of the bacteria, it may be possible to reduce the naturalness of the crystal violet barn, or to be intoxicated in alcohol. Gram-positive microbes turn into a blue-violet color, gram-negative - into erysipelas and red. With proper preparation, the preparation is orange-red color on thin plots, lilac-violet on tovst. |
|
|
Zabarvlennya for Romanovsky |
Zabarvlennya allows you to detect nuclear elements and volutin granules of bacterial cells for sporidity to the main farb. At microscopic examination of nuclear elements, a red-violet color appears, the cytoplasm is slightly erysipelas. In more young cultures, the cytoplasm turns into a blue-violet color. In bacterium sticks, the kernels are turned into a dark red-purple color, volutin - into cherry-red. |
|
|
aniline barvniki |
||
|
trichomonas vaginal |
aniline barvniki |
|
|
pseudomycelium |
native drug |
|
|
Threads in dot-dash |
native drug |
|
|
Inclusion in epithelial cells |
Zabarvlennya for Romanovsky |
|
|
Sticks-pіvmіsyatsі |
aniline barvniki |
|
|
Key cells |
aniline barvniki |
|
|
leukocytes * |
Leukocyte reaction at |
All methods of infection |
|
koilocytosis |
||
|
Giant epithelial cells |
||
|
Atypical epithelial cells |
Precancerous and cancerous disease of the cervix |
* Criteria for the number of leukocytes, which indicate the ignition reaction in the fallow in the state and in the case of the sechostate system (increased x 1000 immersion system)
Interpretation of the leukocyte reaction, as seen on microscopy
|
material |
people |
women |
||
|
leukocytes |
leukocytes |
|||
|
pihvu |
||||
|
cervical canal |
cervicitis |
|||
|
prostate secret |
prostatitis |
|||
* Bigger microscope x 400, phase-contrast microscopy
What is the normal smear in people
|
ostentatious |
Norma (anterior urethra) |
|
leukocytes |
0-5 in field |
|
epithelium |
up to 5-10 in p.z. |
|
peacefully |
|
|
gonococci |
not revealed |
|
trichomonads |
not revealed |
|
key cells |
not revealed |
|
not revealed |
|
|
microflora |
alone coca |
What is the normal smear in women
|
ostentatious |
pihvu |
cervical canal |
|
leukocytes |
0-10 in field of view |
0-30 in the field |
|
epithelium |
lie in the phase of the menstrual cycle |
|
|
peacefully |
||
|
gonococci |
not revealed |
|
|
trichomonads |
not revealed |
|
|
key cells |
not revealed |
|
|
not revealed |
||
|
microflora |
Gram-positive sticks in a large number * |
Daily |
* The number and characteristics of the revealed microorganism are assessed according to the lower classifications
What is the level of purity of pikhvi
The degree of purity of the penis - the assessment of the quantity and severity of normal, mentally pathogenic and pathogenic microflora and clitinic elements of the penis for additional light microscopy
Evaluation of vaginal microflora according to F.M. Heurlien in 1910 roci,
transferring differentiation to several levels of "pure purity" on the basis of microscopy of smears, Gram-based.
Classical assessment of the purity of the Heurlien fur, 1910
|
steps of purity |
|
| I | gram-positive sticks appear ("Dederlein's sticks", stinks are "vaginal" or "vaginal" sticks) and poor number of squamous cells |
| II | there is a small number of third-party bacteria (cocids) in the presence of gram-positive rods |
| III | overwhelm coca flora, presence of leukocytes in a significant number |
| IV | Dederlein's sticks "practically the same number of days, є in a significant amount" third-party "microflora, the number of leukocytes is also large |
Modified classification of purity grades of fir O. Jirovec, 1948
|
steps of purity |
Clinical and laboratory signs |
| I | Smears of healthy women to clean up epithelial cells and "Dederlein's sticks" |
| II | Non-pyogenic bacterial colpitis: manifestation of numerous non-pyogenic bacteria without leukocytes. |
| III | Putrid bacterial colpitis: manifestation of numerous purulent microorganisms and leukocytes. |
| IV | Gonococcal infections: swabs, yakі stavlyat gonococci. |
| V | Trichomonas infection: a picture of trichomoniasis |
| VI | Thrush (Infection Candida albicans): picture of vaginal mycosis. |
Evaluation of the biocenosis of pikhvi E.F. Kira, 1996.
|
biocenosis |
marks |
nosology |
|
normocenosis |
Dominance of lactobacilli, presence of gram-negative microflora, superechka, mycelium, pseudohyphae, leukocytes, single "pure" epithelial cells. |
Typical camp of a normal pikhvi biotope. |
|
intermediate type |
The number of lactobacilli, the presence of gram-positive cocci, gram-negative rods is insignificant. Leukocytes, macrophages, epithelial cells are seen. |
Often seen in healthy women, rarely accompanied by subjective scars and clinical manifestations. |
|
dysbiosis pikhvi |
Insignificant number, but more often the presence of lactobacilli, lax, polymorphic gram-negative and gram-positive colic and coccal microflora. The presence of "key cells", the number of leukocytes, the variability, the duration or the incompleteness of phagocytosis. Polymicrobial smear pattern. |
Bacterial vaginosis. |
|
There is a large number of leukocytes, macrophages, epithelial cells, expressions of phagocytosis. |
Nonspecific vaginitis. |
|
|
When revealed: gonococci |
gonorrhea |
In modern times, in light medical practice, the term - lactobacillary grading (LBG) is used, as it would show the colonization of the lungs with normal lactobacilli.
Lactobacillary step of pineapple C A Spiegel +1993, Gilbert G G Donders 2000)
|
steps |
morphological picture |
| Lactobacillary morphotypes are most important, with an insignificant number of cocids | |
|
Lactobacillary morphotypes and significant number of cocoa flora, but the number of lactobacilli outweighs the number of cocoa |
|
|
Lactobacillary morphotypes and significant number of cocaceae, but the number of cocids outweighs the number of lactobacilli |
|
|
Presence of coccus-like flora and presence of lactobacilli |
Where can you take away the information
|
|
Report on microbiological diagnosis of opportunistic infections of the psychium (Kmax 2001) Recent text |
