Nebraska Challenge Set Exercise February, 2012 1 Continuing - - PowerPoint PPT Presentation

▶
nebraska challenge set exercise
SMART_READER_LITE
LIVE PREVIEW

Nebraska Challenge Set Exercise February, 2012 1 Continuing - - PowerPoint PPT Presentation

Jan 20, 2024 338 likes •769 views

Nebraska Challenge Set Exercise February, 2012 1 Continuing Education Fax to 402.559.7799 Email to kstiles@unmc.edu 2 Resources recommended for Challenge: ASM Sentinel Guidelines Link found on www.nphl.org BIOLOGICAL TERRORISM

slide-1
SLIDE 1

Nebraska Challenge Set Exercise

February, 2012

1

slide-2
SLIDE 2

Continuing Education

Fax to 402.559.7799 Email to kstiles@unmc.edu

2

slide-3
SLIDE 3

3

Resources recommended for Challenge:

ASM Sentinel Guidelines

Link found on

  • www.nphl.org

BIOLOGICAL TERRORISM PROCEDURES

slide-4
SLIDE 4

4

slide-5
SLIDE 5

BT Media Available from NPHL

  • India Ink & wet prep for motility have been

discontinued – not recommended by CDC

  • Optional - Spot Indole now DMACA with

cinnamaldehyde reagent

  • Order in sets of 3 to include positive and negative

controls with every test

5

slide-6
SLIDE 6

Scenario 1

  • Clinical History:

69 year old female

  • Source: Blood Cultures, 1 of 4 bottles positive
  • Note:

Laboratory has received HAN from Nebraska DHHS issuing a warning of a potential Bacillus anthracis outbreak reported in multiple locations across Nebraska.

6

slide-7
SLIDE 7

Images by NPHEL, St E’s and Alegent, Imperial

Direct Gram Stain Morphology

7

slide-8
SLIDE 8

Gram Stain Comparisons

8 Images by NPHL Fall NCSE 2011 - Listeria NCSE 2012 - 01 unknown

slide-9
SLIDE 9

Images by Norfolk

Gram Stain Morphology from Colony

9

slide-10
SLIDE 10

Images by Grand Island

Gram Stain Morphology from Colony

10

slide-11
SLIDE 11

Images by NPHEL, FAMC, Alliance

Gram Stain Morphology from Colony

11

slide-12
SLIDE 12

12

Gram Stain Morphology at 72 hours

slide-13
SLIDE 13

Images by Alliance, FAMC, Bellevue (Offutt), Grand Island

Colony Morphology

Growth on SBA, Choc

13

slide-14
SLIDE 14

NPHL Bench Guide

14

slide-15
SLIDE 15

NPHL Bench Guide

15

slide-16
SLIDE 16

Organism 1 Trigger Points

  • Sterile site
  • Large Gram Positive Rod in direct smear
  • Subterminal spores, cell not swelling
  • HAN warning from NE DHHS
  • Not Hemolytic on SBA
  • Catalase Positive (caution – test produces aerosol)

16

slide-17
SLIDE 17
  • Only 1 of 4 Blood Culture bottles positive
  • Not encapsulated in direct smear
  • Gram stain morphology not consistently chaining
  • Only 3 sentinel labs reported spores
  • Colony morphology more dry wrinkled
  • Growth was not 2-8 mm within 24 hr
  • Is the ground glass appearance and the comma

shaped projections (medusa head) seen?

  • Did patient history or clinical presentation fit

anthrax?

  • Motility? Laboratories differed on results

What did not fit?

17

slide-18
SLIDE 18

Group Biochemical Results:

NCSE 2012 - 01

Oxidase Catalase Indole Motility Nitrate Satellite Urease (2) (12) (0) (2) (0) (0) (0) (1) (9) (3) (16) (0) (0) (2) (19) 3 (1) 3 (19) 3 (4) 3 (22) 3 (22) 3 (20) 3

Did you use any of the following to identify the organism? If yes, please indicate reaction:

Positive Negative Not Applicable No Response

18

slide-19
SLIDE 19

Motility Images

19 Positive QC Negative QC NCSE2012- 01

slide-20
SLIDE 20

Responses to Organism 1

11 10 1

NCSE 2012 - 01

Bacillus spp Unable to rule out B. anthracis Bacillus spp., not B. anthracis Non Bioterrorism Agent 20

slide-21
SLIDE 21

What is the Best Answer for Organism 1?

