Dina Eloseily

Annotated Source List

Al-Adhami, Mustafa, et al. "Optical Sensor for Rapid Microbial Detection." International
Society for Optics and Photonics.

My mentor, Mustafa Al-Adhami, is the author of this article. The primary goal of it is to
explain and introduce his project: the low-cost, highly sensitive, rapid, and portable device to
detect the presence of living cells. In order for this to be completed, samples are stained with a
blue dye called Resazurin. When this dye comes in contact with viable bacteria, it is reduced into
a highly-fluorescent purple dye: Resorufin. This change in fluorescence is quantifiable and is
detected by a fluorometer, which is used in the device. Acrylic microfluidic cassettes were
created specifically for the device. Sheets of various thicknesses are bonded together using heat
to create a non-fluorescent, optical chip that allows the device to read changes in the sample. In
this specific test, the sample was inoculated with E. Coli. The bacteria were combined with
media and incubated at 37 degrees Celsius in order to grow. The sample was then inserted into a
microfluidic cassette and placed into the device for 180 seconds. After the points were
automatically plotted onto the computer, the slope of the relationship between the increase of
fluorescence and time could be correlated with the number of living cells in the sample.
This paper is especially important to me because it explains the device that I am working
on. This is the first source of information I was given on my project, so it was crucial for me to
fully understand what I would be doing at my internship. It helped me become aware of different
aspects of the device that I could possibly work on. I am now able to complete all the processes
explained in the paper, as I have become more familiar with the lab and the functions of the
device. Currently, I am focusing specifically on improving the acrylic microfluidic chips and
create an alternative design that must be compatible with the device.

Nordenson, Nancy J. "Blood Culture." The Gale Encyclopedia of Medicine, edited by Laurie J.
Fundukian, 4th ed., vol. 1, Gale, 2011, pp. 672-674. Gale Virtual Reference
Library, http://link.galegroup.com/apps/doc/CX1919600266/GVRL?u=elli29753&sid=GVRL&
xid=3795ffcb. Accessed 8 Jan. 2018.

A blood culture is completed when a patient experiences symptoms of a blood infection,

known as bacteremia, which is caused by the presence of microorganisms in the blood stream.
Because bacteremia can be deadly, blood cultures are ordered as soon as an infection is
suspected. In order to do a blood culture, blood is drawn and tested, and finally must undergo
further testing if microorganisms are identified. The blood must be drawn at a specific time,
depending on the type of bacteria; intermittent bacteria enter the blood stream at specific
intervals, while continuous bacteria are always in the blood stream. First, a physician must use
cues, such as symptoms, to predict the group of microorganisms causing the infection in order to
know whether to compete an anaerobic, aerobic, viral, or fungal culture. Most commonly tested
are aerobic and anaerobic cultures, while the viral and fungal categories are rarer. Two to three
blood cultures must be completed per blood sample for to increase confidence in results. There
are several factors that may cause false negatives, such as an incorrect environment for bacterial
growth, a mishap with timing, or if the patient was started on antibiotics shortly before the blood
was drawn. There may also be false positives, usually from contaminated samples, which are
eliminated if the patient’s symptoms are inconsistent with the results. For an initial blood culture,
blood is combined with nutritional broth and placed in an environment to grow. Once the growth
is detected, the type of bacteria is identified, then tested with antibiotics to determine a treatment.
To identify the type of bacteria after there is indication of growth, a gram stain and subculture
are completed. For a gram stain, a drop of blood is placed on a slide and observed under a
microscope after being stained with both red and purple die. Depending on the color the bacteria
displays (red or purple), the shape, and the size, scientists are able to gauge a more advanced
understanding of the microorganism. A subculture also uses a drop of blood, however, this blood
is spread over a surface and placed in an incubator before being examined further. When blood is
sent for a culture, it may take a week to receive the final report, so a series of reports are
delivered throughout the course of testing. The first preliminary report is received after just one
day. It informs the physician whether bacteria have been found yet, and if so, the results of the
gram stain. The second preliminary report provides a description of the bacteria growing on the
subculture, and finally, the ultimate report includes the complete identification and the type of
antibiotics to be used. After treatment, additional testing is done to confirm that the infection has
been cured.
As one of the articles I initially read for my internship, this is extremely informative on
the nature of blood testing. It highlights the process in detail from both the patient and
physician’s perspectives, as well as the laboratory perspective. It also helps me understand the
various steps of testing, which is important because my project is focused on the identification of
bacteria in blood. The device that I am working on is focused on one of the initial steps in blood
cultures: identifying the presence of bacteria. By finding a rapid method of doing so, the device
could decrease the amount of time needed to complete a blood culture, and expedite the final
results.

