Infectious Diseases - Suburban Diagnostics

SubUrban Icon Infectious Diseases

Suburban Diagnostics covers the entire spectrum of bacterial, viral, fungal and parasitic infections through a wide and comprehensive range of molecular, microbiology and serology tests.

Our centre of excellence for infectious disorders offers end-to-end solutions for lab diagnosis of all major infections.
Infectione included
Details of our key tests for infectious diseases are given below:

TUBERCULOSIS

As per the WHO’s latest data, India has an average burden of 2.79 million TB cases.

Suburban Diagnostics, an expert in TB diagnosis, offers a comprehensive range of tests.

  • GeneXpert
    • Rapid test for the detection of M. tuberculosis genome and Rifampicin resistance (detects rpoB gene mutation)
  • TB Culture
    • TB Culture using MGIT BACTEC (Liquid Based System) is the Gold Standard in the diagnosis of tuberculosis
  • AFB Smear
    • 3 consecutive early morning sputum samples are advisable for AFB smear tests as there could be intermittent shedding of bacteria in sputum.
  • TB Drug Sensitivity
  • Susceptibility to 13 drugs
1st Line2nd Line3rd Line
StreptomycinKanamycinCiprofloxacin
IsoniazidEthionamideLevofloxacin
RifampicinPASAmikacin
EthambutolMoxifloxacinCapreomycin
Pyrazinamide
  • MTB Detection Test/ TB PCR
    • Targets the IS6110 gene which is present in multiple (4 -15) copies in the TB genome, hence, sensitivity increases in comparison to other gene targets
  • Cytology/ Biopsy
    • Gross examination procedure by a dedicated histopathologist
  • Adenosine Deaminase (ADA)
    • Rapid test useful in accurate and early diagnosis in patients with extra pulmonary tuberculosis
HIV

Offerings in Diagnosis of HIV

  • HIV Immunoassay
    • Allows detection HIV-1 p24 antigen and total antibodies to HIV-1 and HIV-2
  • HIV-1 Qualitative PCR
    • Confirmatory and early diagnosis of HIV
    • HIV-1 RNA can be detected 10 days prior to the appearance of both p24 antigen and HIV-1 antibody
  • HIV-1 Quantitative/ viral load
    • Lower Quantification Limit (LQL) = 20 copies/ml
    • Broad dynamic range of 20 – 1X107 copies/ml
  • Immuno Deficiency (CD4/CD8)
    • Performed on fully automated BD flow cytometer
    • CD4/CD8 is useful as a diagnostic and/or prognostic indicator for immuno-compromised patients
  • HIV-1 Drug Resistance
    • Two different panels available
      • Resistance to NRTI / NNRTI
      • Resistance to NRTI / NNRTI / PI

Hepatitis B Virus

  • Hepatitis B Tests
    • Serological tests used for the diagnosis of acute and chronic Hepatitis B infections
      • HBsAg
      • Anti HBclgM
      • HBeAg
      • HBsAb
      • Anti HBclgG
      • Anti HBeAg
    • HBV Qualitative Real Time PCR
      • Early detection of an acute HBV infection (within 4 weeks following infection)
      • HBV Quantitative/ viral load
        • Lower Quantification Limit (LQL) = 20 IU/ml
        • Broad dynamic range of 20 – 1.7 X 108 IU/ml
    • HBV Genotype
      • Effective prognosis and monitoring of a chronic HBV infection
      • Detects 10 HBV genotypes (A-J)
    • HBV Drug Resistance
      • Drug resistance determined for
        • LAMIVUDINE
        • TELBIVUDINE
        • ADEFOVIR
        • TENOFOVIR
        • ENTACAVIR
      • Minimum viral load required to perform the test is 100 IU/ml

Hepatitis C Virus

  • Hepatitis C Virus Tests
    • HCV Total Antibiotics – Test positive after 4 weeks of infection
    • HCV RNA PCR – Confirmatory diagnosis of active HCV infection (targets all HCV genotype)
  • HCV Qualitative PCR
    • For early and confirmatory HCV diagnosis
    • Confirmatory test for diagnosis of HCV (genotype 1 – 6)
  • HCV Quantitative/viral load
    • Lower Quantification Limit (LQL) = 15 IU/ml
    • Broad dynamic range of 15 – 1 X 108 IU/ml
  • HCV Genotype
    • Detects all 6 genotypes and their subtypes
    • In India, HCV genotypes 1 and 3 are common
  • HCV Drug Resistance
    • Drug Resistance determined for
      • Daclatasvir
      • Elbasvir
      • Ledipasvir
      • Ombitasvir
  • Minimum viral load required to perform the test is 500 copies/mL

HPV INFECTION

  • 6% cancers missed by HPV-Alone
  • 2% cancers missed by PAP-Alone
  • 5% cancers missed by PAP+HPV together
  • Papsure
    • The cell enrichment process separates and removes blood, mucus and other cells, reducing the risk of missed diagnosis
    • Same sample can be used for HPV test
  • HPV DNA Detection & Genotype
    • Detect 40 HPV types involved in causing precancerous lesions and cervical cancer
    • Detects all 14 High Risk (HR) types and other Low Risk (LR) types
    • Rapid, sensitive and confirmatory molecular test for detection of HPV DNA

