PDF(Pubmed)
Abstract：
To better identify emerging or reemerging pathogens in patients with difficult-to-diagnose infections, it is important to improve access to advanced molecular testing methods. This is particularly relevant for cases where conventional microbiologic testing has been unable to detect the pathogen and the patient\'s specimens test negative. To assess the availability and utility of such testing for human clinical specimens, a literature review of published biomedical literature was conducted. From a corpus of more than 4,000 articles, a set of 34 reports was reviewed in detail for data on where the testing was being performed, types of clinical specimens tested, pathogen agnostic techniques and methods used, and results in terms of potential pathogens identified. This review assessed the frequency of advanced molecular testing, such as metagenomic next generation sequencing that has been applied to clinical specimens for supporting clinicians in caring for difficult-to-diagnose patients. Specimen types tested were from cerebrospinal fluid, respiratory secretions, and other body tissues and fluids. Publications included case reports and series, and there were several that involved clinical trials, surveillance studies, research programs, or outbreak situations. Testing identified both known human pathogens (sometimes in new sites) and previously unknown human pathogens. During this review, there were no apparent coordinated efforts identified to develop regional or national reports on emerging or reemerging pathogens. Therefore, development of a coordinated sentinel surveillance system that applies advanced molecular methods to clinical specimens which are negative by conventional microbiological diagnostic testing would provide a foundation for systematic characterization of emerging and underdiagnosed pathogens and contribute to national biodefense strategy goals.
摘要：
为了更好地识别难以诊断感染的患者的新出现或复发病原体，重要的是改善对先进分子测试方法的访问。这对于常规微生物检测无法检测病原体和患者标本检测阴性的情况尤其相关。为了评估此类人体临床标本测试的可用性和实用性，对已发表的生物医学文献进行了文献综述.从4000多篇文章的语料库中，详细审查了一组34份报告，以获取有关在何处进行测试的数据，测试的临床标本类型，使用的病原体不可知技术和方法，并确定潜在病原体的结果。这篇综述评估了高级分子检测的频率，例如已应用于临床标本的宏基因组下一代测序，以支持临床医生照顾难以诊断的患者。测试的样本类型来自脑脊液，呼吸道分泌物,和其他身体组织和液体。出版物包括病例报告和系列，有几个涉及临床试验，监测研究,研究项目,或爆发情况。测试确定了已知的人类病原体（有时在新地点）和以前未知的人类病原体。在这次审查中,没有发现明显的协调努力来制定关于新出现或重新出现的病原体的区域或国家报告.因此,开发一个协调的哨点监测系统，将先进的分子方法应用于通过常规微生物诊断检测呈阴性的临床标本，这将为系统表征新兴和未诊断的病原体提供基础，并有助于国家生物防御战略目标。
