Finding out fast if it's a virus
A snapshot of the immune system may avoid the unneeded use of antibiotics.
WASHINGTON - It happens too often: A doctor isn't sure what's causing someone's feverish illness but prescribes antibiotics just in case, drugs that don't work if a virus is the real culprit.
Now Duke University researchers are developing a blood test to more easily tell when a respiratory illness is due to a virus and not a bacterial infection, hoping to cut the risky overuse of antibiotics and speed the right diagnosis.
It works by taking a fingerprint of your immune system - how its genes are revving up to fight the bug. That's very different from how infections are diagnosed today. And if the experimental test pans out, it also promises to help doctors track brand-new threats, like the next flu pandemic or that mysterious MERS virus that has erupted in the Middle East.
That viral "signature could be quite powerful, and may be a game-changer," said Geoffrey Ginsburg, Duke's genomic medicine chief. He leads the team that on Wednesday reported that a study involving 102 people provided early evidence that the test can work.
Today, when symptoms alone aren't enough for diagnosis, a doctor's suspicion guides what tests are performed - tests that work by hunting for evidence of a specific pathogen. Fever and cough? If it's flu season, you might be tested for the flu virus. An awful sore throat? Chances are you'll get checked for strep bacteria. A negative test can leave the doctor wondering what germ to check for next, or whether to make a best guess.
Moreover, rapid in-the-office tests can miss infections. So patients may have blood or other samples sent to labs to try to grow any lurking bacteria and tell if it's to blame, additional testing that can take days.
"This is something we struggle with every day," said Octavio Ramilo, infectious disease chief at Nationwide Children's Hospital in Columbus, Ohio, who wasn't involved in the study. Particularly with children, a respiratory virus and a bacterial infection "in the beginning look completely alike," he added.
Hence researchers at a number of universities are trying to harness a fairly recent discovery: As your immune system detects an invading bug, different genes are activated to fend off a viral infection than to fight a bacterial or fungal one. Those subtle molecular changes appear to be occurring even before you feel any symptoms. And they form distinct patterns of RNA and proteins, what's called a genomic fingerprint.
The Duke team discovered 30 genes that are switched on in different ways during a viral attack. The test is a freeze-frame to show "what those genes are doing at the moment in time that it's captured," explained Duke lead researcher Aimee Zaas.