Microbiology Case Study: An 11 Year Old with Abdominal Pain

Case History

An 11 year-old patient with a history of a relapsed lymphoma presented to the hematology/oncology clinic with worsening abdominal pain. The patient was recently started on metronidazole to treat a C. difficile infection. In the clinic, the patient was found to be hypotensive, hypoxemic and pancytopenic. Blood cultures were drawn and the patient was admitted directly to the pediatric ICU and started on empiric antibiotics.

The blood cultures turned positive with Gram-positive cocci, which went on to produce small, gray, alpha-hemolytic colonies on the blood agar plate (Image 1). The colonies were catalase negative and PYR negative. The isolate was analyzed by a Bruker MALDI-TOF mass spectrometer and was identified as Streptococcus lutetiensis (score 2.19). Susceptibility testing revealed the isolate susceptible to ceftriaxone, penicillin, and vancomycin.

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Image 1. 5% sheep blood agar growing small, grey, alpha-hemolytic colonies

 

Discussion

S. lutetiensis is part of the complex of organisms previously identified as the Streptococcus bovis group. This group of organisms, which possess the Lancefield Group D antigen, has undergone considerable reclassification schemes as phenotypes and genotypes have been investigated. The original biochemical classification schemes were based on their ability to ferment mannitol as well as the presence or absence of beta-glucuronidase activity. Early observations of the DNA properties from these organisms, such as %-GC base content and DNA-DNA hybridizations, identified six unique clusters of Group D streptococci [1]. One cluster group (cluster group #4) had heterogeneous biochemical phenotypes. A subcluster of this cluster group #4 was separated from the other members of the cluster based upon esculin hydrolysis. This subcluster would later go on to be named S. infantarius, so named as several isolates originated from the feces of human infants [2].

Further DNA-DNA hybridizations and ribotyping analysis led to the declaration of two S. infantarius subspecies: subsp. infantarius and subsp. coli [3]. The 16S rRNA ribotyping was problematic, however, as several species in this genus are 97-99% sequence identical.

In an attempt to address some of the limitations of relying on the 16S rRNA gene, one group analyzed the features of the conserved gene encoding the manganese-dependent superoxide dismutase gene (sodA). They observed substantial differences between S. infantarius subsp. infantarius and S. infantarius subsp. coli [4]. Thus, for the latter organism, a new species of streptococci was proposed: S. lutetiensis. It was named for Lutetia, a historical name for the city of Paris [4].

The species designation S. lutetiensis was not widely accepted, however. Based on further DNA-DNA hybridization experiments and the prior studies of the 16S rRNA, others have rejected the species name “S. lutetiensis” and maintain that it is a subspecies of S. infantarius as previously described [5].

So which name is correct? There appears to be no clear consensus about the designation of these streptococci, whether it is S. infantarius subsp. coli or whether it is another species altogether as S. lutetiensis. The Judicial Commission of the International Committee on Systematic Bacteriology reportedly met to discuss the name changes, however no resolution appears to have been determined [6]. Both names are seen in the literature as well as the names for reference organisms.

The important clinical aspect to recognize is that this organism, as well as the S. bovis group in general, can be a cause of bacteremia, endocarditis, and meningitis in children. Treatment with beta-lactam antibiotics is generally sufficient to cover these organisms.

References

  1. Farrow, J., et al., Taxonomic Studies on Streptococcus bovis and Streptococcus equinus: Description of Streptococcus alactolyticus sp. nov. and Streptococcus saccharolyticus sp nov. System. Appl. Microbiol, 1984. 5: p. 467-482.
  2. Bouvet, A., et al., Streptococcus infantarius sp. nov. related to Streptococcus bovis and Streptococcus equinus. Adv Exp Med Biol, 1997. 418: p. 393-5.
  3. Schlegel, L., et al., Streptococcus infantarius sp. nov., Streptococcus infantarius subsp. infantarius subsp. nov. and Streptococcus infantarius subsp. coli subsp. nov., isolated from humans and food. Int J Syst Evol Microbiol, 2000. 50 Pt 4: p. 1425-34.
  4. Poyart, C., G. Quesne, and P. Trieu-Cuot, Taxonomic dissection of the Streptococcus bovis group by analysis of manganese-dependent superoxide dismutase gene (sodA) sequences: reclassification of ‘Streptococcus infantarius subsp. coli’ as Streptococcus lutetiensis sp. nov. and of Streptococcus bovis biotype 11.2 as Streptococcus pasteurianus sp. nov. Int J Syst Evol Microbiol, 2002. 52(Pt 4): p. 1247-55.
  5. Schlegel, L., et al., Reappraisal of the taxonomy of the Streptococcus bovis/Streptococcus equinus complex and related species: description of Streptococcus gallolyticus subsp. gallolyticus subsp. nov., S. gallolyticus subsp. macedonicus subsp. nov. and S. gallolyticus subsp. pasteurianus subsp. nov. Int J Syst Evol Microbiol, 2003. 53(Pt 3): p. 631-45.
  6. Beck, M., R. Frodl, and G. Funke, Comprehensive study of strains previously designated Streptococcus bovis consecutively isolated from human blood cultures and emended description of Streptococcus gallolyticus and Streptococcus infantarius subsp. coli. J Clin Microbiol, 2008. 46(9): p. 2966-72.

