Chapter 12 : The Emerging Role of Pathology in Infectious Diseases

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Due to increased awareness of infectious diseases, there has been renewed interest and revitalization in infectious disease pathology. Recent experience at the Centers for Disease Control and Prevention (CDC) and other institutions has shown that use of a combination of traditional morphology with immunologic and molecular pathology techniques is an extremely useful approach for the confirmation of diagnoses for patients with otherwise unexplained illnesses. Visualization of microbial antigens or nucleic acids in the context of pathology allows the pathologist to assess the clinical significance of serologic test results or microbial isolation. By comparison, the use of molecular pathology techniques offers several distinct advantages over traditional microbiologic methods, including speed, sensitivity, reduced risk of exposure of laboratory personnel to the agent, and tissue localization of pathogens. Epidemiologic, clinical, and histopathologic findings enable CDC pathologists to use the most appropriate initial immunologic and molecular pathology tests. The chapter highlights some of the contributions of CDC pathologists in addressing some of the challenges posed by new, emerging, and reemerging infectious diseases. Historically, pathologists and the discipline of pathology have played pivotal roles in the discovery and characterization of the rickettsioses and, more recently, the ehrlichioses. Disease recognition by infectious disease pathologists can play a key role in the study of emerging infectious diseases. The chapter provides several examples of the frontline role of pathology in guiding the early phases of epidemiologic investigations of infectious diseases.

Citation: Zaki S, Paddock C. 1999. The Emerging Role of Pathology in Infectious Diseases, p 181-200. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch12

Key Concept Ranking

Rocky Mountain Spotted Fever
Infectious Diseases
Sin nombre virus
Simian immunodeficiency virus
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Emerging infectious diseases. Immunostaining of viral and rickettsial antigens in patient tissues by IHC is shown. (A) Hantavirus pulmonary syndrome, lung. Viral antigens are localized within the pulmonary microvasculature. (B) Leptospirosis, kidney. Intact and granular staining of leptospires within renal interstitium is shown. (C) Epidemic typhus, cerebral cortex. Staining of within a characteristic glial nodule is shown. (D) Rocky Mountain spotted fever, leptomeninges. Spotted fever group rickettsiae are localized within the endothelia of medium-sized vessels. (E) Ehrlichiosis, bone marrow. Morulae of are stained within mononuclear cells. (F) Ebola hemorrhagic fever, skin. Abundant viral antigens in connective tissue surrounding a sweat gland in dermis are shown. (G) Enterovirus 71 encephalitis, central nervous system. Immunostaining of viral antigens within a neuron is shown. (H) Nipah virus encephalitis, cerebral cortex. Viral antigens are present within neurons and glial cells. Note the abundant extracellular antigen.

Citation: Zaki S, Paddock C. 1999. The Emerging Role of Pathology in Infectious Diseases, p 181-200. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch12
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Table 1

Selected examples of emerging infectious diseases with significant contributions by pathology

Citation: Zaki S, Paddock C. 1999. The Emerging Role of Pathology in Infectious Diseases, p 181-200. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch12
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Table 2

IHC and ISH tests used by IDPA, CDC, for diagnosis of infectious disease agents

Citation: Zaki S, Paddock C. 1999. The Emerging Role of Pathology in Infectious Diseases, p 181-200. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch12

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