University Health System Lab Plays Important Public Health Role
When the flu virus tried to sneak into San Antonio this flu season, it was Kathleen Lawless who sounded the alarm.
Lawless, manager of Microbiology Services at University Health System, oversees a staff of 45 medical laboratory scientists and some impressive technology occupying a maze of labs on University Hospital’s third floor. She and her team hunts down and identifies the viruses and bacteria that make people sick.
They have plenty of business, in a sprawling healthcare system that handles 830,000 outpatient visits and 22,000 hospital admissions each year. With such a large volume, the lab often is the first to identify new infections or disease trends in the community. Lawless works closely with the San Antonio Metropolitan Health District and the Centers for Disease Control and Prevention in Atlanta, reporting her findings.
“No day is the same. Every day brings something interesting. My husband always asks me, what are you going to be doing today? I tell him, I don’t know.”
Lawless, the daughter of a former military officer assigned to NATO, spent part of her childhood in Fontainebleau, France, just southeast of Paris. Her father suggested she pursue a career teaching French, but she discovered a passion for science at a young age. She’s worked at University Health System for 32 years.
This year wasn’t the first that Lawless has identified the first culture-confirmed flu case in Bexar County. Metro Health relies on a network of contributing doctors, hospitals and labs to track flu and other infections locally. The lab at UHS is one of the most important in that volunteer network, not only because it’s one of the busiest. It’s also a full-service virology lab —something most hospitals don’t have.
“The ability to perform these tests locally represents a pivotal advance for our epidemiology surveillance and the public health of our community,” said Dr. Anil Mangla, chief of epidemiology at Metro Health.
The tools have improved vastly since early in her career when Lawless grew flu viruses in egg culture and applied fluorescent stains to cells on microscope slides. In 2009, the lab got Multiplex PCR technology that allows the detection of up 13 different respiratory infections and strains from a single sample, including flu, rhinovirus, parainfluenza, respiratory syncytial virus — and one or two others most people have never heard of, such as human metapneumovirus.
That technology also changed the way clinicians understand cold and flu season. A surprising number of patients, it turns out, are infected with more than one bug at the same time.
“Rhinovirus seems to be the biggest culprit. People have rhino and they feel a little down. Then they’re exposed to a second virus, and that may cause them to come and see a doctor.”
Another important tool was acquired in the wake of a big federal investment in community labs after 9-11, and concerns about bioterrorism. At that time the lab gained a device that automatically extracts DNA and RNA from cells to study. Prior to that, the process was slow and labor-intensive.
“It quadrupled our capacity to do DNA extraction and our ability to respond to pandemics, as we saw in 2009-10 when the Swine Flu hit us.”
It’s also not uncommon that the lab picks up some exotic bugs from time to time, given the rise in international travel and the growing diversity of the population in South Texas.
“Interestingly enough, in the past few years we’ve had an influx of refugees from Africa, Southeast Asia,” Lawless said. “We have seen some interesting parasites that we ordinarily don’t see in this country. There have been several cases of malaria, which were imported (by patients infected in another country). We’ve gotten some of the more unusual hepatitis viruses that we don’t ordinarily see in our population.”
And while the technology to detect and identify infectious agents continues to improve, with more rapid tests available to community clinics and doctor’s offices, Lawless said there will always be a need for a highly advanced lab able to find and study rare and new diseases — especially in a major teaching and research center such as University Hospital.
“There will always be something for us to do,” Lawless said.
