In the face of a bacterium that easily resists common antibiotics, members of UAB established testing to identify it in human disease. Mycoplasma, that is.
Mycoplasmas are the smallest free-living organisms. They can cause drug-resistant bacterial infections that target various parts of the body, including respiratory and urinary systems and genitalia. Mycoplasmas commonly cause lung infections and often require a special antibiotic to treat the bacterium. Most antibiotics weaken bacteria by penetrating their cell walls. Mycoplasmas, however, don’t have cell walls to weaken.
Due to their small size and often slow growth, infections caused by mycoplasmas are rarely detected in conventional hospital microbiology laboratories because specialized and very complex laboratory testing must be developed to isolate them.
In 1984, the UAB Diagnostic Mycoplasma Laboratory was established in the Department of Microbiology by Gail Cassell, Ph.D., to test for these tricky bacteria in patients at UAB.
“I met Dr. Cassell when I was a medical student here at UAB,” said Ken Waites, M.D., F(AAM), a professor in the Divison of Laboratory Medicine and medical director of the Mycoplasma Laboratory. “I took her course in medical microbiology in 1978 and was really impressed with it. I applied for a summer scholarship in microbiology, and she became my advisor. I remember my first task was to test patients with urethritis for ureaplasmas at the Jefferson County Health Department. I fell in love with the field and have been involved with mycoplasmology since then.”
Ureaplasmas, like mycoplasmas, are small bacteria that commonly reside in the genital tracts of humans and can often lead to infections.
“The diagnostic lab began by testing neonates in the UAB Regional Newborn Intensive Care Unit for ureaplasma infections,” said Waites. “It became apparent that the need for mycoplasma testing was great. Pharmaceutical companies soon reached out to us to test new investigational antibiotics. The lab earned accreditation by the College of American Pathologists, the Clinical Laboratory Improvement Amendment and the State of Alabama and soon started offering clinical and research services to other hospitals in Birmingham and across the country.”
Waites, who was a pathology resident during the lab’s inception, took over the Mycoplasma Lab as medical director in 2003, and it became part of the UAB Department of Pathology. The lab is unique for its types of mycoplasma and ureaplasma testing, which include culture, PCR and antimicrobial susceptibility testing.
“We’re the only lab that offers antimicrobial susceptibility testing for human mycoplasmas and ureaplasmas for the entire United States and Canada,” Waites said. “Our lab has also been a leader in the development of molecular techniques for detection of these organisms in clinical specimens and we have designed and validated tests that detect these organisms without the need for isolating them in culture.”
Perhaps more unique than the testing the lab offers is its long-serving team, including individuals who have stayed dedicated to the laboratory for more than 40 years. Lynn Duffy, MT(ASCP), Laboratory Finance Manager, and Donna Crabb, MT(ASCP), Laboratory Manager, reminisced about the lab’s early days.
“I knew Gail well in the early eighties,” said Duffy. “She was helping me find a job, but I didn’t think it would be in the Mycoplasma Lab! My previous UAB experience was in cell culture and biochemistry. Dr. Cassell hired me in 1983.”
“The lab started growing in the late eighties and we were desperate for help,” said Duffy. “Donna had been in Dr. Cassell’s research lab in the early eighties but left to earn her degree in medical technology. In 1989, I was begging her to come back to the Mycoplasma Lab.”
“And I’ve been here ever since,” Crabb recalled fondly.
While Waites, Duffy and Crabb have served in the lab for more than forty years, other members of the lab joined not long after.
Top row (l-r): Duffy, Crabb, Ratliff, Gray
Bottom row (l-r): Atkinson, Xiao, Waites, Geisler
Prescott Atkinson, M.D., Ph.D., the lab’s clinical consultant from the UAB Department of Pediatrics, has extensive experience with asthmatic patients, immunodeficiencies and unusual infections caused by mycoplasma. Atkinson became involved in the lab in the late nineties. His connection to the lab allows him to test his patients at Children’s of Alabama for mycoplasmas swiftly.
The Mycoplasma Lab is the only diagnostic facility that has a validated molecular test to detect both macrolide and fluoroquinolone resistance in Mycoplasma genitalium, a sexually transmitted infection. These specialized tests were developed by Li Xiao, Ph.D., the lab’s technical director.
“I joined the lab in 2006,” Xiao said. “I saw an ad in the UAB Reporter for the position of postdoctoral fellow.”
“Li answered the ad I put out,” Waites said. “She’s been here nearly twenty years, is now an associate professor in the UAB Department of Medicine, has designed and developed molecular and antibiotic resistance testing, and has become an internationally recognized expert in laboratory test development for mycoplasmas.”
The UAB Diagnostic Mycoplasma Lab is the blueprint for mycoplasma testing globally. The lab took the lead in an international collaboration organized and administered by the Clinical and Laboratory Standards Institute which resulted in the standardization of in vitro antimicrobial susceptibility testing methods for human mycoplasmas and ureaplasmas.
While Xiao was pursuing an ad, Amy Ratliff, MLS (ASCP)CM, Laboratory Supervisor, was about to join the lab in a less traditional way.
“I was in nursing school and quickly realized it wasn’t for me,” Ratliff recalled. “Lynn was a family friend of ours and I remember calling her to ask more about her role in the Mycoplasma Lab.”
“Amy wanted to change career directions and go to school so she could work in the lab,” Duffy said. “She’s been here with us since 2007.”
The lab runs 400 to 500 tests per month. Several of these are manual tests which are complicated and expensive to perform. In addition to providing diagnostic services for UAB patients and for hospitals and clinics across the United States and Canada, the UAB Mycoplasma Lab has maintained an extramurally funded research program and participates in basic and translational research. Waites and his colleagues in the Mycoplasma Lab have published more than 350 original articles, reviews, books and book chapters in the field of mycoplasmology since 1983.
William Geisler, M.D., MPH, the lab’s research director from the UAB Department of Medicine, joined the lab in 2016 after a collaborative project with Waites. His role as research director was formalized with the Department of Pathology in 2020.
Depending on the species of mycoplasma or ureaplasma involved, these bacteria can be transmitted through respiratory aerosols, by sexual contact, or from mother to offspring either in utero or at birth. They may also cause systemic infections in immunocompromised patients, including organ transplant recipients.
“We don’t have many people join our lab and leave,” Ratliff said. “We really believe in the importance of what we’re doing.”
“The key to it is respect,” Waites explained. “We respect and trust one another. We lean on each other.”
The lab’s newest technologist, McKinlie Gray, graduated from UAB in 2024 and joined the UAB Mycoplasma Lab in 2025.
“I found this lab just a few months ago and have loved it ever since. The team has welcomed me with open arms, and I’m looking forward to what’s next.”
The UAB Mycoplasma Lab has big plans for a bright future. Current and future research projects involve studies on the role of ureaplasma in adverse pregnancy and perinatal outcomes, in vitro evaluation of investigational antimicrobials for treatment of mycoplasmal infections, the spread of antimicrobial resistance in Mycoplasma genitalium, mycoplasmas from domestic cats as a cause of zoonotic infections in humans, and development of new molecular diagnostic testing.
“We started this lab for the patients we serve,” Ratliff said. “And we stay for both them and one another. The UAB Diagnostic Mycoplasma Lab is a family.”