Il6 MEDICAL BACTERIOLOGY 



EXAMINATION OF URINE 



Typhoid bacilli may occur in the urine at times during typhoid fever, in the 

 period of convalescence and occasionally long after recovery, and in carriers, 

 healthy individuals having no history of typhoid fever. Indications for exami- 

 nation of the urine for typhoid bacilli are the occurrence of nephritis or cystitis 

 during the course of typhoid fever or as a sequelae of the disease, before the 

 discharge of patients recovering from typhoid fever and those suspected of being 

 carriers. 



On account of the liability of contamination with colon bacilli, the external 

 genital organs should be thoroughly cleansed before withdrawing urine for 

 examination. The sample should be obtained with a sterile catheter when the 

 bladder is full, and should pass directly from the catheter into a sterile bottle, 

 and be examined without delay. 



Different amounts of urine are planted on the surface of separate plates of 

 Endo's medium from one loopful to several loopsful, and one loopful of the 

 sediment obtained by centrifugalizing 15 cc. of urine. The plants are made by 

 drawing the loop over the medium in the form of the letter Z. 



The plates are incubated at 37C. for 24 hours and then examined for isolated 

 colonies. 



Sterile Endo's medium is colorless or a very faint pink Colonies of typhoid 

 and paratyphoid bacilli do not change the color of the medium and themselves 

 appear colorless or whitish. Colon colonies cause the medium surrounding 

 them to turn red and the colonies may appear colorless or pinkish. If typhoid- 

 like colonies appear on Endo's medium, they are removed with a sterile loop 

 and planted in Dunham's solution, litmus milk, litmus glucose and litmus 

 lactose media. The subcultures are incubated at 37C. for 24 hours and then 

 examined for characteristic changes. 



Colon bacillus infections of the bladder or kidneys are common. In suspected 

 cases the urine is examined by planting on Endo's agar and making subcultures 

 as just described. 



EXAMINATION OF FECES 



Feces always contain large numbers of colon bacilli, which makes isolation 

 of other organisms difficult. 



Typhoid bacilli occur in the feces of typhoid fever patients, some convales- 

 cents, and occasionally for months or years after recovery from typhoid fever. 

 Typhoid bacilli also occur in the feces of carriers. 



Feces should be examined for typhoid bacilli before the discharge of conva- 

 lescent typhoid patients and when a person is suspected of being a carrier. 



The best time to examine feces for typhoid bacilli is immediately after they 

 are expelled from the rectum; attempts made several hours later are usually 

 futile. On account of the great preponderance of colon bacilli in feces it is 

 necessary to first plant the specimen in a medium that will favor the growth of 

 typhoid and paratyphoid bacilli and retard the growth of the colon bacillus. 

 From this primary culture in enriching medium subcultures are made. 



