Saturday, 9 November 2013

Are we testing enough?

I had written this as part of my last post but it didn't fit in with that topic...

Yes there was a case of pneumonia in the Kingdom of Saudi Arabia that apparently went untested for all possible/emerging/out-of-the-box pathogens - does that never happen elsewhere?

In defence of the current MERS-CoV hotzone's testing, there are plenty of research and review papers in the scientific literature that show pneumonia is one of those diseases that could really do with better testing and characterisation. Acute brain inflammatory diseases are another bunch. They are scary diseases, they have an immediate impact and sequelae that may not yet be well defined and they are likely to be triggered by 1 or more viruses and or bacteria. And all that sits on top of the highly variable milieu of our genetic (immune defects?), physiological (prior predisposing tissue damage or changes?) and immunological (previous exposures or lack thereof) background.

Is it possible to effectively manage disease prevention and ill patients if you don't know the cause of the disease? Sure, there are no treatments for most viral diseases - but that's an excuse not to uncover the agent likely causing a patient's ills and not a reason. One can never learn the cause if there has been no testing for the most pertinent bugs. Its a vicious and really annoying cycle that seems to be part of a disconnect between the bed and the lab. At least in some places. I'm deliberately leaving aside being unable to prove causality through detection alone. That's for another day.

In the case of diseases that are poorly tested, that list of bugs should include everything relevant and everything that could be relevant

It feels (oh very scientific) like its been a while since we've really looked hard at the testing of some acute diseases - we tend to stick with what we knew when it comes to testing panels. Over time new technologies have been developed (PCR - kinda old now) and a lot of new bugs have been (and keep being) found. Are we in need of a shake up? I think "paradigm" should really be a dirty word in the testing for infectious agents right now.

I would personally love to get some good collaborations going and do some comprehensive testing for everything under the sun, plus some next-generation sequencing to find things we don't yet know of, on a large number of such cases (and controls). Finding the funding - and the interested collaborators - now there is a trick worthy of Loki and one I have yet to attain.