386
Manipulation of the microbiota by probiotics and/or prebiotics is a therapeutic as
well as prophylactic strategy for many infectious and infl ammatory diseases within
the gut, but it may be also used for improving vaccine effi cacy (Długońska and
Grzybowski 2011 ).
Personalized Management of Sepsis
Severe sepsis and septic shock are among the leading causes of death with mortality
ranging between 35 % and 50 %. Adequate management of sepsis depends on early
detection (earlier than conventional blood cultures) and early administration of
appropriate antimicrobials. This can be achieved by molecular diagnostic tech-
niques. Assessment of the immune status of the host should also be done faster than
that possible by conventional biomarkers. Among assays of rapid identifi cation of
pathogens that have been grown in blood cultures, PNA-FISH is FDA approved for
the diagnosis of enterococcal infections. SeptiFast (Roche Diagnostics) is a com-
mercially available multiplex real-time PCR for simultaneous detection of DNA
of 25 different bacterial and fungal species within a few hours. Other molecular
diagnostics for sepsis are described in a special report (Jain 2015c ).
There is more individual variability among septic patients than previously recog-
nized. Pathophysiology of sepsis is a complex and dynamic process that originates
from the host immune response to infection and varies according to the genetic
predisposition, immune status and co-morbid conditions of the host, the type of
pathogen and the site and extent of infection. Until now, efforts to stratify septic
patients according to their immune profi le were hampered by the lack of specifi c
biomarkers. Advances in molecular medicine have enabled development of tools
that will facilitate a faster and more precise diagnosis of infections. Individual vari-
ability between each patient’s responses to infection can assist in tailoring therapeu-
tic interventions to the individual’s disease profi le and monitoring treatment
response. Gene profi ling of the host is a promising approach because of the indi-
vidualized nature of sepsis to enable personalized management (Kotsaki and
Giamarellos-Bourboulis 2012 ). Advances in genomics will improve personalized
approach to each septic patient.
Personalized Management of Tuberculosis
Tuberculosis (TB) is a global pandemic that threatens to overwhelm healthcare bud-
gets in many developing countries. It is estimated that at least eight million people
develop active TB annually, of whom two million die. It has been the cause of a
global health emergency for over 10 years owing to factors such as social stigma,
patient compliance and lack of investment in a thorough TB control program.
Despite the availability of adequate effective treatment, many patients default on
11 Personalized Management of Infectious Diseases