 

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-I.J. Frame MD, PhD, is a 1st year Clinical Pathology Resident at UT Southwestern Medical Center.

Erin McElvania TeKippe, PhD, D(ABMM), is the Director of Clinical Microbiology at Children’s Medical Center in Dallas Texas and an Assistant Professor of Pathology and Pediatrics at University of Texas Southwestern Medical Center.

Medical Laboratory Professionals Week Approaches

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In light of Medical Laboratory Professionals Week 2017, I wanted to take this quarter’s post and thank all of you who work hard in so many ways to get patients the results they need. You truly are “All Stars.” I thought it would be interesting to have an interactive sort of post; feel free to write in the comments examples of how you and your lab go above and beyond to help patients.

Here is just one example of how the Molecular Diagnostics Lab here at Nebraska Medicine continues to do our part to serve our patient population. Our hospital (University of Nebraska Medical Center) has become a participating center for the TAPUR trial. This stands for “Targeted Agent and Profiling Utilization Registry” study; it is a non-randomized clinical trial that is essentially matching anticancer drugs to genomic variants in the patient’s tumor. Currently, most drugs are given based first on what type of tumor it is, then by the genomic variants. For example, if a patient has a gastrointestinal stromal tumor (GIST), and that tumor has a duplication in the KIT gene (p.A502_Y503dup), that tumor is sensitive to a drug called Imatinib, among others, and that drug has been shown to help fight the GIST. The TAPUR study’s goal is to see if any tumor that presents with that KIT variant is sensitive to Imatinib, whether the tumor is a GIST or some other type of cancer.

What does this have to do with our lab? Well, there are certain criteria necessary for a patient to be eligible for this trial. In addition to being 18 years or older, not currently pregnant or planning to become pregnant, the patient must have a solid tumor, multiple myeloma, or B cell non-Hodgkin lymphoma that is not responding to standard anti-cancer treatment and they must be able to be active for at least half the day, every day. Lastly, they need to have had a genomic or molecular test performed on their tumor. I and the technologists that I work with have seen an increase in our testing since our hospital has become a center for this trial because of that last point. We run an assay that tests areas of 50 genes that are known to contain “hotspot” regions that are commonly mutated in different types of cancers, and we run this by next generation sequencing (more to come regarding this type of technology–stay tuned for next quarter’s post!). We have been testing tumors of patients that have not been responding to treatment, and we all realize that each one of the tests that we perform has an impact on how that patient’s tumor will be treated. And here I have to commend the techs in our lab for thriving when faced with the challenge of this increase in testing–they have done an excellent job with the added workload and with keeping up with the changes that are made in this rapidly evolving area of the lab. I think we all appreciate this aspect of our careers–knowing that the hard work we put in every day to do our jobs to the best of our abilities can and does have an effect on people’s lives. Thank you all for everything you do!

For more information on the TAPUR trial, follow this link: http://www.tapur.org/.

 

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-Sharleen Rapp, BS, MB (ASCP)CM is a Molecular Diagnostics Coordinator in the Molecular Diagnostics Laboratory at Nebraska Medicine. 

Sickle Cell Anemia

Sickle cell disease is a blood cell disorder that affects a lot of Americans, especially those of African descent. The disease is a result of a genetic defect that changes the structure of hemoglobin. This alteration in hemoglobin causes normally round red cells to become sickle in shape as well as sticky and deformed. As a result, these deformed red cells block perfusion of red blood cells into circulation and vital organs and affects the vasculature resulting in severe pain, organ damage and sometimes stroke.

