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Editorial: Pathogenesis and host response in the era of modern diagnostics: let's continue the basics.

This is an exciting time for research on pathogenesis and the immune response to infectious agents. The articles included in this issue illustrate the rapidly expanding knowledge regarding microbial virulence factors, the acute and chronic response to wound infections, and so on. Recent discoveries on virulence mechanisms have resulted in new methodologies for rapid detection, vaccine development, and in-depth epidemiologic studies which include whole genome sequencing of related pathogens. In the clinical microbiology laboratory, rapid pathogen identification by matrixassisted laser desorption/ionization-time of flight mass spectroscopy has reduced the work load and obviated the need for time-consuming classical methodologies using a myriad of biochemical tests. However, these advances combined with computerized ordering and reporting of test results has clearly reduced critical interactions between physicians and clinical microbiologists. This has also resulted in greater reliance on standardized treatment algorithms while deemphasizing the value of more basic diagnostic skills. In contrast to modern times, early pioneers in the field relied heavily on simple tests, a careful history from the patient, and a thorough physical examination. Diagnoses were based on the appearance and evolution of local or systemic signs and symptoms including fever as well as careful microscopic examination of bodily fluids and evaluation of peripheral blood smears. How exciting it must have been to use these clinical features to establish a definitive diagnosis of malaria, trypanosomiasis, leptospirosis, and cholera to mention a few. Even with modern technological advances, the observations and relationships established by early practitioners have stood the test of time and, in this author’s opinion, such clinical acumen is still crucial for a timely and correct diagnosis.