Clinical and epidemiological aspects of viral infections: a molecular approach

Molecular tests have gained a solid position in clinical virology. Developments in molecular diagnostics go rapidly; within a few hours several viruses can be detected in one single, sensitive laboratory test. These developments do raise questions regarding the clinical value of these tests. What does the outcome of a diagnostic test means for the patient, for treatment and additional diagnostic procedures, and preventive measures to reduce further spread of viruses. In this thesis the advantages of molecular diagnostic tests are described by studies into enterovirus 68 , rhinovirus and influenza virus. By combining clinical and epidemiological data with the outcome of viral diagnostic tests, the role of these viruses in causing respiratory tract infections are described. Despite the presence of a potential viral cause of a respiratory tract infection, antibiotic therapy is often still continued. The studies presented in this thesis also show that characterizing viruses using sequence analysis methods is important to understand the transmission of viruses in the hospital. Sequence based information serves as input for the implementation of appropriate infection control measures, focused on the most likely route of transmission. This enables the efficient use of human and material resources. Cost effectiveness studies are needed to address the impact of a timely and accurate diagnosis on all aspects of patient care. Besides, education of health care providers on the proper use and interpretation of molecular tests is crucial for the optimal integration of these tests in patient management