Why is bacterial culture performed on pathogenic microflora and how to decipher the data. Smear for flora and cytology

In any healthy person, the gastrointestinal tract is inhabited by microorganisms. They do not just live there, but perform their significant roles, helping each other. Normal intestinal microflora contributes to the utilization of cholesterol, the production of vitamins, such as B 12 and K. With the participation of healthy microflora, our immunity is brought up, which prevents pathogenic microflora from multiplying in the intestine. The latter leads to many troubles, various diseases develop in the body, which can bring the patient to an extremely serious condition.

What does pathogenic microflora mean?

The body should not contain more than 1% of the total microbiota of representatives of pathogenic microflora. The growth and development of pathogenic representatives is suppressed by our helpers - beneficial microorganisms that live in the gastrointestinal tract.

Pathogenic microbes that got into the body with unwashed products, with insufficiently thermally processed food, and simply through dirty hands, do not immediately cause diseases. They can safely wait until the immune system is weakened. In this case, they immediately actively multiply, kill beneficial microbes, cause various pathologies in the body, including dysbacteriosis.

In the normal microflora, there are four main microorganisms: bacteroids, bifidobacteria, E. coli and lactic acid bacteria. Normally, pathogenic microflora should be absent. A healthy body is able to fight pathogens and keep them out of your home.

Varieties of pathogenic microflora

Pathogenic microorganisms are divided into two significant groups:

Includes Streptococcus, Escherichia coli, Staphylococcus, Peptococcus, Yersenia, Proteus, Klebsiella, Aspergillus and Candida fungi. They can be constantly present in the body, but manifest themselves with a decrease in resistance.

PF (pathogenic microflora). It is represented by salmonella, vibrio cholerae, clostridium, some strains of staphylococcus aureus. These representatives do not live in the intestines, mucous membranes and tissues on an ongoing basis. Once inside the body, they begin to multiply rapidly. At the same time, beneficial microflora is forced out, pathological processes develop.

UPF representatives

Streptococci and staphylococci are considered the most numerous group of UPF. They are able to penetrate the body through microcracks in the mucous membrane and skin. Cause tonsillitis, stomatitis, purulent inflammation in the mouth, nasopharynx, pneumonia. Spreading with the bloodstream throughout the body, bacteria can lead to the development of rheumatism, meningitis, damage to the heart muscle, urinary tract, and kidneys.

Klebsiela causes severe damage to the intestines, genitourinary and respiratory systems. In severe cases, the meninges are destroyed, meningitis and even sepsis develop, which leads to death. Klebsiella produces a very strong toxin that can destroy beneficial microflora. Treatment is very problematic, since this microorganism does not perceive modern antibiotics. Often premature babies suffer, as they do not yet have their own microflora. Mortal risks from pneumonia, pyelonephritis, meningitis, sepsis are high.

Candida fungi are the culprits of thrush. The mucous membranes of the oral cavity, genitourinary system, and intestines are also affected.

Aspergillus molds settle in the lungs and do not show any symptoms of presence for a long time. Sowing on pathogenic microflora, which is studied in laboratories, helps to detect the presence of certain representatives in the body.

PF representatives

The main ones are pathogenic strains of Escherichia coli, as well as Salmonella. Pathogenic microflora causes intoxication of the body, diarrhea, fever, vomiting, lesions of the mucous membranes of the gastrointestinal tract.

The Clostridium bacterium causes tetanus, gas gangrene, and botulism, which affect the soft tissues and nervous system.

When C. difficile enters the body, the gastrointestinal tract is affected, pseudomembranous colitis begins. C. perfringens type A provokes the development of necrotic enteritis and food poisoning.

Such a terrible disease as cholera is caused by Vibrio cholerae. multiplies rapidly, watery diarrhea appears, severe vomiting, rapid dehydration can be fatal.

To identify these microorganisms, it is necessary to analyze the pathogenic microflora. It will help to quickly establish a diagnosis and begin timely intervention.

Microflora in newborns

Pathogenic human microflora is formed gradually. In a newborn, the gastrointestinal tract is not inhabited by flora, which is why it is so susceptible to infections. Often babies suffer from colic, dysbacteriosis. This happens when the amount of UPF in the intestines is exceeded and their own beneficial microbes cannot cope with them. Treatment should be carried out in a timely manner, correctly: to populate the baby's digestive tract with lacto- and bifidobacteria with the help of drugs. So you can avoid the consequences of dysbacteriosis, reproduction of pathological forms.

Normally, during breastfeeding, beneficial microorganisms enter the baby's body with mother's milk, settle in the intestines, multiply there and carry out their protective functions.

Reasons for the development of PF

Pathogenic intestinal microflora causes many diseases. Doctors identify the main reasons why dysbacteriosis develops:

Unbalanced nutrition. The use of a large amount of proteins, simple carbohydrates leads to the spread of putrefactive phenomena and flatulence. This also includes the excess consumption of preservatives, dyes, pesticides, nitrates.

Prolonged use of antibiotics.

Chemotherapy, exposure to radioactive waves, antiviral drugs, long-term hormone therapy.

