WISCONSIN STATE LABORATORY OF HYGIENE 1 State Lab Perspective Julie Tans-Kersten, MS, BS-MT (ASCP)...
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Transcript of WISCONSIN STATE LABORATORY OF HYGIENE 1 State Lab Perspective Julie Tans-Kersten, MS, BS-MT (ASCP)...
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE 1
State Lab Perspective
Julie Tans-Kersten, MS, BS-MT (ASCP)Tuberculosis Laboratory Program CoordinatorWisconsin State Laboratory of [email protected](608) 263-5364
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
Testing Timeline, Index Patient• 4/12/13 (Saturday): sputum specimens
collected• 4/15/13: smear result: 4+ positive• 4/15/13: TB PCR positive• 4/15/13: sent sediment for MDDR testing
– California Public Health Laboratory: pyrosequencing for detection of mutations that confer INH and rifampin resistance
• 4/23/13: Culture confirmation of MTBC
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WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
Initial Molecular Results
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WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
Testing Timeline
• 4/12/13: WSLH received specimens from index case
• ACL started receiving specimens from contacts about 1 week later
• Specimens from index case collected by the public health department (to WSLH)
• Specimens from contacts collected at community hospital (to ACL)
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WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
Discordant Molecular Results: CA (pyrosequencing)
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WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
Discordant Molecular Results: CDC (Sanger Sequencing)
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WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
Testing Timeline
• Learned of drug resistance and possible outbreak at about the same time
• 4/29/13: started receiving bloody specimens from ACL for TB PCR
• 5/7/13: 7 contacts with active TB, most specimens had been going to ACL
• 5/8/13: ACL begins forwarding specimens to WSLH
• 5/10/13: community hospital starts sending specimens directly to WSLH
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WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
Significance of discordant Results
• Sequencing of KatG locus gave “clean” results
• Sequencing of rpoB locus gave “heterogenous” results
• Genotyping for index patient was “heterogenous”
• Genotype results between index case and contacts did not match.
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WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
Discordant Results
• Discovery that the index patient is infected with two strains of TB:–INH-resistant Beijing strain
–INH and rifampin resistant Manila strain
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WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
Significance of discordant Results
• Sequencing of KatG locus gave “clean” results
• Sequencing of rpoB locus gave “heterogenous” results
• Genotyping for index patient was “heterogenous”
• Genotype results between index case and contacts did not match.
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WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
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WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
WSLH Testing Volume (Specimens per week), n=113
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WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
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Sheboygan Public Health Dept
Sheboygan Memorial Hospital
Marathon County Public Health Dept
ACL: smear, culture, MTD
WSLH: smear, culture, TB PCR, conventional DST
CDC:MDDR andConventional second-line DST
MI Public Health Lab: Genotyping
CA Public Health Lab:MDDR and conventional DST
Submitters and Health Care Providers
Local Public Health Departments
State TB Program
CDC
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
Lessons Learned
• It is difficult to keep track of TB suspects, test results and test volumes when specimens are submitted to multiple labs
• Discordant results can cause confusion and delay appropriate patient management
• Data management is critical (everyone has a spreadsheet).
• Routine conference calls were invaluable• This outbreak highlights partnerships between
local laboratories, WSLH, Local Public Health Departments, WI State Division of Public Health and CDC.
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WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
Thank You
• Wisconsin TB Program• Sheboygan public health
Department• Marathon County Public Health
Department• ACL Laboratories• St. Vincent Lab, Green Bay (800
QFTs)
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WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
Contact Information
Julie Tans-KerstenTuberculosis Laboratory Program
CoordinatorWisconsin State Lab of Hygiene(608) 263-5364Fax: (608) [email protected]
TB (Mycobacteriology) Lab: (608) 262-1618
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE
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Dave
Julie TKJulie B.
Nate
Youngmi and Ana
WSLH Laboratory Team
Don