The Tarheel Tech...Award Winners 5 Student Article Malaria “Double Trouble 6AMT (SSSAMT) assisted...

North Carolina State Society of American Medical Technologists

Presidents Message

Volume 57, Issue 1 Spring/Summer 2018

NCSSAMT Leadership

2

Legislative Update 3

Southern District

Councillor’s Report

4

Student Writing

Award Winners

5

Student Article

Malaria “Double

Trouble

6

Rapid Identifica-

tion in Microbiolo-

gy

10

2018 AMT Nation-

al Education and

Business Meeting

12

Inside this issue:

The Tarheel Tech

Dear Members,

Spring is finally here! Hopefully, no more cold weather and snow until next year. Our successful and well attended spring educational confer-ence, Carolina’s Clin-ical Connection 2018 – “Race to Your Fu-ture” was held at the

Greensboro – High Point Marriott Airport, Greensboro, NC from March 22 – 24, 2018. Our state society of AMT (NCSSAMT) hosted the event. The North Carolina state society of ASCLS (NCSCLS) and the South Carolina State Society of AMT (SCSSAMT) assisted with the program, planning, and registration for the event. The CCC website and online registration enhanced the ease of registration, hotel accommodations and meeting documents. A special thank you to Candice Freeman, President of NCSCLS for cre-ating the fabulous website. In attendance were 212, to include 31 speakers, a record number of students (86), 9 SCSSAMT members, and 23 NCSSAMT members and others. Kaye Tschop, our very own Southern District Counsellor, joined us to offer her constant support, guid-ance and encouragement. Seven venders and 3 recruiter organizations participated in the con-ference and several vendor and recruiter repre-sentatives were present. NCSSAMT Student Writing Awards were presented at the opening of the meeting. Winners this year were three Winston-Salem State University Clinical Labora-tory Science students. It is so exciting to see so many students attending the continuing educa-tion meetings! The Carolinas Clinical Connection educational meeting is in the process of being reorganized by the North and South state socie-ties of AMT and the state society of ASCLS. We

are all meeting soon to finalize a place and dates for CCC 2019. Stay tuned!

Mark your calendars for the AMT 80th Educa-tional Program and National Meeting in our nation’s capital, July 1 – 5, 2018 at the Hyatt Regency on Capitol Hill, Washington, D.C. You can find more information on the AMT home website at http://americanmedtech.org. You will find registration, hotel, and the program information there. This year, national award winners from our state are Dr. Georgia McCauley, MT – Cuviello Excellence in Educa-tion; Charlene Lynch, RMA – O.C. Skip Skinner Armed Services Award; Dave McCullough, MT – the GEM award. Also, our award winning news-letter, Tarheel Tech, won 3rd Place Newsletter this year! Congratulation to all of the award winners! Thank you for your dedication and ser-vice to the state and national AMT organiza-tions.

On a sad note, our beloved “trusted advisor”, Mr. Dave McCullough, lost his battle with ALS in January of this year. Dave was a longtime and outstanding member of AMT at both the nation-al and state level. In his memory…

It takes a minute to find a special person, an hour to appreciate them, and a day to love

them, but it takes an entire lifetime to forget them.

—Anonymous

Please join us at our state and national AMT

meetings. You will be delighted in the experi-

ence. AMT is truly a professional organization in

certifying excellence in allied health, with the

added benefit of networking opportunities and

making lifelong friends.

Enjoy your spring and summer!

Georgia

Southern District Councilor

Kaye A Tschop, MT

[email protected]

Board of Directors:

Lisa Maness,

Judy Smith, MT

201 Bluff Street

Mt Airy, NC 27030

[email protected]

Tommie Williams, MT

4435 Clarksburg Road

Clemmons, NC 27012

[email protected]

Catherine Brock, RMA

204 John Deere Drive

Raeford, NC

[email protected]

Lynn Dean, MT

PO Box 103

Hurdle Mills, NC 27541

[email protected]

Charlene Lynch RMA

Committee Chairs 2017-2018

Publications, Publicity, Placement;

Tommie Williams

By-laws, Policies and Procedures:

Mary Midkiff

Membership and Awards

Judy Smith

Scientific

Jerry Johnson

Legislative and Proctoring

David McCullough

Nominating and Budget, Audit

Ray Dean

NMLPW and NMLAW

Lynn Dean, Catherine Brock

Student Writing

Mary Midkiff

President:

Georgia McCauley, PhD, MT

[email protected]

Vice President:

Jerry Johnson, MT

1296 Reeves Mill Road

Mt Airy, NC 27030

[email protected]

Secretary:

Mary Midkiff, MT

252 Paisley Drive

Mt Airy, NC 27030

[email protected]

Treasurer

Ray Dean, MT

PO Box 103

Hurdle Mills, NC 27541

[email protected]

Judiciary Councilor

Kimberly Chervount, MT

100 Fair Oaks Dr

Fairmont, WV 26554

[email protected]

NCSSAMT Officers and Board 2017 –2018

The Tarheel Tech is the official publica-

tion of the North Carolina State Society

of American Medical Technologists.

