Strengthening diagnosis through pathogen detection and discovery, and host genomic approaches
Newer diagnostic approaches, including those we have been developing in Liverpool, offer prospects for improving diagnostic yield. These include multiplex PCR of CSF for common pathogens, next-generation sequencing, and characterising host response genes through mRNA microarray [8, 10, 15]. This latter approach, for example our TRIM test (patent filed, in partnership with Fast Track Diagnostics) is proving especially useful distinguishing bacterial from viral infections, thus supporting appropriate use of antibiotics and helping to combat antimicrobial resistance. Automated molecular diagnostic approaches are reducing in price, and becoming especially suitable for settings where traditional microbiological skill sets are limited.
8. Mallewa M, Vallely P, Faragher B, et al. Viral central nervous system infections in children from a malaria-endemic area of Malawi: a prospective cohort study Lancet Global Health 2013; 1:e153–e60.
10. Benjamin LA, Lewthwaite P, Vasanthapuram R, et al. Human parvovirus 4 as potential cause of encephalitis in children, India. Emerg Infect Dis 2011; 17: 1484-7.
15. Sweeney TE, Wong HR, Khatri P. Robust classification of bacterial and viral infections via integrated host gene expression diagnostics. Sci Transl Med 2016; 8: 346ra91.