Inflammatory processes in the intestines that change the pH, leading to the death of beneficial bacteria.

Chronic and viral infections, in which the production of antibodies decreases (hepatitis, herpes, HIV).

Oncology, diabetes mellitus, pancreatic and liver lesions.

Postponed operations, severe stress, fatigue.

Frequent enemas, bowel cleansing.

The use of spoiled products, non-compliance with hygiene.

The risk group includes newborns, the elderly, and adults with gastrointestinal problems.

Signs of dysbacteriosis

Doctors distinguish four stages in the development of dysbacteriosis. The symptoms for each of them are slightly different. The first two stages usually do not manifest clinically. Only attentive patients can notice a slight weakness of the body, rumbling in the intestines, fatigue, heaviness in the stomach. In the third stage, the following signs are noted:

Diarrhea - manifested as a result of increased intestinal motility. Water absorption functions are impaired. Elderly people, on the contrary, may develop constipation.

Bloating, increased gas formation, fermentation processes. Pain around the navel or in the lower abdomen.

Intoxication (nausea, vomiting, weakness, fever).

At the fourth stage of dysbacteriosis, due to metabolic disorders, the following is observed:

pallor of the skin, mucous membranes;

dry skin;

gingivitis, stomatitis, inflammation in the oral cavity.

To identify the causes of the disease, the doctor during the diagnosis will recommend passing feces for pathogenic microflora. The analysis will provide a complete picture of the disease.

Medical therapy

If a disease is detected, the fault of which is pathogenic microflora, the treatment is prescribed complex. To begin with, the doctor establishes the causes and stage of the disease, then prescribes drug therapy and gives recommendations on nutrition. The following drug groups are used:

Ancient inhabitants of the planet

Bacteria appeared on our planet more than three and a half billion years ago. They survived two ice ages in the history of the planet and continue to successfully evolve today. The classification includes more than a million species of bacteria that live almost everywhere. They are divided into many different groups, but the most interesting for us are enterobacteria. What it is, it is easy to explain - these are our neighbors who share our body and food with us.

Enterobacter family

Representatives of the huge Enterobacteriaceae family live both in the external environment and in the body of animals and humans. In the context of this article, we will consider the genus Enterobacter (pathogenic and opportunistic enterobacteria), which includes 15 species of bacteria. These living creatures are facultative anaerobes (they can do without oxygen) and are considered colimorphic (the environment for enterobacteria is the lower sections of the gastrointestinal tract of all warm-blooded animals and humans).

Features of the structure and life

In appearance, these are sticks with flagella, which serve to move the bacteria. These proteobacteria do not form spores and reproduce by simple division. In the soil and aquatic environment, they are able to remain viable for many months. From disinfectants, they die within a few minutes, and at high temperatures - within an hour. Conditionally pathogenic enterobacteria are natural inhabitants of the intestines of animals. They play an important role in formate fermentation of food products. But among them there are pathogenic and conditionally pathogenic representatives for humans. All of them are gram-negative enterobacteria. What it is will be discussed later.

General information about conditionally pathogenic flora (UPF)

The opportunistic flora includes lactose-negative enterobacteria, clostridia, various cocci, etc. The essence of these microbes is reflected in the name of the group: “opportunistic pathogens”. Normally, they do not cause disturbances. Many of them can even be useful to the body to a certain extent. But when the norm is exceeded and / or the immune defense is ineffective, they can cause serious diseases. Competing with beneficial bacteria, opportunistic flora can become part of the intestinal microbial film and cause functional disorders, inflammatory and allergic diseases.

It is possible that opportunistic flora enters the bloodstream through the intestinal wall and spreads throughout the body (translocation), which is especially dangerous for young children and people with severe immunodeficiencies, in whom these microorganisms can cause various diseases, including life-threatening ones. .

In addition to obligate pathogenic enterobacteria, acute intestinal infections (AII) can be caused by other members of the Enterobacteriaceae family. In the international lexicon, they are usually referred to as opportunists. In the USSR, the term "opportunistic pathogens" became widespread. Also known clostridial OKA. Intestinal infections caused by opportunistic enterobacteria (OPE) are not as widespread as those caused by pathogenic enterobacteria. They are mainly diagnosed and recorded during food outbreaks and as nosocomial infections.

A certain idea of ​​the frequency of spread of the considered infections was obtained as a result of specially performed in 1984-1985. on the instructions of the Russian Ministry of Health for research, in which patients were examined for a wide range of bacterial and some viral intestinal infections. Among the etiologically deciphered acute intestinal infections in children, infections caused by opportunistic enterobacteria accounted for only 4.1%, while in most cases they were due to Klebsiella. This is more than 6 times lower than the proportion of intestinal escherichiosis and shigellosis.