It is published two times per year in May

and November. Electronic versions are

posted to the NCSSAMT webpage at

www.americanmedtech.org

Submit comments and information to:

Editor:

Tommie Williams, MT(AMT)

[email protected]

Associate Editor:

Jerry Johnson, MT(AMT)

[email protected]

Closing dates for material are March 15

and September 15,

Circulation -electronic

Advertisement Rates per issue : Business

card $50.00, 1/2 page $100.00

The opinions expressed in any article

are those of the author and do not nec-

essarily reflect those of the editorial staff

or the NCSSAMT Board of Directors

All photographs contained here within are

the property of NCSSAMT or the Editor un-

less otherwise noted

To request a hardcopy of the newsletter

please contact the Editor –Tommie Williams

Volume 57, Issue 1

If you are interested in serving on a

committee for 2018 please contact

Georgia McCauley, MT(AMT)

[email protected]

T. Williams 2017

Legislative Update: AMT in the spotlight Jerry B. Johnson, MT (AMT) HHS

NCSSAMT Vice-President

AMT Government Affairs Committee Member

AMT participants for the 2018 Legislative Symposium spent March 19th and 20th in Washington, DC to represent our professional organization in discussions with Congress. The AMT leaders and members met with ASCLS, CLMA, ASCP, AGT, and NSH members at the Hilton Alexandria Old Town to be briefed on the current issues regarding our clinical laboratory landscape. The following day the participants traveled to Capitol Hill to meet with Senators and Representatives of their states to make our laboratory profession’s concerns known. The following items were discussed with Congress; additional materials were also ‘left behind’ for our Representatives and Senators to review.

PAMA

Section 216 of the Protecting Access to Medicare Act (PAMA) of 2014, this law required CMS to establish a market-based payment system for laboratories paid on the Clinical Laboratory Fee Schedule (CLFS). However, the regulatory requirements included in the final PAMA regulation do not comply with the statute as the data collected reflects just a small sector of the clinical laboratory market. Information and recommendations to help fix this error in market pricing were discussed and also ‘left behind’. (PAMA and Laboratory Reimbursement)

WORKFORCE – SHORTAGE OF LABORATORY PERSONNEL

To ensure quality health care services the healthcare system must have an adequate supply of clinical laboratory personnel. The Bureau of Labor statistics anticipates the demand for medical laboratory professionals to increase to 12,000 per year. We discussed recommendations to help with this shortage and asked Congress to enhance recruitment and retention efforts within the Veterans Health Administration, to authorize and appropriate funding for a program within the Public Health Service Act to ensure training, and to authorize the Government Accountability Organization (GAO) to study the shortage of clinical laboratory personnel and the impact on the healthcare system, and make recommendations for ways to increase the clinical laboratory profession. (Crisis in the Laboratory Workforce) Laboratory professionals provide diagnostic, technical, therapeutic and direct patient care and support

services. They are critical to physicians and nurses with whom they work and to the patients they serve.

In total, clinical laboratory personnel and other allied health professions account for an estimated 60

percent of the entire health care workforce. More than 4 billion medical laboratory tests are performed

each year in the United States. Approximately 70 percent of physicians' patient interactions are

influenced by laboratory test data. New laboratory tests are being developed constantly to improve

early detection and diagnosis of diseases, more accurately monitor conditions and better protect outcomes.

(Crisis in the Laboratory Workforce)

Reference: htttps://www.americanmedtech.org/Portal/PDF/News/2018 Leg Day

Volume 57, Issue 1

Volume 57, Issue 1

It has been a mild winter with very little precipita-tion to speak of. That only means one thing, spring is just around the corner! The 80th AMT Educational Program and National Meeting July 1-5, 2018 will be held at the Hyatt Regency Wash-ington on Capitol Hill 400 New Jersey Avenue, NW Washington, DC 20001. Phone 202-737-1234.

Room rates will be $ 129.00 plus tax per night single or double, $ 154 plus tax triple occupancy or $ 179 quadru-ple occupancy. Make your reservations as soon as possi-ble. Once the room block is filled, the guaranteed room rate is gone so make your reservations now and if you need to cancel, you need to cancel two days prior to your arrival date. Room rates are good from June 29 through July 8th. Mark your calendars and make your reserva-tions now! Registration for the Washington, DC meeting is now avail-able online. AMT has a special low early bird rate of $ 275 for the full package for all members. Registration will jump up to $ 475 after May 1 so register now so you do not miss out on saving $ 200. You can also register for one day only registrations this year. There will be no ex-tensions to the May 1 deadline for early bird registration. The preliminary program will be available on the website the middle of March. You will notice there will be numer-ous workshops offered on Sunday however there is an additional charge if you want to attend. They are not included in the full package. Check out the preliminary program when it becomes available for times and loca-tions of events as there’s been some shuffling of events due to the July 4th celebration on Wednesday evening. The 81st AMT Educational Program and National Meeting will be held in Chicago, Illinois July 1-5, 2019. Hotel to be announced once the contract is signed. More details will become available on a later date.

