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Microbiology |
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About Department:
The Microbiology laboratory is basically engaged in clinical and diagnostic work in infectious disease as a support for patient care services. This is one of the few Microbiology Laboratories in the country, which offers round the clock services.
- 15 Lab Investigators are posted on 3 shifts. - Faculty and Clinical Registrars are on duty till 8 PM and on call between 8 pm to 8 am.
The entire staff, including Lab Investigators, works in unison to achieve the three vital characteristics of any good laboratory practice, i.e. Accuracy, Precision & Timeliness. Today we can proudly announce that the Microbiology Laboratory at NIMS is one among the few labs in AP that offers reliable and reproducible quality reports.
The various divisions - Bacteriology (aerobic & anaerobic), Mycobacteriology, Mycology, Parasitology and Serology, are identified separately and manned by qualified Laboratory personnel. Each division is supervised by at least two Medical Microbiologists, with rotation once a year among them. All investigations are performed as per standard guidelines using Standard Operating Manuals in every division of the lab. All the protocols are referred to the Clinical Microbiology Practical Handbook (ASM, USA) and NCCLS guidelines. This not only helps in improving and maintaining the work quality but also allows each and everyone to get acquainted and master all the techniques that are being performed in the Lab. These manuals are updated regularly with newer techniques and test assays being added to the diagnostic armamentarium. Over the years since inception, there has been a steady increase in the number of tests that are being performed in the Microbiology lab.
The Microbiology lab is one of the first few departments to computerize all the data and other information generated, including the inventory, in the lab since 1992. All the reports are generated and maintained using a Fox base program. Efforts are being made to develop a windows based program that would be more users friendly and as per the International recommendations.
Faculty : 1. Professor & Head Dr.V.Lakshmi
2. Associate Professors Dr.Vijay.D.Teja.
3. Asst.Professors Dr.P.Uma Bala Dr.K. Anuradha Non -Medical faculty: Associate Professor Dr.M.A.Patil.
Residents:
1. Dr.V.V.Shailaja Senior Resident 2. Dr.Nikhat Sheerin Senior Resident
Supporting Staff:
I. Technical Staff:
1. A.Srinivas 2. B.Aparna 3. C.Padmasri 4. D.Bharat Bhushan 5. Gopal Rao 6. K.Aparna Jyothsna 7. K.S.R.K.Prasad 8. K.Subhada 9. M.Neeraja 10. Rajesh Naidu 11. D.V.S.Sarma 12. Sudha Rani
II. Record Assistants: 1. Shameem Begum 2. Sreenu Prashanth
II. Personal Secretary: S.Syamala
III. Apprentice Trainees: 1. Asrar 2. Sri Sudha 3. Sandhya
Courses Offered:
TRAINING AND TEACHING PROGRAMS
The faculty and the Senior Registrars are regularly involved in conducting Microbiology lectures and demonstrations for the students of various courses not only in the Institute but also in other Institutions in Hyderabad. Several interactive and teaching sessions take place with the other Departments of the Institute.
Training Programs
1. The Department conducted a training program for VCTC lab investigators and Medical Officers between 26th July – 5th August –2005 at NIMS, Hyderabad. 2. The Department conducted a Training Program for all the Medical Officers and Lab Technicians involved in the IX HIV sentinel surveillance on 26th and 27th July 2005 at NIMS, Hyderabad. 3. The Department conducted training on field logistics and sample collection for the field personnel involved in the SRS project under the Global Health Research.
Post Graduate Teaching Programs
- Pathology - Nephrology - Medicine
Major state of art equipment:
LIST OF NEW EQUIPMENT ACQUIRED IN 2005
Specialized Procedures:
TESTS PERFORMED IN THE BACTERIOLOGY DIVISION
This is the major section of the Laboratory. About 100 - 150 clinical specimens are processed both by smear and culture on any given day. ATCC Standard strains are used regularly to check for the quality of testing and reporting.
