REVIEW AND PERSPECTIVES Pathology of infectious diseases: what does the future hold? Paul Hofman 1,2,3 & Sebastian Lucas 4 & Grégory Jouvion 5 & Arnault Tauziède-Espariat 6 & Fabrice Chrétien 5,6 & Gieri Cathomas 7 Received: 11 October 2016 /Revised: 10 December 2016 /Accepted: 30 January 2017 /Published online: 10 February 2017 # Springer-Verlag Berlin Heidelberg 2017 Abstract The demand for expertise in pathology for the diagnosis of infectious diseases (ID) is continually growing, due to an increase in ID in immunocompromised patients and in the (re)-emergence of common and uncommon dis- eases, including tropical infections and infections with new- ly identified microbes. The microbiology laboratory plays a crucial role in diagnosing infections, identifying the respon- sible infectious agents and establishing sensitivity of patho- gens to drug therapy. Pathology, however, is the only way to correlate the presence of an infectious agent with the reac- tion it evokes at cell and tissue level. For pathologists work- ing in the field of ID pathology, it is essential to dispose of competence in cell and tissue pathology as well as in micro- biology. Expertise in ID includes understanding of taxono- my and classification of pathogens as well as morphological criteria supporting their identification. Moreover, ID pathologists must master the methods used to detect patho- gens in fixed cell and tissue samples, notably immunohisto- chemistry, in situ hybridization and the polymerase chain reaction. Paradoxically, the increasing frequency of lesions caused by pathogens and diagnosed in a pathology labora- tory appears to be paralleled by a gradual loss of expertise of pathologists in the field of infectious and tropical diseases. We contend that this may be due at least in part to the con- tinuously increasing number of samples of tumor tissue pa- thologists deal with and the rapidly expanding number of tissue based biomarkers with predictive value for new anti- cancer therapies. In this review, we highlight current and future issues pertaining to ID pathology, in order to increase awareness of its importance for surgical and molecular pa- thology. The intention is to contribute to the development of best practice in ID pathology. Keywords Infectious disease pathology . Tropical disease pathology . Subspecialty . Ancillary methods . Expertise Introduction Several centuries ago pathologists were probably the first to study the pathophysiology of infection and diagnose infec- tious diseases (ID). Microbiology had not yet developed as a separate medical specialty [1, 2], which reflects the com- mon history of pathology and microbiology. Some authors even stated that Bthe microbe was the creator of the pathologist^ [3]. Over time, the center of gravity of diag- nostic histopathology shifted progressively to the field of tumor pathology, and the role of microbiologists in diagnos- ing ID became much more prominent. In recent years, the interest of pathologists in studying and diagnosing ID seems to increase. This is probably related to the following * Paul Hofman hofman.p@chu-nice.fr 1 Laboratory of Clinical and Experimental Pathology (LPCE), Hôpital Pasteur, BP 69, Centre Hospitalo-Universitaire, 06002 Nice, France 2 Pasteur Hospital Biobank (BB-0033-00025), Pasteur Hospital, Nice, France 3 FHU OncoAge, University of Nice Côte d’Azur, Nice, France 4 Department of Histopathology, King’ s College London School of Medicine, St Thomas’ Hospital, London, UK 5 Institut Pasteur, Human Histopathology and Animal Models Unit, Infection and Epidemiology and Paris Descartes University, ED Bio, Sorbonne Paris Cité, Paris, France 6 Centre Hospitalier Sainte-Anne, Neuropathology Laboratory, Paris, France 7 Institut fur Pathologie, Kantonsspital, Baselland, Liestal, Switzerland Virchows Arch (2017) 470:483–492 DOI 10.1007/s00428-017-2082-6