Updated: 01/12/2013
Mandatory clinical microbiology exam syllabus for senior laboratory
technicians
The syllabus is divided into three secondary subjects (virology, bacteriology, and
parasitology).
The examination for a candidate for recognition of standing will cover all the subjects,
with an emphasis on the examinee’s specialization..
Clinical microbiology
A. General
(1) Procedures of taking laboratory samples for culture.
(2) Procedures of accepting/rejecting samples for culture.
(3) Procedures of reporting results
(4) Procedures of laboratory work safety:
a) Knowledge and expertise in working under conditions of biological hazard (BSL
1,2,3)
b) Procedure of handling exposure to various infectious agents.
B. Characterization of aerobic and anaerobic bacteria:
(1) Knowledge of the bacteriological characteristics of the common pathogens
(2) Spot tests
(3) Gram staining
(4) Characterization according to the metabolic profile (Kligler/ API/ Crystal)
(5) Characterization according to the enzymatic profile (part of API and/or Crystal
system)
(6) Characterization according to serology profile
(7) Characterization by robotics (MicroScan, Vitek)
C. Methods of sensitivity tests for anti-microbial agents:
(1) Standardization (such as NCCLS) of sensitivity tests
(2) Disk Diffusion Test (Kirby Bauer)
(3) MIC and MBC
(4) e-test
(5) Agar / Tube dilution
Updated: 01/12/2013
(6) By robotics (MicroScan, Vitek)
(7) Resistance mechanisms: diagnostic methods
(8) Quality control of sensitivity tests
D. Section of urinary tract infections:
(1) Types of samples received for culture
(2) Knowledge of the flow chart for identification of the urinary tract infection
(3) Identification of pathogens vs. external contaminants
(4) Knowledge of the procedures of reporting sensitivities to antibiotic drugs.
E. Section of gastrointestinal tract infections
(1) Knowledge of the flow chart for diagnosis of the gastrointestinal tract infection,
Knowledge of bacterial, parasitic and viral enteropathogens
(2) Microscopy
(3) Diagnosis according to metabolic profile vs. serological profile
(4) Detection of fecal toxins (CD Tox A+B)
F. Section of respiratory infections
(1) Collecting a laryngeal swab and its storage
(2) Gram staining of sputum
(3) Knowledge of the criteria for reporting microcopy results
(4) Knowledge of seeding protocols (complex and selective substrates), including
quantitative seeding
G. Section of blood cultures
(1) Knowledge of the automatic devices for blood culture monitoring. Knowledge of the
various incubation protocols
(2) Knowledge of working protocols – gram staining, seeding on selective growth
substrates, immediate sensitivity testing, validation of sensitivity in isolated colonies,
identification of bacteria
(3) Impacts of various findings of blood culture, criteria for external contaminants
(4) Recognizing the importance of telephone reporting on microscopic and culture
findings
H. Section of wounds, body fluids and monitoring of GBS, SA, MRSA, VIR
(1) Importance of direct smear for the relevant samples. Interpretation of microscopic
findings.
(2) Knowledge of the various seeding protocols according to the sample type,
Updated: 01/12/2013
quantitative seeding.
(3) Type of infection/bacterium and reporting on sensitivity to the appropriate antibiotic
agents.
Bibliography
Microbiology
Relevant chapters of the following books:
1.
Medical Microbiology. G. Kobayashi, PR. Murray, MA. Pfaller and KS. Rosenthal
editors. 2nd edition, C. V. Mosby Comp. 2002.
2.
Manual of Clinical Microbiology. KV. Forrest, JH. Jorgensen, and PR. Murray
editors. 4th edition, ASM Press, 2003.
3.
Clinical Microbiology Procedures Handbook. HD Eisenberg editor, Vol. 1 & 2, ASM
Press, 1992.
‫ הוצאת דיונון – אוניברסיטת תל‬.‫ מהדורה רביעית‬.‫ שליט‬.‫ א‬,‫ ברגר‬.‫ ס‬.‫מבוא למחלות זיהומיות‬
.4
1991 .‫אביב‬
1987 .‫ הוצאת דיונון – אוניברסיטת תל אביב‬.‫ מיכאלי‬.‫ ד‬,‫ ברגר‬.‫ ס‬.‫בקטריולוגיה כללית‬
.5
.‫ הוצאת האוניברסיטה הפתוחה‬. 12 ,11 ,9 ,4 ,3 ,2 ,1 ‫ יחידות‬.‫עולם החיידקים‬
.6
‫ משרד‬,‫ מחלקת המעבדות‬302//1 '‫ חוזר מס‬.‫מחלות המחייבות הודעה – אבחון מעבדתי‬
.7
2//1.‫הבריאות‬
‫ משרד‬,‫ מחלקת המעבדות‬/102//1 '‫ חוזר מס‬.‫עדכון רשימת המחלות המחייבות הודעה‬
.8
2//1.‫הבריאות‬
General
1.
