Laboratory personnel were recently recognized at Strong Memorial Hospital at an event celebrating the launch of the new nucleic acid testing (NAT) laboratory.
The new FDA-approved lab, which officially opened in February, performs serologic testing to screen for HIV, Hepatitis B and Hepatitis C. These results must be obtained before a consenting donor’s organ can legally be transplanted into a recipient.
Prior to the launch, the closest FDA lab that did this testing was located in Philadelphia. Establishing the new lab has significantly reduced the amount of turnaround time for these lifesaving procedures.
Representatives from URMC, the Finger Lakes Donor Recovery Network (FLDRN) and regional organ procurement organizations came together on July 26 to recognize and thank the laboratory personnel who are on call 24/7 to perform this testing when needed.
“Bringing NAT testing here to Rochester really shortens the time, which helps donor organs to be more viable and more appropriate for the recipients, so we really are quite thankful that this team was able to make this testing possible,” said Kathy Parrinello, Chief Operating Officer of URMC.
Since it first opened, the lab has processed tests for 44 donors. It services Rochester, Buffalo, and Albany with hopes to expand this service area in the future.
“We do this because we in the laboratory are uniquely qualified to do this little piece of transplant testing,” said Dr. Dwight Hardy, Director of Clinical Microbiology at URMC. “We do it to be responsible members of the medical center community and Finger Lakes community, to see that organs that are to be potentially transplanted in patients are safe.”
Surgeons like Dr. Roberto Hernandez Alejandro, Chief of Transplantation Surgery at URMC, see many benefits to having NAT testing under the same roof.
“There was a huge push for doing this in a short period of time because families were requesting it,” said Hernandez Alejandro. “For those (surgeons) that are saving organs for transplantations, this is a great benefit.”
He explained that although this testing happens behind the scenes, no transplant can occur without it.
“It’s a huge part of transplantation,” he said. “Helping just one donor and saving one life is huge.”
Read more about the NAT Lab
Just about everyone who knew or worked with Dr. Marilyn Menegus (1943-2017) has a story about her.
There was the time she brought a Cheesy Eddie’s carrot cake to work when she got tired of hearing that her staff had never tried it before. A colleague recalled the way she could cut through complex scientific concepts and make them easy for anyone to understand. And her coworkers can remember how she’d warmly greet them with, “Hey kid,” no matter their age.
Dr. Menegus, known to many as, simply, Marilyn, passed away March 20, 2017 from complications resulting from colon cancer. Since then, the response from those who knew her has been felt deeply by many.
To celebrate her life and legacy, the Department of Pathology & Laboratory Medicine will host an informal event at the University of Rochester Medical Center on Friday, May 12.
Marilyn was an extremely accomplished and well respected microbiologist who joined the Department of Microbiology and Immunology in 1976 with a secondary appointment in Pathology & Lab Medicine.
She trained more than 40 clinical microbiology fellows and five infectious disease fellows during her 41 years at URMC, earning her the title of “mother of the post-doc program.” She stayed in contact with many of her past trainees, whom she treated like family. Many went on to work in prestigious laboratories across the U.S. Her impact on their professional lives remains strong.
“She was truly a mentor, always eager to share interesting clinical cases and inserting educational tidbits along the way,” said former fellow, Kristen Smith, Ph.D. “The depth of her knowledge and passion always amazed me.”
Former Pathology resident Vanesa Bijol, M.D., who now works in the Harvard University health system, said the sheer number of lives touched by Marilyn was huge. “In that sense, her professional impact was huge, and very few of us who devote life to academia can achieve that level of success,” Bijol wrote. “But she never thought of it that way. She just simply enjoyed her work, science, and teaching, and was very humble about her achievements.”
Marilyn was born and raised in Passaic, New Jersey with siblings, Dorothy and Herbert. She earned her bachelor’s degree from the College of Saint Elizabeth and later received her Ph.D. in virology from Cornell University in 1971.
In her early career, she established a clinical virology laboratory at St. Luke’s Hospital in New York City and also founded a clinical virology lab at URMC, which was one of the few of its kind in the U.S. during the late 1970s. During the course of her career, she published more than 100 articles and book chapters as an author and co-author.
She was an active member of organizations including the American Academy of Microbiology, and the American Society for Microbiology. In 2013 she received the Diagnostic Virology Award from the Pan American Society for Clinical Virology.