Management of sickle cell disease includes blood transfusion, hydorxyurea and pain management. The long-term administration of hydroxyurea to stimulate the production of fetal hemoglobin is a form of therapy that provides relief in that fetal hemoglobin essentially protects the red cells from sickling. The transfusion of red cells lowers the amount of sickle hemoglobin levels.

Transplantation of hematopoietic stem cells from HLA-identical siblings can be curative in several nonmalignant hematologic disorders, including aplastic anemia, β-thalassemia major, congenital immunodeficiency disorders, and certain inborn errors of metabolism. Pilot studies of bone marrow transplantation for the treatment of young patients with symptomatic sickle cell disease have demonstrated eradication of the underlying disease with low transplantation-related mortality (Bhatia and Walters, 2007).

The process for successful bone marrow transplant to cure sickle cell involves administration of chemotherapy or immunosuppressive drugs to eradicate all the cells.  Now, doctors have developed a more successful regimen where patients take immunosuppressive drugs with a low dose body irradiation, a treatment much less harsh than chemotherapy. Next, donor cells from a healthy and tissue-matched sibling are transfused into the patient. Stem cells from the donor produce healthy new blood cells in the patient, eventually in sufficient quantity to eliminate symptoms. In many cases, sickle cells can no longer be detected. Patients must continue to take immunosuppressant drugs for at least a year.

In the reported trial, published online in the journal Biology of Blood & Marrow Transplantation, physicians from the University in Illinois Chicago transplanted 13 patients, 17 to 40 years of age, with a stem cell preparation from the blood of a tissue-matched sibling. In a further advance of the NIH procedure, the physicians successfully transplanted two patients with cells from siblings who matched but had a different blood type (Parmet, 2015)

Stem cell transplantation has proven itself to provide cures for a lot of hematologic malignancies, now it is successfully finding its way to cure other hematologic abnormalities, including sickle cell anemia.  This continued advancement in medicine will provide relief to a lot of patients who are suffering from sickle cell disease.

References

  1. Bhatia, M., & Walters, M. C. (2007). Hematopoietic cell transplantation for thalassemia and sickle cell disease: past, present and future. Bone Marrow Transplantation, 41(2), 109-117. doi:10.1038/sj.bmt.1705943
  1. Parmet, S. (2015). Adults with sickle cell disease cured with stem cell transplants. Retrieved March 25,2017, from https://news.uic.edu/cure-for-sickle-cell

 

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-Carlo Ledesma, MS, SH(ASCP)CM MT(ASCPi) MT(AMT) is the program director for the Medical Laboratory Technology and Phlebotomy at Rose State College in Midwest City, Oklahoma as well as a technical consultant for Royal Laboratory Services. Carlo has worked in several areas of the laboratory including microbiology and hematology before becoming a laboratory manager and program director.

Urine Luck: The Diagnostic Value of Urine Dipstick Testing

A major challenge to providing diagnostic laboratory services in resource-limited settings, like the refugee camps discussed in last month’s post, is lack of infrastructure. Without running water, electricity, and even access to good phlebotomy supplies, specimen collection and preparation can be difficult, let alone the actual testing. I’ve found that in many instances, going back to the basics can often help determine a means of providing useful laboratory results. This post focuses on the humble, yet powerful, urine dipstick.

The urine dipstick is lightweight, easily portable, requires no special handling or storage and most have long shelf lives. These characteristics make the dipstick a great tool for use in the field. The specimen–simply urine–is also easy to collect and requires no special preparation. Dipstick testing can serve as a screening tool for some diseases and a diagnostic test for others. Urine dipstick measures pH, specific gravity, nitrites, leukocyte esterase, peroxidase activity, glucose, ketone, bilirubin, protein, and urobilinogen all performed within about a minute.

Urine is slightly acidic fluid and its pH is maintained essentially by the kidney. Any acid-base imbalance affects urinary pH. Urinary pH levels are helpful in the evaluation of nephrolithiasis, infection, and renal tubular acidosis. Kidney’s ability to concentrate urine is readily assessed by measuring the specific gravity of urine and the measurement generally correlates with urine osmolality.

