From Guessing to Knowing: Closing Diagnostic Gap in Pediatric Infection | Expert Interview
2025-07-18
For years, diagnosing infections in children meant relying on a mix of instinct, limited testing, and broad-spectrum antibiotics. Pediatricians, constrained by nonverbal patients and vague symptoms, often made educated guesses and erred on the side of caution with aggressive treatments.
Breakthroughs in genetic pathogen detection have ushered in a new age of precision medicine in pediatrics. Professor Tian Man, Director of the Respiratory Department at Nanjing Children's Hospital, has stood at the frontline of pediatric respiratory medicine, witnessing the development of genetic testing in how clinicians approach infectious diseases.
Professor Tian Man Interview
Difficulty in Diagnosing Children
"Treating children is different from treating adults. Communication can be tricky,” Prof. Tian describes some challenges in diagnosing children. “Some parents notice every detail and describe symptoms clearly, while others miss things, so pediatricians have to rely more on our examinations to catch any changes.
Pediatric respiratory infections are typical, highly seasonal, and predominantly viral. Due to the complex nature of infectious origin, it is difficult to identify the specific pathogens of infection. Doctors are also worried that children will have bacterial infections, so the over-dependence on antibiotics is extremely common.
"In the early days, physicians had limited understanding of etiology, and precise pathogen detection techniques were not widely available – these constraints significantly hampered clinical decision-making," said Prof. Tian.
Without clarity, even mild viral infections triggered concerns about potential bacterial complications. Antibiotics became a routine prescription.
Shifting to Precision Diagnostics
Professor Tian Man is explaining to the patient
"In recent years, our hospital has made rapid advances in precision pathogen testing. Doctors can now accurately identify seasonal respiratory infection trends and pinpoint each child's specific cause of infection, enabling truly targeted treatment." Prof. Tian said with pride.
The clinical results speak volumes. Over just two years, antibiotic use for respiratory cases at the hospital has decreased dramatically as clinicians moved away from empirical prescriptions.
This shift is not just statistical. It’s deeply personal for the families affected, just as the story of a 10-month-old boy. He had already been receiving antibiotics before being brought to Prof. Tian. The treatment was not only ineffective, but it was also harming him by triggering severe side effects.
Instead of continuing down the empirical path, Professor Tian relied on rapid pathogen testing. Within hours, results identified respiratory syncytial virus (RSV). She discontinued the unnecessary antibiotics and provided appropriate supportive care. The child recovered fully at home, avoiding hospitalization and further complications.
This shift away from guesswork has benefited individual children and transformed the hospital's entire approach to infectious disease care. What began in one department has become a hospital-wide movement toward antibiotic stewardship.
Genetic Testing Guide Treatment
Modern pathogen detection uses a layered approach, selecting the right method based on clinical needs. Multiplex PCR is frequently the first-line method, offering rapid and precise detection of over a dozen predefined common pathogens—particularly valuable during seasonal outbreaks like respiratory infections.
However, because PCR panels are limited to preset targets, they may miss less common or unexpected infections. In such cases, targeted next-generation sequencing (tNGS) provides a broader scope, covering hundreds of clinically relevant pathogens with results often available within the same day. It strikes a balance between speed, coverage, and cost, making it a practical upgrade from traditional nucleic acid testing.
In particularly challenging diagnostic dilemmas, metagenomic NGS (mNGS) acts as a powerful discovery tool, capable of identifying even rare or novel pathogens from among more than 36,000 microbial targets. This layered diagnostic system, often in collaboration with leading genomic firms like BGI Genomics, empowers clinicians to tailor testing to the patient’s speed, scope, and cost needs.
Toward Prevention and Prediction
Professor Tian Man speaking at a conference
Beyond individual patient care, these technological advances are reshaping public health strategies, research pipelines, and even our understanding of epidemiology. The ability to rapidly identify pathogens has enhanced outbreak tracking and regional disease surveillance. In research settings, uncovering rare pathogens has opened new avenues for therapeutic development.
In a recent study with the Jiangsu Provincial Center for Disease Control and Prevention, Tian’s team analyzed chlamydia trends across seasonal outbreaks. The goal is to uncover hidden patterns that could enable prediction and prevention.
"Leveraging technological advances for early detection, diagnosis, treatment, and isolation of infections is crucial for disease control and children's health, both regionally and nationwide." Tian Man said.
What’s happening at Nanjing Children’s Hospital reflects a global trend: the rise of data-driven, genomics-powered infection care. As genetic testing becomes faster, cheaper, and more comprehensive, the pediatric community is no longer limited to treating what it can see. Instead, it can now uncover and act on what used to be hidden.
About BGI Genomics
BGI Genomics, headquartered in Shenzhen, China, is the world's leading integrated solutions provider of precision medicine. Our services cover more than 100 countries and regions, involving more than 2,300 medical institutions. In July 2017, as a subsidiary of BGI Group, BGI Genomics (300676.SZ) was officially listed on the Shenzhen Stock Exchange.
Read:
Stopping Preventable Hypertension: Fight Against the Silent Killer | Expert Interview
Healing in the Womb: Precision Fetal Medicine in the New Era | Expert Interview
Safeguarding Fertility in the Battle Against Gynecologic Cancer | Expert Interview
From Needles to Blood Tests: Advancing Prenatal Care for Millions in China | Expert Interview