In what became one of her final professional contributions, Marilyn worked closely with the Finger Lakes Donor Recovery Network to establish a nucleic acid testing lab at Strong Memorial Hospital to significantly expedite the organ transplant process for organ recipients. This was launched successfully in February just weeks before her passing.
Rob Kochik, executive director of FLDRN, said he was heartbroken to hear the news of Marilyn’s death.
“She was always such a joy to work with,” he wrote. “She was committed to helping establish the NAT testing facility because she truly understood how vitally important it was to help the donation process.”
Despite her expertise and accomplishments, many remember Marilyn as an extremely approachable and down to earth person; a lover of gardening, food, wine, and a good joke.
Her brother describes her as “fiercely independent” and a rule breaker at heart. This was evidenced by one of her favorite movies, “Ferris Buehler’s Day Off,” and a stack of unpaid red light tickets.
An avid gardener, she once served as president of the Genesee Region Orchid Society and had more than 200 orchids in her house, in addition to a lush garden at her Rochester home where she lived with two cats, Bella and Luigi, and frequently hosted parties for friends.
Whether you knew her for 20 years or 20 minutes, Marilyn made a warm and lasting impression on the people she encountered at or outside of work. Debra Jesien, chief supervisor of Clinical Microbiology at URMC, worked closely with Marilyn for many years.
“She could bond with people very quickly,” said Jesien. “She was the type of person you could talk to once and you felt like you knew her.”
What: Memories of Marilyn, an informal memorial to celebrate the life of Dr. Marilyn Menegus. Guests are encouraged to bring their stories and photos to share.
When: Friday, May 12 from 12:00-2:00 p.m.
Where: LeChase Assembly Hall (G-9576) University of Rochester Medical Center. Drinks and light refreshments will be provided.
RSVP: Please follow this link to enter your RSVP online or contact Bethany Bushen for more information.
Read the obituary of Dr. Menegus in the Democrat and Chronicle
If you’ve ever had a sore throat swabbed to test for strep, you have experienced just one way bacteria cultures can be used to help sick patients get answers.
The Bacteriology Laboratory at Strong Memorial Hospital runs hundreds of tests around the clock to identify the bacteria and fungi that cause everything from urinary tract infections to food poisoning. This identification process is the first step in stopping sickness in its tracks and putting patients on the road to recovery.
There is a rainbow array of plates that medical technologists use to grow different bacteria. An ordering provider may suspect a certain type of infection and ask the lab to run a specific test, or tests, to confirm the identity of the culprit and see what drugs it best responds to.
Most bacteria are traditionally grown on an agar media plates that contain sheep’s blood. Historically, this has been the way to obtain bacterial growth in order to determine which organisms are “normal flora” and which bacteria are “bad,” causing disease or infection. Culturing allows “bad” bacteria to be tested for susceptibility to certain antibiotics. Advances in modern technology are now making this process more automated than ever before.
How it starts
If you have symptoms of a urinary tract infection, for example, your urine sample will be sent to the lab for testing from your doctor’s office. After it has been received, labeled, and entered into an electronic database for tracking, the specimen goes to a medical technologist.
He or she will then dip a tiny calibrated plastic loop into the urine and make a streak onto a sterile blood plate to start the process of growing bacteria. This process is called inoculation.
About 80 percent of all UTIs are caused by the bacteria E. coli, classified as Gram-negative bacilli due to the composition of the cell wall. The tech will also select media (another name for agar plates) that will only grow Gram-negative bacteria (called MacConkey agar in this case) to help identify the “bad” bacteria and prevent growth of other organisms.
“That’s what a lot of bacteriology is: knowing who the good guys are – the normal flora – and who the pathogens are,” said Jennifer Barrante, education coordinator for Microbiology at URMC. “We’re trying to enhance the recovery of our ‘bad’ guys.”
Since bacteria need warmth and time to grow, the inoculated plates are then placed into and incubator that looks like a refrigerator with a glass door, but warms up to body temperature instead of cooling. The plates are allowed to incubate for a minimum of 18 hours to give the bacteria time to grow.
After incubation, the technologist takes the culture and counts the number of bacterial “colonies” that have grown overnight. E. coli, for example, will appear as pink colonies on the MacConkey plate after it has incubated overnight. This is a quantitative culture because the quantity of bacteria reported is based on the actual number of colonies grown, multiplied by 1,000 to determine colonies per milliliter of urine.
Most cultures are not quantified this way. Instead of counting the number of colonies, cultures are usually read semi-quantitatively using a four-quadrant system.
