EMERGING DIAGNOSTIC CHALLENGES IN MICROBIOLOGY

1. Medical Microbiologyisachallengingprofessiondealswithall aspectsof infection,throughinitial
diagnosis,totreatment.Itincludeshandsonbenchworkinthe laboratory,whichisoftenneglected
and close involvementwithclinical staff inavarietyof acute and communitysettingstoeffectively
manage infectionsandensure effective surveillance andinfectionpreventionandcontrol acrossthe
healthcare community.
Unlike manyothermedical specialitiesthe Microbiologydepartmentsare neglectedby
Governmental andseveral private Medical colleges.Andouryoungergenerationof Microbiologists
shouldadaptto the changingscenarioto acquire theirspace inMedical Profession,whichcontinues
to be competitive anddrivenbycommercialinterestsaswell.
UpcomingMicrobiologistsshouldrealise thatnodayis the same inmedical microbiologypractice
and eachday bringsitsownchallengesanduncertainty. The goal of microbiologicevaluationisto
provide accurate,clinicallypertinentresultsinatimelymanner.
Howeveroptimal utilizationof the available resourcesisthe needof the hour,whichcanbe
implementedwithdedicatedpractice whichinclude -
1. Scientificsterilizationpractiseswill certainlycutshortthe rate of infectionreduce the coststothe
hospital andreducesmorbidityandmortality.The recentdocumentonSterilizationreleasedbyCDC
Atlantawithtitle GuidelineforDisinfectionandSterilizationinHealthcare Facilities, 2008 will clarify
all the doubtsof practice,includingthe decreasingrole of biohazardouschemicalanduse of
environmentallysafe agents.Fumigationwhichwe practice withoutknowingitsbiohazardsneedsa
rethinking.Microbiologistsshouldlearnmore; educatethe ParamedicalandNursingstaffswhoare
our greaterpartnersininfectioncontrol.
2. Specimencollectionandasepticprecautionsincollectionisamajorconcernto validmicrobiology
reporting,several lifethreateningsepticcomplicationsincludingbloodculturesinbacterial
infectionsare contaminateddue tolapsesinspecimencollection.A frequentlycontaminatedblood
culture reportslossesthe confidence of PhysiciansonMicrobiologyDepartments.
Delayedreportsdue toineffective,age oldculture methods,certainlyaconcerntopatientsand
treatingphysician.
3. Bacteriologydepartmentsshouldbe updated,asmostof the life threatening infectionsare
bacterial indevelopingworld,effectiveearlydiagnosisreduce the costof antibacterial agents,on
manyoccasionsare mostcostlierthanhospital occupancyrates.Howeveritiscertainlyneedof the
hour.
Benchwork.
Is the mostimportantcomponentof the DiagnosticMicrobiologyTypical tasks:include logsin
sample orspecimennotingdate,time,andteststobe performed;basedonquantitative growth

