Experts In Microbiology Research Articles

The microbiology laboratory's role in response to bioterrorism.

○ Context.-Bioterrorism has existed since before the 14th century; however, the specter of such an attack is much greater today than ever before. Technical expertise in microbiology and molecular testing, combined with the rapidity of worldwide air travel, has ensured that no geographic area would be untouched in a widespread attack. Clinical microbiology laboratories will play a pivotal role in the detection of attacks involving weapons of mass destruction. Objective.-To identify and discuss the microorganisms most likely to be used as agents of bioterrorism. Data Sources.-Data were obtained from literature searches from 1997 through June 2001 using the subject headings of bioterrorism, biological weapons, biological warfare, anthrax, brucellosis, tularemia, smallpox, plague, and botulism. In addition, information was obtained from publications of the Center for Civilian Studies, Johns Hopkins University, the Centers for Disease Control and Prevention, American Society for Microbiology, and the United States Army Medical Research Institute of Infectious Diseases. Data Extraction and Synthesis.-Findings obtained from these studies and publications were analyzed for the most likely microorganisms that would be involved in a bioterrorist attack and the most efficient means by which they could be identified. In all instances, the guidelines from the Centers for Disease Control and Prevention for Level A laboratories were observed. Conclusions.-The most likely microorganisms to be utilized as biological weapons include Bacillus anthracis (anthrax), Brucella species (brucellosis), Clostridium botulinum (botulism), Francisella tularensis (tularemia), Yersinia pestis (plague), and variola major (smallpox). While knowledge of the potential of these microorganisms is critical, clinical microbiologists and medical technologists possess the basic tools to rule out the suspected pathogens or to refer these isolates to public health laboratories for identification and susceptibility testing.

The microbiology laboratory's role in response to bioterrorism.

Bioterrorism has existed since before the 14th century; however, the specter of such an attack is much greater today than ever before. Technical expertise in microbiology and molecular testing, combined with the rapidity of worldwide air travel, has ensured that no geographic area would be untouched in a widespread attack. Clinical microbiology laboratories will play a pivotal role in the detection of attacks involving weapons of mass destruction. To identify and discuss the microorganisms most likely to be used as agents of bioterrorism. Data were obtained from literature searches from 1997 through June 2001 using the subject headings of bioterrorism, biological weapons, biological warfare, anthrax, brucellosis, tularemia, smallpox, plague, and botulism. In addition, information was obtained from publications of the Center for Civilian Studies, Johns Hopkins University, the Centers for Disease Control and Prevention, American Society for Microbiology, and the United States Army Medical Research Institute of Infectious Diseases. Findings obtained from these studies and publications were analyzed for the most likely microorganisms that would be involved in a bioterrorist attack and the most efficient means by which they could be identified. In all instances, the guidelines from the Centers for Disease Control and Prevention for Level A laboratories were observed. The most likely microorganisms to be utilized as biological weapons include Bacillus anthracis (anthrax), Brucella species (brucellosis), Clostridium botulinum (botulism), Francisella tularensis (tularemia), Yersinia pestis (plague), and variola major (smallpox). While knowledge of the potential of these microorganisms is critical, clinical microbiologists and medical technologists possess the basic tools to rule out the suspected pathogens or to refer these isolates to public health laboratories for identification and susceptibility testing.

Infection control in Danish healthcare: organization and practice

Medical care, including treatment in hospital, is a highly esteemed public service free of charge to the Danish population. Less than 1% of hospitals are private (exclusive of Psychiatry). Managed care and insurance companies play no important role in the organization of healthcare, and choice of doctor and hospital is free. All public hospitals have enrolled in the national infection control programme and maintain a high standard of hygiene. The importance of infection control is recognized and open to public scrutiny. The present organization and infection control programme was drafted in 1975 by the National Board of Health (NBH),1 placing decentralized functions at county level with the county administrations and national functions with Statens Serum Institut (SSI). The National Centre for Hospital Hygiene (NCHH) at SSI opened in 1977, with the aim of introducing a modern concept of surveillance and infection control.2 Presently the NCHH staff comprises seven or eight persons including two infection control nurses (ICN) and two medically qualified microbiologists. Its annual budget is around £350 000 financed by the Ministry of Health. NCHH was deliberately placed at SSI, which is a Research and Development institution with epidemiological and microbiological expertise and close relations with Danish healthcare. It has proved a great advantage to be part of this respected and efficient scientific organization. The national organization of infection control is illustrated in Figure 1.

Role of clinical microbiology laboratories in the management and control of infectious diseases and the delivery of health care.

