Development of a Mobile Laboratory for Sudden Onset Disasters.

OBJECTIVES: Clinical diagnostics in sudden onset disasters have historically been limited. We set out to design, implement, and evaluate a mobile diagnostic laboratory accompanying a type 2 emergency medical team (EMT) field hospital. METHODS: Available diagnostic platforms were reviewed and selected against in field need. Platforms included HemoCue301/WBC DIFF, i-STAT, BIOFIRE FILMARRAY multiplex rt-PCR, Olympus BX53 microscopy, ABO/Rh grouping, and specific rapid diagnostic tests. This equipment was trialed in Katherine, Australia, and Dili, Timor-Leste. RESULTS: During the initial deployment, an evaluation of FilmArray tests was successful using blood culture identification, gastrointestinal, and respiratory panels. HemoCue301 (n = 20) hemoglobin values were compared on Sysmex XN 550 (r = 0.94). HemoCue WBC DIFF had some variation, dependent on the cell, when compared with Sysmex XN 550 (r = 0.88-0.16). i-STAT showed nonsignificant differences against Vitros 250. Further evaluation of FilmArray in Dili, Timor-Leste, diagnosed 117 pathogens on 168 FilmArray pouches, including 25 separate organisms on blood culture and 4 separate cerebrospinal fluid pathogens. CONCLUSION: This mobile laboratory represents a major advance in sudden onset disaster. Setup of the service was quick (< 24 hr) and transport to site rapid. Future deployment in fragmented health systems after sudden onset disasters with EMT2 will now allow broader diagnostic capability.

Antibiosis of Burkholderia ubonensis againist Burkholderia pseudomallei, the causative agent for melioidosis.

Melioidosis, caused by Burkholderia pseudomallei, is an enigmatic infectious disease that afflicts individuals in many tropical and developing regions. Treatment is hampered by the organism's innate antibiotic resistance and the disease's non-pathognomic presentation. Recently, added attention has been given to this organism due to its classification as a potential biowarfare agent. Therefore, methods of preventing acquisition of infection are needed. We investigated antagonism between Burkholderia spp and B. pseudomallei derived from the same ecological niche in a melioidosis endemic region in Papua New Guinea. Isolates of environmentally derived non-pseudomallei Burkholderia spp (n=16) were screened for antibiosis against 27 B. pseudomallei isolates. Three isolates subsequently identified as B. ubonensis produced specific antagonistic activity against all B. pseudomallei isolates tested. The antagonistic compound in a cell-free state was obtained from a representative producing strain, with subsequent biological characterization revealing a pepsin sensitive peptide moiety consistent with a bacteriocin-like compound. To our knowledge, this is the first report of antagonistic activity demonstrated by near-neighbor Burkholderia against B. pseudomallei. This antagonism may be important in the micro-ecology of B. pseudomallei, and could also have application in the biocontrol of this pathogen.