All body fluids (other than blood and urine) submitted for cultures are examined microscopically by using cytospin smears of the fluids to make an early and presumptive detection of any pathogen. The accuracy of the microscopy is as high as 98%.
Continuing improvements in microprocessors, robotics and microcomputers have allowed the development of instruments capable of providing antimicrobial susceptibilities in as short time as 3 - 4 hours. Such instruments represent the highest level of automation and precision now available for use in the Clinical Microbiology laboratory. With the introduction of automated identification and sensitivity testing of all bacterial and yeast isolates using the API system the time to reporting of culture results has tremendously reduced to 24 hours. The availability of the test results within a short time is helpful to the clinician in early initiation of the specific anti-infective therapy in the patient. The system is also user friendly and helps maintain a database for surveillance of the hospital flora and their susceptibility patterns. The sensitivity results are also analyzed using the WHO NET - 5 of the WHO. A quarterly Antibiogram of the common bacterial isolates within the hospital is issued to every treating unit so as to guide in the choice of the appropriate antibiotic. This has definitely helped in reducing the misuse of antibiotics and thereby reducing the resistant strains in the hospital.
A major part of the workload is blood cultures, which are processed using the BacT/Alert (Bio Merieux) an automated system for the early and rapid detection of positive blood cultures. The system has been analyzed for its utility for rapid recovery of pathogens from large volume body fluids (other than blood and urine) and was found to be very useful, especially for anaerobic organisms. The system not only enables the rapid detection but also improves the rate of positive cultures.
Anaerobic cultures are processed using the Gen bag Biomerieux anaerobic system. In association with the BacT/Alert the yield of positive anaerobic cultures has improved significantly.
Total tests performed in the Bacteriology = 47,874
TESTS PERFORMED IN THE MYCOBACTERIOLOGY DIVISION
All the specimens submitted to this division are screened for the presence of Acid Fast Bacilli both by the conventional Zeihl Nelson stain and the Auramine Rhodamine florescence stain. The latter has proven to be more sensitive, especially for paucibacillary specimens.
This is the only laboratory in the whole of AP State that is equipped with the BACTEC 460 TB System, an automated system for culture and sensitivity of Mycobacteria. By this system, positive cultures are detected within 1 week to 10 days unlike the conventional method of 6 – 8 weeks. The isolated Mycobacteria are identified and tested for their antibiogram using the system. The greatest advantage of the system is its ability to increase the yield of Mycobacteria from extra pulmonary and paucibacillary specimens, like the CSF and other body fluids.
The division is also involved in the DOTS program of the RNTCP, Govt. of India, for the past 4 years. Catering to the population within our jurisdiction, we have recorded a cure rate of 85% with a compliance of 87%.
Over 400 M.tb isolates have been preserved and are under further analysis for their RFLP patterns and homology with existing probes for M.tb. The aim of this study is to identify and to develop a molecular probe specific for the local strains of M.tb, which would be applied directly on clinical specimen for a rapid and definite diagnosis of Tb.
TESTS PERFORMED IN THE MYCOLOGY DIVISION
With an increasing incidence of fungal infections especially among the immunocompromised patients, every effort is made to detect and identify the specific fungus at the earliest possible time. This Mycology facility, using standard protocols with utmost care to avoid contamination, is now gaining popularity as a reference lab. Samples are also received from several dermatologists and ENT surgeons from outside hospitals. The high yield of positive cultures from Para nasal specimens is a noteworthy point. The incidence of rhino cerebral and traumatic Zygomycoses is also significant in our series.
As a policy, any tissue specimen submitted for routine culture is simultaneously processed for any fungal infection. Our efforts have resulted in isolating very rare but clinically significant fungi. All such rare isolates are sent for confirmation to an external laboratory in Belgium. These case reports have been peer reviewed and published in the Journal of Clinical Microbiology, the best rated International Journal in Microbiology. Several Opportunistic fungal pathogens, like Aspergillus species, Nocardia species etc, have been isolated from renal transplant and other immunocompromised patients.