Modern medicine has led to dramatic changes in infectious diseases practice. Vaccination and antibiotic therapy have benefited millions of persons. However, constrained resources now threaten our ability to adequately manage threats of infectious diseases by placing clinical microbiology services and expertise distant from the patient and their infectious diseases physician. Continuing in such a direction threatens quality of laboratory results, timeliness of diagnosis, appropriateness of treatment, effective communication, reduction of health care-associated infections, advances in infectious diseases practice, and training of future practitioners. Microbiology laboratories are the first lines of defense for detection of new antibiotic resistance, outbreaks of foodborne infection, and a possible bioterrorism event. Maintaining high-quality clinical microbiology laboratories on the site of the institution that they serve is the current best approach for managing today's problems of emerging infectious diseases and antimicrobial agent resistance by providing good patient care outcomes that actually save money.

Introducing the Fifth Edition of theCanadian Tuberculosis Standards

The fifth and latest edition of the Canadian Tuberculosis Standards is now available through the offices of the Canadian Lung Association (CLA), and the individual provincial and territorial lung associations. Since the publication of the last edition of the Canadian Tuberculosis Standards (1) of the CLA and Canadian Thoracic Society (CTS), there has been renewed interest in the global resurgence of tuberculosis. In Canada, the epidemiology of tuberculosis reflects the many important challenges for tuberculosis control: an increasing proportion, now 64%, of all patients with tuberculosis in Canada are born outside Canada; there has been limited success in reducing the incidence of tuberculosis among aboriginal peoples, particularly in western Canada and the Territories; and tuberculosis-human immunodeficiency virus coinfection and drug resistance are growing problems. As a result, there has been increasing collaboration between the various tuberculosis stakeholders in the country including the provincial and territorial tuberculosis control programs, Health Canada, Citizenship and Immigration Canada and the CLA/CTS. It is altogether fitting, therefore, that the fifth edition of the Canadian Tuberculosis Standards has been coproduced by the CLA/CTS and the Division of Tuberculosis Prevention and Control at the Centre for Infectious Disease Prevention and Control, Health Canada. Some may ask, why a fifth edition of the Standards in such close succession to the fourth, published in 1996? Perhaps the best answer is the need to prepare ourselves in the new millennium to better respond to two major tuberculosis elimination initiatives: a National Tuberculosis Elimination Strategy issued by Medical Services Branch, Health Canada in 1992, with the aim of eliminating tuberculosis in First Nations peoples by the year 2010; and a National Consensus Conference on Tuberculosis, such as the one held in 1997, sponsored by Health Canada, at which there was agreement by conference participants on an interim elimination goal of a 5% reduction in the number of tuberculosis cases in Canada each year. Historically, the Canadian medical and public health communities have had a genuine interest in tuberculosis, with many notable persons and organizations having made significant regional, national and international contributions in the field. The fifth edition of the Standards draws upon a cross-section of current Canadian epidemiological, medical microbiological, respirological, infectious disease and public health expertise in tuberculosis (see appended Table of

Report of the xenotransplantation advisory committee of the international society for heart and lung transplantation:: The present status of xenotransplantation and its potential role in the treatment of end-stage cardiac and pulmonary diseases

An urgent and steadily increasing need exists world-wide for a greater supply of donor thoracic organs. Xenotransplantation offers the possibility of an unlimited supply of hearts and lungs that could be available electively when required. However, anti-body- mediated mechanisms cause the rejection of pig organs transplanted into non-human primates, and these mechanisms provide major immunologic barriers that have not yet been overcome. Having reviewed the literature on xenotransplantation, we present a number of conclusions on its present status with regard to thoracic organs, and we make a number of recommendations relating to eventual clinical trials. Although pig hearts have functioned in heterotopic sites in non-human primates for periods of several weeks, median survival of orthotopically transplanted hearts is currently ,1 month. No transplanted pig lung has functioned for even 24 hours. Current experimental results indicate that a clinical trial would be premature. A potential risk exists, hitherto undetermined, of transferring infectious organisms along with the donor pig organ to the recipient, and possibly to other members of the community. A clinical trial of xeno-transplantation should not be undertaken until experts in microbiology and the relevant regulatory authorities consider this risk to be minimal. A clinical trial should be considered when approximately 60% survival of life-supporting pig organs in non-human primates has been achieved for a minimum of 3 months, with at least 10 animals surviving for this minimum period. Furthermore, evidence should suggest that longer survival (.6 months) can be achieved. These results should be achieved in the absence of life-threatening complications caused by the immunosuppressive regimen used. The relationship between the presence of anti-HLA antibody and anti-pig antibody and their cross-reactivity, and the outcome of pig-organ xenotransplantation in recipients previously sensitized to HLA antigens require further investigation. We recommend that the patients who initially enter into a clinical trial of cardiac xenotransplantation be unacceptable for allotransplantation, or acceptable for allotransplantation but unlikely to survive until a human cadaveric organ becomes available, and in whom mechanical assist-device bridging is not possible. National bodies that have wide-reaching government-backed control over all aspects of the trials should regulate the initial clinical trial and all subsequent clinical xenotransplantation procedures for the foreseeable future. We recommend coordination and monitoring of these trials through an international body, such as the International Society for Heart and Lung Transplantation, and setting up a registry to record and widely disperse the results of these trials. Xenotransplantation has the potential to solve the problem of donor-organ supply, and therefore research in this field should be actively encouraged and supported.

