Dr.T.V.Rao MD
In the past we are all identified as Bacteriologists and doing the work related to culturing few
bacteria an...
women; with a few exceptions, these represent bacteria that are indigenous to the urethra and
periurethral region. Infecti...
The responsibility of the microbiology laboratory includes not only microbial detection and isolation
but also the determi...
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Be a competent medical microbiologist


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Be a competent medical microbiologist

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Be a competent medical microbiologist

  1. 1. Dr.T.V.Rao MD In the past we are all identified as Bacteriologists and doing the work related to culturing few bacteria and our teachers were committed to the Profession and teaching was their real capability. There was lot of silence in Microbiology after the elimination of Smallpox in 1978 matters went in many directions after the pandemic of AIDS, Diagnostic Microbiology picked up with fear of AIDS, and we learnt to identify many opportunistic infections and we searched books, Internet to improve our capabilities, most of thesis written after 90’s have some element of Opportunistic Infections, I was always committed to my Diagnostic work as many neglect and think bench work is for technicians, I wish to state the power of Diagnostics I learnt from Late, Dr.CSV Subramanian our Chief of Diagnostics at Apollo Hospitals Chennai, who used to take a frozen section in Histopathology at the Age of 70 years, and I Leant my strengths and weakness working is dedicated environment , I changed several Institution todays many Professor and many senior Microbiologists have become arm chair Microbiologists, rarely do anything, avoid the work and keep themselves safe with authority, However with the raise of many Institutes once again the Microbiology has become a competitive profession, Many dedicated post graduates are once again to change the face of Microbiology Microbiologists need both theoretical knowledge and laboratory skills for their work with viruses, bacteria and other invisible organisms. Many work in scientific research and development or for pharmaceutical companies, government or universities. Today we have many opportunities to thrive and improve the standards in Diagnostic Microbiology. Still the Many private medical colleges and even the public run Institutions lack the work culture, and one needs a degree of MD and one should be below 70 years to be recognised as professor competent to train the students, this has created lot of setbacks, improving the Department's, many seniors are protecting their job and really compromising the interests of the department and colleagues. To survive the younger generation to be competitive as Employers look for applicants with hands-on laboratory experience for microbiology positions at every level. I think new generation of Microbiologist must have a plan of action to improve the talents which is more difficult than said I wish the students can improve the career with following objectives with more systematic approaches in organization of their knowledge .Some infectious diseases are distinctive enough to be identified clinically. Most pathogens, however, can cause a wide spectrum of clinical syndromes in humans. With the demands for evidence based Medicine we have a more prominent role than in the past. Microbiologic Examination In many instances, the cause of an infection is confirmed by isolating and culturing microorganism either in artificial media or in a living host Direct Examination and Techniques: Direct examination of specimens reveals gross pathology. Just have a look at the specimens which have arrived in the department not necessarily everything but at random. We get many times saliva spitted for culturing of sputum and identification AFB to rule out Tuberculosis, just make your observation at least 25 % of the specimens are not fit for processing, however we all compromise with many principles of Diagnostic Microbiology, however If senior professors take interest it can never be corrected .Never forget Microscopy is the most rapid method of Diagnosis in Bacteriology and Parasitology and Mycology in spite of so many advances, just remember to plan good thing with effective Media we have in the laboratory, never forget we have 4- 5 routine media, if we are logical we do many wonders. The number of bacteria in specimens may be used to define the presence of infection. For example, there may be small numbers (≤ 103 CFU/ml) of bacteria in clean-catch, midstream urine specimens from normal, healthy
  2. 2. women; with a few exceptions, these represent bacteria that are indigenous to the urethra and periurethral region. Infection of the bladder (cystitis) or kidney is usually accompanied by bacteraemia of about ≥ 104 CFU/ml. For this reason, quantitative cultures of urine must always be performed.Many laboratories work with Human discarded blood in many developing countries it needs the real wisdom and knowledge of the practising Microbiologist to interpret matter, when you are in look back to clinicians what they write on the request paper It is still a luck to work with sheep blood, and many times we do not grow the bacteria in abundance to qualify to the expected and peer reviewed counts in many Microbiology textbooks due to many compromises. Many working in good institutes have capacities to use modern methods may identify microorganisms. Immunofluorescence, immunoperoxidase staining, and other immunoassays may detect specific microbial antigens. Genetic probes RT PCR newer emerging methods to identify genus- or species- specific DNA or RNA sequences. Culture: Isolation of infectious agents some microorganisms, such as Shigella dysenteriae, salmonella spp Mycobacterium tuberculosis, Coccidioides immitis, are always considered clinically significant. Others that ordinarily are harmless components of the indigenous flora of the skin and mucous membranes or that are common in the environment may or may not be clinically significant, depending on the specimen source from which they are isolated. Frequently requires specialized media. I still remember the worthy words of my teacher that the worth of post-graduation lies to identify a pathogen from commensals, and many inexperienced Microbiologists are more happy to isolate rather than probability of pathogenicity, this is how many Medical Microbiology laboratories spoiling the advantages of Diagnostic microbiology and testing commensals for Antibiotic sensitivity pattern, I think however Indian Antibiotic policy will have no progress unless there is some innovation on diagnostic microbiology and pharmaceutical industry Non Selective (non inhibitory) media permit the growth of many microorganisms. Selective media contain inhibitory substances that permit the isolation of specific types of microorganisms. And we have to improve the quality of reporting investing in many differential Media, Automation is like a rapid computer with many errors, and do not forget we qualified medical microbiologists are the soul of the quality of the services and do not ascertain your role, If we are dependent on technicians and leave the laboratories your technicians will become the masters of the game, and we will be silent spectators to many errors. Microbial Identification: Colony and cellular morphology may permit preliminary identification. Growth characteristics under various conditions, utilization of carbohydrates and other substrates, enzymatic activity, immunoassays, and genetic probes are also used.in many advancing laboratories. Serodiagnosis: A high or rising titer of specific IgG antibodies or the presence of specific IgM antibodies may suggest or confirm a diagnosis. And most the serology is turned into Rapid diagnostic test, however it needs a check and quality issues. The matters in do not improve their knowledge in infectious diseases and rationalistic use of Antibiotics Physicians must also consider that the composition of microbial species on the skin and mucous membranes may be altered by disease, administration of antibiotics, endotracheal or gastric intubation, and the hospital environment. For example, potentially pathogenic bacteria can often be cultured from the pharynx of seriously ill, debilitated patients in the intensive care unit, but may not cause infection. Never forget every isolate is not causative agent, it is along way if the seniors take interest in bench work and spend few hours in the diagnostic laboratories the Microbiology will improve for benefit of many deserving patients. Antimicrobial Susceptibility
  3. 3. The responsibility of the microbiology laboratory includes not only microbial detection and isolation but also the determination of microbial susceptibility to antimicrobial agents. Many bacteria, in particular, have unpredictable susceptibilities to antimicrobial agents, and their susceptibilities can be measured in vitro to help guide the selection of the most appropriate antimicrobial agent. I found that WHONET continues to be best in systemic approach for better quality for now the event and audit our own results. Today many Medical Microbiologists claim to be Clinical Microbiologists, however we should set right our laboratory reporting before we imagine to be a Clinical Microbiologists. Dr.T.V.Rao MD Professor of Microbiology Freelance writer