As another source of information on the incidence of acute intestinal infections caused by opportunistic enterobacteria, one can cite the analysis of outbreaks of this etiology registered in the USSR in 1985-1987. During this period, 23 AII outbreaks occurred in the country, the causative agents of which were Klebsiella, Proteus, Enterobacter or Citrobacter; during them 971 people fell ill. At the same time, 13 outbreaks with 684 cases were registered, in which opportunistic enterobacteria were the etiological cause in association with other microorganisms. The proportion of outbreaks of AII caused by UPE was significantly lower than that caused by Shigella or Salmonella. Thus, in 1986 in the USSR, out of the total number of AII outbreaks (154) caused by any representatives of the Enterobacteriaceae family, outbreaks of Shigella etiology accounted for 58.7%, Salmonella etiology - 23.8%, and those caused by opportunistic enterobacteria - only 10.4 %, i.e., almost 6 and 2.5 times less, respectively.

Clostridial acute intestinal infections in the USSR and abroad are more often registered as foodborne diseases. In the USA in 1979, out of the total number of foodborne outbreaks with an established etiology, outbreaks caused by only one type of Clostridium accounted for 18.7% and in 1982 - 15.7%, and in the UK in the period 1970-1979. their share was even higher; 39.4%. In the United States, Clostridium is the third leading cause of foodborne AII (after Salmonella and Staphylococcus aureus).

Opportunistic enterobacteria are also natural inhabitants of the intestines of many animals, including agricultural ones.

Conditionally pathogenic enterobacteria are widespread in nature; their constant presence in the water of open reservoirs, especially Proteus, Enterobacteria and Klebsiella, has been proven. The latter are more common in the plant world than others; they were isolated from potato tubers, lettuce leaves and other plants, from flowers, grains, seeds, sawdust, as well as from soil and wastewater. The vastness of the ecological sphere of Klebsiella is associated with the significant stability of their capsule forms, capable of withstanding various biological and physico-chemical influences, including the effects of disinfectants and high temperatures. This leads to the frequent contamination by Klebsiella of household items, food products, as well as objects of the intrahospital environment.

How to "read" the analysis for dysbacteriosis?

In the form of each analysis for dysbacteriosis there are indicators of microflora, which we will decipher.

Pathogenic enterobacteria

Usually this indicator in the analysis form comes first. This group of microorganisms includes such bacteria that cause acute intestinal infection (Salmonella, Shigella - causative agents of dysentery, causative agents of typhoid fever). The detection of these microorganisms is no longer an indicator of dysbacteriosis, but an indicator of a serious infectious bowel disease.

bifidobacteria

These are the main representatives of the normal intestinal microflora, the number of which in the intestine should be 95 - 99%. Bifidobacteria perform the important job of breaking down, digesting and absorbing various food components, such as carbohydrates; they themselves synthesize vitamins, and also contribute to their absorption from food; with the participation of bifidobacteria, iron, calcium and other important trace elements are absorbed in the intestine; bifidobacteria stimulate the motility of the intestinal wall and contribute to the normal emptying of the intestine; bifidobacteria neutralize various toxic substances that enter the intestine from the outside or are formed as a result of the vital activity of putrefactive microorganisms. The analysis form indicates the titer of bifidobacteria, which must be at least 10 7 - 10 9 . A significant decrease in the number of bifidobacteria is always a sign of severe dysbacteriosis.

Lactobacilli (lactobacilli, lactic acid bacteria, lactic acid streptococci)

The second representative (5% in the total of intestinal microorganisms) and the most important representative of the normal flora. Lactobacilli or lactic acid microbes, as their name suggests, produce lactic acid, an essential component for normal bowel function. Lactobacilli provide anti-allergic protection, promote normal bowel movements, produce highly active lactase, an enzyme that breaks down milk sugar (lactose). In the analysis, their number should be at least 10 6 - 10 7 . Deficiency of lactobacilli can lead to the development of allergic diseases, constipation, lactase deficiency.

Escherichia coli with normal enzymatic activity (escherichia)

It should be noted that the bacteria of the normal intestinal flora live by attaching to the intestinal wall and forming a film that covers the intestine from the inside. Through this film, all absorption in the intestine occurs. Bacteria of normal intestinal microflora together provide 50-80% of all digestion, and also perform protective (including anti-allergic) functions, neutralize the action of foreign and putrefactive bacteria, promote bowel movement, provide adaptation to nutrition and to external influences.

Escherichia coli with reduced enzymatic activity

This is an inferior E. coli, which does not pose any harm, but does not perform its beneficial functions. The presence of this indicator in the analysis is a sign of incipient dysbacteriosis, as well as a decrease in the total number of Escherichia coli can be an indirect sign of the presence of worms or protozoa in the intestine.

Some assays describe bacteroids whose role is unclear, but known to be non-harmful bacteria, usually their number is of no practical importance.

All other indicators of microflora are conditionally pathogenic flora. The very term “opportunistic pathogenic” denotes the essence of these microbes. They become pathogenic (violating the normal functions of the intestine) under certain conditions: an increase in their absolute number or percentage of normal flora, with the ineffectiveness of protective mechanisms or a decrease in the function of the immune system.

