A Publication of the Maryland Department of Health and Mental Hygiene The Laboratories Administration—Maryland’s State Public Health Laboratory Success Story Nancy Reilman from the Receives Public Health Recognition for Microbiology Safekeeping of Gonorrhea Drinking Water Laboratory On August 11, 2009, on behalf of the staff of the Division of Environmental Chemistry, a unit in the Laboratories “Unsatisfactory” Administration, DHMH had the distinct result reports pleasure to present an appreciation plaque to Ms. Nancy Reilman, Chief of reduced from the Safe Drinking Water Act Implementation Division, Maryland 7% to less than 1% Department of the Environment Water Ms. Nancy Reilman, Chief, Safe Drinking Supply Program. This plaque was Water Act Implementation Division, MDE Up until the beginning of the summer of awarded to Ms. Reilman for her many Water Supply Program. Photo: Taiyin Wei 2009, local health departments and years of support and contributions to the health care providers were frustrated State’s public health drinking water with the high number of reports of the laboratories. Inside this issue: result “unsatisfactory” due to Ms. Reilman has worked tirelessly in overgrowth of patient normal flora. obtaining funds to help the Division Discovery of a upgrade instrumentation and equipment New Variant On his first day as the Laboratories used for the analysis of drinking water Administration’s Chief of the Public samples. It’s a pleasure working with of the HIV-1 Virus Health Microbiology Division, Dr. Jafar Ms. Reilman, as she is both a visionary Razeq was asked by Director Dr. Jack and a person with a practical outlook and ON PAGE 3 DeBoy to pay special attention to this novel ideas for ensuring the effective problem. implementation of the State’s Safe Drinking Water Program. After a thorough inspection of hundreds September 2009 of GC culture plates over a period of This article written by Dr. Prince Kassim. (Continued on page 2) Volume 13, Number 9 Critical Link • www.dhmh.state.md.us/labs/html/critical-link.html • December 2008 • Vol. 12, No. 12 Page 1 PRODUCTION MANAGER Georgia Corso EDITORIAL BOARD Jack DeBoy, Dr. P. H. Prince Kassim, Ph.D. The staff of the Gonorrhea Laboratory of the Public Health Microbiology Division, from left Fizza Majid, Ph.D. to right: Yaaqobah Evans, Damini Jain, Kim Shoutz, Carla Rollins, and Mara Johnson. Robert Myers, Ph.D. Jafar Razeq, Ph.D. Jim Svrjcek, B.A. (Continued from page 1) reported out as “unsatisfactory.” This Michael Wajda, M.S., J.D. Success Story from the Public Health certainly is a significant improvement Microbiology Gonorrhea Laboratory that reflects well on patient test Chengru Zhu, Ph.D. management. several months, and after spending many LABORATORIES ADMINISTRATION hours investigating what might have The Public Health Microbiology gone wrong, the Division made the Division’s staff in the GC Laboratory Director following recommendations: (see photo) and their partners in the Jack DeBoy, Dr.P.H. LHDs, especially in Howard and • Handle media properly, during Frederick counties where pilot studies Deputy Director storage and transport, both before were conducted, can be proud about this for Scientific Programs and after being inoculated; success and their commitment to Robert Myers, Ph.D. providing quality laboratory services. • Modify the laboratory’s reporting This problem could not have been and interpretation guidelines; solved without the hard work and Deputy Director for Administrative and • Switch to a culture medium support of all involved. Regulatory Programs (GC-Lect™) that the literature1,2 Michael Wajda, M.S., J.D. has shown to improve suppression To ensure that this problem does not of normal patient flora; recur, the “unsatisfactory” rate will remain under continuous monitoring TECHNICAL QUESTIONS • Work closely with local health departments (LHDs) to ensure proper This article written by Dr. Jafar Razeq. Questions concerning collection, inoculation, and transport technical content of this newsletter of GC specimens. References may be referred to Implementating these recommendations 1 Evans, G.L et al. 1989. New selective medium Dr. Jack DeBoy at 410-767-6100 for the isolation of Neisseria gonorrhoeae. J. Clin. has resulted in a ten-fold decrease in Microbiol. 27: 2471-2474 reporting the result “unsatisfactory.” Between May 5 and July 5 of this year, 2 The Critical Link is published monthly Reichart, C.A. et al. 1989. Comparison of GC- by the staff of the 0.7% (34) were reported out with the Lect and Modified Thayer-Martin media for the result of “unsatisfactory.” During the isolation of Neisseria gonorrhoeae. J. Clin. Laboratories Administration Microbiol. 