The Tail Wagging the Dog (or the Challenges Faced When the Financing of Medicine Gets Ahead of the Science of Medicine)

Journal of Clinical Microbiology
David W Kimberlin

Abstract

In their article in this issue of the Journal of Clinical Microbiology, S. R. Dominguez et al. (J Clin Microbiol 56:e00632-18, 2018, https://doi.org/10.1128/JCM.00632-18) describe the performance of PCR detection of herpes simplex virus (HSV) DNA versus viral culture in skin and mucosal samples from 7 neonates with HSV disease. This is a significant contribution to our understanding of the optimal diagnostic approach in babies being evaluated for neonatal HSV disease. Many diagnostic laboratories already have made the change to molecular diagnostics for skin and mucosal swab testing, however, in large part due to the labor costs associated with viral cultures. Thus, important studies such as this one are being conducted to support a decision that has already been made in many locations on mostly economic grounds. This small case series supports the decision to use molecular testing for samples from skin and mucosal sites, but larger studies are needed to more fully define the performance characteristics of PCR in this population. Since a false-positive result would commit a baby to months of management that would be unnecessary and have potential harm, it is critical to base diagnostic decision making on data that support the u...Continue Reading

References

Feb 1, 1994·Journal of Oral Pathology & Medicine : Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology·K TateishiH Tashiro
Jun 22, 1999·Archives of Disease in Childhood. Fetal and Neonatal Edition·G Malm, M Forsgren
Sep 29, 2004·Antiviral Research·S L SacksR J Whitley
May 23, 2012·The Journal of Pediatrics·Joseph B CanteyPablo J Sánchez
Feb 11, 2015·The Journal of Pediatrics·Scott H James, David W Kimberlin
Jun 8, 2018·Journal of Clinical Microbiology·Samuel R DominguezChristine C Robinson

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