Monday Medical: Lab work helps solve medical mysteries


— Milk that is safe to drink. Development of a rabies vaccine. A Northwest Colorado woman afflicted with a rare, life-threatening disease.

These three seemingly unrelated items have one thing in common - medical microbiology, or the study of microscopic organisms that are associated with various types of diseases. This scientific process, which dates back to the 1600s, helps save lives every day.

Louis Pasteur is arguably the most famous microbiologist. In the 1860s he invented pasteurization, a preservation process for foods and beverages that we still depend on today. Pasteur also developed vaccines for rabies and anthrax.

That explains two of the items mentioned in the first paragraph. But what's this about a rare, potentially fatal illness in Northwest Colorado? For an answer, we turn to Yampa Valley Medical Center pathologist William F. Cox, Jr., M.D., and microbiology lab supervisor Brad Noble, ASCP.

"A couple of months ago a local woman picked up one of her kittens and got bit on the arm," Cox said. "She became ill, and her symptoms were consistent with a disease called 'cat-scratch fever.' The plague was another possibility. However, something very different showed up in our lab."

"It was tularemia, which I've never seen before in my 24 years in microbiology," Noble said. "The barn cats and kittens had been catching and eating rabbits that were infected with it. We sent a sample to the Mayo Clinic for DNA testing while we grew a culture in our microbiology lab.

"Our results confirmed what Mayo discovered - tularemia. This is really a serious disease, and we were able to help solve the mystery and save a life," he added.

Cox describes microbiology as an art, and Noble agrees. "It's not just pushing a button and getting results," Noble said. "We look through microscopes at what is called a gram stain, we grow microorganisms in a sterile agar solution kept at body temperature, then we interpret what we see."

Most microbiology tests at Yampa Valley Medical Center reveal routine results. The most common condition Noble identifies is urinary tract infection, followed by Staphylococcus aureus, usually referred to as staph.

"We always look not only for staph, but the strain that is resistant to antibiotics. This is called MRSA for methicillin-resistant Staphylococcus aureus," Noble said. "There are only a couple of antibiotics that can treat this type so it's very important to get the patient on the right medication."

Sometimes physicians will alter a prescription based on results from YVMC's microbiology lab. Because it can take from two to five days for a microorganism to grow, a patient can be started on one medication and switched to a different one when the disease is more defined.

"The most important aspect of microbiology is identification of organisms and their sensitivities to antibiotics," Cox explained. "We need to be very specific in matching the most effective antibiotic to the organism."

When cultures grow more quickly, or when a fluid sample has enough organisms to be seen through a microscope, a definitive diagnosis can be made rapidly. This was the case at YVMC last week when Noble found an infection within 24 hours of the dog bite that caused it.

This week, Noble is attending an educational seminar at the Mayo Clinic to learn more about new technologies in microbiology. Cox is excited about the possibilities presented by DNA testing and the genetic identification of organisms.

"We are proud to have a full-service, 24-hour laboratory here, which is unusual for a hospital this size," he said. "There's a new world of microbiology, and though this is not an overnight change, we'd like to be on the leading cusp of developing technology in this field."

Christine McKelvie is public relations director at Yampa Valley Medical Center.


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