Utafiti wa Chuo Kikuu cha San Antonio ulionyesha kuwa ugonjwa wa homa ulipojaribu kuingia San Antonio, ilikuwa Kathleen Lawless ambaye alipiga kengele. Lawless, meneja wa huduma za microbiolojia katika mfumo wa afya wa chuo kikuu, anaongoza wafanyakazi wa wanasayansi wa maabara ya matibabu 45 na teknolojia ya kuvutia inayomiliki maabara ya maabara kwenye ghorofa ya tatu ya Hospitali ya Chuo Kikuu. Yeye na timu yake huwinda na kutambua virusi na bakteria zinazofanya watu wagonjwa. Kwa mfano, katika nchi ya Marekani, mfumo wa huduma za afya unaoshughulikia majaribio ya wagonjwa 830,000 na uandikishaji wa wagonjwa 22,000 kwa mwaka. Kwa kiasi kikubwa kama hicho, maabara mara nyingi ni ya kwanza kutambua maambukizo mapya au mwenendo wa ugonjwa katika jamii. Lawless anafanya kazi kwa karibu na Wilaya ya Afya ya San Antonio Metropolitan na Vituo vya Kudhibiti na Kuzuia Magonjwa huko Atlanta, akiri matokeo yake. <unk>Hakuna siku sawa. Kila siku huleta jambo fulani lenye kupendeza. Mume wangu hunuliza kila wakati, utafanya nini leo? "Laure, binti ya afisa wa zamani wa jeshi aliyetumwa NATO, alitumia sehemu ya utoto wake huko Fontainebleau, Ufaransa, kusini mashariki mwa Paris.""" Baba yake alipendekeza afanye kazi ya kufundisha Kifaransa, lakini aligundua shauku ya sayansi akiwa na umri mdogo. Alifanya kazi katika Chuo Kikuu cha Afya kwa miaka 32. Mwaka huu haukuwa wa kwanza Lawless kutambua kesi ya kwanza ya mafua iliyothibitishwa na utamaduni katika Kaunti ya Bexar. Metro Health inategemea mtandao wa madaktari, hospitali na maabara kusaidia kufuatilia mafua na maambukizi mengine ndani ya nchi. Maabara katika UHS ni moja ya muhimu zaidi katika mtandao huo wa kujitolea, si tu kwa sababu ni moja ya shughuli nyingi. Pia ni maabara ya virolojia ya huduma kamili - kitu ambacho hospitali nyingi hazina. "Uwezo wa kufanya vipimo hivi ndani ya nchi inawakilisha maendeleo muhimu kwa ajili ya ufuatiliaji wetu wa magonjwa na afya ya umma ya jamii yetu,"" alisema Daktari Anil Mangla, mkuu wa magonjwa ya magonjwa katika Metro Health." "Kama ilivyoelezwa hapo juu, Lawless alianzisha ""kuzalisha virusi vya mafua katika utamaduni wa mayai na kutumia rangi za fluorescent kwenye seli kwenye slaidi za darubini.""" "Mwaka 2009, maabara hiyo ilipata teknolojia ya ""Multiplex PCR"" ambayo inaruhusu kugundua maambukizo 13 tofauti ya njia za kupumua na aina kutoka kwa sampuli moja, ikiwa ni pamoja na homa, rhinovirus, parainfluenza, virusi vya kupumua vya syncytial na moja au mbili wengine ambao watu wengi hawajawahi kusikia, kama vile metapneumovirus ya binadamu." Teknolojia hiyo pia ilibadili jinsi madaktari wanavyoelewa majira ya homa na homa. Inasemekana kwamba idadi kubwa ya wagonjwa huambukizwa virusi zaidi ya moja kwa wakati mmoja. <unk> Rhinovirus inaonekana kuwa mhalifu mkubwa zaidi. Watu wengi wanaona rhino na wanaona kuwa ni hatari. "Kisha wanakabiliwa na virusi vya pili, na hiyo inaweza kuwafanya waje na kumwona daktari. ""Kifaa kingine muhimu kilipatikana baada ya uwekezaji mkubwa wa shirikisho katika maabara ya jamii baada ya 9-11 na wasiwasi juu ya ugaidi wa kibiolojia." Wakati huo, maabara hiyo ilipata kifaa kinachoweza kuchimba DNA na RNA kutoka kwa chembe kwa njia ya moja kwa moja ili kuchunguza. Kabla ya hapo, mchakato huo ulikuwa wa polepole na ulihitaji kazi nyingi. "Hiyo iliongeza mara nne uwezo wetu wa kufanya uchimbaji wa DNA na uwezo wetu wa kukabiliana na magonjwa ya janga, kama tulivyoona katika 2009-10 wakati Gripia ya Nguruwe ilipotushika. ""Hiyo pia si nadra kwamba maabara hupata baadhi ya wadudu wa kigeni mara kwa mara, kutokana na kuongezeka kwa safari za kimataifa na kuongezeka kwa utofauti wa idadi ya watu katika Texas Kusini. """ "Inavutia sana, katika miaka michache iliyopita tumekuwa na mtiririko wa wakimbizi kutoka Afrika, Asia ya Kusini Mashariki", Lawless alisema. <unk>Tumeona baadhi ya vimelea vya kuvutia ambavyo kwa kawaida hatuoni katika nchi hii. Kumekuwa na visa kadhaa vya malaria, ambavyo vililetwa (na wagonjwa walioambukizwa katika nchi nyingine). "Hata hivyo, ""tuna virusi vya hepatitis visivyo vya kawaida ambavyo hatuwezi kuona kwa kawaida katika idadi yetu ya watu,"" na wakati teknolojia ya kugundua na kutambua vimelea vya maambukizi inaendelea kuboresha, na vipimo vya haraka zaidi vinapatikana kwa kliniki za jamii na ofisi za daktari, Lawless alisema ""kutakuwa na haja ya maabara ya hali ya juu inayoweza kupata na kusoma magonjwa nadra na mapya, haswa katika kituo kikuu cha ufundishaji na utafiti kama Hospitali ya Chuo Kikuu.""" "Kila wakati kutakuwa na kitu cha kufanya", Lawless akasema.