DNA Sequencing Can Change Medicine
DNA sequencing, in my opinion, will revolutionize how medicine approaches the challenges of chronic infections.
Since the beginning of the 21st Century, many of us have become aware that there is a correlation between chronic disease and chronic infection. Before DNA sequencing, it was always thought that the reason patients who had non-healing wounds was due to the host. Though this may be true to an extent, it is also becoming clear that the microbial milieu itself can be a large part of why chronic wounds were not healing.
Other areas where I see the potential for DNA sequencing is in the area of endocarditis or heart valve infections. In many instances there is never a definitive organism identified because the organism is too fastidious to grow on routine culture medium. Identifying these organisms through DNA sequencing will allow clinicians to have a more narrow spectrum of therapy than treating with broad-spectrum antibiotics.
Two areas of interest in which I am seeing a use for DNA sequencing is identifying patients who have underlying chronic sinusitis that have an acute exacerbation of their sinus symptoms due to a viral syndrome, too. A colleague and I have already identified multiple patients who have had both upper respiratory viral infections and pathogenic bacteria, simultaneously. Just like patients who have acute exacerbations of COPD, these chronic sinus suffers need to be managed aggressively and, in the past, they have not.
DNA sequencing will allow us to show that these chronic sinus suffers must be treated much more aggressively than they have been in the past because the viral infection will cause an exacerbation due to the pathogens already there. Another area of interest are patients with persistent IgM antibodies for Epstein-Barr (EBV). There is limited literature out there that says that EBV IgM may persist for 2 years.
Unfortunately, these patients are also suffering from fatigue and their quality of life is affected greatly. Currently, I have several such patients in my practice. It would be interesting to see, through DNA sequencing, if these patients truly have active EBV persisting or if there is another infectious agent that causes the IgM titers to persist, and is this the real contributor to their fatigue.
In conclusion, we are just now beginning to understand the value of DNA sequencing. With time I believe that this new technology will help many patients who have a chronic disease and are now living longer with these chronic diseases.