Please attend your state society meetings. Consider hav-ing joint meetings with other AMT state societies. They are an excellent source of continuing education, an op-portunity to share your knowledge with your AMT family

and to keep abreast of current AMT information. The Magnolia Educational Treasures (MET) Southern District

meeting will be held October 19-20, 2018 in Gulfport, Mississippi. Come join us!

Publications are available on State Society websites how-ever AMT will need to start archiving previous year is-sues. Currently there are eight years of publications posted. AMT plans to keep the most current two years of publications readily available on the websites.

This is a special time for me to say how very proud I am of the Southern District and to congratulate all national award and publication winners. Thank you for all your hard work! I would like to say thank you to each of you for your hard work and dedication to AMT throughout the year and making the Southern District shine. Each of you truly are the “Pride of the Profession”. I look forward to seeing each of you at your state meeting this year and the national meeting in Washington, DC.

If you have any questions or concerns. Please do not hesi-tate to contact me at [email protected] or phone me at (h) 615-833-3427 or (c) 615-424-0550

AMT is the choice for allied health professional certifica-tion.

Respectfully submitted, Kaye A. Tschop, MT (AMT) AMT Southern District Councillor

District Councillor’s Comments Kaye A. Tschop, MT

Volume 57, Issue 1

Submissions must be emailed to the North Carolina State Society President. The address is listed in The Tarheel Tech or may be

NCSSA

MT Student M

ember Corner

NCSSAMT Student Writing Award Winners-2018

At the professional laboratory meeting, Carolinas Clinical Connection, March 22 – 24,

2018, held at the Greensboro – High Point Marriott Airport, Greensboro, NC, the 2017

NCSSAMT Student Writing Award winners were recognized.

Dr. Jude Okoyeh, senior Clinical Laboratory Science student at Winston-

Salem State University received the 1st place winner for the NCSSAMT

2018 Student Writing Awards. The title of Dr. Okoyeh’ s paper was

“Malaria in Pregnancy: A Double Trouble”. He received a commemora-

tive plaque and a $300 monetary award.

The second place winner was Ms. Jennifer Preuss Osborne, a junior Clini-

cal Laboratory Science major also from Winston-Salem State University.

Ms. Osborne’s manuscript was entitled, “Does Knowledge Equal Power

with HBCU Students” Several student papers were submitted to the

AMT national writing contest and Ms. Jennifer Preuss Osborne’s paper

earned the 1st Place writing award. Jennifer will receive her national

award at the 80th American Medical Technologists Educational Program

and National Meeting, July 1 – 5, 2018, Hyatt Regency on Capitol Hill,

Washington, DC.

The third place winner was Ms. Sabrina Turner for her paper,

“Streptococcus Pneumonia”. Ms. Osborne and Ms. Turner also re-

ceived commemorative plaques and $200 and $100 monetary awards

respectively. Congratulations to all of our award winners! Job well

done.

Congratulations to all of our award winners! Job well done.

Student Article –Jude Okoyeh Malaria in Pregnancy: “A double Trouble.”

Introduction

Presently, malaria undoubtedly, remains a major global health challenge. The cause of malaria disease is Plasmodium - a single cell parasite. Plasmodium belongs to the domain Eukaryota, order Haemosporida and the family of Plasmodiidae1. Besides Antartica, malaria in-fection has been reported in every continent in the world from countries that are located around the equa-tor1 (Figure 1). It is spread in humans by the bites of female anopheles mosquito (the vector) which has been infected by the parasite. There are different species of anopheles mosquito that are responsible for trans-mitting malaria parasites2. Five different species of Plas-modium protozoa causes malaria in humans, namely Plasmodium falciparum, P. malariae, P. ovale, P. vivax and P. knowlesi. Although, the parasites cause various mortality and morbidity rates, the highest threat of the disease is posed by P. falciparum and P. vivax. About half of the populations of the world are at risk, but ma-jority of the cases occur predominantly in sub-Saharan Africa and the prevalent malaria parasite in Africa is P. falciparum 2. Beside the African continent, malaria pos-es a serious heath challenge in the Middle East, Latin America, and South-East Asia. P. vivax can be found mostly in South America and Asia countries, P. ovale is found mainly in West Africa and P. knowlesi (very rare) exists in southeastern Asian countries3. In 2015, over 200 million cases of malaria were reported worldwide which resulted in about 429000 deaths4. Disproportion-ately, the morbidity and mortality burden of malaria are evident in the “malaria belt” – mostly sub-Saharan Afri-can countries where P. falciparum parasites occur most. Worldwide, more than 125 million pregnant women are at risk of malaria infection. Sadly, a child dies of malaria every two minutes4. Although, malaria can be prevented and treated, ac-tive malaria transmission is on-going in 91 countries. The populations that are particularly affected by malaria infection are pregnant women, children less than 5 years old, non-immune travelers, HIV/AIDS patients and other immune-compromised individuals4. P. falciparum causes Pregnancy-associated malaria (PAM, a.k.a Pla-cental Malaria), an illness that is associated with para-site sequestration in the placenta. Often, PAM results in fatal outcome for both mother and the unborn child if the infection is not adequately treated4 – which indeed is a double trouble (Table 1)! For the past few years,