Conditionally pathogenic flora - these are lactose-negative enterobacteria (Klebsiella, Proteus, citrobacters, enterobacters, hafnia, serrations), hemolyzing Escherichia coli and various cocci (enterococci, epidermal or saprophytic staphylococci, Staphylococcus aureus). In addition, opportunistic pathogens include clostridia, which are not sown in all laboratories.

Conditionally pathogenic flora is introduced, competing with beneficial bacteria, into the microbial film of the intestine, colonizes the intestinal wall and causes disruption of the entire gastrointestinal tract. Intestinal dysbacteriosis with a high content of opportunistic flora may be accompanied by allergic skin reactions, stool disorders (constipation, diarrhea, greens and mucus in the feces), abdominal pain, bloating, regurgitation, vomiting. In this case, usually the body temperature does not rise.

Coccal forms in the total amount of microbes

The most harmless representatives of conditionally pathogenic flora are enterococci. They are most often found in the intestines of healthy people, their number up to 25% does not pose a threat to health. If the amount exceeds 25% (more than 10 7), this is most often associated with a decrease in normal flora. In rare cases, an increase in the number of enterococci is the main cause of dysfunction associated with dysbacteriosis.

Epidermal (or saprophytic) staphylococcus aureus (S. epidermidis, S. saprophyticus)

These types of staphylococci can cause disturbances, but their number up to 25% is acceptable. Even among the relatively harmless cocci named above, more pathogenic cocci can occur, which is indicated in this position. If the total number of cocci is, for example, 16%, and the percentage of hemolytic cocci is 50%, this means that half of the 16% are more harmful cocci, and their percentage in relation to the normal flora is 8%.

Staphylococcus aureus (S. aureus)

One of the most unpleasant (along with hemolyzing Escherichia coli, Proteus and Klebsiella) representatives of conditionally pathogenic flora. Even small amounts of it can cause pronounced clinical manifestations, especially in children during the first months of life. Therefore, usually in the norms given in the analysis form, it is indicated that it should not be (in fact, quantities not exceeding 10 3 are acceptable).

The pathogenicity of Staphylococcus aureus directly depends on the state of the normal flora: the more bifidobacteria, lactobacilli and normal E. coli, the less harm from staphylococcus. Its presence in the intestines can lead to allergic reactions, pustular skin rashes, and intestinal dysfunction. Staphylococci are common environmental microbes, in particular, they live in large numbers on the skin and mucous membranes of the upper respiratory tract.

They can pass to the baby through breast milk. Weakened children are most susceptible to infection with staphylococci (problem pregnancy, prematurity, caesarean section, artificial feeding, use of antibiotics - risk factors for weakening the immune system). It is important to understand that staphylococci, like other opportunistic bacteria, manifest themselves under certain conditions, the main of which is a weakening of the immune system, therefore, immunocorrective therapy is important in the treatment of dysbacteriosis associated with staphylococcus aureus.

Hemolysing Escherichia coli

It is a representative of lactose-negative enterobacteria, but stands out separately due to its prevalence and significance. Normally, it should be absent. Almost everything said about Staphylococcus aureus applies to this microbe. That is, it can cause allergic and intestinal problems, is very common in the environment (although it is almost never found in breast milk), causes problems in weakened children, and requires immunocorrection.

It should be noted that the term "hemolysing" does not mean that there is any effect on the blood. Conditionally pathogenic flora in dysbacteriosis should not overcome the intestinal wall and enter the bloodstream. This is possible only with extremely pronounced forms of dysbacteriosis in children with severe immunodeficiencies, which, as a rule, pose a threat to life. Fortunately, such conditions are rare.

lactose-negative enterobacteria

A large group of opportunistic bacteria of a greater or lesser degree of pathogenicity. Their number should not exceed 5% (or in credits: 10 3 - 10 6 - a moderate increase, more than 10 6 - a significant increase). The most unpleasant bacteria from this group are Proteus (most often associated with constipation) and Klebsiella (they are direct antagonists (competitors) of lactobacilli, which leads to the development of allergies and constipation, as well as manifestations of lactase deficiency).

Mushrooms of the genus Candida

Permissible presence up to 10 4 . An increase in this parameter may be after the use of antibiotics. If the number of fungi is increased, and the amount of normal intestinal flora is sharply reduced, while candidiasis (thrush) of the visible mucous membranes (oral cavity, genitals) is noted - these are manifestations of systemic candidiasis, that is, there is an infection with intestinal fungi. If the number of fungi in the analysis for dysbacteriosis is increased, but there is no decrease in the normal intestinal flora, this indicates that the fungi live on the skin around the anus, and not in the intestines, in this case external therapy using antifungal ointments or creams is sufficient.

Clostridia

Due to technical difficulties and little practical importance, not all laboratories determine it. Permissible quantity up to 10 7 . They usually show pathogenicity in combination with other opportunistic flora, rarely cause problems in isolation (most often - liquefaction of the stool, diarrhea). Their number depends on the function of local intestinal immunity.

Other microorganisms

This parameter describes rare species of bacteria, the most dangerous of which is Pseudomonas aerugenosa (Pseudomonas aerugenosa). Most often, the microorganisms described in this position of analysis are of no practical importance.