Picture the circular plate evenly divided into four sections with a specimen streak in each quadrant. If growth appears only in the first quadrant where the specimen was inoculated, the reading is “one-plus.” If there is also growth in the second section of streaking, it’s 2+, and so on.
What else can you grow?
Lab techs are able to culture bacteria from a wide variety of biological material. This can be a swab of something as innocuous as a blister or a cut on your finger, to something as serious as spinal fluid to detect meningitis.
If a patient undergoes a biopsy on a tissue mass that’s suspected to be cancerous, part of the tissue specimen can be cultured to see if the growth is caused by an infection instead of cancer.
Blood specimens can also be cultured to detect bacteremia (bacteria in the blood) or sepsis (a severe reaction to an infection that may involve the blood) which can be caused by different organisms like staph, or Haemophilus.
Besides urine and blood, stool specimens are routinely cultured to identify bacteria – like Salmonella, Shigella, or Campylobacter – that cause food poisoning.
You can also test for fungal infections like ringworm, a yeast infection or oral thrush, which appears as white spots inside the mouth.
The lab also tests specimens for acid-fast bacilli, a group of bacteria that includes the cause of tuberculosis.
While these methods of culturing specimens have been around for many decades, new technologies allow labs to get the same results more quickly, and with less hands-on work.
There are several large instruments at URMC that perform testing on a molecular level. This kind of test is called a PCR, or polymerase chain reaction, and it uses small samples of DNA to detect patterns that indicate the presence of certain bacteria, viruses, or infections.
One PCR instrument can test stool samples for presence of C. difficile and Norovirus. That same instrument can use a nasal swab to test for MRSA. Another instrument allows for testing of the respiratory virus panel based on a nasal swab.
The newest instrument, the BD MAX, has replaced the traditional stool culture method for detecting Salmonella, Shigella and Campylobacter. It can also detect the stool parasites Giardia, Cryptosporidium, and E. histolytica when requested by a doctor.
This instrument reduces the time it takes the result to get to the doctor. A traditional stool culture can take 3-4 days to be resulted once received in the lab, but the BD MAX can get the same results within 24 hours.
Automated molecular instruments can also provide much faster results for some sexually transmitted diseases just hours after they are run on the instrument, rather than patients having to wait days for traditional cultures to yield a result.
Yes, PCR automation saves time, but identifying the causative agent of an illness is just one step in determining how it should be treated. Many specimens must still be cultured to determine their susceptibility – to find out which antibiotics will kill off the offending bacteria. This process is called susceptibility testing.
One method of S.T. is the Kirby-Bauer disk diffusion test. For this test, the surface of a large culture plate is swabbed with the pathogenic organism and small discs of antibiotics are placed on the plate. After incubating overnight, a tech will measure the diameter of the circles that have formed around each “pill” to determine what medications are most effective.
"We have different panels of drugs to test depending on the bacteria and specimen source the organism comes from in order to provide the best treatment options,” said Barrante.
She explained that using antibiotics incorrectly can wipe out populations of very susceptible bacteria and can leave more resistant strains behind. Or, organisms can swap resistance genes and cause “superbugs” that can’t be killed by antibiotics.
Susceptibility testing informs the clinician of the antibiotics that can be used, as well as those drugs that the bacteria is resistant to. This provides a range of responses to determine the most effective treatment, even if it means testing more than one drug.
One person’s story
With thousands of lab tests making their way through the Bacteriology Lab each month, it’s important to remember that each one represents a patient who needs help.
Barrante recalls her own experience with severe illness as a child, and how it inspired her to get into the field of Microbiology.
She remembers the discomfort of getting her blood drawn frequently, and feeling like a “human pin cushion.”
Since being treated, Barrante says she has always wanted to give back, and becoming a medical technologist was the way to do it; performing tests that guide the doctors who treat patients.
“I wanted to help people because I was sick and somebody in a lab somewhere figured out what was wrong with me,” she said.
Top: A medical technologist inoculates an agar plate with a small amount (approximately 1 microliter) of urine. The plate will incubate in a warm environment to allow bacteria to grow.
Second from top: E. coli bacteria shown in this culture is consistent with what causes most urinary tract infections.
Third: A Haemophilus bacterial infection is visible in the lower plate, which is a media called chocolate agar due to its color.
Second from bottom: Medical technologist Marie Rouse holds a respiratory virus panel, a multiplex PCR test that will run through an automated testing instrument.
Bottom: The Kirby-Bauer disk diffusion test determines what antibiotics are most effective in fighting the bacteria that has grown in culture.