Figure 1: World map illustrating the global distribution of

malaria. international awareness and implementation of sustain-able strategies aimed at reducing and ultimately elimi-nating the burden of malaria globally are yielding posi-tive outcomes. Recently, the World Health Organization (WHO) reported that in 2010 and 2015, the global inci-dence of malaria dropped by 21% and 29%, respective-ly, among the vulnerable/risky groups, 35% in children less than 5 years of age and 29% in every age group that are affected by malaria4. History

The word malaria - “mal” (bad) “aria” (air) was from Medieval Italian language that associated the disease with the bad/foul- smelling air vapor that emanated from marshes and swamps, which incidentally, are the natural breeding habitats for mosquitoes. Malaria pre-dates history as a zoonotic disease. Evidence from Pal-aeogenic time-line revealed that malaria parasites dat-ed back to 300 million years2. Malaria parasites were first discovered in a patient’s blood by Charles Lavern in 1880 and this was validated by a histologist, Camilo Gol-gi in 1886, when he identified P. malaria and P. vivax. Golgi also accurately described the fever that occurs in humans in association with the life cycle of these para-sites. Giovanni Grasssi and Ronald Ross in 1897 de-scribed the life cycle of malaria parasites and confirmed that the transmitting vector were mosquitoes as sug-gested by Patrick Manson in 1894. The life cycle of P. falciparum was further explained and clarified by Short and Garnham in 19485. Life cycle

The female Anopheles mosquito (Anopheles gambi-ae) vector transmits malaria parasites by biting humans, mostly at night, to obtain a blood meal for production of eggs. Sporozoites are the infective forms of malaria

Continued on page 7

Volume 57, Issue 1

Continued from page 6

Figure 2. Life Cycle of the Malaria Parasite

parasites and they reside in the salivary glands of the mosquito. As the mosquito bites and sucks the blood through her proboscis, the sporozoites are injected into the human blood stream. In 30 minutes, the sporozotes travel to the liver where they multiply and grow asexu-ally for 6-32 days into schizonts (packs of merozoites). The schizonts burst to release the merozoites (the ring form) into the blood (Figure 2). The merozoites further invade other erythrocytes where they in-turn, grow and multiply or they can sexually discriminate into female and male immature reproductive forms known as game-tocytes. The gametocytes circulate freely in the blood stream. Every 4-72 hours (depending on the Plasmodi-um species), the infected erythrocyte bursts to release merozoites that re-invade fresh erythrocytes. Multiple invasion of a single erythrocyte is common. The periodic release of merozoites, with malaria antigens, are re-sponsible for the bouts of fever – a symptom often as-sociated with malaria infection. If an infected person is bitten by a mosquito, the in-gested gametocytes develop into the male and female gametes in the mosquito gut. The gametes fuse to be-come ookinetes which penetrate the midgut of the mosquito where they develop into oocytes. Each of the oocytes multiple into sporozoites that bursts to release the sporozoites into the body midguts of the mosqui-to6. From the midguts, the sporozoites travel to and remain in the mosquito salivary glands. The cycle is re-peated when the sporozoites are injected into a healthy person if bitten by an infected mosquito. P. vivax prefer-ably invades reticulocytes and requires Duffy antigen on the surface of red blood cells for invasion. In-vitro, plasmodium falciparum can be cultured (continuous propagation) in nutrient media like Roswell

Park Memorial Institute medium (RPMI 1640) with hu-man serum or serum substitutes and incubated at 370C. The incubator consists of 93% nitrogen, 4% carbon diox-ide and 3% oxygen gas mixture. Alternatively, candle jars can be used as incubators for culturing the para-sites9. Microscopic examination of Giemsa-stained thick and thin blood smears remains the diagnostic standard for the laboratory diagnosis of malaria. Newer and faster diag-nostic techniques have been developed. Acridine or-ange staining of malaria parasites, is quicker than Giem-sa staining. Parasite development can readily be as-sessed by using a dip strip technique that detects the presence of histidine-rich protein II (HRP2) in blood sample of patients10. Although, PCR and enzyme immu-noassay techniques are highly sensitive and specific for detecting and differentiating various types of malaria parasites than the standard methods, they are more expensive to be used for routine monitoring and assess-ment of parasitemia in patients. Pathogenicity:

