Microbiology Kijabe Hospital

I've been promising some discussion of the microbiology lab here in Kijabe.  It's pretty impressive, especially in comparison with other hospitals in the area (more on this below).  Here's a brief walk-through.

The heart of ALL classical microbiology labs, whether basic science or clinical, is an autoclave and media preparation area since the basis of microbiology for 130 years has been to isolate and grow organisms on sterile media.

The thing that looks like a pressure cooker at the left side of the photo is the autoclave.  Because an autoclave is a glorified pressure cooker.  The fridge at right keeps reagents fresh! 

Almost every day begins with media preparation.  Reagents are mixed, autoclaved to kill environmental bugs, and then poured into petri dishes ("plates" in our lingo).  The autoclave also serves to decontaminate infectious waste from the laboratory.  It is in heavy use every day.

A key component of the microbiology lab is an instrument that monitors growth of bacteria in little tubes of culture media into which small amounts of a patient's blood (or other fluid; not poop though) has been added.

I know, this photo doesn't give a sense of scale and I will try to do better.  But for now, just know that this fits on a benchtop.  The whole model is about 3 ft wide x 2 ft deep x 2 ft high.

The machine maintains temperature and senses when conditions in the bottles have changes, indicating that the bacteria have grown.

I'll try to get a picture of blood culture bottles here, but ANYONE in the US would recognize them.

When blood culture bottles go positive, a little bit gets put onto the "plates" prepared in the media room.  There's a separate incubator for this.  Bacteria can then be identified through a series of basic tests.  First, a Gram stain is still a standard in all microbiology labs and is used routinely here. Second, biochemical tests are really useful: pour a little catalase onto your culture and see if it bubbles (catalase positive); put a little disc with optichin or dribble some bile salts onto your culture and see if it doesn't grow (optichin sensitive) or dissolves (bile soluble).  Voila!  Gram positive organism classified/identified!

For gram negatives, here we use Analytical Profile Index (API) strips.

Vibrio cholerae, many thanks to the UPMC Lab Med cases section

Add a little bit of culture into each well on this strip and test the bacteria's ability to ferment a bunch of different sugars (or reduce hydrogen).  Look up the pattern of fermentation (there are a LOT) and voila, gram negative organism identified.

Of course tuberculosis is a big deal here.  So we have a biosafety hood for making smears

You can see part of the incubator used for plates at the left.

And then we have one of the truly fantastic moves in global public health/microbiology, a self-contained box, molecular (PCR-based) diagnostic tool for sensitive detection of TB and rifampin resistance: the GeneXpert!

The machine is hooked up to a computer which automatically updates the Kenyan National TB monitoring center back in Nairobi, which tracks both cases of TB and rates of rifampin resistance.
The GeneXpert can be found everywhere from our labs back home, all the way to remote Kenyan hospitals (and Kijabe Hospital).

This set-up is actually really impressive; way more than I had expected.  Tonight I spoke with some Internal Medicine residents who had spent a week at the Naivasha District Hospital who described quite minimal microbiologic diagnostic capabilities.  The GeneXpert is their main piece of equipment.  This impression has been confirmed by other prior Pathology & Lab Med residents who have rotated here at Kijabe Hospital with Rochelle and visited Naivasha.

Stay tuned!  More Microbiology come and will include a possible outbreak in the ICU and validating more sophisticated microbiological identification equipment.