Among the many effects of the SarS-CoV-2 pandemic is the understandable, but dangerous, loss of attention on some infectious diseases that may become a new threat to the health of citizens in the coming years. One of these is tuberculosis, erroneously considered an outdated infection limited to developing countries but which is actually present in Europe, including Italy, also due to the migrations of populations from Africa and Eastern countries. A situation that was expected to be eradicated not only with prevention but also with targeted therapeutic treatments within the next 15 years but which, also due to Covid, is feared to move forward over time.
The topicality of the threat posed by tuberculosis was discussed in Rimini, on the occasion of the 49th congress of the Italian Clinical Microbiologists Association (AMCLI), during the workshop ‘Diagnosis and therapy of tuberculosis: what changes’, during which the the point on diffusion and available contrast and treatment interventions. An effective method – it was recalled – consists of a surveillance program by sequencing the genome of Mycobacterium tuberculosis, the causative agent of tuberculosis, on the basis of what was done for SarS-CoV-2. A tool that would allow to better characterize the active infection contracted by the latent infection.
During the work – a note reports – it was recalled how incorrect treatment of infected patients exposes them to the development of antibiotic resistance whose effect is the further increase in the incidence of spread among the healthy population. In this context, therefore, the development of a genetic typing plan (DNA profiling) makes it possible to identify the origin of the strain that triggered the infectious process. All this would have an important impact on the health of individual citizens because it would immediately identify the type of bacterium responsible and treat it with targeted drugs. It is clear, it was recalled during the meeting, that a significant effort is needed in terms of both tests and drugs capable of counteracting or promoting recovery, with the remote objective of identifying a vaccine.
Furthermore, the organizational experiences and activities of the Microbiology laboratory during the Covid period were discussed in a joint Amcli session – Ministry of Health and Higher Institute of Health (Iss). The experience gained in these two years must be the starting point for redesigning a territorial network of microbiological surveillance in step with the threats that could come from new viruses with human circulation, a result almost always due to viruses of animal origin that through one or more vectors, have made the leap of species. In these cases it is essential to isolate the virus and carry out as quickly as possible the genomic characterizations essential to prepare adequate prevention and treatment plans. In this sense – the note details – is part of the reorganization project of the sequencing activity proposed by the ISS which, starting from the 112,038 Sars-CoV-2 genomic sequences present today on the national Icogen platform and also shared by the international Gisaid platform, will include the weekly execution of about 1000 sequences, by the laboratories of the network, where Amcli is very represented. This regular activity will be accompanied by monthly Flash surveys.
During the session ‘The role of microbiology in the various phases of the Covid-19 pandemic for prevention and research activities’, chaired by Pierangelo Clerici, president of Amcli, Giovanni Rezza, Director General of Health Prevention at the Ministry of Health and Anna Teresa Palamara, head of the Infectious Diseases Department of the ISS, Clerici stressed how, once the Covid emergency is over, Amcli is confident that the professional, organizational and economic resources gained during the pandemic will be consolidated both in the regional and national contexts. Particular emphasis was placed on molecular and antigenic tests, the use of which during the pandemic phases has almost always been supported by small clinical studies in relation to the number of samples examined and the execution times. In the light of the many experiences accumulated over time, today it is necessary to thoroughly analyze the data of the literature and program multicentre studies precisely to achieve the consolidation of these tests.
Finally, a focus was made on spillover mechanisms and on how other viruses dangerous to humans can arise and spread from them in the future. In particular, the evolution of viruses through mutations constitutes a challenge within the challenge, since potentially over time new variants and / or sub-variants could emerge that could escape vaccine control up to the hypothesis in which the vaccines in use today , may no longer be 100% effective. Question on which the world of clinical microbiology, in collaboration with other disciplines, has paid particular attention precisely to give certain and sure answers in the near future.
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