Candidal infections being the most common of all fungal infections, all significant isolates are identified using the rapid identification panel of the API system. We are now in the process of standardizing the sensitivity testing for yeasts as per the NCCLS guidelines. The Department is one of the major sources of Candidal blood isolates for the Fugisawa GmbH, an international study on Candidemia.
DIAGNOSTIC TESTS PERFORMED IN IMMUNOLOGY DIVISION: 2005
Next to Bacteriology, this is a major section of the Department. Serodiagnosis for infectious agents and autoimmune disorders are carried out regularly. Over 250 – 300 tests are conducted daily. Majority of the tests are ELISA based and the lab is well equipped with state of the art instruments including an automated ELISA workstation (ARCHITECT), Bio-rad PhD system for performing Fluorescent assays, ELISA reader, Mini Vidas, Auto blot (automated western blot processor), FACS count for CD4 & CD8 estimations, Thermal Cycler and PCR instrumentation for HIV Viral Load estimations. The lab services are utilized by many clinicians in and around AP.
Major part of the work involves screening of patients for HIV by ELISA and confirmatory tests by Western Blot. With the kind courtesy of NACO, Govt of India, ours was the first laboratory in the City of Hyderabad that started performing CD4 and CD8 estimations using the FACS count. As per the recent national statistics, our center was declared to have the largest series of CD4 estimations. Pre and post-test counseling of the individuals is carried out regularly.
The serodiagnosis for other infectious agents like HAV, HBV (complete profile), HCV, TORCH agents, Dengue, EBV, VZV, Measles and Mumps viruses is also done using capture based ELISA assays for IgM antibody detection. The entire profile for febrile agglutinins is also carried out.
The serology lab is also recognized for its excellent quality and reproducible results for auto antibodies in the diagnosis of systemic and or organ specific autoimmune disorders. Antinuclear antibody screening is first done by Immunoflorescence using Hep2 cell lines and the positive results are confirmed by ELISA for the specific disease markers.
Research Projects:
RESEARCH ACTIVITIES - 2005
The Department is involved in intra and interdepartmental research activity and guided many postgraduates for their dissertations / thesis. The Department participates in research collaboration with other organizations.
RESEARCH COMPLETED
In Collaboration with National Organizations:
In Collaboration with International Organizations:
RESEARCH ONGOING
In Collaboration with National Organizations:
In Collaboration with International Organizations:
INTER/INTRA DEPARTMENTAL PROJECTS
DISSERTATIONS
PhD PROJECTS
PHD Program was started in 2000 and the first candidate has been awarded the degree in 2004. 2 more candidates have completed the project and are due for submission and evaluation.
Total PhD students in year 2005 – 6
1. Postoperative infections in Surgical Gastroenterology patients – Thesis submitted. 2. HCV infections in chronic renal failure and renal replacement therapy patients – Thesis submitted. 3. HIV genotypes prevalent in Andhra Pradesh - ongoing. 4. Study of immune response among patients with TB using PGL TB 1 & ESAT6 - CSP 10 antigens of M.tb – ongoing. 5. Incidence of Leptospirosis and prevailing Serovars in Hyderabad.
6. Characterization of phenotype Vs genotype expression in MRSA.
MSc PROJECTS
Patient Services:
Mantoux test and Blood cultures are being done in the dept. Blood from the patient are collected by Senior Residents/Faculty for blood cultures. Counseling of HIV infected and their relatives
Academic Achievements and Awards:
Academic Achievements & Awards - 2005
CMEs & Workshops conducted:
1. Dr.Lakshmi was a CONVENOR for a PANEL DISCUSSION ON “ PREVENTION OF NOSOCOMIAL INFECTIONS”, in the INFICON 2005 – NATIONAL CONFERENCE OF HOSPITAL SOCIETY of INDIA, IN JANUARY 2005.
2. ORGANIZED A ONE DAY CME ON “HIV / AIDS” ON WORLD AIDS DAY, 1st DECEMBER 2005 IN COLLABORATION WITH DEPT. OF MEDICINE, NIMS.
