New directions in diagnostics.

BACKGROUND: Infectious diseases are still a significant clinical problem in children, and accurate identification of the causal pathogen plays an important role in clinical management. The availability of an etiologic diagnosis enables the clinician to make appropriate therapeutic decisions and to avoid the indiscriminate use of antibiotics. The availability of a microbiologic diagnosis and the susceptibility profile of the pathogen allows the prompt initiation of suitable antibiotic treatment. However, the usefulness of current culture and identification methods is limited by the time needed and by their sensitivity and specificity. Also some microorganisms are difficult or impossible to grow in the laboratory.

OBJECTIVES: To review the newer and more rapid diagnostic techniques that are becoming available and consider their application in the diagnosis of specific infections.

DISCUSSION: Immunoassays have many advantages and it is hoped that new optical immunoassays will overcome the problems of poor sensitivity. Nucleic acid amplification techniques have enormous potential in the diagnosis of infectious diseases because of their high specificity and sensitivity and the speed with which the results can be obtained. However, there are still a number of difficulties that must be overcome before these methods can be widely adopted for routine testing. These techniques may be particularly relevant for the rapid diagnosis of streptococcal pharyngitis, where throat culture is slow and beset by a number of factors which reduce its accuracy. Polymerase chain reaction methods have been developed for many respiratory pathogens, including Mycoplasma pneumoniae, Chlamydia pneumoniae and Mycobacterium tuberculosis, and are likely to play an increasingly important part in diagnosis. In bacterial meningitis culture is still the gold standard and molecular techniques have not yet been developed to the point where they can be used in routine diagnosis. Nucleic acid techniques are likely to be very valuable in the diagnosis of streptococcal pharyngitis and viral central nervous system infections in the near future.