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Laboratory Tests for Diagnosing Infection

and Identifying Bacterial Agents

Although antibiotics are available

that can destroy a wide spectrum
of organisms, it would be
preferable to use an antibiotic that
can target the specific
microorganism causing the
pneumonia. Researchers, then, are
looking for laboratory tests that
would identify the specific
organism or virus causing the
pneumonia. Unfortunately, people
harbor many bacteria, and sputum
and blood tests are not always
effective in distinguishing
between harmless and harmful
microscopic agents.

In severe cases, physicians particularly need to use invasive diagnostic measures to identify the
infecting agent.

Sputum Tests

A sputum sample coughed from the lungs will yield physical information that will help the
physician determine severity. In addition, only a sputum sample will reveal the infecting

Typically, The physician first asks the patient to cough as deeply as possible to produce an
adequate sputum sample. (A shallow cough produces a sample that usually only contains normal
mouth bacteria.) A person who is not able to cough sufficiently may be asked to inhale a saline
spray that helps produce an adequate sputum sample. In some cases, a tube will be inserted
through the nose down into the lower respiratory tract to induce a deeper cough.

The physician will check the sputum for the following indications:

• Presence of blood (an indication of infection).

• Color and consistency. If the sputum is opaque and colored yellow, green, or brown, then
infection is likely. Clear, white, glistening sputum indicates no infection.
Blood Tests

Blood tests may be used for the following:

• White blood cell count. High levels

indicate infection.

• Blood cultures. They may be performed for

detecting the specific organism causing the
pneumonia, but are not often helpful in
distinguishing harmful from harmless
organisms. They are accurate in only 10% to 30% of cases, and their use should generally
be limited to severe cases.

• Detection of antibodies to S. pneumoniae. Researchers are using specialized techniques

to detect antibodies to S. pneumoniae (immune factors that target specific foreign
invaders), but it is not clear if they are accurate.
• Polymerase Chain Reaction. In some difficult cases, a polymerase chain reaction (PCR)
may be performed. A PCR is able to make multiple copies of the genetic material (the
RNA) of a virus or bacteria

Urine Tests

A urine test (NOW) can detect S. pneumonia within 15 minutes. It may identify up to 77% of
pneumonia cases and may rule out the infection in 98% of patients who do not have S.
pneumonia. It may not be very useful in diagnosing S. pneumoniae as a cause of pneumonia in
children, since the organism is so common anyway in this population, whether they have
pneumonia or not.

Laboratory Tests for Less Common Organisms

If uncommon organisms, such as Legionella, Mycoplasma, and Chlamydia organisms, are

strongly suspected more advanced laboratory tests may be used:

• Specialized techniques can detect antibodies to the organisms in blood samples, but these
antibodies, such as those responding to Mycoplasma or Chlamydia, are not present early
enough in the course of pneumonia to permit prompt diagnosis and treatment.

• A test performed on whole blood samples that uses a technique called polymerase chain
reaction (PCR) is useful for identifying certain atypical strains, including Mycoplasma
and Chlamydiapneumoniae and possibly Haemophilus influenzae type b, but it is

• A urine test can be used to diagnose some cases of Legionnaire’s disease.

• Specialized tests called DNA probes are being developed to detect these organisms in
respiratory secretions.

• In addition, special stains and cultures are required to detect fungal infections

It may reveal the following:

• White areas in the lung called infiltrates, which

indicate infection.
• Complications of pneumonia, including pleural
effusions (fluid around the lungs) and abscesses.
Enzyme-linked immunosorbent assay (ELISA),
also known as an enzyme immunoassay (EIA), is a
biochemical technique used mainly in immunology to
detect the presence of an antibody or an antigen in a
sample. The ELISA has been used as a diagnostic tool
in medicine and plant pathology, as well as a quality
control check in various industries. In simple terms, in
ELISA, an unknown amount of antigen is affixed to a
surface, and then a specific antibody is applied over the surface so that it can bind
to the antigen

TORCH screen
This is a blood test that screens for several infections that may be present in the
newborn, including Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex and
HIV (hence the name), and other infections. Sometimes the test is spelled TORCHS,
where the extra S stands for Syphilis.

Microbiologic Stool Exam

This is a test to determine the presence of a parasite or worm-like infection of the intestine from
stool analysis. Ova refers to the egg stage of the parasite life cycle. Some parasites are single-cell
organisms such as amoeba, Giardia, and Trichomonas, while others have a worm-like

Coombs Test
An agglutination test used to detect proteins and especially antibodies on the surface of red blood

Direct Coombs Test

The direct Coombs' test measures the presence of antibodies on the surface of red blood cells.

Indirect Coombs Test

The indirect Coombs' test measures the presence of antibodies to red blood cells in the blood.

Widal Test, Febrile Serology

The Widal test is used to demonstrate rising titres of antibodies to flagellar (H), somatic (O)
antigens in typhoid and paratyphoid fever.

An increasing O antibody level signifies acute infection, whilst a raised H antibody level may
indicate the serotype of the infecting organism.

Widal's test is of limited use because H and O antibody levels may rise non-specifically due to
cross reactions with other enterobacteriacea.
The interpretation of the serology thus requires consideration of factors such as previous
immunization, the stage of the illness and the effect of any antibiotic treatment, etc. Widal's test
and particularly its interpretation requires an expert.