Schwartz D A
Department of Pathology, Emory University School of Medicine, Atlanta, Ga, USA.
Arch Pathol Lab Med. 1997 Aug;121(8):776-84.
Emerging and reemerging infections are attracting greater attention from the public health and medical communities. Pathologists and other physicians are increasingly aware of the importance of the subspecialty of infectious disease pathology as a tool for diagnosis, surveillance, and research of emerging infections. In this communication, we describe the role that infectious disease pathologists have played during the last 2 years in broadening our understanding of selected emerging infections, including such examples as new variant Creutzfeldt-Jakob disease and bovine spongiform encephalopathy, leptospirosis, microsporidiosis, Ebola hemorrhagic fever, and cyclosporiasis. The significance of providing pathology services, especially the autopsy, to patients with potentially hazardous communicable diseases is discussed with the supposition that it is unethical to exclude or withhold health care from a patient based on his or her underlying disease or on risk factors for acquiring a disease. The increasing occurrence of infectious diseases imported into the United States and other nations, including human immunodeficiency virus-1 group O, dengue fever, tuberculosis, malaria, diphtheria and cholera in immigrants and travelers, and Ebola virus in nonhuman primates, emphasizes the necessity for pathologists of having competence with infectious disease pathology. It is critical that new generations of pathologists not only be trained in the subspecialty of infectious disease pathology, but that they also be willing participants in the diagnosis and investigation of infectious diseases. The lack of training programs for infectious disease pathologists, as well as the deficiency in infectious disease pathology support for ongoing and future epidemiologic investigations and research, has led to the broadening of pathology services and initiation of a dedicated section of Infectious Disease Pathology at one of the nation's premier public health institutions, the Centers for Disease Control and Prevention in Atlanta, Ga. Together with preexisting groups of medical and veterinary infectious disease pathologists at universities, the Armed Forces Institute of Pathology, the US Army Medical Research Institute of Infectious Diseases, and the National Institutes of Health, this new program will significantly strengthen the capability of the United States to respond to future challenges of emerging and reemerging infections, both in this country and abroad.
新出现和再次出现的感染正吸引着公共卫生和医学界越来越多的关注。病理学家和其他医生越来越意识到传染病病理学亚专业作为诊断、监测和研究新出现感染的工具的重要性。在本通讯中，我们描述了传染病病理学家在过去两年中在拓宽我们对某些新出现感染的理解方面所发挥的作用，包括新变异型克雅氏病和牛海绵状脑病、钩端螺旋体病、微孢子虫病、埃博拉出血热和环孢子虫病等例子。讨论了为患有潜在危险传染病的患者提供病理服务，特别是尸检的重要性，并假定基于患者的基础疾病或获得疾病的风险因素而将其排除或拒绝提供医疗保健是不道德的。包括人类免疫缺陷病毒1型O组、登革热、结核病、疟疾、移民和旅行者中的白喉和霍乱以及非人类灵长类动物中的埃博拉病毒等输入美国和其他国家的传染病日益增多，强调了病理学家具备传染病病理学能力的必要性。至关重要的是，新一代病理学家不仅要接受传染病病理学亚专业的培训，而且还要愿意参与传染病的诊断和调查。传染病病理学家培训项目的缺乏，以及对正在进行和未来的流行病学调查与研究缺乏传染病病理学支持，导致了病理服务的拓宽，并在佐治亚州亚特兰大市美国主要公共卫生机构之一疾病控制与预防中心设立了一个专门的传染病病理学部门。与大学、武装部队病理研究所、美国陆军传染病医学研究所和美国国立卫生研究院现有的医学和兽医传染病病理学家小组一起，这个新项目将显著增强美国应对国内外新出现和再次出现感染的未来挑战的能力。
