The diagnosis of central nervous system infections in resource-limited settings and the use of novel and molecular diagnostic platforms to improve diagnosis.

IF 3.9 3区 医学 Q1 PATHOLOGY Expert Review of Molecular Diagnostics Pub Date : 2024-03-01 Epub Date: 2024-02-19 DOI:10.1080/14737159.2024.2317414
James Milburn, Rachita Suresh, Ronan Doyle, Joseph N Jarvis
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Abstract

Introduction: Central nervous system infections (CNSI) disproportionately affect individuals in low-resource settings where diagnosis is challenging; large proportions of patients never receive a confirmed microbiological diagnosis resulting in inadequate management and high mortality. The epidemiology of CNSI varies globally and conventional diagnostics deployed in resource-limited settings have significant limitations, with an urgent need for improved diagnostic strategies.

Areas covered: This review describes molecular platforms and other novel diagnostics used in the diagnosis of CNSI that are applicable to resource-limited settings. An extensive literature search of Medline and PubMed was performed. The emphasis is on investigations targeting infections of relevance to resource-limited settings either due to variation in regional CNSI epidemiology or due to increased prevalence in patients with immunosuppression. This includes commercially available multiplex PCR platforms, mycobacterial PCR platforms, and rapid diagnostics tests. To offer a framework for the optimal implementation in clinical settings, existing evidence highlighting the advantages and limitations of available platforms is reviewed.

Expert opinion: The implementation of molecular platforms and other novel diagnostics has the potential to transform CNSI diagnosis in resource-limited settings, with several examples of successful rollout of novel diagnostics such as Xpert MTB/RIF Ultra and cryptococcal antigen testing.

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在资源有限的环境中诊断中枢神经系统感染,利用新型分子诊断平台改进诊断。
导言:中枢神经系统感染(CNSI)对资源匮乏地区的患者造成的影响尤为严重,因为那里的诊断难度很大;大部分患者从未得到过微生物学确诊,导致治疗不当和死亡率居高不下。CNSI 的流行病学在全球范围内各不相同,在资源有限的环境中使用的传统诊断方法有很大的局限性,因此迫切需要改进诊断策略:本综述介绍了用于诊断 CNSI 的分子平台和其他适用于资源有限环境的新型诊断方法。对 Medline 和 PubMed 进行了广泛的文献检索。重点放在针对与资源有限环境相关的感染的研究上,这些感染或是由于地区性 CNSI 流行病学的变化,或是由于免疫抑制患者患病率的增加。其中包括市售的多重 PCR 平台、分枝杆菌 PCR 平台和快速诊断检测。为了给临床环境中的最佳实施提供一个框架,本文回顾了现有证据,强调了可用平台的优势和局限性:专家意见:分子平台和其他新型诊断方法的应用有可能改变资源有限环境中的 CNSI 诊断,Xpert MTB/RIF Ultra 和隐球菌抗原检测等新型诊断方法已有多个成功推广的实例。
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来源期刊
CiteScore
6.60
自引率
0.00%
发文量
71
审稿时长
1 months
期刊介绍: Expert Review of Molecular Diagnostics (ISSN 1473-7159) publishes expert reviews of the latest advancements in the field of molecular diagnostics including the detection and monitoring of the molecular causes of disease that are being translated into groundbreaking diagnostic and prognostic technologies to be used in the clinical diagnostic setting. Each issue of Expert Review of Molecular Diagnostics contains leading reviews on current and emerging topics relating to molecular diagnostics, subject to a rigorous peer review process; editorials discussing contentious issues in the field; diagnostic profiles featuring independent, expert evaluations of diagnostic tests; meeting reports of recent molecular diagnostics conferences and key paper evaluations featuring assessments of significant, recently published articles from specialists in molecular diagnostic therapy. Expert Review of Molecular Diagnostics provides the forum for reporting the critical advances being made in this ever-expanding field, as well as the major challenges ahead in their clinical implementation. The journal delivers this information in concise, at-a-glance article formats: invaluable to a time-constrained community.
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