Reller, L. Barth, et al. "Antimicrobial Susceptibility Testing: A Review of General Principles and
Contemporary Practices." Clinical Infectious Diseases, vol. 49, no. 11, 1 Dec. 2009, pp.
1749-55. Oxford Academic, academic.oup.com/journals. Accessed Jan. 2018.

The goal of antibiotic susceptibility testing is to detect possible drug resistances in

common pathogens and to assure susceptibility to drugs of choice for particular infections. When
testing for susceptibility, a minimal inhibitory concentration (MIC) is measured by identifying
the “lowest concentration of antibiotic that prevented growth.” This MIC is used to determine the
result of the test, which is ultimately placed into one of the three categories: susceptible,
resistant, and intermediate. A susceptible test result means the antibiotic is effective and should
successfully treat the patient using normal and healthy doses. Contrastingly, an antibiotic is
ineffective to the given strain of bacteria if the result of the susceptibility test is resistant.
Between the two previous results is the intermediate test result for which the bacteria are
resistant to the antibiotic at unusual doses with unknown effects. Some tests provide only
qualitative MIC results (in one of the categories), but most provide quantitative results to be
interpreted and the susceptibility subsequently determined. The most commonly used methods
are broth dilution, antimicrobial gradient, disk diffusion, and automated instrument systems. The
first four are manual methods, however I focused primarily on the automated instruments, as that
is what we are competing with. Four instruments that are currently used in the United States;
three are rapid tests (3.5-16 hours), and one is labeled as an overnight appliance. The first, the
MicroScan WalkAway, utilizes photometry, the measurement of light, and fluorogenic
identification, the measurement of fluorescence. It can simultaneously incubate up to ninty-six
trays inoculated with bacteria. Depending on whether the bacteria is gram-negative or gram-
positive, this appliance produces results within four to eighteen hours. A competing machine is
the BD Phoenix Automated Microbiology System that can test up to ninty-nine panels using
turbidimetry and colorimetry. Turbidimetry analyzes bacterial growth through the change of
intensity through a solution depending on the particles suspended within it, in this case bacteria.
Similarly, colorimetry determines the concentration of a chemical element using a color reagent.
Using identical techniques is the Vitek 2, a highly automated system that repetitively monitors
turbidity of a sample to measure bacterial growth. This machine can complete thirty to two-
hundred-forty tests in anywhere between four to ten hours. The final and most time-consuming
instrument is the Sensititre ARIS 2X that takes about eighteen to twenty-four hours per test.
Using fluorescence, the Sensititre can test sixty-four panels at any given time. Finally, the
authors of this article highlighted that “there is a need for development of new automated
instruments that could provide faster results and also save money.”
This article is extremely helpful to me because it outlines the most commonly used
methods for antibiotic susceptibility testing. By describing each of the automated devices that are
approved in the United States, this article helps me understand the competition in the market for
antibiotic susceptibility testing. It also identifies the key characteristics of each instrument,
providing me with information to identify what must be improved upon. The author specifically
stated the most essential problems that must be addressed, which I believe Mustafa has
appropriately targeted in the device that he has created at the University of Maryland, Baltimore
County.

“Sepsis.” Human Diseases and Conditions, edited by Miranda Herbert Ferrara, 2 nd ed., vol. 4,
Charles Scribner’s and Sons, 2010, pp. 1474-1477. Gale Virtual Reference Library,
http://link.galegroup.com/apps/doc/CX2830200380/GVRL?u=elli29753&sid=GVRL&xi
d=a4753c79. Accessed 8 Jan. 2018.

