When we were setting the theme of "infection control dilemmas and practical solutions" for this symposium, we asked ourselves a basic question: What are some of the most vexing problems and situations facing the hospital microbiologist epidemiologist team in today's world of opportunistic and new infectious diseases unheard of as common pathogenic occurrences 10 years ago? One of the areas which we immediately focused upon was the tremendous amount of time, energy, and financial resources that are presently being expended to satisfy the requirements mandated by the recognition of the danger of spread of blood-borne pathogens in the hospital environment. With the advent of Universal Precautions, primarily in response to HIV infection and the AIDS crisis, but certainly augmented by the increased incidence of hepatitis in its various forms, a significant effort has been required to meet the standards rec ommended and/or required by OSHA and the CDC. With this in mind we brought together experts in the field of infectious diseases to address the problems engendered by the threat of nosocomial spread of selected pathogens. Further, we devoted several sessions to discussing the investi gation and resolution of institutional outbreaks of disease, particularly with reference to methicillin-resistant Staphylo coccus aureus (MRSA). Special problems of dental offices and clinical teaching as well as extended care facilities were also selected for attention, particularly with relation to blood borne pathogens.
The papers published herein comprise the presentations given at the eighteenth of an annual series of clinical symposia arranged under the auspices of the Eastern Pennsylvania Branch of the American Society for Microbiology. This symposium allowed approximately 200 persons to gather and exchange ideas on the rapid laboratory diagnosis of infectious diseases. The institution of the Diagnosis Related Group (DRG) method for reimbursement by both government agencies and private insurance carriers has provided a financial aspect to the established clinical reasons for rapid laboratory diagnosis. Now the health of the institution, as well as the patient, is dependent on a timely diagnosis and, hopefully, cure. Accordingly, the goal of this symposium was to present the latest developments in "same-day microbiology". In the face of stable or diminishing resources, the laboratory director is presented with many choices. Do nucleic acid probes, non instrumental ELISA techniques, or time-resolved fluorometry have a place in his or her laboratory? Should the laboratory test for newly described human pathogens such as human immunodeficiency virus or human papilloma virus? Can rapid techniques supplant conventional methods? Or are they merely adjunctive? This symposium attempted to assist in the formulation of informed decisions. Bruce Kleger Donald Jungkind Eileen Rinks Linda A. Miller vii ACKNOWLEDGEMENTS We would like to thank the Eastern Pennsylvania Branch of t~e American Society for Microbiology for sponsoring this symposium and for making this publication possible. We especially thank the Symposium Committee for their diligent work in organizing an informative and successful symposium.
THE ERA OF ANTIVIRALS Introduction Although there are more than one hundred medically useful antibiotics and fungicides, there are only seven compounds licensed for use as antiviral agents, in the USA. Some of these (acyclovir and ganciclovir) are actually derivatives of each other, making the number of new discoveries even smaller. Moreover, most of these agents are of only limited therapeutic value and have substantial toxicity. It has been more than 100 years ago since Pasteur studied rabies virus (2) and Rous (4) showed that a small filterable agent (not bacteria) caused disease (sarcoma) in chickens. It was nearly 100 years ago that yellow fever virus, the first recognized human pathogenic virus, was unambiguously associated with disease (3). Enteroviruses were cultured for the first time nearly 50 years ago (1). Why then has effective chemotherapy against viruses lagged behind that of other microorganisms? Viruses are often difficult to grow and image. However, with the dynamic advances in molecular biology and increased sophistication in tissue culture, the field of virology has blossomed and resulted in improved methods for detection of virus infection. The use of viruses as models of gene regulation and replication has also resulted in a massive accumulation of information.