INFECTIOUS-DISEASES - A FOCUS ON CURRENT CONCEPTS AND EMERGING THERAPIES IN EMERGENCY CARE

The proceedings in this issue of Annals are based on selected lectures given at the symposium ''Infectious Diseases: A Focus on Current Conc epts and Emerging Therapies in Emergency Care,'' which was sponsored b y the Department of Emergency Medicine of the Wayne State University S chool of Medicine. The conference took place on September 21 and 22, 1 993, and the invited speakers were recognized experts in the field. Th e rapidly evolving world of infectious diseases has changed the practi ce of medicine. The battle against microbes has not been won. The emer gence of new pathogens, the rapid development of antibiotic resistance in known pathogens, and the return of old foes provide new challenges for emergency physicians. No longer can we assume that ''standard the rapy'' will always be effective. We must be aware of local, regional, and global epidemiologic patterns to provide quality patient care. The papers in this issue review some of these important issues in infecti ous diseases. The first three papers deal with antimicrobial resistanc e and sepsis. The first paper provides a brief introduction to the pro blem of antimicrobial resistance and is followed by a review of resist ant Gram-positive bacteria. The next important paper, ''Molecular Meth ods: Applications for Clinical Infectious Diseases,'' provides a basis for understanding the molecular biology of infectious diseases. Altho ugh this material may be less familiar to the older practicing physici an, recent graduates will be conversant with much of the information. The concepts discussed are used in much of the current research and em erging practice in clinical medicine. In the near future, rapid diagno stic tests, derived from the molecular biology laboratory, will revolu tionize the practice of medicine. This paper is followed by a summary of the virology and mechanisms of disease of HIV, together with a guid e to the evaluation and treatment of HIV-associated illness in the eme rgency department. The final papers discuss rapid diagnosis and resist ance testing of Mycobacterium tuberculosis. The return of this notorio us pathogen is a major issue of urban EDs. Traditional diagnostic meas ures often take weeks or months, and this has removed the diagnostic a nd therapeutic decisions from the ED. The possibility of obtaining a d efinitive diagnosis in a matter of hours, again based on the methods o f molecular biology, will both enhance patient care and provide for be tter epidemiologic control of this killer disease.