H.Pylori infection

Serological diagnosis and monitoring of H.Pylori infections

  • Serological Diagnosis – IgG levels rise with an infection and remain constantly high until the infection is eliminated
  • Therapy Decisions – Efficacy of antimicrobial therapy can be monitored with changes in specific antibodies
  • Therapeutic Monitoring – As IgA levels decrease more rapidly than IgG, this parameter can be useful in the follow-up of patients

Global Scenario – Urinary Tract Infection

  • Nearly seven million doctor visits
  • One million emergency department visits
  • 100,000 hospitalizations of women and other elderly patients
  • Females are more commonly affected
  • Most common medical complications of pregnancy occuring in 5% – 10% of all pregnancies

URINE CULTURE

  • Urinary isolate is identified and susceptibility is done using Vitek 2 Compact
  • The susceptibility to various groups of antibiotics is deduced using MIC and breakpoint MIC values
  • We use special containers with boric acid, a urinary preservative, to maintain the colony count of bacteria and avoid over growth

At Suburban Diagnostics, we retrospectively studied around 25000 samples of urine culture, over a period of 3 years. The study concluded the following:

  • 71%

    of patients are females

  • 60 Years

    Majority of the cases confirmed by urine culture belong to this age

  • 93%

    of causative organisms detected by urine culture are Gram negative

  • ALMOST 60%

    of the gram negative isolates are ESBL producers

A comprehensive test range to diagnose common fevers
  • Dengue
    • IgM
    • IgG
    • NS 1
    • Real Time PCR
  • CHIKUNGUNYA
    • IgM
    • Real Time PCR
  • MALARIA
    • Malaria Smear
    • Malaria Antigen
    • Real Time PCR
  • LEPTOSPIROSIS
    • IgM {recommended after Day 5 of fever}
    • IgG {recommended after Day 5 of fever}
    • Real Time PCR {From Day 1 to Day 5 of fever}
  • TYPHOID
    • Blood Culture
    • Real Time PCR
    • IgM

SYNDROMIC DOUBLE MULTIPLEX PCR FOR COMMON FEVERS

Suburban Diagnostics has successfully adopted a syndromic approach for the diagnosis of common fevers through its “Syndromic Double Multiplex PCR” test that diagnoses 5 common fevers at one go.

5 fevers

H1N1 and Influenza

  • CDC recommended H1N1 and influenza screening by Real Time PCR

Typhoid

  • Blood Culture
    • Blood culture or paired culture is accurate and precise and is therefore the gold standard in the diagnosis of typhoid fever
  • Vitek Susceptibility
    • Antimicrobial susceptibility of 16 antibiotics with MIC values
    • Identification based on 64 biochemical values and hence gives better precision and accuracy

BioIntense – MRF plus

To help you overcome the diagnostic challenge that syndromatic infections present, especially in an intensive care setting, Suburban Diagnostics introduces syndromic molecular diagnostic panels for syndromic infections.

Syndromic BIOINTENSE – MRF PLUS

  • BioIntense Meningitis
  • BioIntense Respiratory
  • BioIntense Fungal
  • BioIntense Septicemia

A range of syndromic molecular test panels for intense infections in ICU, ICCU, NICU and PICU with an intense limit of detection

Meningitis Real Time PCR

For early and confirmatory diagnosis of viral, bacterial and fungal pathogens

  • Infection can be caused by viral (69%), bacterial (20%) and fungal (1%) pathogens
    • Choose real-time PCR over conventional methods
  • Early and confirmatory diagnosis
    • Early initiation of appropriate therapy

Pathogens Tested

Syndromic BioIntense Meningitis real-time PCR assay detects 17 pathogens

  • Virus
    • Enterovirus
    • HSV-1/2
    • VZV
    • EBV
    • CMV
    • HHV-6/7/8
  • Bacteria
    • Neisseria meningitidis
    • Streptococcus pneumoniae
    • Haemophilus influenzae
    • Mycoplasma pneumoniae
    • Chlamydia pneumoniae
    • Leigionella pneumonia
  • Fungal
    • Cryptococcus neoformans/gattii

RESPIRATORY REAL TIME PCR

  • For early and confirmatory diagnosis of a lower or upper respiratory tract infection
    • In Mumbai and Pune, approximately 25-30% of pneumonias are caused by Respiratory Syncytial Virus (RSV) and 15% are due to influenza viruses
    • Bacterial etiologies like Streptococcus pneumoniae represent 36% of respiratory infections
  • Choose Real Time PCR over conventional methods
    • Early and confirmatory diagnosis
    • Early initiation of appropriate therapy
  • Pathogens Tested
    • Syndromic BioIntense Respiratory Real Time PCR detects 13 pathogens
  • Virus
    • Influenza A and B
    • RSV A and B
    • Para-influenza 1, 2, 3, 4
  • Bacteria
    • Streptococcus pneumoniae
    • Haemophilus influenzae
    • Mycoplasma pneumoniae
    • Chlamydia pneumoniae
    • Legionella pneumonia