Self-Assessment in Clinical Laboratory Science. AH. Wu, RE. Moore, GJ. Tsongalis
and RW. Burnett editors. 3rd edition. AACC Press. 2000.
2.
Clinical Laboratory Science Review. RR. Harr editor. 2nd edition. AACC Press.
1999.
3.
Westgard QC: Quality Requirements, Levey Jennings Plot, Westgard Multirules, QC
Applications. http://www.westgard.com
4.
CLIA Regulations. CDC, Division of Laboratory Systems. 2003 version.
http://www.phppo.cdc.gov/CLIA/regs2/toc.asp
Updated: 01/12/2013
Virology
A. Clinical virology – general background
1. Knowledge of viral families, structure and classification.
2. Knowledge of diseases caused by viruses.
3. Treatments and prevention of viral diseases.
4. Epidemiology of viral diseases
5. Ways of viral infection and pathogenesis.
6. Immune response to viruses.
7. Viruses as bio-terror agents.
B. Work at the laboratory of virology
1. Rules of caution and safety in work with viruses and clinical substance.
2. Packaging and shipment of samples containing viruses in Israel and overseas.
3. Diagnostic approach in virology (serology vs. isolation/ identification)
4. Pre- analytical stage
a) Taking samples and transporting them to the laboratory
b) Accepting and rejecting samples sent for testing
c) Preparation of samples for testing
d) Storage of samples
C. Methods of work at the laboratory of virology
1. Serology
a) Types of antibodies examined and for what purposes
b) Methods of serological tests: IFA, ELISA, WB, other (NT)
c) Use of serological methods – when and how to use
2. Virus isolation
a) Knowledge in the field of tissue culture and sterile work
b) Principles of growing viruses in culture
c) The process of isolation and adjustment of culture to the virus
d) Identification of viral growth in culture (CPE, HA and other)
e) Preparation of viral stock
f) Determination of viral titer
g) Neutralization and other methods of virus identification
h) Shell Vial
Updated: 01/12/2013
Updated: 01/12/2013
3. Identification of viral antigen
a) Principles and methods (IFA, DFA, Dipstick, antigenemia and other)
b) Advantages and disadvantages of the method
c) Use – RSV, CMV, Ad, Rota, Flu
4. Molecular methods
a) Principles of work: prevention of molecular contamination
b) Methods of nucleic acid extraction
c) Methods of nucleic acid identification: PCR, RT/PCR, Real time PCR
d) Quantitative PCR – viral load
e) Molecular characterization by restriction enzyme digest
f) Molecular characterization by determination of specific sequences
D. Diagnosis of specific viruses
(1)
Respiratory viruses: influenza, RSV, adenovirus
(2)
CMV: Diagnosis of CMV in pregnancy, diagnosis in transplant patients, follow up in
transplant patients
(3)
Rubella, measles and mumps viruses: Determination of immunity and disease
diagnosis
(4)
Parvo B19 virus: Diagnosis in pregnant women and transplant patients
(5)
EBV: Diagnosis of infection status
(6)
Poliovirus: Determination of immunity level, transfer of samples to the National
center of poliomyelitis for diagnosis
(7)
Enteroviruses
(8)
HSV: Diagnosis in pregnant women, neonates and others. Identification of the virus
type.
(9)
Varicella zoster virus (VZV): diagnosis of chickenpox and herpes zoster and
determination of immunity in pregnant women.
(10) Other herpes viruses: HHV6, HHV7, HHV8
(11) Hepatitis B: Determination of immunity and disease diagnosis
(12) Hepatitis C: Infection diagnosis and treatment follow up
(13) Hepatitis A: Determination of immunity and infection diagnosis
(14) Diagnosis of AIDS – Principles and methods, primary diagnosis and treatment
follow up.
(15) Arboviruses (WNV, Dengue) - Principles and methods of disease diagnosis
Updated: 01/12/2013
(16) Polyomaviruses: JC/ BKV and papilloma
(17) Rabies virus: Diagnosis in the reference laboratory
(18) POX viruses: smallpox, vaccinia, molluscum and others.
E. Reporting to the Ministry of Health and diagnostic services overseas
1. Viral diseases requiring notification in Israel
2. Government and national centers in Israel
3. Diagnostic services overseas and rules of sample shipment
Bibliography and information resources
1.
Clinical Virology Manual (Third Edition, 2000), ASM press, S. Spector, RL Hodinka
and SA Young (Eds),
2.
Manual of Clinical Microbiology, volume 2, (8th edition, 2003), ASM press PM
Murray, EJ Baron, JH Jorgnesen, MA Pealler and RH Yolken (eds)
3.
Diagnostic Procedures for Viral, Rickettsial and Chlamydial Infections 6th ed. NJ
Schmidt and RW Emmons (eds), American Public Health Association
4.
