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The Journal
Odd CPD material for pharmacists
From Mr J. H. A. J. Durodie, MRPharmS
May I take it that the brief section on “Microscopy and stool cultures” (PDF 100K) in
Pamela Mason’s continuing
professional development article (PJ, 1
May, p544) reflects rather weak microbiology knowledge and experience?
As a clinical microbiologist, I would like to make a few comments.
Clostridium botulinum is a rare, acute and generally fatal intoxication
diagnosed by toxin detection, not by culture — unless this was confused
with C perfringens which is generally diagnosed from culture (subsequently
confirmed by toxin detection).
Staphylococcus aureus poisoning is also an intoxication and rarely diagnosed
by culture. More suitable examples of gastrointestinal pathogens would
have been Campylobacter spp, Bacillus cereus and Yersinia
enteroclitica,
which are culture-based diagnoses.
Dr Mason said that a sample of stool smeared on to a microscope slide and
Gram stained can enable the identification of infecting organisms and that
the stained smear is examined under the microscope for the presence of
bacteria. Since faeces contain well over a thousand million bacteria per
gram of material, it would be difficult to spot and correctly identify
a pathogen based on “colour, size and shape”.
An understanding of the use of selective and enrichment media is generally
more relevant and appropriate to the everyday workings of the microbiology
laboratory. Suspect colonies may then be used for confirmatory tests, eg,
serology. It should additionally be noted that this is based on colony
observation on suitable media (ie, agars) and not in media (ie, broths). “Observing
bacterial growth in culture media” has never helped anyone undertake
a GI diagnosis and is only useful as part of a selection process from which
a sample is plated on to solid media: colony isolation, observation and
identification can then be undertaken.
All the above points should be clear from textbooks. It strikes me as odd
that such material is presented as CPD for pharmacists — most are
never likely to have anything to do with stool culture.
J. Durodie
Redhill,
Surrey |
The
Pharmaceutical Journal