Infectious Disease Diagnostics Laboratory, Children's Hospital Boston, Boston, Massachusetts, USA.
J Clin Microbiol. 2012 Jun;50(6):1836-40. doi: 10.1128/JCM.00488-12. Epub 2012 Mar 14.
Over the past decade, there has been an explosion in the use of molecular tests to diagnose and manage infectious diseases. HIV is a prime example of an infectious agent whose diagnosis at least in the acute stage, susceptibility testing, and management are all dependent on molecular diagnostics. The ability to accurately diagnose a plethora of respiratory pathogens quickly, simply, and relatively inexpensively compared to traditional methods is becoming a reality. Direct sequencing and microarray analysis holds great promise for directly detecting a wide variety of organisms from clinical specimens. The question is where this testing should be done in the clinical laboratory. There are at least four models that have emerged: Molecular infectious disease testing as an arm of the clinical microbiology laboratory. Molecular infectious disease testing done in a central molecular pathology laboratory under the leadership of a clinical microbiologist. Molecular infectious disease testing done in a central molecular pathology laboratory under the leadership of an individual whose primary interest is in another area of molecular pathology. Molecular infectious disease testing sent to a reference laboratory and not done on site or within the institution's health care system. We have asked three individuals who have thought about this very complex issue to share their rationale for supporting one of these models. Frederick Nolte is the Director of Clinical Laboratories and Director of Molecular Pathology at the Medical University of South Carolina, is active in and held several positions of responsibility in AMP (Association of Molecular Pathology) and is Chair of the CLSI's Area Committee for Molecular Methods, Alex McAdam is the Director of the Infectious Diseases Diagnostic Division at Children's Hospital Boston and an editor of this journal, and his colleague, Nima Mosammaparast, is the Assistant Director of the Infectious Diseases Diagnostic Laboratory at Children's Hospital Boston.
在过去的十年中，分子检测在诊断和管理传染病方面的应用呈爆炸式增长。HIV 是一个很好的例子，其诊断（至少在急性期）、药敏试验和管理都依赖于分子诊断。与传统方法相比，快速、简单且相对经济地准确诊断大量呼吸道病原体正在成为现实。直接测序和微阵列分析为直接从临床标本中检测各种生物体提供了巨大的潜力。问题是这种检测应该在临床实验室的哪个地方进行。至少出现了四种模式：
分子传染病检测作为临床微生物学实验室的一个分支。
在临床微生物学家领导下的中央分子病理学实验室中进行分子传染病检测。
在以另一个分子病理学领域为主要兴趣的个人领导下的中央分子病理学实验室中进行分子传染病检测。
将分子传染病检测送到参考实验室，而不在现场或在机构的医疗保健系统中进行。
我们请三位对这个非常复杂的问题进行了思考的人分享他们支持其中一种模式的理由。弗雷德里克·诺尔特（Frederick Nolte）是南卡罗来纳医科大学临床实验室和分子病理学主任，积极参与并担任 AMP（分子病理学协会）的几个职务，是 CLSI 分子方法领域委员会主席。他的同事亚历克斯·麦克亚当（Alex McAdam）是波士顿儿童医院传染病诊断科主任，也是该杂志的编辑，他的同事尼玛·莫萨马帕拉斯（Nima Mosammaparast）是波士顿儿童医院传染病诊断实验室的助理主任。