Both nitrites and leukocyte esterase are used to evaluate urinary tract infection (UTI). A specific group of bacteria with reductase enzyme reduces nutritional nitrates in urine to nitrites which is detectable by urine dipstick testing. Some bacteria are not capable of converting nitrates to nitrites and therefore patients with UTI could still be negative for nitrite. Patients on a nitrate-deficient diet could be negative for nitrite despite the presence of bacteria with reductase enzyme in urine. In addition, the conversion of nitrate to nitrite requires time as well as at least 10,000 bacteria in milliliter of urine for the chemical reaction on the pad to occur. Thus, first morning urine is a specimen of choice for nitrite test. Outdated dipstick or a dipstick exposed to air could also cause a false positive reaction for nitrite. In the context of these limitations, nitrite test is only specific (92-100%) for bacteria capable of converting nitrate to nitrates and has very poor sensitivity (19-48%).

Leukocyte esterase is an enzyme produced by neutrophils. This enzyme is released from lysed neutrophils. The presence of esterase enzyme in the urine may imply UTI. However, white blood cells could present in the urine secondary to bacterial and viral infections, or because of other conditions such as tumor in the bladder. Unlike nitrite, leukocyte esterase is somewhat sensitive (72-97%) but not as specific (41-86%).

The presence of glucose or ketone in the urine is not normal. Glucose is detected in the urine when the blood glucose level is greater or equal to 180 mg/dL. In this level of glucose in blood, the kidney readily overwhelms its ability to re-absorb by filtering excess glucose. The presence of ketone in urine is suggestive of poorly managed blood glucose level, starvation, and prolonged fasting. When used combined, both measurements can be used to identify and monitor diabetic patients.

Detectable protein (only detects albumin, not other proteins) in urine is indicative of renal disease. The normal protein level in urine is less than 150 mg/dL and is below the threshold a urine dipstick can detect. Significant proteinuria with 96% sensitivity and 87% specificity is detected when urine protein level exceeds 300 mg/dL. Because of its insensitivity to microalbuminuria, dipstick test has limited clinical utility in screening diabetic patients.

Urine dipstick is used to identify the peroxidase activity of red blood cells, not for the presence of intact erythrocytes. Therefore, urine dipstick alone cannot be used to diagnose hematuria unless combined with microscopy finding. Hematuria is defined by American Urological Association the presence of at least 3 red blood cells per high power field. Positive peroxidase activity in the absence of red blood cells under microscope could mean myoglobinuria (e.g. caused by rhabdomyolysis), hemoglobinuria (e.g. caused by hemolytic condition and infections), or false positives. False-positives could arise from urine contamination with oxidizing agents, semen in the urine, blood contamination from hemorrhoids or vaginal bleeding, or from foods and medications such as beets, hydroxocobalamin, and phenazopyridine.

The presence of detectable conjugated bilirubin and/or urobilinogen is suggestive of liver disease, in vivo hemolysis, and/or biliary obstruction. Low concentration of urobilinogen in urine is normal. Bilirubin is converted to urobilinogen by bacteria in the intestine.

The chemical analysis of urine provides valuable information about the function of multiple organs or systems within a very short analytical time. If the limitations and inferences of the chemical reactions are properly addressed during interpretation, the diagnostic utility of urine chemical test is high. In situations where access to laboratory testing is low, the dipstick can provide clues to aid diagnosis.

 

-Merih Tewelde, PhD, contributed to this post.

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Sarah Riley, PhD, DABCC, is an Assistant Professor of Pediatrics and Pathology and Immunology at Washington University in St. Louis School of Medicine. She is passionate about bringing the lab out of the basement and into the forefront of global health.  

 

Microbiology Case Study: A 28 Year Old Woman with Acute Onset Fever Post Delivery

Case History

A 28 year old woman at 37 weeks and 2 days presented in labor to our ED. After 22 hours, she delivered a healthy baby boy and sustained a second degree perineal laceration requiring repair. On hospital day 2, she reported feeling lightheaded, nauseous and “shaky.” She attempted to walk around the unit but became tremulous and unsteady, requiring assistance to get back into bed. Her vital signs were as follows: febrile at 38.8 C, BP 108/54, HR 104 and normal respiration rate at 12 breaths/min. On exam, she appeared pale and lethargic, and was noted to have a tender uterus on palpation. Based on her presentation and status post SVD, the diagnosis of endometritis was established. Blood cultures were obtained and within 16 hours, blood culture bottles were positive for gram-positive cocci. The patient was started on antibiotic therapy with ampicillin, gentamycin and clindamycin, and clinically improved within 36 hours.

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Image 1. Blood culture on blood agar.
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Image 2. Blood culture on chocolate agar.

