The Emerging Role of Pathology in Infectious Diseases

Abstract

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.