Active substances: Doxycycline
These kits generally allow species identification in the same experiment. The cost of these techniques is decreasing but remains to be balanced with the benefits that are expected from their use.
Niesters Rotterdam, NL The advantages of molecular diagnostics in virology has become clear for a growing number of clinically important questions, and has left from the research state to become integrated in the routine diagnostic setting.
The repertoire of assays available was mostly focussing on the detection of the blood-borne viruses HBV, HCV and HIV-1, but due to the availability of new and easy-to-use technologies mostly real-time amplification based the detection of every target is possible.
Targets like the herpesviruses and a large panel of viruses infecting the respiratory tract, are already routinely detected in larger university hospitals. More knowledge with easy-to-use real time technologies, the improved isolation and detection platforms, the availability of better controlled proficiency panels for an increasing number of targets, and the introduction of universal internal controls, have all resulted in a better and more standardized assay performance.
This resulted not only in a discrepancy of the number of commercially available assays used for virological targets compared to in-house develop assays, but also in the acceptability of molecular diagnostics, simply because clinical decisions can now be better made due to the information provided.
The last two hurdles, costs and time-to-result are very close to be solved. The developments of molecular technologies and assays during the last years, as well as the detection of new pathogens which in most cases cannot be detected by other technologies like virus culture or serology, and the improved quality control possibilities, has generated from virology a dynamic discipline with an impact in good clinical practice.
Although improvements are always possible, like multiplexing, small volumes, very fast turn-around-time, DNA chip technology, the finish is just around the corner.
Roilides Athens, GR Invasive fungal infections IFIs have become a major cause of increased morbidity and mortality in immunocompromised patients.
While a number of new antifungals have been lately introduced in the fight against opportunistic fungi, patients with these generally devastating diseases have had very dismal prognosis partly due to the late diagnosis of IFIs.
Historically, microscopic examinations of body fluids or tissue biopsies as well as culture of the material on appropriate culture media have been the principal modalities for diagnosis of IFIs.
High resolution CT scans serially performed have been proven to be sensitive tool of diagnosis of fungal pneumonias in haematological patients. Lung densities with halo sign and central cavitation of small nodules with air crescent formation can be found in adult patients and they are very useful signs of invasive aspergillosis IA.
Recently, novel diagnostic methods both serological and molecular have been developed and evaluated as well as improved culturing techniques. Identification now is performed more accurately to the species level with the use of automated methods and genetic sequencing.
Evaluation of susceptibility of clinical fungal isolates to antifungal drugs is also more widespread and more standardized.
Correlation between in vitro and in vivo effectiveness has been achieved at least in the case of Candida infections. Among serological methods, galactomannan assay has become very helpful in the early diagnosis of IA and its sequential performance in high-risk patients has been shown to help.
Its use is still problematic in young pediatric patients in whom the assay has given low specificity with a high number of false positive results as well as low sensitivity in certain cases such as chronic granulomatous disease. Evaluation of galactomannan in body fluids other than blood is also feasible and provides important information; it needs, however, further standardization.
It is being under intense study. Detection of nucleic acids of fungi by the use of polymerase chain reaction PCR is a powerful method for rapid identification of fungi; this method, however, needs further development and standardization before it is widely applied in the clinical microbiology lab.
These techniques coupled with enhanced radiology are expected to enable the physician to diagnose serious fungal infections earlier in their course increasing the chance for an improved outcome.