EMERGING DIAGNOSTIC CHALLENGES IN MICROBIOLOGY

Dr.T.V.Rao MD*

Medical Microbiology is a challenging profession deals with all aspects of infection, through initial diagnosis, to treatment. It includes hands on bench work in the laboratory, which is often neglected and close involvement with clinical staff in a variety of acute and community settings to effectively manage infections and ensure effective surveillance and infection prevention and control across the healthcare community.

Unlike many other medical specialities the Microbiology departments are neglected by Governmental and several private Medical colleges. And our younger generation of Microbiologists should adapt to the changing scenario to acquire their space in Medical Profession, which continues to be competitive and driven by commercial interests as well.

Upcoming Microbiologists should realise that no day is the same in medical microbiology practice and each day brings its own challenges and uncertainty. The goal of microbiologic evaluation is to provide accurate, clinically pertinent results in a timely manner.

However optimal utilization of the available resources is the need of the hour, which can be implemented with dedicated practice which include -

1. Scientific sterilization practises will certainly cut short the rate of infection reduce the costs to the hospital and reduces morbidity and mortality. The recent document on Sterilization released by CDC Atlanta with title Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 will clarify all the doubts of practice, including the decreasing role of bio hazardous chemical and use of environmentally safe agents. Fumigation which we practice without knowing its biohazards needs a rethinking. Microbiologists should learn more; educate the Paramedical and Nursing staffs who are our greater partners in infection control.

2. Specimen collection and aseptic precautions in collection is a major concern to valid microbiology reporting, several life threatening septic complications including blood cultures in bacterial infections are contaminated due to lapses in specimen collection. A frequently contaminated blood culture reports losses the confidence of Physicians on Microbiology Departments.

Delayed reports due to ineffective, age old culture methods, certainly a concern to patients and treating physician.

3. Bacteriology departments should be updated, as most of the life threatening infections are bacterial in developing world, effective early diagnosis reduce the cost of antibacterial agents, on many occasions are most costlier than hospital occupancy rates. However it is certainly need of the hour.

Bench work.

Is the most important component of the Diagnostic Microbiology Typical tasks: include logs in sample or specimen noting date, time, and tests to be performed; based on quantitative growth

patterns and effective reporting? A good control on the bench work by Senior Microbiologists keeps everybody under check.

All uncommon isolates should be studied to species level with extended biochemical testing, and will be a boon to publish case reports in good academic journals.

All uncommon isolates should not be reported without the wisdom of the senior Microbiologists.

All upcoming Microbiologists should seek the help of reference centres for assistance and guidance as all we think may not be correct.

4. The diagnostic work on Mycobacteriology and Mycology lags the advances to the growing needs of the physicians. Tuberculosis being a major health problem in the country, yet no dedicated laboratories to diagnose the disease beyond smear examination, and increasing drug resistant tuberculosis is a concern to the treating physician. The attention and dedicated work of the young Microbiologists will certainly supported by everyone. However we certainly need new generation of Microbiologists to take up the Tuberculosis related work.

5. The anaerobic culture work remains least attempted and younger generation of Microbiologists should explore this division of bacteriology as many anaerobes are developing drug resitance.

Reporting the Microbiology Results

Reporting the results should be done with caution as the Physicians are not familiar with what really we mean and matters to be made clear and understandable. The greatest communication gap between clinicians and microbiologists remain with terminology.

Molecular methods is diagnosis of Infectious diseases

The PCR is the most sensitive of the existing rapid methods to detect microbial pathogens in clinical specimens. In particular, when specific pathogens that are difficult to culture in vitro or require a long cultivation period are expected to be present in specimens, the diagnostic value of PCR is known to be significant. However, the application of PCR to clinical specimens has many potential pitfalls due to the susceptibility of PCR to inhibitors, contamination and experimental conditions. It is known that the sensitivity and specificity of a PCR assay is dependent on target genes, primer sequences, which are expensive. However molecular methods are most talked, highly expensive and creating dedicated laboratories continues to be difficult in our economy If modern methods of molecular diagnostics are not implemented we will we out of scene in Modern Medicine.

Computer documentation with use of WHONET

Continuous surveillance of local antimicrobial susceptibility patterns is a must for combating emerging antimicrobial resistance. WHONET is an effective computerized microbiology laboratory data management and analysis program that can provide guidance for empiric therapy of infections, alert clinicians of trends of antimicrobial resistance, guide –the antibiotic policy decisions and preventive measures. The program facilitates sharing of data amongst different hospitals by putting each laboratory data into a common code and file format, which can be merged for national or global collaboration of antimicrobial resistance surveillance. All the documentation can be stored retrieved and analysed with the freely available software from WHO, just needing computer The

program supports routine entry of susceptibility test results performed by disk diffusion, MIC, and/or Etest or by Hi comb method The majority of laboratories in the Armed forces use comparative disc diffusion techniques based on Stokes or Kirby Bauer method to determine antibiotic sensitivity. Interpretation guidelines for most standardized testing methodologies are built into the system.

WHONET working make you familiarise with optimal drug choice, zone sizes, easier to understand in interpretation in precise reporting.

Tele diagnostic services in Infectious Diseases

When a laboratory would like assistance in identifying a parasitic organism, or confirmation of a presumed diagnosis, and they have access to a digital camera, they can use telediagnosis. Tele diagnosis involves email transmission of data, such as digital images captured from samples and clinical and travel history, to CDC. Response to these inquiries can be provided in a matter of minutes to hours.

If you are a Microbiologist or a Pathologist and want to use telediagnosis assistance*, please visit the Diagnostic Assistance section on the DPDx Web site.

Caring for self is equally important

Our health and disease is a concern to us and family member apart from the society. All Bio hazardous micro-organisms and materials to be handled with caution. Be a champion to promote the “Universal Precautions” make the best contributions in prevention of infection in your own working arena.

Publishing your work

Always publish your genuine work in Journals and periodicals; do not get disappointed if you cannot publish in a reputed journal. Now there are good quality on line Microbiology Journals (e-Journals) and periodicals which are indexed and available for your rescue. Every attempt to publish an article makes you realise where we have to improve and by going through good references we can certainly improve ourselves.

Internet and e-learning.

All young and senior professionals should refer the good potential of information high way, the Internet and get the best out it. E-learning should be our next option to know what the world is thinking about. I consider it is the best emerging option for improving our knowledge in Microbiology.

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* Dr.T.V.Rao MD professor of Microbiology Freelance writer