Topic Update

The Roles and Expectations of the Specialist in Clinical Microbiology and Infection

Volume 1, Issue 2, July 2006

Raymond WH Yung

Infection Control Branch, Centre for Health Protection, Department of Health & Infectious Disease Control Training Centre, Hospital Authority

In the past three years, we have witnessed the revived recognition of the importance of the specialty of Clinical Microbiology and Infection. The SARS outbreak reminded the medical profession that the line of defence which we had built against infection was still not robust enough to handle major outbreaks. Three reports were published after the outbreak. They outlined the deficiencies found and recommended what should be done for the future.1-3 Many of the recommendations are relevant and will impact on the future development of the specialty of Clinical Microbiology and Infection. Let me quote from the report of the Hospital Authority Review Panel, Paragraph 2.40: ‘… to control an outbreak of an unknown infectious disease … rapid implementation of measures to prevent spread and control the impact are vital, viz. 1) effective surveillance, data collection and sharing; 2) high level of awareness and implementation of effective infection control measures; 3) rapid and comprehensive contact tracing; and 4) timely declaration and enforcement of isolation and quarantine measures’.

Other than infection control is sues, the SARS outbreak further reinforced the role of the Clinical Microbiologist in several aspects. Firstly, the clinical microbiology service supports not only clinical care of individual infected patients, but also supports the protection of the health of the general population. Besides possessing strong command in the science of clinical microbiology, solid knowledge in epidemiology and crisis management to facilitate investigation and control of outbreaks is al so essential. In the context of provision of the daily service, the Clinical Microbiologist has a consultative role in managing patients with infectious diseases, from the arrival at a presumptive diagnosis based on clinical and ancillary laboratory/radiological findings, to advising on the appropriate diagnostic microbiological investigations, to interpreting results based on clinical and epidemiological information, and to recommendation of management options. Apart from attending to the individual patient, the Clinical Microbiologist, as the infection control specialist, undertakes to decisively direct and advise on the consequent infection control issues, both within the institution and in the community. Synthesis of epidemiological data with knowledge of the infectious agent, such as transmission route, incubation period, duration of infectiousness and susceptibility to disinfection, will enable the microbiologist to recommend specific measures to define at risk groups for contact tracing and to implement measures to prevent and control further spread of the infection to ensure public health.

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Laboratory diagnosis of human disease caused by H5N1 influenza virus

Volume 1, Issue 1, March 2006

JSM Peiris & Wilina Lim

Department of Microbiology, The University of Hong Kong & Virology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Hong Kong SAR 

Avian influenza A subtype H5N1 is endemic in poultry across south-east Asia and continues to cause zoonotic disease in humans. So far, transmission of virus from avian to humans appears very inefficient and sustained transmission from human-to-human has not occurred. However, with the continued opportunity for human exposure over an ever increasing geographic range, it is possible (though not inevitable) that H5N1 virus may acquire the ability to transmit efficiently from human-to-human, leading to a pandemic.

Human disease caused by H5N1 influenza virus typically presents either as a rapidly progressing viral pneumonia, often with evidence of marked lymphopenia, leucopenia and mild to moderate liver dysfunction. Some patients also have evidence of diarrhea and other gastro-intestinal manifestations. The disease may progress to acute respiratory distress syndrome (ARDS), multiple organ dysfunction and death (1-5). However, in the individual patient, it is not possible to make a reliable diagnosis of avian influenza H5N1 purely on clinical grounds. Furthermore, some patients may manifest a milder course of the disease presenting merely as a self-limited influenza-like illness. Virological diagnosis is therefore essential.

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