How to quickly recover from an infection?

The treatment regimen for poisoning is made by a doctor individually for each patient.

To recover faster from an intestinal infection, they usually use:

• means replenishing the reserves of liquid and ions;
• enterosorbents;
• enzyme preparations.

Step 1. We replenish the loss of electrolytes

The main danger in case of poisoning is the development of dehydration. To prevent this, even during the recovery period, it is recommended to drink more fluids and take special drugs that compensate for the loss of vital potassium and sodium ions. One of these drugs is Regidron.

Powder Regidron is diluted in 1 liter. boiled water at room temperature. Drink the resulting solution should be 1-2 tbsp. l. every 10-15 minutes until diarrhea and vomiting completely stop. If there is no medicine at hand, you can prepare a simple saline solution yourself. Take:

Dissolve sugar, salt and soda in 1 liter of boiled water and take according to the scheme above.

Step 2. Remove toxins from the body

Sorbents are drugs that act in the intestines like a sponge, collecting toxins and removing them from the body. The most popular sorbent is activated carbon. You can use it or choose more modern drugs:

Step 3. Helping digestion

Enzyme preparations are designed to digest food that enters the body. They help to "unload" the inflamed intestines in the first days after poisoning. It is worth taking them in the case when the appetite has recovered, and the patient returns to his usual diet. The use of enzymes in the complex treatment of poisoning allows you to quickly get in shape.

In the body there is a large number of bacteria that are with a person in various relationships. A significant part of the microflora is represented by microorganisms that coexist on the basis of symbiosis with humans. In other words, a large mass of microbes from a person benefits. These bacteria at the same time themselves benefit by breaking down proteins, synthesizing vitamins, and competing with pathogens.

Conditionally pathogenic microorganisms of the gastrointestinal tract are fighting for their existence, so their generation develops resistance to normal flora. Bifido and lactobacilli produce in the process of life substances that are similar in their action to antibiotics. Also, the body itself, thanks to its immune system, inhibits the reproduction of harmful bacteria. Tobacco smoking and alcohol intake, physical activity, nervous stress, physiological imperfections of the lymphatic system, age-related changes, various diseases - all this disrupts the normal balance of the microflora of the gastrointestinal tract. The nature of emptiness does not tolerate and beneficial bacteria that have died are replaced by conditionally pathogenic bacteria. From this point on, dysbacteriosis and dysbiosis develop. Each person's normoflora is individual in its composition. This also applies to conditionally pathogenic microflora. Almost all Enterobacteriaceae are opportunistic pathogens of the gastrointestinal tract. This includes Enterobacter, Klebsiella pneumonia.

Non-hemolytic forms of staphylococcus constantly live in the intestines from the family of staphylococci, whose number normally reaches ten thousand microorganisms per cal. Hemolytic forms in the intestine, in a normal state, should not be. A very large number of bacteroids from UPM is found in the large intestine. These bacteria are involved in fat metabolism. But their number should not go beyond 109 units. Also in the intestines you can find a small number of streptococci, which, in addition to hostile properties, also carry a payload in the human body - they stimulate the production of immunoglobulins and actively suppress pathogenic bacteria.

Representatives of the normoflora include microorganisms that can lead to intestinal dysfunction. That is, these bacteria are opportunistic, but their beneficial properties prevail over pathogenic properties.

Mushrooms belonging to the genus Candida, which are present in large numbers in the environment, have also taken root in the gastrointestinal tract.

Representatives of the conditionally pathogenic microflora of the gastrointestinal tract include those that quite rarely can lead to illness. These include fusobacteria and veillonella. Their localization is limited to the oral cavity. But if they enter the intestines, they can lead to various inflammations.

Unlike Fusobacteria and Veillonella, Helicobacter pylori has been well studied. He got a lot of attention. Peptic ulcer of the stomach, which is of an infectious nature, gastritis, is associated primarily with Helicobacter pylori.

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Analysis of feces for dysbacteriosis is a biological method for the quantitative assessment of beneficial and conditionally pathogenic intestinal microflora.

In different laboratories, the form of the test sheet may vary. Most often this refers to the order in which the bacteria are arranged.

The main representatives of the beneficial intestinal microflora:

• bifidobacteria
• lactobacilli
• Escherichia coli (E. coli) with normal enzymatic activity.

These are the most numerous representatives of the normal flora of the large intestine.

Opportunistic pathogens intestines:

• Klebsiella, Proteus, Citrobacter, Enterobacter, Pseudomonas aeruginosa, Hemolyzing Escherichia coli, Yersinia, Candida.
• epidermal and saprophytic staphylococci, Staphylococcus aureus, streptococci.
• clostridia.

The term “opportunistic” means that, while in the intestines, they usually do no harm. However, under certain conditions, they become pathogenic and cause intestinal disorders. This can happen in case of an increase in their absolute number or number in relation to the normal flora, as well as in violation of the function of the immune system.

Pathogenic microorganisms:

This group includes bacteria that cause acute intestinal infections: Salmonella, Shigella, Yersinia.