CME/WORK-SHOPS ATTENDED IN 2005
INFICON – 2005 – ANNUAL CONFERENCE OF HOSPITAL INFECTION SOCIETY OF INDIA
1. AN OUTBREAK INVESTIGATION - OUR EXPERIENCE AT NIMS .K.ANURADHA, A. SRINIVAS, V.LAKSHMI
2. SPECTRUM & ANTIBIOGRAM OF URINARY ISOLATES AT A TERTIARY CARE HOSPITAL G.ASHOK, V.V. SAILAJA, V.LAKSHMI
3.INCIDENCE OF POSTOPERATIVE WOUND INFECTION IN PATIENTS WITH PREOPERATIVE BILIARY STENTING. R. ASHOK, K. ANURADHA, ANANDA KUMAR, S. SAI BABU, N.BHEERAPPA, R.A. SASTRY, V.LAKSHMI.
4. SPECTRUM OF BACTERIAL ISOLATES CAUSING NOSOCOMIAL BLOOD STREAM INFECTION IN A TERTIARY CARE HOSPITAL V.V. SHAILAJA, P.UMA BALA, D.V.S. SHARMA S.NIKHAT SHEERIN, V.LAKSHMI
8thANNUAL CONFERENCE OF IAMM (AP CHAPTER) ELURU– FEBRUARY 2005
1.EVALUATION OF NEWLY DEVELOPED ELISA IN THE DIAGNOSIS of TUBERCULOSIS. LAKSHMI V, HIMA BINDU V, SATHEESH KUMAR T & LAGRANGE P
2. UTILITY OF SEROLOGICAL TESTS & RT-PCR IN THE DIAGNOSIS OF SUSPECTED CASES OF DENGUE VIRUS INFECTION PRESENTING TO A TERTIARY CARE HOSPITAL. NEERAJA M, VIJAY D TEJA, UMA BALA P & LAKSHMI V.
3. PROFILE OF BACTERIAL AND FUNGAL PATHOGENS ISOLATED FROM CASES OF NEONATAL SEPTICAEMIA. V.V.SHAILAJA, S.NIKHAT SHEERIN, UMA BALA P, SRIKANTH BHATT S, SUDHAKAR & LAKSHMI .
4. ESTIMATION OF INTESTINAL HELMINTHIC WORM BURDEN AMONG SCHOOL CHILDREN USING THE KATO-KATZ THICK SMEAR TECHIQUE S.NIKHAT SHEERIN, V.V.SHAILAJA, V.LAKSHMI, SAKKU BAI, ASHWIN CHENJI. 5. ISOLATION OF MYCOBACTERIA BY BACTEC 460 TB SYSTEM FROM CLINICAL SPECIMEN SUBHADHA K, HIMA BINDU V, S NIKHAT SHIREEN & LAKSHMI V 6. COMPARATIVE EVALUATION OF HIV RAPID TEST WITH FOURTH GENERATION ELISA – A HOSPITAL BASED STUDY FROM SOUTH INDIA MRS. SUDHA R.T, DR. VIJAY D. TEJA & DR. LAKSHMI V
7. EFFICIENCY OF DRIED BLOT SPOT AS A CLINICAL UTILITY OVER SERUM IN SEROEPIDEMIOLOGICAL STUDIES. LAKSHMI R, HIMA BINDU V & LAKSHMI V.
8. EVALUATION OF COMMERCIALLY AVAILABLE 3RD GENERATION ANTI HCV ELISA IN PATIENTS ON HEMODIALYSIS. ASHOK G, DAKSHINA MURTHY KV& LAKSHMI V
9. APPLICATION OF EPI INFO IN THE SURVEILLANCE OF SURGICAL SITE INFECTIONS ASHOK R, RA SASTRY & LAKSHMI V
Dr. Vijay Dharma Teja: Associate Professor
Attended a workshop on “Communications skills” on 5th & 6th September 2005, conducted by ICMR at NIMS, Hyderabad.