The invasion of erythrocytes by malaria parasites is a multistep process that is mediated by specific molecular interactions between erythrocyte receptors and para-sites ligands16. Accumulation or sequestration of malar-ia parasites in the intervillious spaces of the placenta (PAM) is the hall mark of malaria in pregnancy that re-sults in damage to placental trophoblastic base mem-brane by leukocytes. P. falciparum causes cytoadher-ence of infected-erythrocytes to specific receptors that are located on vascular and placental endothelial walls by expressing certain glycoproteins such as chondroitin sulfate A (CSA). This binding interferes with transplacen-tal transport of both nutrients and oxygen between the mother and the fetus, and possible damage to end or-gans by causing infarction or hemorrhage in the micro-vasculature7.8. Heavy placental infection without pe-ripheral blood parasitemia and asymptomatic clinical signs, often occur. Therefore, in malaria endemic areas, the severity of the disease is more pronounced in preg-nant than non-pregnant women. Lower parity and younger primgravida women are 6% to 63% at risk of getting placental malaria which occurs only in 12%-33% of multigravidas8. IgG antibody protects against maternal malaria by blocking the binding interactions between infected erythrocytes and CSA. Multiple pregnancies build such IgG antibodies and confer a higher protection against placental malaria in multigravidas.

Continued on page 8

Volume 57, Issue 1


A recent study indicated that in malaria infected general adult population, IgG and IgM did not show any observ-able variation with malaria infection, but there was a strong positive correlation between IgE and parasite density14. Folic acid deficiency and anemia are exacer-bated in pregnancy due to clearing of infected erythro-cytes by phagocytosis in the spleen8. Increased pancre-atic activity, maternal demand for glucose in febrile sickness, nausea and vomiting that reduces intake of oral glucose nutrients and glycogen storage coupled with parasitic needs for glucose during the life cycle can cause hypoglycemia during pregnancy. Placental malar-ia causes spontaneous abortion, low birth weight (8-36%) and infant deaths (3-8%) from intrauterine growth delay, increased predisposition for preterm deliveries and stillbirth4 (Table 1). Clinical Presentations

Malaria infection causes acute, and occasionally, chronic illnesses and affects many organs. Infected semi-patterns of plasmodium species to locally available an-timalarial drugs, the delicate balance between the ben-efits and risks of the drug to the fetus and other drug-associated contraindications in pregnancy7,8. The WHO recommends the use of intermittent preventive treat-ment in pregnancy (IPTp), and insecticide-treated bed net (ITN) during pregnancy7. Chloroquine or hy-droxychloroquine and quinine can be used safely in all trimesters for the treatment of chloroquine-sensitive P falciparum species. Low dose of mefloquine in second and third trimesters11, quinine and clindamycin in first trimester have been found effective. Artemisinin Com-bined Therapy (ACT) is safe, with less treatment failures, in all trimesters12. In severe cases, IV artesunate or qui-nine plus clindamycin can be used in second and third trimesters8. Prolonged treatment and recurrent hypo-glycemia are disadvantages of using quinine. Prophylac-tic administration of chloroquine and proguanil are rec-ommended in all trimesters or MQ in second and tri-mesters in areas where P. falciparum is sensitive to these drugs. Due to paucity of safety information, doxycycline, primaquine, tetracycline, doxycycline, halo-fantrine and malarone should not be administered to pregnant women13. Supplementation with iron and screening for anemia, at prenatal visits, are routinely recommended throughout pregnancy in malaria en-demic areas

Case study17

Summary: A 28 year of female traveled from Indian to Saudi Arabia, became sick and was initially diagnosed and treated for pneumonia. She had seizures and was unconscious. Her travel history and additional la-boratory tests revealed that she had cerebral malaria caused by P. vivax malaria.

Case presentation:

A 28-year old female went to Saudi Arabia for a Hajj from India. She had a normal hospital delivery two months earlier. After two weeks in Saudi Arabia, she was seen at a polyclinic with complaints of drowsiness, confusion, shortness of breath and intermittent fever. The initial diagnosis and treatment was for pneumonia. However, her conditions continued to deteriorate and she returned the next day in respiratory distress, pyrex-ia and renal dysfunction. She was transferred to King Abdulaziz Medical Center (KAMC) after 5 days, but was unconscious.

Laboratory report:

The initial patient’s CBC showed anemia that was normocytic normochromic, extracellular fluid of 35% on an echocardiograph. At KAMC, PE revealed an increased BP, respiratory and pulse rates, non-focal neurological abnormalities, leukocytosis, thrombocytopenia, elevat-ed creatinine (1.6mg/dl; Ref. range: 0.6-1.3mg/dl) and low albumin levels (2.2 gm/dl; Ref. range: 3.5-5.2 g/dl). Treatment with noradrenaline and renal replacement therapy were initiated. Test for methicillin-resistant Staphylococcus aureus (MRSA) was positive, but Den-gue fever serology test was negative. She started receiv-ing Meropenem, Vancomycin and Levofloxacin. Unfor-tunately, her condition did not improve.

Differential diagnosis:

Due to her country of origin, it was suspected that the patient had malaria infection. Both thick and thin blood smears and Rapid Antigen Detection (RAD) test were positive for P. vivax but the RAD and anti-falciparum antibodies were negative for P. falciparum. She had sei-zures which were treated with midazolam and phenyto-in. Immediate CT scan indicated cerebral malaria, MRI of the brain showed she had extensive vasculitis that indicated possible malaria infection. Subsequent blood smears did not show P. falciparum parasite infection.