Analysis of feces for dysbacteriosis is normal

In the absence of any microorganism, the term "abs" or "not found" may be used.

Leukocytes in a smear in the vast majority of cases are a sign of an inflammatory process in the organs of the urogenital tract, both female and male. However, a rare man, especially at a young age, can “boast” that he had a smear taken if everything is in order with the genitourinary system. For men, smears do not belong to mandatory tests during medical examinations. Another thing is women. Probably, those do not exist, which, at least once a year, are not subjected to such manipulations. And this is in the absence of pathology, but if there are problems, then smears are taken as needed.

Norm and pathology

The material from the male urethra is normally not abundant. Solitary leukocytes, transitional epithelium in a smear, single rods - that's all that a healthy man can provide us. The appearance of a large number of leukocytes in a smear of the stronger sex, as a rule, is accompanied by the presence of the culprits of inflammation(, yeast-like fungi of the genus, etc.), which is treated, and then the analysis is taken again to ensure the success of the measures taken.

As for women, an increased number of leukocytes is observed before menstruation and is considered an absolutely natural phenomenon. In addition, the elevated content itself (the norm is up to 30 cells in the field of view) does not apply to reliable indicators, the absence of morphological signs of these cells is considered evidence of the norm of leukocytes. They are “calm”, not destroyed (the nuclei are preserved), there are no signs of phagocytosis. In addition, sometimes the reason for the error of the diagnostician may be incorrectly taken material. An example is a “thick” smear, which is practically not visible due to the fact that the entire field is dotted with clusters of overlapping cells (including leukocytes). Without risking a mistake, in such cases, the woman is offered to take the test again.

Table: Norms for smear results for women

V - material from the vagina, C - cervical canal (cervix), U - urethra

Flora and cytology - what is their difference?

If in men the analysis is taken only from the urethra, then in women there are more objects of study: urethra, vagina, cervix, cervical canal. True, sometimes they take an aspirate from the uterine cavity and also make smears, but this is considered a biopsy material that is viewed by a cytologist. He also draws a conclusion. Aspirates are not taken during routine examinations, this analysis is used exclusively for diagnostic purposes to detect cancerous and precancerous diseases of the main reproductive organ in women. In addition, if the aspirate is filled with formalin, and then applied to the slides and painted, a histological preparation will be obtained, which is considered the last resort in the diagnosis of malignant neoplasms.

Probably, many have heard the expressions: “a smear for flora”, “a smear for cytology”. What does all of this mean? How are they similar and how are they different?

The fact is that in a smear on the flora at high magnification with immersion, the doctor can count the cells, detect trichomonas, yeast, diplococci, gardnerella and other microorganisms, representing a rich biocenosis of the female genital area. But he will not be able to determine the morphological changes in the epithelium, since these are different areas of laboratory diagnostics, where cytology occupies a separate niche. The study of the cellular composition of some material requires, in addition to certain knowledge, also special training. The study of pathological changes in the cell and nucleus theoretically gives very little, here, as they say, a trained eye is needed.

The doctor is engaged in deciphering the analysis in both cases (flora and cytology), we only have to slightly familiarize ourselves with some concepts so that when faced with a similar problem, we do not get scared and do not panic.

Cytological examination

The tasks and functions of cytology are much broader, and therefore its possibilities are wider. The doctor examining the material focuses on the state of epithelial cells in order to identify pathological processes (inflammation, dysplasia, malignant neoplasms) and at the same time notes the flora. Most often, the vaginal portion of the cervix, represented by stratified (four-layer) squamous epithelium (SPE) and the cervical canal, is subject to research. With a correctly taken smear from the cervical canal in the cytological preparation, at the norm, the prismatic (cylindrical) epithelium, single leukocytes and depleted microflora, which could come from the underlying sections (from the vagina, for example), are clearly visible.

It should be noted that the cytological preparation is more informative, since the method of staining (according to Romanovsky-Giemsa, Pappenheim or Papanicolaou) gives a clearer picture. Cells are viewed first at low magnification to assess the general state of the preparation, and then at high magnification (with immersion) in order to consider not only the epithelium itself, but also changes in the nucleus characteristic of a particular disease. In a word, the cytologist sees the flora, inflammation, and in most cases its cause and changes that this inflammatory process entailed. As well as indicative signs of infections that present particular difficulties in diagnosis, precancerous and neoplastic conditions of the epithelium.

Video: about a smear for oncocytology

Indirect signs of some STIs in cytology

As for the smear for STIs, it is desirable to examine it as a cytological preparation. A smear taken on the flora and stained with methylene blue is the most important, affordable and cheap, and therefore the most common diagnostic method in gynecology. However, unfortunately, it does not provide the necessary completeness of the picture for the diagnostic search for STDs and their consequences.

