Zagreb, Croatia SRL

Description

The Croatian Tuberculosis National Reference Laboratory (NRL) has a long tradition in TB diagnostic and is one of the first TB laboratories in this part of Europe. Due to experience and good results in supranational quality control testing, it was recognized first as the Croatian NRL and then become a supranational TB reference laboratory (SRL). Currently it is appointed as SRL for Montenegro. The activities of the Croatian NRL besides routine diagnostics (AFB smears, culture, DST, latent TB detection) at national level include confirming DST results for all resistant strains, MIRU-VNTR typing for all newly diagnosed TB patients and identification of nontuberculous mycobacteria. The NRL is the only facility in Croatia teaching and training MDs specializing in microbiology and epidemiology in TB diagnostics. Also, it is involved in teaching and training students of the University in Zagreb, as well as health care workers and students from other countries. NRL is active in conducting the Croatian National program against TB providing guidelines for routine TB diagnostics. In 2012, the laboratory was completely renovated and is now a BSL 3 facility.

Structure and organization

TB diagnostics in Croatia is performed in 14 TB laboratories organized as the national TB network which is divided in three levels: level 1 represent 8 laboratories performing AFB smears and culture, 5 laboratories of level 2 also performing DST and one level 3 laboratory, the NRL.

The NRL/SRL Zagreb is situated at the Croatian Institute of Public Health and it is a part of the Microbiology service. It is divided into two Units: Unit for TB diagnostics and Unit for diagnostics of nontuberculous mycobacteria. Since February 2016, after the leadership of Vera Katalinic Jankovic, MD, the Head of the NRL is Ljiljana Zmak, MD, PhD.

Services provided by the SRL

Routine laboratory mycobacterial diagnostics:

• microscopy

• culture and species identification

• fast molecular detection of M. tuberculosis from clinical samples and drug resistance detection using GeneXpert

• DST – first and second line ATD

• latent TB detection using IGRA

• genotyping of M. tuberculosis strains using 24-loci MIRU-VNTR method

PCR/DNA based methods:

• BD MGIT™ TBc Ident. Test 

• GenoType CM/AS, Hain Lifescience

• GenoType MTBC, Hain Lifescience

• GenoType MTBDRplus, Hain Lifescience

• GenoType MTBDRsl, Hain Lifescience

• GenoType NTM DR, Hain Lifescience

Referral services:

• DST of isolated M. tuberculosis strains (for level 1 labs)

• confirmation of resistance and DST for second-line TB drugs (for level 2 labs in Croatia and Montenegro)

• nontuberculous mycobacteria identification to species level (for level 1 and 2 labs in Croatia and Montenegro)

• genotyping using 24-loci MIRU-VNTR method of all M. tuberculosis strains isolated in new TB patients (National and for Montenegro)

• providing EQC M. tuberculosis strain panels for DST (for level 2 labs in Croatia and Montenegro)

• technical assistance and training

Current links and partnerships outside of SRLN

The Unit is part of the European Reference Laboratory Network for TB (ERLTB-Net, formerly ERLN-TB), launched by the ECDC in January 2010.The aim of the network is to support methods harmonisation within the EU/EEA, to develop EQA schemes and to provide training activities to ensure EU-wide capacity building.