University Health System Lab Plays Important Public Health Role

January 02, 2012

When the flu virus tried to sneak into San Antonio this flu season, it was Kathleen Lawless who sounded the alarm.

Lawless, manager of Microbiology Services at University Health System, oversees a staff of 45 medical laboratory scientists and some impressive technology occupying a maze of labs on University Hospital’s third floor. She and her team hunts down and identifies the viruses and bacteria that make people sick.

They have plenty of business, in a sprawling healthcare system that handles 830,000 outpatient visits and 22,000 hospital admissions each year. With such a large volume, the lab often is the first to identify new infections or disease trends in the community. Lawless works closely with the San Antonio Metropolitan Health District and the Centers for Disease Control and Prevention in Atlanta, reporting her findings.

“No day is the same. Every day brings something interesting. My husband always asks me, what are you going to be doing today? I tell him, I don’t know.”

Lawless, the daughter of a former military officer assigned to NATO, spent part of her childhood in Fontainebleau, France, just southeast of Paris. Her father suggested she pursue a career teaching French, but she discovered a passion for science at a young age. She’s worked at University Health System for 32 years.

This year wasn’t the first that Lawless has identified the first culture-confirmed flu case in Bexar County. Metro Health relies on a network of contributing doctors, hospitals and labs to track flu and other infections locally. The lab at UHS is one of the most important in that volunteer network, not only because it’s one of the busiest. It’s also a full-service virology lab —something most hospitals don’t have.

“The ability to perform these tests locally represents a pivotal advance for our epidemiology surveillance and the public health of our community,” said Dr. Anil Mangla, chief of epidemiology at Metro Health.

The tools have improved vastly since early in her career when Lawless grew flu viruses in egg culture and applied fluorescent stains to cells on microscope slides. In 2009, the lab got Multiplex PCR technology that allows the detection of up 13 different respiratory infections and strains from a single sample, including flu, rhinovirus, parainfluenza, respiratory syncytial virus — and one or two others most people have never heard of, such as human metapneumovirus.

That technology also changed the way clinicians understand cold and flu season. A surprising number of patients, it turns out, are infected with more than one bug at the same time.

“Rhinovirus seems to be the biggest culprit. People have rhino and they feel a little down. Then they’re exposed to a second virus, and that may cause them to come and see a doctor.”

Another important tool was acquired in the wake of a big federal investment in community labs after 9-11, and concerns about bioterrorism. At that time the lab gained a device that automatically extracts DNA and RNA from cells to study. Prior to that, the process was slow and labor-intensive.

“It quadrupled our capacity to do DNA extraction and our ability to respond to pandemics, as we saw in 2009-10 when the Swine Flu hit us.”

It’s also not uncommon that the lab picks up some exotic bugs from time to time, given the rise in international travel and the growing diversity of the population in South Texas.

“Interestingly enough, in the past few years we’ve had an influx of refugees from Africa, Southeast Asia,” Lawless said. “We have seen some interesting parasites that we ordinarily don’t see in this country. There have been several cases of malaria, which were imported (by patients infected in another country). We’ve gotten some of the more unusual hepatitis viruses that we don’t ordinarily see in our population.”

And while the technology to detect and identify infectious agents continues to improve, with more rapid tests available to community clinics and doctor’s offices, Lawless said there will always be a need for a highly advanced lab able to find and study rare and new diseases — especially in a major teaching and research center such as University Hospital.

“There will always be something for us to do,” Lawless said.