2. patternsand effective reporting? A goodcontrol on the benchwork bySeniorMicrobiologistskeeps
everybodyundercheck.
All uncommonisolatesshouldbe studiedtospecieslevel withextendedbiochemical testing,andwill
be a boonto publishcase reportsingoodacademicjournals.
All uncommonisolatesshouldnotbe reportedwithoutthe wisdomof the seniorMicrobiologists.
All upcomingMicrobiologistsshouldseekthe helpof reference centresforassistance andguidance
as all we thinkmay notbe correct.
4. The diagnosticworkonMycobacteriologyandMycologylagsthe advancesto the growingneeds
of the physicians. Tuberculosisbeingamajorhealthprobleminthe country,yetnodedicated
laboratoriestodiagnose the disease beyondsmearexamination,andincreasingdrugresistant
tuberculosisisaconcernto the treatingphysician.The attentionanddedicatedworkof the young
Microbiologistswill certainlysupportedbyeveryone. Howeverwe certainlyneednew generationof
Microbiologiststotake upthe Tuberculosisrelatedwork.
5. The anaerobicculture workremainsleastattemptedandyoungergenerationof Microbiologists
shouldexplorethisdivisionof bacteriologyasmanyanaerobes are developingdrugresitance.
Reportingthe MicrobiologyResults
Reportingthe resultsshouldbe done withcautionasthe Physiciansare notfamiliarwithwhatreally
we meanand mattersto be made clear andunderstandable.The greatestcommunicationgap
betweencliniciansandmicrobiologistsremainwithterminology.
Molecularmethodsisdiagnosisof Infectiousdiseases
The PCR is the mostsensitive of the existingrapidmethodstodetectmicrobialpathogensinclinical
specimens.Inparticular,whenspecificpathogensthatare difficulttoculture invitroorrequire a
longcultivationperiodare expectedtobe presentinspecimens,the diagnosticvalue of PCRis
knownto be significant.However,the applicationof PCRtoclinical specimenshasmanypotential
pitfallsdue tothe susceptibilityof PCRtoinhibitors,contaminationandexperimental conditions. It
isknownthat the sensitivityandspecificityof aPCRassay isdependentontargetgenes,primer
sequences,whichare expensive.Howevermolecular methodsare mosttalked,highlyexpensive and
creatingdedicatedlaboratoriescontinuestobe difficultinoureconomyIf modernmethodsof
moleculardiagnosticsare notimplementedwe will we outof scene inModernMedicine.
Computerdocumentationwithuse of WHONET
Continuoussurveillance of local antimicrobial susceptibilitypatternsisamustfor combating
emergingantimicrobial resistance.WHONETisan effective computerizedmicrobiologylaboratory
data managementandanalysisprogramthatcan provide guidance forempirictherapyof infections,
alertcliniciansof trendsof antimicrobialresistance,guide –the antibioticpolicydecisionsand
preventivemeasures.The programfacilitatessharingof dataamongstdifferenthospitalsbyputting
each laboratorydataintoa commoncode and file format,whichcanbe mergedfornational or
global collaborationof antimicrobialresistance surveillance.Allthe documentationcanbe stored
retrievedandanalysedwiththe freelyavailablesoftware fromWHO,justneedingcomputerThe

3. program supportsroutine entryof susceptibilitytestresultsperformedbydiskdiffusion,MIC,
and/orEtest or byHi comb methodThe majorityof laboratoriesinthe Armedforcesuse
comparative discdiffusiontechniquesbasedonStokesorKirbyBauermethodtodetermine
antibioticsensitivity.Interpretationguidelinesformoststandardizedtestingmethodologiesare built
intothe system.
WHONET workingmake youfamiliarise withoptimal drugchoice,zone sizes,easiertounderstandin
interpretationinprecise reporting.
Tele diagnosticservicesinInfectiousDiseases
Whena laboratorywouldlike assistance inidentifyingaparasiticorganism, orconfirmationof a
presumeddiagnosis,andtheyhave accesstoa digital camera,theycan use telediagnosis.Tele
diagnosisinvolvesemail transmissionof data,suchas digital imagescapturedfromsamplesand
clinical andtravel history,toCDC.Response tothese inquiriescanbe providedinamatterof
minutestohours.
If you are a Microbiologist ora Pathologistandwanttouse telediagnosisassistance*,please visitthe
DiagnosticAssistance sectiononthe DPDx Website.
Caringfor self isequallyimportant
Our healthanddisease isaconcern to usand familymemberapartfromthe society.All Bio
hazardousmicro-organismsandmaterialstobe handledwithcaution.Be achampionto promote
the “Universal Precautions”make the bestcontributionsinpreventionof infectioninyourown
workingarena.
Publishingyourwork
Alwayspublishyourgenuine workinJournalsandperiodicals;donotgetdisappointedif youcannot
publishinareputedjournal.Nowthere are goodqualityonline MicrobiologyJournals(e-Journals)
and periodicalswhichare indexedandavailable foryourrescue.Everyattempttopublishanarticle
makesyourealise where we have toimprove andbygoingthroughgoodreferenceswe cancertainly
improve ourselves.
Internetande-learning.
All youngandseniorprofessionalsshouldreferthe goodpotential of informationhighway,the
Internetandgetthe bestout it.E-learningshouldbe ournextoptiontoknow whatthe worldis
thinkingabout.Iconsideritisthe bestemergingoptionforimprovingourknowledge in
Microbiology.
Article availableonwww.ariclesbase.com
* Dr.T.V.RaoMD professorof MicrobiologyFreelance writer