Describe the epidemiology and clinical manifestations of Bordetella pertussis infection
• Define recommendations for use of pertussis-containing vaccines in infants and children and in
teenagers and adults
• Recognize the strengths and limitations of available diagnostic tests for pertussis including PCR
Dominique Hernandez
(owner)
Metagenomics: when a culture, serology and PCR testing cannot identify the cause of a patient's infection, then it's time to try metagenomic next-generation sequencing (mNGS). mNGS analyzes a broad spectrum of microorganisms at once, theoretically providing a quicker diagnoses and avoiding unpleasant outcomes. Although testing is very expensive currently it’s worthwhile for those that are immunocompromised and are infected with a pathogen or for patients who cannot tolerate invasive diagnostic procedures. Clinical mNGS typically involves extracting cell-free DNA, RNA or both from a body fluid, amplifying the nucleic acids via PCR, generating libraries. Genomic labs use software that analyze millions of mNSG reads generated in each sample and identify those that align to nucleotide sequences of pathogens in various databases. The only challenges we currently face is sample contamination with nucleic acid during collections and from sequencing reagents, and design of test for particular pathogens. Some databases may contain mislabeled information and include pathogen strains that do not infect humans. This method shows lots of promise for our future in the laboratory for testing, but will take time to evolve in the clinical lab setting.