Discussion

Streptococcus pyogenes is one of the most aggressive pathogens encountered in clinical microbiology. It is a beta hemolytic streptococcus and is notoriously associated with Streptococcal Toxic Shock Syndrome (STSS), necrotizing fasciitis, as well as more benign (yet still problematic) conditions, like Scarlet Fever, Impetigo, Rheumatic heart disease and Acute Post-streptococcal Glomerulonephritis. A gram-positive cocci, it possesses several virulence factors, including protein F, M protein (involved in antigen mimicry leading to valvular heart disease) hemolysins and exotoxins. These factors allow S. pyogenes to attach to and invade epithelial tissue, and in the case of hyalurondiase, potentially use hyaluron as a carbon food source. S. pyogenes agglutinates with Lancefield group A antisera and is pyrrolidonyl arylamidase (PYR) positive and VP, hippurate and CAMP test negative. Penicillin (PCN) remains the drug of choice in treating most S. pyogenes infections. Alternative antibiotic therapy includes macrolides and certain cephalosporins (e.g. cefixime, cefpodoxime). Vancomycin should be used in more severe infections such as sepsis or for patients with a PCN allergy.

 

-Christina Litsakos is a Pathology Student Fellow at University of Vermont Medical Center.

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-Christi Wojewoda, MD, is the Director of Clinical Microbiology at the University of Vermont Medical Center and an Assistant Professor at the University of Vermont.

 

Interference in Lab Assays

A 69 year old patient with cirrhosis presented to the ER with fever. Her bilirubin was markedly elevated at 7.4 g/dl and her hemoglobin and hematocrit were measured at 13.4 g/dl and 35.6% respectively with a MCV of 103.2 fl and MCH of 38.5 pg. The next day her H/H were 11.9 g/dl and 31.3 % respectively. While her hemoglobin one day later was 11.9 g/dl, the reported hematocrit was 39.3%. Patient had a bilirubin level of 8.7 g/dl at this time.

The fluctuating numbers together with the discrepancy between hemoglobin and hematocrit over a very short period of time was concerning. We realized that presence of markedly icteric plasma was responsible for these discordant values. Saline replacement and spun crit were performed in order to correct interference by bilirubin. Subsequent measurements of H/H revealed hemoglobin in the range of 12.9 g/dl with a hematocrit of 38% and a MCV of 113 fl. As the bilirubin levels started dropping (in the range of 6.5 g/dl) the hemoglobin level measured by the analyzer fell in the range of 10.3 to 11 g/dl. The instrument (XN-200) gave no error codes and therefore we were able to report out the analyzer results without correction. It was however very important to convey to the clinical team that the H/H values did not truly represent a fall from the previous values. As the two methodologies were different (spun crit and plasma replacement was being no longer performed) the numbers should be interpreted accordingly. Patient was not bleeding actively and did not require any blood transfusion.

Interference occurs when a substance or process falsely alters an assay result. Interferences are classified as endogenous or exogenous. Endogenous interference originates from substances present in the patient’s own specimen. Exogenous interferences are substances introduced into the patient’s specimen. Interference from hemolysis, icterus and lipemia are most frequently studied. Protein interferences are most often associated with paraproteins and predominantly with IgM or IgG and rarely with IgA. Drug interference may be due to the parent drug, metabolite(s) or additives in the drug preparation. Determining if interference is significant requires deviation limits from the original result. Once interferences are identified there is a need to establish procedures for handling affected results as part of the quality system.

Hemoglobin is quantified based on its absorption characteristics. Conditions such as hyperlipidemias, hyperbilirubinemia, a very high white blood cell count, and high serum protein can interfere with this measurement and result in falsely elevated hemoglobin values. When the values of hemoglobin, red cell count, and MCV are affected, MCH and MCHC also become abnormal, since these indices are calculated and are not directly measured. Sometimes a set of spurious values may be the first clue to an otherwise unsuspected clinical condition (e.g., the combination of low hematocrit, normal hemoglobin, and high MCV and MCHC is characteristic of cold agglutinins).

Although one must pay attention to very high amounts of bilirubin within the plasma, most hematology analyzers do not presently demonstrate any interference with bilirubin, at least for concentrations up to 250 mg/l. Above these values attention is however needed.

High serum or plasma bilirubin concentrations can cause spectral interference with assays near the bilirubin absorbance peak of ~ 456 nm. Chemical interference e.g. with peroxidase-catalysed reactions may also occur.