Continued on page 9

Volume 57, Issue 1


Table 1: Consequences of Malaria during Pregnancy

Treatment after laboratory diagnosis:

The patient received quinine 600 mg IV three times dai-ly, including other supportive therapy, midazolam and phenytoin for the seizures.

Two days after commencing antimalarial treatment, the patient became conscious and had improved kidney function with normal creatinine and urea levels. To pre-vent a relapse, the patient received oral primaquine for two weeks. The patient

made a full recovery and was discharged from the hos-pital a month after she was admitted.

Conclusion :

Unlike other diseases, such as polio myelitis which once posed a global health challenge to humans but are now at the verge of elimination worldwide, the morbidity and mortality rates of malaria in humans are still phe-nomenal. As previously noted, semi-immune pregnant women are at high risk of infection and gravidity and parity of the pregnant woman are predisposing factors to increased severity of malaria disease, with primigrav-idas being more at risk. They develop more severe symptoms and complications, including miscarriages, premature deliveries, fetal intrauterine and neonatal death, delivery of low weight babies (<2.5kg), severe anemia and ultimately, the death of mother in untreat-ed cases of malaria infection. Use of available antimalar-ial medications is based on the risk-to-benefit ad-vantages of such medications to both the mother and the unborn child. The emergence and spread of malaria parasites that are resistant to antimalarial medications have limited the choice of these medications. There-fore, there is an urgent need for the development of effective malaria vaccine(s), increased awareness of the beneficial use of antimalaria-impregnated bed nets, and the discovery of safe and effective antimalarial thera-peutic drugs.

References 1. Center for Disease Control. 2016. Malaria. U.S. Centers for Disease Con-trol and Prevention. 2. Morrison DA. 2009. Evolution of the Apicomplexa: Where are we now? Trends in Parasitology 25 (8):375–82. 3. Malaria: http:// www.nhs.uk/Conditions/Malaria/Pages/Causes.aspx. Retrieved No- vember 20th, 2017. 4. Fact Sheet: World Malaria Report. 13 December 2016. 5. Malaria: http://www.faqs.org/health/topics/4/Malaria.html. Retrieved November 18, 2017. 6. Malaria. https://dressageafrica.com/malaria/malaria-life-cycle-in-the-body. Retrieved November 20th, 2017. 7. Schantz-D, Nour NM. 2009. Malaria in Pregnancy: A global Health Per-spective. Obstetrics & Gynecology 2(3):186–192. 8. Lagerberg R. 2008. Malaria in Pregnancy: A literature Review. Journal of Midwifery and Women’s Health, 2008. 53(3):209-215. 9. Trager W, Jensen JB. 1997. Continuous culture of Plasmodium falcipa-rum: its impact on malaria research. International Journal of Parasitology. 27(9):989–1006. 10. Knott L. 2016. Malaria in Pregnancy. Infectious Disease. https://patient.info/doctor/malaria-in- pregnancy. Retrieved November 18th, 2017. 11. Iqbal J, Sher A, Rab A. 2000. Plasmodium falciparum Histidine-Rich protein 2 Based Immunocapture Diagnostic Assay for Malaria: Cross-Reactivity with Rheumatoid Factors. Clinical Microbiology 38(3):1184-1186. 12. Okoyeh JN, Lege-Oguntoye L. 1996. Malaria in pregnancy: efficacy of a low dose of mefloquine in an area holoendemic for multi-drug resistant Plasmodium falciparum. Annals of Tropical Medicine and Parasitology 90(3):265-268 13. McGready R, Lee SJ, Wiladphaingern J, Ashley EA, Rijken MJ, Boel M, Simpson JA, Paw MK, Pimanpanarak M, Mu O, Singhasivanon P, White NJ, Nosten FH. 2012. Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based study. Lancet Infectious Disease l2(5):388-96. 14. Eze EM, Christian SG. 2016. Immunological levels of Plasmodium falci-parum malaria infected subjects in Port Harcourt, Nigeria. International Journal of Advanced Multidisciplinary Research 3 (5): 49-55. 15. Okoyeh JN, Pillai CR, Chitnis CE.1999. Plasmodium falciparum Field Isolates Commonly Use Erythrocyte Invasion Pathways That Are Independent of Sialic Acid Residues of Glycophorin A. Infection and Immunity 67(11): 5784-5791. 16. Barnwell JW, Galinski MR. 1998. Invasion of vertebrate cells: erythro-cytes, p. 93–120. In I. W. Sherman (ed.), Malaria: parasite biology, pathogenesis, and protection. American Society for Microbiology, Washington, D.C. 17. http/infection.conferenceseries.com/speaker-ppts/2015/mona-abd-el-fattah-ahmed-ain- shams-university-egyptking-abdullah-medical-city-saudi-arabia.pdf. Retrieved November 20th, 2017

Dr. Jude Okoyeh is a senior Clinical Laboratory Science student at Winston-Salem State University