Fungal Real Time PCR

Early and confirmatory diagnosis of fungal infection

  • More than 90% of all invasive fungal infections are caused by aspergillus and candida species
Pathogens Tested
  • Candida Species
    • Candida albicans
    • Candida glabrata
    • Candida parapsilosis
    • Candida tropicalis
    • Candida krusei
  • Aspergilus Species
    • Aspergillus fumigatus
    • Aspergillus niger
    • Aspergillus flavus
    • Aspergillus nidulans
  • Others
    • Cryptococcus neoformans/ gattii
    • Pneumocystis jirovecii

Limit of Detection (LoD): 10 copies/ µL for all Candida & Cryptococcus species | 100 copies/ µL for P. jirovecii & Aspergillus species

Fungal Culture

  • Following samples can be processed:
    • Nail, Hair and Skin: done in suspected cases of onychomycosis, fungal infections of the hair and skin
  • Antifungal sensitivity of Candida to 5 antifungal agents (Fluconazole, Voriconazole, Caspofungin, Amphotericin B and Flucytosine)
Gram PositiveGram NegativeFungi
Corynebacterium amycolatumAcinetobacter baumanniiCandida albicans
Enterobacter casseliflavusBrucella sppCandida albicans
Enterococcus faecalisBurkholderia cepaciaCandida glabrata
Enterococcus faeciumCitrobacter koseriCandida glabrata
Micrococcus letusEnterobacter aerogenesCandida parapsilosis
Staphylococcus aureusEnterobacter hormaecheiCandida parapsilosis
Staphylococcus capitisEscherichia coliCandida tropicalis
Staphylococcus epidermidisMorganella morganiiCandida krusei
Staphylococcus haemolyticusProteus mirabilisCandida krusei
Staphylococcus haemolyticusProteus mirabilisCandida krusei
Staphylococcus hominisProteus vulgarisAspergillus fumigatus
Streptococcus agalactiaePseudomonas aeruginosaAspergillus fumigatus
Streptococcus mitisPseudomonas stutzeriAspergillus niger
Streptococcus mitisSalmonella paratyphi AAspergillus niger
Streptococcus mitisSalmonella typhiAspergillus flavus
Streptococcus mitisSerretia marcesensAspergillus flavus
Streptococcus pneumoniaeShigella sonneiAspergillus nidulans
Streptococcus pneumoniaeStenotrophomonas maltophiliaAspergillus nidulans

PAIRED BLOOD CULTURE

  • Helps differentiate contaminants from true pathogens
  • Maximizes pathogenic yield 2.5 times
  • The CLSI* guidelines recommend

EBV DNA QNAT

  • Therapeutic monitoring of PTLD Post-Transplant Lymphoproliferative Disorder (PTLD)
  • Limit of detection (LoD): 68 copies/mL
  • Quantification Range: 68 – 1 X106 copies/mL

CMV DNA Detection Real Time PCR

  • Differential testing strategy for patients below and above 12 months of age
  • Diagnose congenital infections
  • Screen organ donor and recipient for presence of CMV DNA prior to transplantation
  • Screen immuno-compromised patient for presence of CMV infection

CMV DNA QNAT

  • Adopting International Standards for reporting
  • Assess the presence of active CMV disease in a symptomatic patient
  • Predict the risk of active disease in an asymptomatic patient
  • Optimize therapeutic regimen
  • Predicts the relapse of infection
  • Limit of Detection (LoD): 99 IU/mL; Quantification Range: 99 – 1×106 IU/mL

STI Screening by Real Time PCR

  • Advances in sample collection & screening for sexually transmitted infections (STI)
  • Globally, more than 200 million new cases of STI (Chlamydia and Gonnoehoeae alone) occur every year

In India, 30-35 million episodes of STI are reported every year

The most common STIs (excluding HIV) are
  • Gonorrhoea
  • Chlamydia
  • Syphilis
  • Mycoplasma
  • Trichomoniasis
  • Genital herpes
Pathogens Tested
  • STI Real Time PCR assay detects 7 pathogens.
  • Bacteria
    • Neisseria gonorrhoea
    • Chlamydia trachomatosis
    • Treponema pallidum
    • Trichomonas vaginalis
  • Virus
    • HSV-1
    • HSV-2
  • Mycoplasma
  • Mycoplasma genitilum

CLOSTRIDIUM DIFFICILE INFECTION (CDI) REAL TIME PCR

  • Early and confirmatory diagnosis
  • Support timely clinical management
  • Minimize progression to serious illness
  • Interrupt transmission in hospital/community

Choose real-time PCR over conventional methods

Assay typeLimitations
Culture or cytotoxicity assaysLong TAT, labor-intensive, delay in diagnosis and treatment
Toxin A/B detection immunoassaysLow sensitivity
Real-Time PCRLoD – 10 copies/ µL, rapid TAT

For any further information, please email Dr. Anupa Dixit at dranupa@suburbandiagnostics.com or Dr. Shweta Naik at shweta.naik@suburbandiagnostics.com or Dr. Heena Satam at heena.satam@suburbandiagnostics.com

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