THE INTRODUCTION TO COMMERCIAL FLORICULTURE OF RECALCITRANT AUSTRALIAN NATIVE PLANTS

The strategy for introduction used in our program relies on collaboration with a commercial partner and market research. Our aim is to identify commercially desirable Australian native species that have not yet been introduced into floricultural markets because they are difficult to propagate or grow. Species are collected and preliminary studies on the ecology, distribution and growth cycle are conducted. The barriers to propagation or production are identified and strategies to overcome the barriers devised. Several species are investigated at the same time to reduce risk and to increase the likelihood of synergistic discovery. The team consists of several University and commercial members with expertise in propagation, horticulture, breeding, pathology and microbiology. This paper will illustrate the research being done with various species, show the continuum from exploration to the market place, and how this approach differs to that described by Armitage, 1998.

The Tools of Environmental Litigation Support: How Environmental Litigation Support Teams Employ a Unique Set of Skills and Tools to Improve the Outcome and Reduce the Cost of Legal Disputes

While the primary goal of environmental investigations is to assess and clean up contaminated properties, significant efforts are also directed towards resolving various matters in legal dispute. Opposing parties often disagree about the cause and timing of contamination and the associated liability and costs for meeting regulatory site closure requirements. Environmental experts are often needed to help resolve such legal disputes with expertise in hydrogeology, toxicology, microbiology, chemistry, engineering, and process safety. These experts, or teams of experts, provide technical approaches to determine the liability and cost apportionment amongst the various potentially responsible parties. Fate and transport models, environmental forensics, and risk assessment help to answer the issues in dispute. Skillful communication of these technical findings is needed to present conclusions to audiences that do not necessarily have technical backgrounds.

New Trends in Food Microbiology: an AOAC INTERNATIONAL Perspective

Abstract The paper discusses 5 major trends in food microbiology from an AOAC INTERNATIONAL perspective. The first trend, and perhaps the one with the greatest impact on food microbiology during the past 10 years, is the introduction of the rapid test kit. The development of these kits is a result of attempts to expedite, simplify, miniaturize, and automate methods. The second trend is the introduction of new method validation programs. AOAC INTERNATIONAL offers 2 alternatives to method validation by collaborative study: the Test Kit Performance Tested Method Program and the Peer-Verified Method Program. The third trend is the increasing use of microbiological reference materials. Applications of reference materials and of certified reference materials is addressed. The fourth trend is the evolving international character of not just AOAC INTERNATIONAL but other recognized scientific organizations as well. An attempt at method harmonization is one important consequence of this evolving internationalism. Moreover, there is a growing trend toward sharing of microbiological expertise on a global scale, reflecting our ever-shrinking geographical differences. The fifth trend is the implementation and increasing use of the Hazard Analysis Critical Control Point (HACCP) concept. The nature of the HACCP program and its influence on microbiological testing of the finished product are described.

Evaluation of a commercial enzyme immunoassay (EHEC-Tek) for detecting Escherichia coliO157 in beef and beef products

A commercial enzyme immunoassay system (EHEC-Tek) was compared with immunomagnetic separation followed by culture to cefixime–tellurite–sorbitol MacConkey agar (IMS/C) for detectingEscherichia coli O157 in artificially inoculated beef samples and naturally contaminated beefburgers. The EHEC-Tek assay used modifiedE. coli broth supplemented with novobiocin (mECn) as a primary enrichment medium, followed by immunomagnetic separation, secondary enrichment of magnetic beads in tryptone soya broth supplemented with acriflavine, followed by a standard monoclonal antibody-based immunoassay to detect O157 antigen. Twelve diverse strains ofE. coli O157 were used to inoculate samples of minced beef in triplicate at each of three different concentrations (50, 5 and 0.5 cfu 25 g −1). When the 108 samples of minced beef were examined, there was complete agreement between EHEC-Tek and IMS/C on 87 samples. Ten samples were positive only by IMS/C and 11 samples were positive only by EHEC-Tek, such discrepant results occurring mainly at lower inoculum levels; of the latter 11, eight were confirmed culturally as containing E. coli O157. Five beefburgers naturally contaminated withE. coli O157 atc . 2 g −1were negative by both EHEC-Tek and IMS/C after primary enrichment in mECn, but when the primary enrichment medium was buffered peptone water supplemented with vancomycin, cefixime and cefsulodin (BPW-VCC) E. coli O157 was detected in four out of five samples by EHEC-Tek and five out of five samples by IMS/C. The EHEC-Tek immunoassay is a technically simple and sensitive method for detectingE. coli O157 in beef, and requires a minimum of microbiological expertise for its performance: the assay is improved by use of BPW-VCC in place of mECn as the primary enrichment medium.