Volume 57, Issue 1

Maternal Fetus Newborn

Parasitemia Abortion Low birth weight

Morbidity Stillbirth Prematurity

Anemia Congenital Intrauterine growth

Febrile illness Infection Restriction

Cerebral malaria Malarial illness

Hypoglycemia Mortality

Puerperal sepsis

Mortality

Severe disease

Hemorrhage

Rapid Identification in Microbiology

The BioFire FilmArray®

Lisa Maness, Ph.D. MT(AMT)

The FilmArray® by BioFire Diagnostics is capable

of identifying multiple pathogens within an hour after

only 2 minutes of hands-on time by a laboratory tech-

nologist.1 The decrease in turnaround time compared to

traditional methods has allowed microbiology laborato-

ries to play a role in improving patient care. Since its

initial FDA approval in 2013, several additional panels

have been introduced.

Trials for automated nested multiplex PCR sys-

tems began in 2011 during which time the systems

were already being used for military defense strate-

gies2,3. Idaho Technology, Inc. changed their name to

BioFire Diagnostics, Inc. in 2012 and this company re-

ceived FDA approval in 2013 for its first FilmArray® and,

thus, commercial sales began.4 They then merged with

Biomerieux in 2014.

The first film array panel that received FDA ap-

proval was the BioFire FilmArray® Blood Culture Identifi-

cation Panel, which consists of 27 targets, including

gram positive and gram negative bacteria and yeast.5 It

also contains genes coinciding with carbapenem re-

sistant Enterobacteriaceae, methicillin resistant Staphy-

lococcus aureus and vancomycin resistant Enterococcus

faecalis. In 2015, FDA approval was granted for the Fil-

mArray® Meningitis/Encephalitis Panel, which tests for

14 common bacterial, viral, or yeast causes of meningi-

tis or encephalitis6 In 2106, BioFire received FDA ap-

proval for the FilmArray Respiratory Panel EZ, which

contains 11 viral and 3 bacterial pathogens.7 This respir-

atory panel is a simpler version of the original FilmAr-

ray® respiratory panel, which can identify 17 viruses

and 3 bacteria.8 The company also offers a Gastrointes-

tinal Panel that targets common bacterial, parasitic, and

viral causes of disease as well as several biothreat kits.9

Several processing platforms are offered by Bio-

Fire, the simplest being the FilmArray® EZ Configura-

tion.10 There is also the FilmArray® 2.0, which can test

up to 175 daily samples and has an automated LIS-

interfacing system, which minimizes data entry errors.

The most advanced system is the FilmArray® TORCH,

which is also automated, but with the addition of a bar-

code scanner and touch screen; it is compatible with all

FilmArray® panels.

The FilmArray® works by injection of a hy-

drating solution, along with an unprocessed patient

sample, into a pouch containing reagents for a specific

panel of pathogens.10 Reagents freeze-dried within the

pouch function to prepare the sample, carry out nested

multiplex PCR, and detect the presence of pathogens.

Software then uses end-point melting curve data to an-

alyze each sample and report whether or not each path-

ogen within a specific panel is present.

Several studies have been conducted to deter-

mine the sensitivity and specificity of the BioFire FilmAr-

ray®. Popowitch et al. (2013) reported that the Respira-

tory Panel was 100% specific and 84.5% sensitive after

testing 300 specimens using this platform, the Luminex

XtAG RVPv1, the Genmark eSensor RVP, and the Lu-

minex XTAG RVP Fast Multiplex Assays. The other

platforms had similar specificity, while Genmark eSen-

sor RVP and Luminex XtAG RVPv1 had greater sensitivi-

ty.11 Buss et al. (2015) compared conventional culture

identification of 1,556 stool samples to the Biofire Film

Array® Gastrointestinal Panel.12 12 of 22 targets on the

array had 100% sensitivity, 7 had ≥94.5% sensitivity, and

the specificity of all were reported as ≥97.1%. Three

targets, including Vibrio species and Entamoeba histo-

lytica, did not have sensitivities reported since there

were not enough cases identified in the study.

A study involving BioFire FilmArray® Blood Culture Iden-

tification Panel consisted of 206 blood culture bottles.13

While 153 of 167 bottles with monomicrobial growth

were detected by the array, 13 had growth of patho-

gens from traditional blood culture methods that are

not part of the array panel. An additional organism was

detected in 6 of the bottles that was not detected from

culturing. When traditional blood culture methods de-

tected polymicrobial growth, the array detected all or-

ganisms in 17 of 24 samples, the remaining organisms

not being targets on the panel. In 12 cases where blood

cultures were positive but without growth on media,

the FilmArray® was also negative. An additional study

comparing spinal fluid samples tested using the array,

Continued on page 11

Volume 57, Issue 1

Continued from p 10

PCR, and culture also reported favorable results and the

authors anticipated improved patient care using the

FilmArray®.14

While turnaround time can be a matter of days

using traditional methods to identify pathogens, the

BioFire FilmArray® can decrease identification time to

hours with reliable sensitivity and specificity. This im-

proves patient care by hastening treatment. Additional-

ly, since the array is simple to use and requires only sev-

eral minutes to process, laboratory technologist time is

reduced compared to other methods, especially tradi-

tionally culturing. Decreasing turnaround time as well as

technologist time has made this methodology an attrac-

tive option for laboratory managers.

