In the past we are all identified as Bacteriologists and doing the work related to culturing few
bacteria and our teachers were committed to the Profession and teaching was their real capability.
There was lot of silence in Microbiology after the elimination of Smallpox in 1978 matters went in
many directions after the pandemic of AIDS, Diagnostic Microbiology picked up with fear of AIDS,
and we learnt to identify many opportunistic infections and we searched books, Internet to improve
our capabilities, most of thesis written after 90’s have some element of Opportunistic Infections, I
was always committed to my Diagnostic work as many neglect and think bench work is for
technicians, I wish to state the power of Diagnostics I learnt from Late, Dr.CSV Subramanian our
Chief of Diagnostics at Apollo Hospitals Chennai, who used to take a frozen section in
Histopathology at the Age of 70 years, and I Leant my strengths and weakness working is dedicated
environment , I changed several Institution todays many Professor and many senior Microbiologists
have become arm chair Microbiologists, rarely do anything, avoid the work and keep themselves
safe with authority, However with the raise of many Institutes once again the Microbiology has
become a competitive profession, Many dedicated post graduates are once again to change the face
of Microbiology Microbiologists need both theoretical knowledge and laboratory skills for their work
with viruses, bacteria and other invisible organisms. Many work in scientific research and
development or for pharmaceutical companies, government or universities. Today we have many
opportunities to thrive and improve the standards in Diagnostic Microbiology. Still the Many private
medical colleges and even the public run Institutions lack the work culture, and one needs a degree
of MD and one should be below 70 years to be recognised as professor competent to train the
students, this has created lot of setbacks, improving the Department's, many seniors are protecting
their job and really compromising the interests of the department and colleagues. To survive the
younger generation to be competitive as Employers look for applicants with hands-on laboratory
experience for microbiology positions at every level. I think new generation of Microbiologist must
have a plan of action to improve the talents which is more difficult than said I wish the students can
improve the career with following objectives with more systematic approaches in organization of
their knowledge .Some infectious diseases are distinctive enough to be identified clinically. Most
pathogens, however, can cause a wide spectrum of clinical syndromes in humans. With the demands
for evidence based Medicine we have a more prominent role than in the past.
In many instances, the cause of an infection is confirmed by isolating and culturing microorganism
either in artificial media or in a living host Direct
Examination and Techniques: Direct examination of specimens reveals gross pathology. Just have a
look at the specimens which have arrived in the department not necessarily everything but at
random. We get many times saliva spitted for culturing of sputum and identification AFB to rule out
Tuberculosis, just make your observation at least 25 % of the specimens are not fit for processing,
however we all compromise with many principles of Diagnostic Microbiology, however If senior
professors take interest it can never be corrected .Never forget Microscopy is the most rapid
method of Diagnosis in Bacteriology and Parasitology and Mycology in spite of so many advances,
just remember to plan good thing with effective Media we have in the laboratory, never forget we
have 4- 5 routine media, if we are logical we do many wonders. The number of bacteria in
specimens may be used to define the presence of infection. For example, there may be small
numbers (≤ 103 CFU/ml) of bacteria in clean-catch, midstream urine specimens from normal, healthy
women; with a few exceptions, these represent bacteria that are indigenous to the urethra and
periurethral region. Infection of the bladder (cystitis) or kidney is usually accompanied by
bacteraemia of about ≥ 104 CFU/ml. For this reason, quantitative cultures of urine must always be
performed.Many laboratories work with Human discarded blood in many developing countries it
needs the real wisdom and knowledge of the practising Microbiologist to interpret matter, when you
are in look back to clinicians what they write on the request paper It is still a luck to work with sheep
blood, and many times we do not grow the bacteria in abundance to qualify to the expected and
peer reviewed counts in many Microbiology textbooks due to many compromises. Many working in
good institutes have capacities to use modern methods may identify microorganisms.
Immunofluorescence, immunoperoxidase staining, and other immunoassays may detect specific
microbial antigens. Genetic probes RT PCR newer emerging methods to identify genus- or species-
specific DNA or RNA sequences.
Culture: Isolation of infectious agents some microorganisms, such as Shigella dysenteriae, salmonella
spp Mycobacterium tuberculosis, Coccidioides immitis, are always considered clinically significant.
Others that ordinarily are harmless components of the indigenous flora of the skin and mucous
membranes or that are common in the environment may or may not be clinically significant,
depending on the specimen source from which they are isolated. Frequently requires specialized
media. I still remember the worthy words of my teacher that the worth of post-graduation lies to
identify a pathogen from commensals, and many inexperienced Microbiologists are more happy to
isolate rather than probability of pathogenicity, this is how many Medical Microbiology laboratories
spoiling the advantages of Diagnostic microbiology and testing commensals for Antibiotic sensitivity
pattern, I think however Indian Antibiotic policy will have no progress unless there is some
innovation on diagnostic microbiology and pharmaceutical industry Non Selective (non inhibitory)
media permit the growth of many microorganisms. Selective media contain inhibitory substances
that permit the isolation of specific types of microorganisms. And we have to improve the quality of
reporting investing in many differential Media, Automation is like a rapid computer with many
errors, and do not forget we qualified medical microbiologists are the soul of the quality of the
services and do not ascertain your role, If we are dependent on technicians and leave the
laboratories your technicians will become the masters of the game, and we will be silent spectators
to many errors.
Microbial Identification: Colony and cellular morphology may permit preliminary identification.
Growth characteristics under various conditions, utilization of carbohydrates and other substrates,
enzymatic activity, immunoassays, and genetic probes are also used.in many advancing laboratories.
Serodiagnosis: A high or rising titer of specific IgG antibodies or the presence of specific IgM
antibodies may suggest or confirm a diagnosis. And most the serology is turned into Rapid diagnostic
test, however it needs a check and quality issues.
The matters in do not improve their knowledge in infectious diseases and rationalistic use of
Antibiotics Physicians must also consider that the composition of microbial species on the skin and
mucous membranes may be altered by disease, administration of antibiotics, endotracheal or gastric
intubation, and the hospital environment. For example, potentially pathogenic bacteria can often be
cultured from the pharynx of seriously ill, debilitated patients in the intensive care unit, but may not
cause infection. Never forget every isolate is not causative agent, it is along way if the seniors take
interest in bench work and spend few hours in the diagnostic laboratories the Microbiology will
improve for benefit of many deserving patients.
The responsibility of the microbiology laboratory includes not only microbial detection and isolation
but also the determination of microbial susceptibility to antimicrobial agents. Many bacteria, in
particular, have unpredictable susceptibilities to antimicrobial agents, and their susceptibilities can
be measured in vitro to help guide the selection of the most appropriate antimicrobial agent. I found
that WHONET continues to be best in systemic approach for better quality for now the event and
audit our own results.
Today many Medical Microbiologists claim to be Clinical Microbiologists, however we should set
right our laboratory reporting before we imagine to be a Clinical Microbiologists.
Dr.T.V.Rao MD Professor of Microbiology Freelance writer