Laboratory Studies

Laboratory Studies

The central laboratories at SMRU provide both diagnostic services and high profile research support to the investigations carried out in the fields of malaria and other infectious diseases. 

They include: microscopy, malaria in-vitro, entomology, haematology, and microbiology laboratories. 

Microscopy Lab

There are a total of 31 laboratory technicians working currently at SMRU They are all local people who have been trained by SMRU at various times since it’s inception in 1986.

There are 26 lab technicians working in 3 clinics spread along the Thai-Myanmar border (from 25 km north of Mae Sot to 60 km to the south) and 1 clinic in Maela refugee camp (60 km north of Mae Sot). Their main activity is malaria diagnosis by microscopy (Giemsa stain). They are also able to perform Urine analysis, Stool examination, C.S.F examination, direct vaginal discharge examination and Gram’s stain, Haematocrit, Reticulocytes counts, Heinz body screening, G6PD deficiency rapid fluorescence test, Bilirubin measurement and Blood transfusion testing. They are also involved in a lot of blood sample processing including centrifugation and storage for various clinical studies. Placental biopsies are also collected as part of studies on maternal and child health.

4 senior lab technicians are working in SMRU central lab in Mae Sot. Their main roles are to train and supervise lab technicians in the clinics, manage the staff, perform internal quality control, perform external quality control for various NGOs working in the region, perform second blind readings and third readings for clinical trials, reading malaria smears from malaria surveys, perform quality control on malaria rapid diagnostic tests (R.D.T) used in the field, manage supplies stocks and order, clean and maintain regularly microscopes and other equipment and data entering.

1 lab technician is in charge of training and supervising staff (home visitors) performing malaria R.D.T and preparing malaria blood smears in the clinics. He is now involved with the METF (Malaria Elimination Task Force) supervising malaria posts and exhaustive malaria surveys.

Apart from supporting all the clinical studies in the field, our department has been more directly involved in studies evaluating malaria rapid diagnostic tests and other new malaria diagnostic methods against microscopy and P.C.R.

Our laboratories have been certified for registered studies through trainings and external QC by pharmaceutical companies such as G.S.K and Novartis. We follow the regular external quality control organized by the Thai Public Health and all our lab technicians achieved grade 1 in malaria parasites detection and specie identification during a WHO test evaluation in 2014.

Watch SMRU's video tutorial of How to Perform a Proper Thick and Thin Smear for Malaria Diagnosis.

Microscopy Quality Control (QC) updates:

  • QC done at SMRU: Repartition per NGOs 
  • QC results at SMRU for Maela Clinics
  • QC results SMRU clinics (Thai Border)
  • QC results done at SMRU for main NGOs camp (Malaria Task Force, MTF)
  • QC results done at SMRU for Myanmar
  • QC Protocol
  • QC Form

Malaria In-vitro Lab

Established in 1994, the SMRU malaria laboratory initially focused on malaria screening and diagnoses. Since then the laboratory and its activities have developed with the evolution of growth of SMRU, and is now a research hub for malaria scientists from different parts of the world.  To facilitate the malaria research at SMRU the laboratory receives stores and analyses clinical samples and data, using traditional methods of detection, quantification and characterisation (microscopy) as well as novel methods including ELISA and flow cytometry. The malaria laboratory has been and is involved in numerous studies, from initiating the usage of low cost white blood cell filtering from blood samples, drug sensitivity testing, invasion studies of P. vivax, to rosetting phenomenon of malaria parasites. The laboratory also supports other activities on the unit by performing biochemistry and VDRL tests.

The Malaria laboratory is staffed by one laboratory manager, three laboratory technicians, one data manager and three lab assistants. 

Main activities:

  • P. falciparum gametocyte studies
  • P. faciparum and  P. vivax drug susceptibility studies 
  • Malaria screening, samples processing and storage
  • External collaborations with other Institutes on malaria research

Entomology Lab

The secure insectary was built in 2010 at SMRU to study the interaction between mosquitoes and malaria parasites along the Thailand-Myanmar border. It hosts three mosquito colonies: two belonging to the Dirus family, An. cracens and An. scanloni and one colony of An. minimus; all susceptible to malaria parasites.