References

1. BioFire Diagnostics, Inc. 2013. Biofire submits 501(k) application to FDA for FilmAr-

ray®blood culture identification test. Available from http://biofiredefense.com/pdfs/

mediakit/PRESS%20RELEASE%20-%20BCID510k.pdf

2. Poritz, MA, Blaschke, AJ, Byington, CL, et al. 2011. FilmArray, an automated nested

multiplex PCS system for multi-pathogen detection: development and application to

respiratory tract infection. PLoS One. 6(10): e26047.

3. Military Systems and Technology. 2010. Available from http://www.militarysystems-

tech.com/suppliers/biothreat-detection/biofire-diagnostics-inc

4. RBS Global Media Limited. 2012. Biofire Defense. Military biothreat detection and

biosurveillance systems. Available from http://www.defence-suppliers.com/supplier/

BioFire_Defense/

5. Business Wire, Inc. 2018. BioFire receives FDA clearance for the FilmArray® Blood

Culture Idenfitication Panel. Available from https://www.businesswire.com/news/

home/20130625005551/en/BioFire-Receives-FDA-Clearance-FilmArray%C2%AE-Blood-

Culture

6. bioMerieux. 2018. FilmArray® Meningitis/Encephalitis (ME) Panel. Available from http://

www.biomerieux-diagnostics.com/filmarray-meningitis-encephalitis-me-panel

7. MDBR Diagnostics In Vitro Diagnostics. 2016. bioMerieux gets FDA approval for FilmAr-

ray Respiratory Panel EZ. Available from http://invitrodiagnostics.medicaldevices-

business-review.com/news/biomrieux-gets-fda-approval-for-filmarray-respiratory-panel

-ez-130416-5030182

8. bioMerieux. 2018. FilmArray® Respiratory Panel. Available from http://www.biomerieux

-diagnostics.com/filmarrayr-respiratory-panel

9. BioFire Defence. 2018. FilmArray® Test Kits. Available from http://biofiredefense.com/

biosurveillance-systems/filmarray-test-kits/

10. BioFire. 2018. FilmArray. Available from https://www.biofiredx.com/products/filmarray/

11. Popowitch, EB, O’Neill, SS, and Miller, MB. 2013. Comparison of the Biofire FilmArray

RP, Genmark eSensor RVP, Luminex xTAG RVPv1, and Luminex xTAG RVP Fast Multiplex

Assays for Detection of Respiratory Viruses. Journal of Clinical Microbiology. 51(5):5126-

5133.

12. Buss, SN, Leber, A, Chapin, K, et al. 2015. Multicenter Evaluation of the BioFire FilmArray

Gastrointestinal Panel for Etiologic Diagnosis of Infectious Gastroenteritis. Journal of

Clinical Microbiology. 53(3):915-925.

13. Altun O, Almuhayawa, M, Ullberg, M, et al. 2013.

Clinical Evaluation of the FilmArray Blood Culture Identification Panel in Identification of

Bacteria and Yeasts from Positive Blood Culture Bottles. Journal of Clinical Microbiology.

51(12): 4130-4136.

14. Leber, AL, Everhart, K, Balada-Llasat, JM, et al. 2016. Multicenter Evaluation of BioFire

FilmArray Meningitis/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in

Cerebrospinal Fluid Specimen. Journal of Clinical Microbiology. 54(9): 2251-2261.

Dr. Lisa Maness is an Assistant

Professor in the Clinical Labora-

tory Science Program at Win-

ston Salem State University,

Winston Salem, NC

Volume 57, Issue 1

Editors Note

Tommie Williams, MT(AMT)

Summer Greetings fellow NCSSAMT Members!

It is difficult to believe that it is time for the AMT

2018 National Convention again. It seems like

just a short period of time that our delegation

made the trip to Kanas City in 2017. The AMT

National Convention has always been an event I

look forward to year after year. It is a trip with

good friends, a time to network with our AMT

Family we only see once a year, and a time to

stay abreast of all the changes in our profession.

This year will the first time for many of us that

one of beloved members will not be with us.

David McCullough passed away in January and

his prescience and guidance will be greatly

missed, not only by the NCSSAMT delegation but

the entire AMT Family. Dave was a leader, a

mentor, a teacher and a dear friend for many.

He will be missed by all!

2017 NCSSAMT Delegation in Kanas City

Volume 57, Issue 1

The Tarheel Tech...Award Winners 5 Student Article Malaria “Double Trouble 6AMT (SSSAMT) assisted...

Documents

Transcript of The Tarheel Tech...Award Winners 5 Student Article Malaria “Double Trouble 6AMT (SSSAMT) assisted...