In addition to all the possible inhabitants that, when infected or disturbed, are visible in a smear on the flora (Trichomonas, yeast, leptothrix), indirect signs of the presence of microorganisms can be found in the test material (cytology), which are very problematic to identify using microscopic methods:

• The appearance of giant multinucleated MPE cells, sometimes of a rather bizarre shape, often with signs of parakeratosis and hyperkeratosis (keratinization), indicates a possible lesion;
• Cells in the form of an "owl's eye" with coarse-grained cytoplasm are characteristic of;
• When it is possible to detect koilocytic atypia (MPE cells with large nuclei and an area of ​​enlightenment around the nucleus);
• Indicative are the bodies of Provachek in the cells of metaplastic epithelium, which are characteristic of and play an important role in screening studies.

Of course, it is impossible to diagnose a herpetic, cytomegalovirus or papillomavirus infection with a cytological analysis, but it can be assumed, and this is already the basis for a further, more in-depth examination in a specific direction (, etc.). Thus, cytology allows you to narrow the range of diagnostic search, avoid unnecessary tests, save time, and promptly start treatment.

How to prepare for the analysis?

Since the simplest and most accessible method for detecting inflammatory processes in the urogenital tract, both in men and women, is a smear on the flora, it is necessary to pay more attention to it and teach the reader to understand a little about the entries on the form.

However, before making a visit to the doctor, Patients should know some simple rules:

1. A couple of days before the test, it is necessary to exclude not only sexual contacts (sometimes spermatozoa can be seen in a female smear), but also all sorts of interventions such as douching, the use of local medications (suppositories, creams, tablets);
2. You should not go for such a study during menstruation, because menstrual blood will interfere with viewing the drug, where the doctor will see it mainly;
3. On the day of the examination, you need to calculate the time so that you urinate for the last time in 2-3 hours, since urine can wash out all the “information”;
4. 7-10 days before the analysis, stop taking pharmaceuticals, especially antibacterial ones, or take a smear only a week after the end of treatment;
5. Another rule that women often ignore is not to use intimate hygiene products. Of course, it is very difficult to refrain from such procedures in general, as experts recommend, but at least you can limit yourself to clean warm water. Men, on the other hand, carry out the last toilet of the external genital organs in the evening on the eve of visiting the doctor.

After following these tips, a person goes to an appointment, where they will take a smear, paint and look under a microscope. The doctor will take care of the decoding, and the patient will receive a conclusion in his hands, and he will probably be interested to know what all these numbers and words mean.

Video: preparing for a smear

What can be seen in a male urethral smear?

Probably, the reader has guessed that the analysis of men is unlikely to leave pleasant memories, because the object of study is not so accessible to them, so there will really be unpleasant sensations that may not leave the person for several more hours. Sometimes, in order to avoid this, the doctor prescribes a prostate massage to the patient, which is carried out a few days before the procedure per rectum, that is, through the rectum.

However, if the burning sensation and soreness in the penis continues to remind of itself for several days, and these phenomena have also been added similar to, a trip to the doctor is inevitable. But if everything went well, then maybe men will be reassured by the fact that everything looks much simpler in their smear taken from the urethra, unless, of course, normal analysis:

• The norm of leukocytes is up to 5 cells in the field of view;
• The flora is made up of single sticks;
• The general background dilutes the urethral epithelium (mostly transitional) - approximately 5-7 (up to 10) cells;
• A small amount of mucus, which does not play any role;
• Sometimes a smear may contain opportunistic flora in single specimens (streptococci, staphylococci, enterococci), however, in order to differentiate it, it is necessary to stain the smear according to Gram.

In the case of an inflammatory process, the smear changes:

1. A large number of leukocytes appear in the smear, sometimes not countable;
2. Coccal or cocco-bacillary flora displaces rod;
3. The preparation contains microbes that caused inflammation (trichomonas, gonococci, yeast, etc.);
4. It is hardly possible to see microorganisms such as chlamydia, urea- and mycoplasmas under a microscope, just like distinguishing pathogenic diplococci that cause gonorrhea from enterococci lying in pairs or a chain of Enterococcus faecalis (enterococci too) from streptococci, therefore, in such cases, to clarify the species pathogen, the study is supplemented by a cultural method or the almost universal and popular nowadays PCR (polymerase chain reaction);
5. With rare exceptions, in a man's smear, you can find E. coli (a flagrant violation of hygiene rules!), Beneficial in the intestines, but causing cystitis, getting into the urethra of a man. For its differentiation, additional laboratory research methods are also needed.

They do the same with female smears, since the found diplococci may not be Neisseria at all and do not cause gonorrhea. By the way, E. coli (Escherichia coli), enterococcus (Enterococcus faecalis), staphylococci with streptococci and other microorganisms in female smears are much more common, due to the structure of the female genital organs.

Ecosystem of the female urogenital tract

Leukocytes in a smear taken in gynecology, even for flora, even for cytology, are not the only cells present in the preparation. In addition, they act only as a consequence or reaction to events occurring in the ecosystem (hormonal fluctuations, inflammation). For example, their increase in different phases of the cycle is due to hormonal influence, therefore, when taking material, the date of the last menstruation is indicated in the referral form.

