Introduction
Immune-based diagnosis is based on the detection of processes related to the immune response against Mycobacterium avium subsp. paratuberculosis (MAP). This poses a challenge because there are many aspects of the immune response that we do not fully understand (see Chapter 17, this volume).
However, the immune response also provides an opportunity to observe how the individual responds to infection, which is crucial if we are to understand the process. The sequence of events that may occur in an infected individual, and the temporal aspects of immune responses related to these, are inadequately characterized and understood, adversely affecting the interpretation and use of diagnostic test results. Another challenge in the ‘diagnosis' of MAP infections is the difference in the concepts and terminology used in relation to management of the infection. This chapter is based on existing knowledge about the immune response and how this knowledge can be used for decision making in relation to the management of MAP infection. The utility of these tests can be optimized if one considers the context in which the diagnostic test is used. This chapter discusses immune-based diagnostics for various testing and decision making purposes and outlines the diagnostic process (Table 20.1).20.2
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