Bacteremia is a condition in which bacteria enters the bloodstream. This condition may
go away on its own, or it may worsen and lead to sepsis by releasing toxins that trigger an
overwhelming response by the immune system. This may be caused by local infections, most
commonly pneumonia and urinary tract infections. It may also be caused if bacteria that is
normally around the nose, skin, and intestines, enter the blood stream. Those who have
undergone organ transplants, have weak immune systems, or have HIV/AIDS or cancer are more
susceptible to sepsis. Healthy individuals most at risk include infants and the elderly. Babies
whose mothers had been carrying a strain of bacteria called Streptococcus pneumoniae, are at a
higher risk of sepsis, as the bacteria is passed on from mother to child. In adults, sepsis is most
common after an invasive medical procedure. The symptoms can be very harsh and include
fever, shaking chills, rapid heartbeat, and even delirium; however, these symptoms are less
identifiable in children whose temperatures and behaviors are less stable. While sepsis is not
contagious itself, the bacteria that cause sepsis may be transmitted between individuals.
Conflicting with another source, this article states that sepsis is rather uncommon among the
population. This may be due to the time disparity between the two, as this is an older article –
showing that the number of sepsis cases as grown dramatically in the past few years. To
diagnose sepsis, doctors observe symptoms and analyze blood for bacteria, or an abnormal
amount of white blood cells. As soon as it is diagnosed, treatment with antibiotics begins. If the
condition becomes severe, patients may be placed on dialysis in response to failing kidneys, or
on breathing tubes if the respiratory system has trouble functioning. The harshest condition is
septic shock, which may ultimately lead to death. One illness associated with septic shock is
disseminated intravascular coagulation in which the body’s blood-clotting system becomes
unmanageable and may lead to intense internal bleeding. Sepsis is unpreventable in many cases;
however, taking precautions such as vaccinations may limit the risk. The article specifically
highlights the importance of rapid detection, saying that “quick diagnosis and treatment can help
improve outcomes and save lives.”
It is important for me to understand the characteristics of sepsis, the people it affects, and
its diagnosis and treatment process. This article helped me have a deeper understanding of the
condition and compare the information with that of other sources. It was interesting to see how
the number of people affected by sepsis was much lower at the time this article was written when
compared to another, more recent article. However, both highlight the need for an earlier
diagnosis, showing that little has changed in the past few years, or simply not enough. This
proves that the device that I am working on at my internship to create a more cost-efficient
method for rapid microbial detection is something that is truly needed in today’s world.

"Sepsis." National Institute of General Medical Sciences, Sept. 2017,

www.nigms.nih.gov/education/pages/factsheet_sepsis.aspx. Accessed Jan. 2018.

Sepsis is a severe medical condition that is one of the leading causes of death among
hospitals. It is caused by a powerful immune response to an infection. When chemicals are
released by the immune system into the body, they cause inflammation and lead to defective
blood flow. Most often, sepsis is caused by bacteria entering the bloodstream, which most
commonly results from invasive medical procedures. Depending on the severity of the case,
sepsis can lead to organ failure, a decrease in blood pressure, weakening of the heart, and
eventually septic shock which may result in death. The patient may also experience a fever, rapid
breathing, rashes, and disorientation. Some people recover from sepsis with no long-term effects,
however others may experience permanent organ damage, or an increased susceptibility to future
infections caused by the weakening of the immune system. As one of the most prominent causes
of death, sepsis affects over one million Americans each year, and kills about fifteen to twenty
percent of these victims. This number is increasing due to several factors including an increased
awareness of the disease, extended average lifespans, the growing resistance to antibiotics, and
the increased number of organ transplants. To diagnose sepsis, doctors analyze both symptoms
and blood tests. Most patients are treated within intensive care units of hospitals, and often with
antibiotics. In closing, the article discusses the necessary research on early diagnosis methods for
the severe infection.
 At my internship, I am working on a device with the ultimate goal of rapidly detecting
the presence of bacteria in blood. This would provide a method to diagnose sepsis at early stages;
desperately needed in the medical world. This article was very important by helping me better
understand the symptoms of sepsis, how it is treated, and the wide the large number of people it
affect each year. I also briefly learned about how it is caused, the symptoms, and the actions that
are being taken, or need to be taken, towards decreasing the number of sepsis patients. It is
crucial that I understand as much as possible about the severe infection in order to apply it to my
work at UMBC.