The main research studies focus on:

  • Infection of mosquitoes with patients’ infected blood to produce Plasmodium vivax sporozoites to support liver stages research in order to screen drugs capable of eradicating the relapsing stages of P. vivax malaria.
  • Anopheles infections to test the susceptibility of mosquitoes to Plasmodia.
  • Infection of mosquitoes with in vitro cultured gametocytes for the “Tracking Resistance to Artemisinin Collaboration” (TRAC 2 study) in order to investigate the susceptibility of resistant strains to Asian and African mosquitos’ species.
  • Detection of Plasmodia gametocytes in patients’ blood using a qRT-PCR assay.
  • Studying the dynamics of malaria transmission in mosquitoes on the Thailand-Myanmar border following targeted malaria elimination through mosquitos’ collection in the field and malaria detection.
  • Repellent studies.

The secure insectary consists of four rooms: one contains incubators for infected mosquitos and a blood feeding area, two temperature and humidity controlled rooms for mosquitos’ colonies and one microscopy area for dissection and analysis. In 2015 another insectary was built in order to expand the original colonies: two rooms are temperature and humidity controlled and one room is dedicated to mosquito identification and repellent studies.

The insectaries are run by an amazing lab technician, two fantastic lab assistants and one funny research scientist. 

Haematology Lab

The haematology laboratory was set up in 2010 with two main goals: the support to the clinical activities of SMRU (by performing routine blood analysis of patients and pregnant women) and the research activities correlated to the deployment of primaquine for radical cure of P. vivax.

Over the years, the research activities have focused on the characterization of prevalence, phenotypes and causing mutations of G6PD deficiency in the local populations allowing the study of safety of different primaquine regimens for P. falciparum and P. vivax; validation of new Point-Of-Care tests for the diagnosis of G6PD deficiency is ongoing and new laboratory tools for the study of drug-induced haemolysis are under development. The laboratory is also actively supporting clinical studies on the causes of anaemia in pregnant women (using phenotypic and molecular characterization of inherited RBCs disorders, such as Thalassaemia and SAO) and research studies on the genetic factors contributing to the onset of neonatal jaundice.

The laboratory is involved in different international collaborations for mapping G6PD variants in South-East Asia and is supported by PATH (Program for Appropriate Technology in Health, USA) for validation of new diagnostic tools for G6PD deficiency.

The laboratory is run by 3 lab technicians, 2 lab assistants and 1 research scientist.

Microbiology Lab

The SMRU Microbiology department, located in Mae Sot, was established in 2006 to provide a diagnostic service for the SMRU patient population and to facilitate research on regionally important non-malaria infectious diseases.  Since then it has expanded to include the malaria molecular team.  This department carries out a wide range of routine, surveillance and research activities in collaboration with the Oxford Tropical Network and other organisations as summarised below. 

The department is staffed by one Laboratory Microbiologist (department head), two senior laboratory technicians, seven laboratory technicians, and two laboratory assistants; with the addition of visiting students and volunteers. It participates in a number of external quality assurance schemes and is an active member of the MORU Tropical Health Network Clinical Microbiology Group, which aims include harmonising standard operating procedures across the network.

Main Activities:

  • Diagnosis of infectious diseases using microscopy, culture, serology and molecular methods;
  • Antibiotic sensitivity profiling for treatment and surveillance purposes;
  • Evaluation of diagnostic tests for acute undifferentiated febrile illness on the Thailand-Myanmar border;
  • Influenza and bacteraemia surveillance in the refugee and migrant populations on the Thailand-Myanmar border (part funded by the CDC);
  • Providing microbiological support the for the SMRU Tuberculosis programs; 
  • Providing microbiological support for SMRU maternal and child health activities, for example routine antenatal urine screening was introduced in 2012 for all pregnant women;
  • Performance of molecular assays for malaria including the qPCRs that contribute to the activities of the Malaria Elimination Task Force