b'Chapter 4 Is it time to substitute culture with molecular diagnostics for infectious diseases?Dr. Charissa WongMicrobial culture is traditionally the gold standard for theBenefits of molecular diagnosticsdetection of many infectious pathogens [1-3]. However,Apart from being quicker and more accurate than microbial limitations such as long turnaround times, intensive labor,culture, MDx have made the next generation of testing possible: and failure to identify difficult-to-culture microorganisms havea multiplex molecular panel yielding results for a breadth of prompted laboratorians and clinicians to consider alternatives.potential pathogens in a single test from a single specimen. Molecular diagnostics (MDx) technologies, such as nucleic acidWhen the dominant symptom is diarrhea, for example, amplification tests (NAATs), are faster, more sensitive, moreclinicians can order various individual tests, including a set specific, and can detect organisms missed by routine culture. of pathogen-specific cultures, yet the causative agents often These advantages are acknowledged by infectious diseaseremain unknown even after repeated testing. This makes experts who have included more NAAT-based diagnosticsdiagnosis difficult and treatment nonspecific. Similar situations in their recommendations. A 2018 guideline by the Infectiouscan occur when a clinician tries to delineate flu-like symptoms Diseases Society of America (IDSA) and the American Societyin an upper respiratory tract infection, a burning sensation in a for Microbiology (ASM) states that NAATs have largelyurinary tract infection, a vaginal discharge, or a fever of unknown replaced rapid antigen tests and culture for respiratory virusorigin. In recent years, various multiplex molecular panel tests detection [4]. Indeed, MDx have played a pivotal role throughoutfor gastrointestinal, respiratory, urinary, sexually transmitted, the coronavirus crisis and in the outbreaks of monkeypox.and other infections have become available. With faster and Laboratory-based NAATs are considered the most sensitivemore accurate diagnosis, these panel tests allow earlier and tests for detecting SARS-CoV-2, notes the US Centers formore specific treatments. Such streamlined approach could Disease Control and Prevention (CDC) [5]. According to the Worldpotentially lead to better clinical outcomes and less inappropriate Health Organization (WHO), confirmation of monkeypox infectionantibiotic usage.relies on NAAT, using real-time or conventional polymerase chain reaction (PCR) to detect unique sequences of viral DNA [6].13 Molecular testing thermofisher.com/infectiousdisease Contents'