(Near patient microbiological tests)
Advances in "near patient tests" (testing and diagnosing patients for infection on the spot, without the need to send samples to a laboratory) could bring great improvements in public health, says Prof Peter Borriello in the week's BMJ. The author, who is the director of the PHLS Central Public Health Laboratory in London, predicts that near patient testing kits of the future will be able to make a diagnosis and automatically transmit the information to a central database as a source of valuable information for health policy decision makers.
The main driving force behind the development of near testing kits has been the search for life in space and the military's need to detect biological warfare agents says Prof Borriello. In the future we could see remote patient testing, he says whereby patients swallow a small capsule that has the ability to detect pathogens (microorganisms that cause disease), transmit the data to a physician or advice centre and which will then transmit advice back to the patient. It might also be possible to connect breath analysers directly to telephones or computers to transmit diagnostic information, says the author.
The benefits of near patient testing include:- improved antibiotic prescribing; rapid diagnosis for communicable diseases such as tuberculosis and acute infections such as meningitis; determination of whether to instigate community contact tracing and screening and targeting of vaccinations to high risk groups.
The down sides of such advances also need to be considered, says Prof Borriello and these include:- quality control and assurance; misuse of kits, for example by testing others without their knowledge; patients using over the counter kits in the absence of the availability of counselling; misinterpretation of the meaning of positive results; deliberate infection of others after infection has been confirmed and the self administration of remedies.
Prof Borriello also suggests that the development of kits will be market driven and this could create a tendency for kits to be developed by pharmaceutical companies to identify diseases and infections for which they also manufacture a treatment. However, the most important problem of an increase in near testing patients could be the potential loss of epidemiological data - if patients test and treat themselves, public health doctors will not be able to ascertain the true prevalence of diseases. He says that the greatest challenge of near patient testing will be to ensure that data is captured.
Prof Borriello concludes that we should be optimistic that the technological development of near patient testing kits will bring great advances in detecting and controlling infections.
Contact:
Prof Peter Borriello, Director, PHLS Central Public Health Laboratory, London Pborriello@phls.nhs.uk