Fields Virology Fourth Edition, 2001 Lippincott, Williams and Wilkins DM Knipe, PM
Howley (eds)
Internet resources
.‫ האוניברסיטה הפתוחה‬.5 ,3 ,2 ,1 ‫ יחידות‬.‫עולם הנגיפים‬
.1
‫ המרכז הלאומי לבקרת מחלות‬,‫ המחלקה לאפידמיולוגיה‬:‫אתר האינטרנט של משרד הבריאות‬
.2
)‫ רשימת מעבדות ומרכזים ארציים‬,‫והמחלקה למעבדות (מידע לגבי מחלות מחייבות דיווח‬
)‫אתרי בתי החולים השונים בישראל (אגף המעבדות‬
.2
‫( ושל המרכז הלאומי לבקרת מחלות בארה"ב‬WHO) ‫אתרי המידע של ארגון הבריאות העולמי‬
.3
.‫( מידע כללי ומידע עכשווי לגבי התפרצויות ותחלואה‬CDC)
Parasitology
A. General
1. Procedures of receipt of samples of feces, urine, blood, other body fluids and tissues.
2. Procedures of sample collection, sending samples to the laboratory, sorting and
procedures of acceptance or rejection.
3. Procedures of sample storage until testing and procedures of storage or destruction
after the test.
Updated: 01/12/2013
4. Registration and documentation of laboratory tests, manual and computerized
registration.
5. External and internal quality control, understanding and implementation of
professional procedures (SOPs), knowledge of quality SOPs based on ISO
standards for medical laboratories.
6. Safety procedures (as detailed in the recommendations, microbiology syllabus).
7. Procedures of results documentation and reporting: Procedures of reporting to the
referring entity and other entities, attending physician/ health bureaus/ infectious
disease specialist/ epidemiology nurse/ center for disease control.
8. Knowledge of the procedures of the Department of Laboratories and the National
center of parasitology at the Ministry of Health.
9. Sending samples in which positive findings for diseases requiring reporting have
been detected: malaria and schistosomiasis, for verification by the National center of
parasitology at the Ministry of Health.
10. Sending samples to external agencies in Israel and overseas: laboratories of the
Ministry of Health, CDC
B. Identification and characterization of parasites:
Theoretical knowledge:
1. Types of parasites and diseases caused by them, including: life cycles, morphology,
definitive host and inter-host, vector
2. Animal reservoir, epidemiology, parasite- host relationships, diagnosis and treatment.
List of parasites:
1. Single cell parasites
2. Blood and tissue flagellates (leishmania, trypanosome)
3. Plasmodium
4. Opportunistic parasites (toxoplasma, cryptosporidium, pneumocystis)
5. Intestinal and urogenital flagellates (giardia, trichomonas)
6. Intestinal amoebas and free amoebas
7. Round worms, flat worms, leeches
8. Insects transmitting parasitic diseases
Methods of work:
1. Microscopy
a. Expertise in microscopic examination: light microscopy, phase microscope and
Updated: 01/12/2013
fluorescent microscope.
b. Preparation of a live sample for examination.
c. Histochemical and immunohistochemical staining methods, including: acid fast,
Giemsa, Fast green, Lugol, silver stain etc.
d. Identification of parasites (single cell including life cycle stages, various insects,
worms, including eggs and larvae in a stained and non-stained specimen).
e. Identification of artefacts, shapes looking like parasites.
2. Methods of growing parasites in culture
a. Serological methods of antibody identification (leishmania, malaria, schistosoma,
trichinella, toxocara, echinococcus).
b. Serological methods of parasitic antigen identification in blood, feces and urine
(amoebas, giardia, cryptosporidium, malaria, filariae, schistosoma).
c. Identification of parasites by special immunological methods (electrophoresis,
immunoblotting) and by molecular techniques (PCR).
d. Identification of parasites by unique methods: enterotest, xenodiagnosis
Bibliography
1994 .‫ הוצאת דיונון – אוניברסיטת תל אביב‬.‫ גולד‬.‫ ד‬,‫ לגני‬.‫ י‬.‫ דפי עזר לפרזיטולוגיה‬.1
2.
Muller ,R. & Baker, J.R. (1990) Medical Parasitology.
3.
Markell, e.k.; Voge, M.& John, D.T.(1999) Medical Parasitology. 7 th ed. W.B.
Saunder Comp.
4.
Garcia, L.S & Brukner D.A.(1998) Diagnostic Medical Parasitology. Elsevier.
N.Y Amsterdam, London.
5.
Kats, M., Despommier, D.D. & Gwads, R. (1986) Parasitic Diseases. SpringerVerlog, N.Y. Heidelberg Berlin.
6.
Peters, W.& Gilles, H.M. (1989) A colour Atlas of Tropical Medicine & Parasitology.
3rd ed. Wollfe Medical Publication.
7.
http://www.dpd.cdc.gov/DPDx/