New Pathogens and Rapid Diagnostic Methods -Clinical Microbiology in the 21st Century-
This presentation is actually a predictive opinion piece from the author's experience. No one really knows what new pathogens are awaiting us around the year of 2000 corner but, in 1985, the author was asked by the NCCLS (USA) to predict the emerging pathogens for the 1990's in the U.S. and hit on 80% of them. Thus, using the experience of this decade, we can predict what will happen in the U.S. in the first decade of the new century with 80-90% accuracy of those we predict. In the next millennium we will see a marked increase in the infection rate of the atypical (non-TB) mycobacteria, the environmental fungi, and even greater problems with the "water organisms". All of this will be described in detail with the preliminary data that indicates these trends for the years "2000 and beyond". In the area of what will be new in rapid testing, whether manual or automated, the future is even more cloudy. Manufacturers will not discuss with consumers what their long-range plans are for new products. Even long-time associations with Becton-Dickinson, Gen-Probe, Vitek, etc., has yielded little if any indication of their company's plans for the years "2000 and beyond". One can, however, conceive and get into their minds to some degree based on their previous track records. We think these companies are working very hard on current tests or instruments to upgrade and improve their products yielding tests with greater sensitivity and specificity, while decreasing the technicians "hands-on time". We anticipate the increased utilization of chromogenic detectors rather than nucleotides due to the inherent problem of disposal of radioactive compounds regardless of how few actual "micro-curies" involved. The use of ligand assay technology to supplement or replace currently employed PCR technology is totally predictable and will occur. One must remember that industry faces the same problems as we do with the "new pathogens" of the future. They will need to develop detection and identification systems for organisms that at this time don't even have names because we haven't encountered them yet. Additionally there are all those organisms out there that environmental microbiologists may be familiar with, but not clinical microbiologists. Industry will respond to need, they always have, they always will, but it is hard to respond to the unknown organism at this time. That problem relates to the philosophical nature and brevity of this abstract, that is "the unknown". If we knew for sure what the future was, it would be the past.
Department of Pathology, University of Iowa Hospitals & Clinics.
F
Koontz