Northwick Park infection Consultation Service Part II. Contribution of the service to patient management: An analysis of results between September 1987 and July 1990

The establishment of Infectious Disease teams combining microbiological and clinical expertise has recently been recommended by a joint working part of the Royal College of Physicians and the Royal College of Pathologists. The Northwick Park Infection Consultation Service (ICS) has been operating on these lines since 1983; details are given in Part I. Part II assesses the contribution that the ICS has made to the management of infection in a study of 1038 patients undertaken between September 1987 and July 1990. The areas of patient diagnosis, treatment, investigation and isolation were examined to assess the appropriateness of the attending doctor's management of infection and the benefits resulting from recommendations made by the ICS. At the time of consultation the correct diagnosis had already been made or considered in 93% of patients, essential investigations needed to confirm or refute the diagnosis performed in 92%, and side-room isolation correctly instituted in 81% of patients requiring it. However, 41% of 776 infected patients were receiving suboptimal treatment: this was significantly more frequent in unsolicited consultations (P less than 0.05). Advice was given following consultation in 893 of 1038 patients (86%) and related to treatment (66%), investigation (41%), diagnosis (30%) and patient isolation (4%). Of 844 patients where receipt of advice could be accurately assessed, it was taken fully in 708 (84%), partly in III (13%), and went unheeded in 25 (3%). Advice on diagnosis or investigation enabled the correct diagnosis to be reached in 30% of consultations and in a further 47 patients (5%), the diagnosis was proposed by the ICS on initial consultation.(ABSTRACT TRUNCATED AT 250 WORDS)

Training of personnel for infection control.

The overall objectives for implementing an infection control program are to make hospital personnel aware of nosocomial infections and to educate these persons in their role in decreasing the risk of these infections. The infection control practitioner (ICP) implements these objectives by performing surveillance to determine problem areas and by developing policies and procedures that prevent and control nosocomial infections. Appropriate qualities for an ICP include initiative, leadership, communication skills, commitment, and charisma. Expertise in patient care practices, aseptic principles, sterilization practices, education, research, epidemiology, microbiology, infectious diseases, and psychology are acquired skills. Local, state, and national organizations, as well as universities, are responsible for ICP training, In the US the Centers for Disease Control have established a training program for the beginning ICP and the Association of Practitioners in Infection Control (APIC) has developed a study guide for developing infection control skills. The ultimate responsibility for education is an individual obligation, however. Certification of the ICP would insure a minimum level of knowledge, thereby standardizing and upgrading the practice of infection control.

MICROBIOLOGICAL CRITERIA IN USDA REGULATORY PROGRAMS FOR MEAT AND POULTRY

Whereas food agencies must consider the consumer first, the expertise in microbiology lies instead in the universities, the government, and the industry. Scientists should make a point of showing businessmen many of the aspects of microbiological control that would show an economic advantage. Control of contamination and time-temperature abuse can be related indirectly to health hazard. Control of microbial level maintains natural food flavors. Low microbial level increases the shelf life of chilled products to a marked degree.The Consumer Protection Programs of the Consumer and Marketing Service (C&MS) have many microbiological control procedures built into them: General sanitation, separation of cooked from raw products, requirement for a midshift clean-up (with a bacteriological monitoring system as an alternative), cooking requirements, and labeling requirements. A recent development is the decision to extend microbiological control to the use of microbiological criteria.Microbiological criteria can be applied in three ways: first, by picking a figure out of the air. This is, of course, the bad way; second, by determining the general microbiological level in foods in commerce without regard to the effect of processing (this is a better way) and, third, (the best) by determining what is good manufacturing practice and then determining the microbial levels associated therewith. When a microbiological criterion is established, methods for sampling and analysis should be specified. The data both for establishment of microbiological criteria and for establishment of acceptability of given lots should be statistically significant; therefore, it is necessary to know the natural variation of levels of microbial groups within various commodities. As technology improves, it may often be necessary to re-evaluate any criteria in use. If microbiological criteria require drastic changes in an entire industry, they should be applied with great discretion to avoid seriously damaging the industry. On the other hand, those that require changes in the less satisfactory segments of an otherwise satisfactory industry could be applied more promptly.Consumer and Marketing Service policy on microbiology criteria was reported in detail in the December 20, 1968, issue of the Federal Register. Our group has recently published the Microbiology Laboratory Guidebook, which is available on request.Heating, adding a chemical, canning, or even freezing could be used to reduce microbial levels to meet a microbiological standard, but this is not satisfactory to the Consumer and Marketing Service.