Dr. Umabala P: Assistant Professor
Attended a pre-conference workshop in “Diagnostic Mycology – Conventional and Molecular Techniques” conducted at the 29th Annual Conference of IAMM held at SRMC, Chennai on 19th and 20th October 2005.
Dr. Anuradha K: Assistant Professor
Attended a workshop on “Communications skills” on 5th & 6th September 2005, conducted by ICMR at NIMS, Hyderabad.
Dr. Sailaja VV: Senior Resident
Attended a pre-conference workshop in “Applications of Nucleic acid based techniques (PCR) in Diagnostic Microbiology – Hands on training” conducted at the 29th Annual Conference of IAMM held at SRMC, Chennai on 19th and 20th October 2005.
Mrs. Sudha Rani T: Research Scholar
Attended a pre-conference CME on “Clinical Microbiology in the Millennium” conducted at the 29th Annual Conference of IAMM held at SRMC, Chennai on 19th and 20th October 2005.
GUEST/ INVITED LECTURES – 2005
Total guest lectures delivered – 13
Dr. V. Lakshmi: Professor & Head of the Department
1. Was a Convener for the Panel Discussion On “Prevention of Nosocomial Infections”, in the INFICON 2005 – National Conference of Hospital Society of India - January 2005. 2. Delivered a Guest Lecture on “Carbapenems & Resistance Mechanisms” Astra Zeneca, January 2005. 3. Delivered an Invited Lecture on “Infections In Febrile Neutropenia” in the Pre Conference CME of the IAMM Chapter (AP State), at Eluru, February 2005. 4. Delivered a Guest Lecture on “Milestones in the Laboratory Diagnosis of Tuberculosis” at KIMS, Hyderabad, and April 2005. 5. Delivered a Guest Lecture on “Infection Control in Operation Theatres’ At ESI Hospital, Sanathnagar, Hyderabad, June 2005. 6. Delivered a Guest Lecture on “Milestones in the Laboratory Diagnosis of Tuberculosis” at the Dept. of Microbiology, Osmania University, Hyderabad, on 11th December 2005. 7. Delivered an invited lecture on “Infections in the Dialysis patients” in Twin City’s meet on 20th December 2005. 8. Delivered a lecture on “HIV infection & awareness” on World AIDS Day, 1st December 2005 in Shadan College. 9. Delivered an invited lecture on “The importance of Red Ribbon” on World AIDS Day, 1st December 2005 at Lion’s Club Secunderabad. 10. Panelist for a panel discussion on “Laboratory diagnosis of Tuberculosis” organized by Mahavir Hospitals, 22nd December 2005. 11. Organizing Secretary for the VI SIHAM Work-Shop on “Medical Mycology” jointly conducted by Department of Microbiology, Nizam’s Institute of Medical Sciences and Global Hospitals on 17th and 18th January 2006 at Nizam’s Institute of Medical Sciences, Hyderabad. 12. Organizing Secretary for the VI SIHAM Pre-conference CME on “Antifungal Susceptibility testing from laboratory to bedside” jointly conducted by Department of Microbiology, Nizam’s Institute of Medical Sciences and Global Hospitals on 17th and 18th January 2006 at Nizam’s Institute of Medical Sciences, Hyderabad.
Dr. Vijay Dharma Teja: Associate Professor
1. Delivered a Faculty Lecture on “Epidemiology of AIDS” for the VCTC Training program conducted by the Dept. of Microbiology on 26th July and 3rd August 2005 at NIMS, Hyderabad. 2. Delivered a Faculty Lecture on “Laboratory Diagnosis of AIDS” for the VCTC Training program conducted by the Dept. of Microbiology on 27th July and 4th August 2005 at NIMS, Hyderabad.
