Implications of New Technology for Infectious Diseases Practice

Abstract

New assays for the diagnosis of infectious diseases--particularly those that use molecular technologies--will revolutionize infectious diseases practices, but the fulfillment of the promise is several years away. Problems with currently available molecular assays include a lack of knowledge about the extent of microbial nucleic acid in "normal" hosts, concentration of agent material in small volume samples, lack of microbiologist expertise, lack of adequate reimbursement, and difficulty with validation based on conventional methods. Clinicians must appreciate the shortcomings of new technology to use it effectively and appropriately. However, we are realizing tangible progress in our ability to detect new etiological agents; the availability of rapid, accurate diagnostic tests for previously difficult infections; and advances into new, human response-based paradigms for diagnostic testing.

Unmet diagnostic needs in infectious disease

“…9,10 Physicians are becoming familiar with the concept of “stewardship” (interventions designed to improve appropriate use) as associated with antibiotic use 11 , and over half of our survey respondents felt that diagnostic testing could benefit from stewardship as well. Diagnostics stewardship could address overuse of testing, guidance regarding test selection and interpretation, and implementation of work-flow that insures that critical results are received and acted on in a timely manner.…”

Impact of international laboratory partnerships on the performance of HIV/sexually transmitted infection testing in five resource-constrained countries

“…Although testing capabilities and technology continue to rapidly expand, detection of many emerging and reemerging pathogens remains difficult for sentinel laboratories because of the cost. 21 …”

Application of Culture-Independent Rapid Diagnostic Tests in the Management of Invasive Candidiasis and Cryptococcosis

“…As in other areas of microbiology, the application of molecular biology, specifically the polymerase chain reaction (PCR), offers great promise for the rapid diagnosis of fungal infections [ 34 , 36 , 39 , 42 , 43 , 44 , 63 , 64 , 95 , 148 , 149 , 150 , 151 ]. At present, most of the research has been focused on the diagnosis of IC [ 42 , 43 , 44 , 109 , 112 , 148 , 149 , 150 , 152 ] and invasive aspergillosis (IA) [ 39 , 113 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 ]; however PCR has also been applied to the diagnosis of other IFI, including CM [ 36 , 39 , 42 , 95 , 105 , 106 , 156 , 161 , 162 , 163 , 164 , 165 , 166 ].…”

“…Under these conditions the pooled sensitivity and specificity of PCR in diagnosing IC was 95% and 92%, respectively [ 44 ]. Importantly, PCR-based tests for Candida DNA in blood are negative in most subjects with gastrointestinal colonization with Candida species and the specificity of these tests is quite high [ 44 , 112 , 149 , 150 , 151 , 173 , 174 ].…”