The diagnostic criterion of the inflammatory process is considered not only a large amount of Le, "escaping" to the place of "military operations", but also the state of their nuclei. When leukocytes react, they try to absorb the “enemy”, phagocytize, but they themselves begin to break down. Destroyed cells are called neutrophilic leukocytes, however, this phenomenon is not indicated in the decoding of the analysis. A large number of neutrophilic leukocytes, together with abundant cocco-bacillary or coccal flora, serves as the basis for confirming the presence of an inflammatory process.

The ecosystem of the female genital organs includes microorganisms that occupy certain niches, which are: the epithelium of the vagina, cervix, cervical canal, rich in endocervical glands. These anatomical formations provide conditions for the vital activity of certain microorganisms. Some of the inhabitants are mandatory (obligate), while others come from outside due to certain circumstances and cause various inflammatory reactions of the epithelium.

In addition, the balance in the ecosystem can be disturbed various factors, negatively affecting the body of a woman (both internal and external), which lead to the fact that microbes living in small quantities begin to displace natural inhabitants representing rod flora and occupy a dominant position. An example of this is the colonization of the vaginal environment with gardnerella, which for a number of reasons displaces lactobacilli (Doderlein sticks). The result of such a "war" is widely known.

The norm in a gynecological smear

The microscopic creatures that live in the genital tract of a woman are diverse, but the norms still exist, although sometimes it is very difficult to determine their boundaries, but we will still try to do it. Thus, in a smear taken in gynecology, you can find:

• Leukocytes, the norm of which in the urethra is up to 10 cells per field of view, in the cervix and its canal - up to 30 cells. During pregnancy, these indicators change upwards;
• The type of epithelium in the smear depends on the place where the material was taken: the urethra, the neck, the vagina are lined with stratified squamous epithelium (SSE), which we will get in the preparation. A smear from the cervical canal will be represented by a cylindrical (prismatic) epithelium. The number of cells changes in different phases of the cycle; in general, it is generally accepted that, at the norm, their content should not exceed 10 units. However, all this is very conditional, since for accurate diagnosis it is necessary to take into account morphological changes in cellular structures(nucleus, cytoplasm, the presence of "naked nuclei"), that is, to conduct a cytological analysis;
• Mucus in the preparation is considered an obligatory, but moderate, component, because the glands of the cervical canal and vagina secrete it. The mucus looks interesting in the ovulatory phase of the menstrual cycle, it crystallizes and forms patterns similar to the leaves of a plant, which is called the "fern symptom" (cytology);
• A normal smear, as a rule, is represented by rod flora (lactobacilli) and single cocci.

Conditionally pathogenic flora is not always the norm

In addition to lactobacilli - the main representatives of the normal microflora of the genital tract, which are entrusted with the important function of "self-purification of the vaginal environment", other opportunistic microorganisms can be found in a smear in small quantities:

All these representatives of the microflora can live without disturbing anyone, or cause inflammation under certain conditions. By the way, even lactobacilli in excess and in abundant bacterial flora can provoke an inflammatory process - lactobacillus, manifested by itching, burning, discharge. The disease, of course, is not fatal, but very painful.

Pathogenic "guests"

The presence of pathogenic microorganisms, transmitted mainly through sexual contact, almost always causes trouble. Local inflammation caused by the pathogen can spread to other organs and systems and (often) become chronic if not treated in time.

This phenomenon is especially dangerous during pregnancy, since many pathogens can have a very negative effect on the fetus, so a bad smear during pregnancy is a guide to action, moreover, immediate. What microorganisms can threaten the human reproductive system through sexual transmission? Probably, we will not surprise anyone by naming them, but once again it still does not hurt to recall the danger posed by microscopic creatures.

gonococcus - the causative agent of gonorrhea

Thus, the pathogenic microflora of the genital tract includes:

What is the degree of purity?

A smear for the degree of purity of the vagina is taken as a regular smear for the flora, but is evaluated somewhat differently. In gynecology, the IV degree of purity is distinguished:

I degree- a rather rare phenomenon, the smear is clean, only rod flora, single leukocytes and squamous epithelial cells in optimal quantities;

II degree- among the sticks, single cocci can “slip” or other non-pathogenic microorganisms can also be mixed in single copies, this degree is the most common among gynecologically healthy women;

table: standards for assessing the cleanliness of the vagina

III degree- it is characterized by conditionally pathogenic flora and yeast-like fungi, which tend to actively reproduce. This may indicate the development of an inflammatory reaction to the presence of an excessive number of opportunistic microorganisms. This analysis involves an additional examination of the woman;

IV degree- signs of an obvious inflammatory process: abundant coccal or cocco-bacillary (mixed) flora, the presence of Trichomonas, gonococci or other pathogenic microorganisms is possible. In such cases, additional laboratory tests (bacteriological, PCR, etc.) are prescribed to search for the pathogen and further treatment.

A smear on the flora, although it is considered a simple method, but has great potential. The first step in the laboratory diagnosis of diseases of the urogenital tract, sometimes, immediately solves the problem and allows you to immediately begin therapeutic measures, the quality of which will subsequently be controlled by the smear itself, therefore it is not recommended to avoid such an accessible procedure. It does not require a lot of expenses, and the answer will not have to wait long.