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Data entry is a huge bottleneck in our facility when it comes to testing. Entering the patient information, reporting location, and testing requested into the laboratory system probably takes the most amount of hands on time in the entire process.
Of course, patient care should come first, not seeing how many requisitions you can enter, and we have always harped on stopping and double checking your entry before moving on. Missing a test or sending results to the wrong location affects quality of care in many ways (there was once a report from anatomical pathology indicating that a patient had cancer that we could not find the correct physician to send the report to for about a week. The result was a delay in their treatment, leaving the patient knee deep in suspense over their results, and breaching their health privacy since the report went to the wrong location the first time.)
Missing tests, however, is a larger concern than reporting, and you’ll understand if you’ve ever seen some of the requisitions physicians make for us. This one time, microbiology missed a request for an extra plate for a gonococcal culture from a patient’s throat swab. It was noticed too late for the swab to be replanted and she needed a recollect. The unfortunate part is she was a sexual assault patient and it was a terrible thing to put her through more.
A mixed blessing was that the physician had the sense to start her on antibiotics after the first swab was taken, but that meant that on the recollect, the bug would not grow either way and in the end, we never knew the result on that patient.
The video is of phagocytosis of Shigella sp bacteria.
I had a coworker who was serotyping someone’s positive stool. They ended up getting it on their hand and didn’t wash well enough. Shigella has a very low infectious dose (about 10-200 bacteria) and serotyping uses incredibly concentrated suspensions. So… she got shigellosis and basically spent the week on the toilet with diarrhea while holding a bucket for her vomit.
SEM of fibroblast cells infected by the herpes simplex virus. Fibroblasts are normally long and star-shaped. The HSV2 infected the cells 24 hours earlier, causing them to shrink and become rounded. HSV2 is a DNA-containing virus that causes genital herpes, an important sexually- transmitted disease.
I have a friend who is a virologist and was doing work with adenovirus at one point. Once, he held up a tube after ultracentrifuging a tube to purify the virus and a drop of it had splashed into his eye (and that is why you wear goggles).
He went down into emergency (after flushing at the eyewash station) and the first thing they asked was, “It’s not Herpes Simplex is it?” because herpes keratitis is the leading cause of adult blindness in North America. He didn’t go blind because it was adeno, but it was a ferocious case of conjunctivitis regardless. Ironically, he now researches HSV.
Brucella sp (tiny Gram negative coccobacilli) gram stain.
As part of our proficiency testing, accrediting bodies send us mystery samples to identify. In paper, they tell us they’re typical specimens, but in practice, they are always incredibly difficult to work through!
This one time, we were super stumped on this one organism. Everyone was smelling the plates (as an aside, “smell” the plates but don’t smell them, that’s dangerous) and throwing test after test at it. We had all of our microbiologists and a good chunk of the staff standing around huming and hawing over this and sniffing it for about a week.
We eventually realized it was Brucella abortus which should have been sent to the Level 3 lab and safely sealed away from day one when that indole didn’t go positive… any of the 6 times we did it.
Only one person got sick with it which is pretty impressive but still terrible.
Larval Echinococcus granulosus, light micrograph.
Let’s do another story.
There was a cancer patient who had one day, in the middle of her chemo, discovered a mass in her breast. Thinking this was a tumor, the doctors decided to go in and do a biopsy. The surgeon cut just a little bit below the mass, expecting to do a regular biopsy, when a hydatid cyst full of tiny dog tapeworm larvae explodes out of the incision. The surgeon freaks out and sucks most of them up but manages to save enough to send to the lab to make a diagnosis.
What the heck? Let’s look into the history.
Not too long ago, her dog had died of unexplained seizures (no autopsy). Turns out, she had been in Aruba not too long ago and one of the two got infected and passed it on. When she went onto chemotherapy, it knocked out her immune system enough that the parasite began to flourish.
Not really lab medicine, but still ultra cool. A team of scientists created the one-of-a-kind advertisements to promote director Steven Soderbergh’s film Contagion.
Using 35 strains of bacteria and fungi, a team of 25 microbiologists and immunologists tested different strains of bacteria to see which would work best at creating a message that would slowly grow into letters making up the film’s name. It should continue to grow until the message was illegible, much like an out of control disease.
Vaginal smear showing bacterial vaginosis.
I am fine with making that diagnosis on smears alone, which is how it is done. But I have always thought the name was very odd. Where Vaginal Bacteriosis is “a vagina with lots of bacteria”, bacterial vaginosis is just… bacteria with lots of vaginas. Which is weird.
Trichomonas vaginalis, the causative agent of trichomoniasis, which is more common than you might expect!
In our micro department, when you work nights, your whole shift is basically looking at genital smears. This is not a very exciting shift so a very bored someone (not me) took a wet mount positive slide and put iodine at one end of the coverslip. She then watched the advancing iodine front as it made all the jiggling trich seize up and die what looked like a painful death on contact.
Moraxella lacunata, direct gram smear.
The last time I saw these was on an eye infection. These guys have a pretty distinct shape on the smear, but mostly I find it neat that they pit the media.
It goes without saying that they will also make pits in your eyeball if you get them there.
Light micrograph of adult intestinal blood flukes, Schistosoma mansoni. The adults (male thick & bluish, female white & threadlike) normally live in pairs in blood vessels of the small intestine, causing dysentery & diarrhoea. Their spiked eggs cause anaemia, inflammation & tissue scarring. The brown pigmentation is a blood meal.
After picking up a leaky urine that was submitted for schistosomiasis testing, I have officially reached that point in my life where things that are wet and are not supposed to be wet will gross me out because they remind me of my daily pile of leaky containers.