A Regional Centralized Microbiology Service in Calgary for the Rapid Diagnosis of Malaria

Abstract

Abstract Context.—A regional centralized laboratory service for the rapid diagnosis of malaria was implemented 3 years ago in May 1999 within the Division of Microbiology, Calgary Laboratory Services. Objective.—To describe the design and performance of this unique microbiology laboratory service. Design.—Blood specimens must arrive at the central laboratory within 2 hours of collection. Thin blood smears are read and reported from suspected acute cases within 1 hour of receipt, 24 hours per day, 7 days a week, by trained and experienced microbiology technologists. All positive malaria smears are reviewed by a medical microbiologist and confirmed by polymerase chain reaction at a reference laboratory. Setting.—Calgary Laboratory Services provides integrated laboratory services to the Calgary Health Region, an urban area of more than 1 million people. Main Outcome Measures.—Performance of the service has been continuously monitored by measuring preanalytic and analytic test turnaround times, test accuracy, clinical relevance, and the results of proficiency testing. Results.—More than 90% of blood specimens for malaria from community locations have consistently arrived within 2 hours of collection, and hospitals have reached this target within the past year. Although polymerase chain reaction was more sensitive at detecting the presence of malaria, the expert microscopists were as accurate at determining the type of Plasmodium infection. More than 95% of all positive smear results are consistently reported within 2 hours of receipt of a blood specimen. Conclusions.—Implementation of a regional centralized microbiology service has improved our ability to make a rapid and accurate diagnosis of malaria in this region.