 

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-Neerja Vajpayee, MD, is the director of Clinical Pathology at Oneida Health Center in Oneida, New York and is actively involved in signing out surgical pathology and cytology cases in a community setting. Previously, she was on the faculty at SUNY Upstate for several years ( 2002-2016) where she was involved in diagnostic work and medical student/resident teaching.

Social Accountability Inside and Outside the Laboratory

Being a medical laboratory scientist is more profession than occupation. Those of us who are affiliated with ASCP through our certification or work know the value of being part of an organization that values education, certification, and advocacy for patients. Finding a place in this network has given me a strong foundation through years of understanding a “best practices” paradigm. If you’ve been following my posts these last few months, you’ll have heard all about my work with Zika virus prevention and detection initiatives on the island country of Sint Maarten. Being here at the right time and right place have provided ample opportunity to flourish as a medical student with a history of laboratory experience. Recently, my school honored me with the Social Accountability Award and Scholarship for outstanding service during my time as a student with respect for my colleagues and the surrounding community of Sint Maarten. Having authored proposals and leading initiatives coalesced into an ongoing functional public health initiative, partnered with local government and NGOs. My experience as a certified scientist allowed me to build on three major ASCP foundations:

  1. Leadership. Receiving the award from the school validated my confidence in the work that I and my team have been doing this last year. Letters of recommendation came from my service-learning course director and Dean of Community Affairs, and the consultant advisor to the public health prevention office of the local Ministry of Health. The Dean of Medical Sciences even spoke about me with kind words and an inspired tone that really meant a lot to me, personally. This overall validation was not just for me—it was for the work, my team, and our efforts in local public health. The exercise in textbook-to-field informatics, education, and interventions could not have come to fruition without experiences I drew from in my lab years. Responding to CAP inspections, spearheading changes to SOPs or operations, and being a voice at the conference table taught me how to collaborate as well as lead.

 

  1. Education. If there’s anything I would say has been paramount in my time (both here in medical school and back in the lab) it’s the value of education. I could not do the work or pursue the projects I do today without backgrounds in molecular science, lab informatics, or general pathology and disease. Through numerous degrees and opportunities to work in the field of laboratory medicine, there are countless venues for someone to continue to patient care. My journey included a foundation of molecular biology, a graduate degree in lab science, an ASCP certificate with continuing maintenance as an MLS—now in post graduate work; I continue to work and learn in a dynamic environment. I have created SOPs from scratch, researched literature on seroprevalence and epidemiological statistics, managed and interpreted specimen collection and ELISA testing, and contributed to public health awareness and education. If you want diverse and exciting, this field has it! Education doesn’t stop with the degrees and certificates on the wall behind my desk, however. A very important, and arguably mandatory part, of being a scientist/clinician is being able to engage in an educational conversation with a wide variety of audiences. Talking about Zika virus prevention, seroprevalence, and risk mitigation is a different conversation with children, or local adults, or medical colleagues.
  1. Advocacy. Finally, I should say: if there’s one major thing professional organizations like the ASCP do for its members and our communities, it’s advocacy. Giving a concrete voice and substantial representation to the causes we care about as professionals yields positive returns for our overall shared goal of improved patient outcomes. My work here is first as a medical student, and second as a public health partner. Sharing and collaborating on how this community can best utilize its resources to address a local epidemic is at the forefront of my team’s work. When I started this project, I was inspired by the aims and goals of the Partners for Cancer Diagnosis and Treatment in Africa Initiative from the ASCP Foundation. I first heard about this at the annual meeting in Long Beach, and, as I prepared for my own stint overseas, I tried to keep that close to heart. Improving global health outcomes and increasing laboratory visibility were two of the major tenets of this project. Proudly, I would say I’ve been involved in both aims. Clear success has been documented (and continues to be seen!) in my Zika initiatives, and more and more people engage in conversations with me about translational medicine. With all my documents signed “C. Kanakis, MS, MLS (ASCP),” people have been surprised by all the things someone with “just a lab” background can really do! Breaking stereotypes and inspiring others to reach out for improving patient outcomes is all part of the same conversation I have with my community partners.

In short, my work with Zika virus prevention is an ongoing project, with new events and achievements tallied weekly. But before I get back to recounting the most successful events each month, I wanted to take a step back and say that I could not have been a Social Accountability Award recipient in this community without first learning the way to be a leader, educator, and advocate in our community.

Thanks for reading! Until next time…

 

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Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.