  • Bacillus spp Not B. anthracis
  • Non Bioterrorism Agent??
  • Bacillus spp Unable to rule out B. anthracis

Actual mimic organism sent: Bacillus spp

Reference:

  • Organism was actual patient case which NPHL consulted with via STATPack
  • University of Minnesota College of Veterinary Medicine Fact Sheet 7/7/2006
  • Gastrointestinal Anthrax in New Hampshire: A 2009 Case Report - Laboratory Medicine; June

2011 CE Update. http://labmed.ascpjournals.org/content/42/6/363

21

slide-22
SLIDE 22

Morphology Comparisons

22

  • Image by NPHEL at 5 days
slide-23
SLIDE 23

23

Morphology Comparisons

slide-24
SLIDE 24

Gram Stain Comparisons

24 Images by NPHL, CDC PHIL image library NCSE 2012 - 01

slide-25
SLIDE 25

Worldwide anthrax outbreaks

2010-2012 http://healthmap.org/en/

25

slide-26
SLIDE 26

NSCE 2012 - 02

Clinical History: 2 year old male in ICU with aspiration pneumonia. Source: Endotracheal Note: Laboratory has isolated out multiple

  • rganisms including this organism.

26

slide-27
SLIDE 27

Images by Alegent, St E’s, Grand Island, North Platte, 27

Direct Smear Images

slide-28
SLIDE 28

28

Gram Stain Morphology from Colony Enlarged image to show “Bipolar” characteristics

Images by Pender

slide-29
SLIDE 29

Images by P Lab, Norfolk, Offutt, Grand Island 29

Colony Morphology

slide-30
SLIDE 30

Images by Norfolk, Imperial 30

Colony Morphology @ 48 hours

slide-31
SLIDE 31
  • Gram Negative Rod – Bipolar Staining
  • Small growth at 24 hours?
  • Oxidase?

Organism 2 Trigger Points

31

slide-32
SLIDE 32

NPHL Bench Guide

32

slide-33
SLIDE 33

Group Biochemical Results:

NCSE 2012 -02

Oxidase Catalase Motility Indole Beta-lactamase Nitrate Satellite Urease (20) (15) (15) (0) (3) (3) (0) (0) (2) (5) (1) (19) (1) (0) (0) (14) (0) 3 (2) 3 (6) 3 (3) 3 (18) 3 (19) 3 (22) 3 (8) 3

Did you use any of the following to identify the organism? If yes, please indicate reaction:

Positive Negative Not Applicable No Response

33

slide-34
SLIDE 34

Burkholderia Algorithm

34

slide-35
SLIDE 35

NPHL Bench Guide

35

Add Motility Negative

slide-36
SLIDE 36

Responses to Organism 2

13 4 2 1 2

NCSE 2012 – 02

Burkholderia spp, unable to rule out B pseudomallei Burkholderia spp, unable to rule out B pseudomallei or mallei Burkholderia pseudomallei Yersinia spp, unable to rule out Y pestis Non Bioterrorism Agent 36

slide-37
SLIDE 37

What is the Best Answer for Organism 2?

  • Burkholderia spp, unable to rule out B.

pseudomallei Actual mimic organism sent: Burkholderia thailandensis

Reference:

Pneumonia and Septicemia Caused by Burkholderia thailandensis in the United States, Journal of Clinical Microbiology, Dec 2006, p 4601-4604 Comparison of Routine Bench and Molecular Diagnostic Methods in Identification of B. pseudomallei, Journal of Clincial Microbiology, March 2009, p 1578-1580. Burkholderia pseudomallei Misidentified by Automated System, Emerging Infectious Diseases, Nov 2009, p 1799-1801.

37

slide-38
SLIDE 38

Nebraska Challenge Set 2012

38

 Next shipment date – July 16  Automatic Enrollment for 2013  BT Training needed?

slide-39
SLIDE 39

APHL On Demand Course

Bioterrorism Preparedness Training for LRN Sentinel Laboratories

  • Description
  • Each of these Intermediate-level, interactive online course modules

review a component of the Laboratory Response Network (LRN) protocols for bioterrorism agent identification. The modules include case studies, real-life laboratory scenarios and links to resource

  • information. Course materials may be used as part of a laboratory’s

competency assessment program for terrorism preparedness. Updated for 2012, seven course modules are available, including:

  • · Anthrax (Bacillus anthracis)
  • · Brucella (Brucella spp)
  • · Burkholderia (Burkholderia spp)
  • · Plague (Yersinia pestis)
  • · Tularemia (Francisella tularensis)
  • · Laboratory Biosecurity
  • · The Laboratory’s Role in Bioterrorism Preparedness (Laboratory

Response Network, LRN)

39

slide-40
SLIDE 40

STATPack Training – 3 CEU’s

http://training.statpack.org

40

slide-41
SLIDE 41

Changes to Packaging & Shipping

  • New documentation requirements for couriers
  • Will affect how you send:
  • Shiga Toxin positive
  • MTB
  • Coccidiodes immitis
  • ROAR isolates (case by case basis)
  • Dates in June 2012
  • June 5 - Omaha
  • June 7 - Kearney

41

slide-42
SLIDE 42

Questions??

42