Dr. Umabala P: Assistant Professor
1. Delivered a Public Awareness Lecture on “ Antibiotics- Use & Misuse” in January – 2005, NIMS, Hyderabad. 2. Delivered a Faculty Lecture on “Standard Precautions” for the VCTC Training program conducted by the Dept. of Microbiology on 28th July and 5th August 2005 at NIMS, Hyderabad. 3. Delivered an invited lecture on “Morphological Identification of Aspergillus species” on 18th January 2006 in the VI SIHAM Work-shop jointly conducted by NIMS and Global Hospitals at Nizam’s Institute of Medical Sciences, Hyderabad. 4. Delivered an invited lecture on “Diagnosis of fungaemia and fungal sepsis - Experience at NIMS” on 20th January 2006 in the VI SIHAM Conference conducted by Global Hospitals at Green Park, Hyderabad. 5. Delivered lectures on “Neuro-Aspergilloses” and “Neuro-Zygomycoses” on 20th January 2006 in the VI SIHAM Conference conducted by Global Hospitals at Green Park, Hyderabad.
Papers Published:
PUBLICATIONS – 2005-2006
INTERNATIONAL PUBLICATIONS
Total International Publications - 4
1. Teja VD, Sudha Rani T, Lakshmi V. Neurological Manifestations in HIV – A Hospital based study in South India. The Aids Reader: 2005:3 (15):139.
2. T. Sudha, VD. Teja, M. Gopal, M. Rajesh and V Lakshmi. Comparative Evaluation of Tridot Rapid HIV Test with 4th Generation Elisa for the Detection of HIV. Clinical Microbiology & Infection. 2005:11:34-55.
3. Sudha RT, Vijay DT, Lakshmi V. Woman & HIV – a 12 years Indian hospital based study. Accepted for publication in the ‘International Journal of Infectious diseases’.
4. Ashok R, Anuradha K, Bheerappa N, Sastry RA & Lakshmi V. Post Cholecystectomy Surgical Site Infection By Salmonella Enteritica Var Weltevreden – A Case Report. Surgical Infections: 6 (4).
NATIONAL PUBLICATIONS
Total National Publications – 9
1. GA Reddy, Dakshina Murthy KV, Neela Prasad, Gangadhar T& Lakshmi V. Prevalence of HBV & HCV Dual Infections in Patients on Haemodialysis. Indian J. Of Med.Microbiol: 23(1): 41 – 43, 2005. 2. Sarguna P, Lakshmi V. Septic Arthritis Due To Salmonella Typhimurium - Case Report. Indian J. Of Med.Microbiol 23(1): 66: 2005. 3. AK Reddy, Dakshina Murty KV, Lakshmi V. Prevalence of Hepatitis C Virus Infection in Patients on Hemodialysis – Survey by Antibody and Core Antigen Detection. IJMM 23(2): 106 – 110: 2005. 4. Sudha RT, Vijay DT, Lakshmi V. Awareness, attitudes and beliefs of the general public towards HIV/AIDS in Hyderabad, a capital city from South India. IJMS. 2005: 59 (7): 307-316. 5. Lakshmi V, Ashok R, Susmita J, Shailaja VV. Changing trends in the antibiogram of Salmonella isolates at a Tertiary Care Hospital in Hyderabad. IJMM.2006:24(1):45-8. 6. Lakshmi V, Sarguna P. Ventriculoperitoneal shunt infections. IJMM.2006: 24(1): 45-8. 7. Reddy AK, Dakshinamurthy KV, Lakshmi V. Utility of HCV Core Antigen ELISA in the screening for Hepatits C Virus infection in patients on Haemodialysis. IJMM.2006:24(1):55-7. 8. Lakshmi V, Patil MA, Subhada K, Hima Bindu. Isolation of Mycobacteria by Bactec 460 TB System from Clinical Specimens. Accepted for publication in IJMM. 9. Rajashekhar T, Anuradha K, Suhasini T and Lakshmi V. The role of Quantitative culture of non –bronchoscopic samples in ventilator associated pneumonia. Accepted for publication in IJMM. 10. Sudha T, Lakshmi V, Teja VD, Westernblot profile in HIV infection. IJDVL, 2006:72(5): 357-360.
Any Other Information:
HONORABLE VISITORS - 2005
The following National and International scientists visited the Department:
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