27: 808-811. Department of Health & Mental Hygiene same three month period last year (May 201 W. Preston Street 5 through July 5, 2008), 7% (467) were Baltimore, Maryland 21201 (Phone 410-767-6909) Page 2 Critical Link • www.dhmh.state.md.us/labs/html/critical-link.html • September 2009 • Vol. 13, No. 9 Patient RBF168 was born in Cameroon Her husband died in 1984 (HIV status Discovery of a in the southeast portion of the country unknown) and she reported having other and lived in towns around the capital, sexual partners (HIV status unknown) New Variant of Yaoundé. She did not live in rural areas after his death. Her positive HIV status of the country and reported no contact was discovered after her move to France the HIV-1 Virus with apes or bushmeat (meat of 4 1 in 2004. terrestrial wild animals.) Though HIV is transmitted primarily through sexual contact, exposure to bushmeat from the Classification Strain more closely butchering process and exposure to the related to a Simian hunted animals themselves is thought to A brief review of HIV classification is be a mechanism for the transfer of presented to help in understanding the 2,3 Immunodeficiency virus simian viruses to humans. need for further test results. HIV is (SIV) found in gorillas classified as a retrovirus (Family Retroviridae, genus Lentivirus) which has RNA as the major genetic French scientists at the University of component instead of DNA. The enzyme, reverse transcriptase, contained Rouen have announced the discovery of a new variant of the HIV-1 virus, more in the retrovirus, enables it to convert this RNA to DNA which is then closely related to a simian immunodefi- ciency virus (SIV) found incorporated into the in gorillas. Genetic host cells’ genetic testing showed this strain material. This enables was more closely related the virus to replicate to a Simian Immuno- along with the host deficiency virus (SIV) cells’ DNA. found in gorillas than the Human Immuno- HIV is divided into two deficiency virus (HIV). types, HIV-1 and The scientists proposed HIV-2. Both cause this new strain should be disease though it is designated as HIV-1 believed that the group P.1 transmission of HIV-2 is more difficult and the One characteristic that period from infection to 5,6 determines further study illness is longer. is inconsistent or HIV-1 is the negative viral loads in a predominant virus and patient that is confirmed is found throughout the HIV positive with no world. HIV-2 is antiviral therapy. centered in West Africa Discrepancies in and is rarely found in 5 molecular and viral load other areas. testing of a 62-year-old woman (patient RBF168) HIV-1 is further from Cameroon resulted subdivided into three in further analysis of her groups, M (major), N HIV strain because she (non-M, non-O), and O met these criteria. Her (outlier). With the background and virus discovery of the novel strain were studied HIV-1 variant, a forth (Continued on page 4) further. Critical Link • www.dhmh.state.md.us/labs/html/critical-link.html • September 2009 • Vol. 13, No. 9 Page 3 (Continued from page 3) Laboratory has demonstrated that approximately 30% of specimens Discovery of a New Variant considerable HIV diversity in Maryland. from patients attending HIV treatment of the HIV-1 Virus Conducting HIV-2 specific testing is clinics in Maryland contained non- standard procedure on all HIV subtype B HIV-1 Group M viruses (see group may be added, group P. Group M serological screening test reactive figure 1). is the predominant group and is specimens that were not confirmed as subdivided into 12 subtypes or clades HIV-1 antibody positive by Western RBF 168 Test Results (A1, A2, B, C, D, F1, F2, G, H, J, and Blot testing. Since the early 1990’s, the K). The twelfth subtype consists of retrovirology laboratory has identified After reviewing patient RBF 168’s circulating recombinant forms (CRFs) 30 cases of HIV-2 in Montgomery and background (see above), her medical which are composed of viruses with Prince George’s Counties. history and test results were reviewed. mixed genetic material derived from HIV screening tests were reactive and recombination with other subtypes. In 1996, working in conjunction with a western blot showed weak reactivity to HIV-2 is divided into 7 groups, A CDC study, a rare HIV-1 Group “O” HIV-1 group M proteins. Her CD4+ 5,7 through G. virus infection was identified by count was stable. Viral load was high genotyping viruses from West African using nonspecific group M and O PCR Since HIV was first recognized as the expatriates attending HIV treatment commercial assays. Virus isolation and etiological agent of AIDS in the early- clinics in the Maryland suburbs of growth procedures proved that the virus 1980’s, HIV-1 Group M subtype B Washington DC. In more recent years, would replicate in human cells. She viruses have predominated North genotyping portions of polymerase (pol) shows no sign of AIDS, and has not America. However, through enhanced genes initially sequenced at the received any treatment.4 surveillance testing, the Laboratories retrovirology laboratory for anti-viral Administration Retrovirology drug resistance testing has demonstrated Viral load quantification was not successful when using group M specific assays.