Advanced Pathology Techniques for Detecting Emerging Infectious Disease Pathogens

Shieh, Wun-Ju; Zaki, Sherif R.

Detection and surveillance for emerging and reemerging pathogens need a multidisciplinary approach. The intertwining complexity of these pathogens with their diverse tissue tropisms, direct effects on host cells, multiphasic immunological responses, and additional influence of superimposed secondary agents is beyond the expertise of a single discipline in modern medicine. A combined evaluation of patient’s history, clinical manifestations, and physical examination may suggest a list of differential diagnosis, but it is often insufficient to determine the specific infectious etiology. Laboratory methods are essential to identify an etiologic agent from testing clinical samples, such as blood, serum, nasopharyngeal swab, etc. These methods, including traditional microbiological techniques, conventional immunological assays, and modern molecular methods, remain the mainstay in today’s practice of clinical microbiology and infectious disease medicine. Nevertheless, there are technical and logistic issues associated with these methods, and the test results often lack a clinicopathologic correlation that can confound the interpretation of their clinical significance. For example, microbiological culture may fail to grow a causative organism, while the organism isolated by the laboratory in vitro may arise from contamination and does not represent the actual infective agent in vivo.