Ann Infect Dis Epidemiol | Volume 3, Issue 1 | Review Article | Open Access
Christopher Stone1 and James B Mahony2*
1Department of Medicine, Dalhousie University, Canada
2Department of Pathology and Molecular Medicine, McMaster University, Canada
*Correspondance to: James B Mahony
Fulltext PDFNucleic acid amplification tests (NATs) have become the cornerstone of clinical laboratories providing a same day diagnosis for a wide range of infections. Although polymerase chain reaction (PCR) has served laboratories well since its inception, PCR tests have significant disadvantages as they are labor intensive, require a thermal cycler, and are relatively slow compared with newer isothermal amplification methods. Following the introduction of isothermal amplification methods such as strand displacement amplification (SDA) and loop-mediated isothermal amplification (LAMP), several other isothermal amplification methods have been introduced, and some of these can yield positive results in as little as 5-10 minutes. First generation POC tests for bacterial and viral infections were antigen based and these tests lacked sensitivity. Laboratory-based molecular diagnostic tests using isothermal amplification have demonstrated excellent sensitivity and speed, both of which are required for POC tests for infectious diseases. Other attributes required for next generation POC tests are low cost and ease-of-use for resource poor settings including developing countries. Isothermal amplification with improved sensitivity is therefore well suited for the next generation of molecular POC tests. Since most amplification methods require nucleic acid extraction to remove inhibitors of amplification, specimen preparation is often the rate limiting step for clinical laboratories to provide rapid turn-around times. Nucleic acid purification also presents a challenge for POC tests and advances in specimen treatment will therefore be required for rapid POC tests for virus detection. The next generation POC tests will employ engineering advances in the areas of microfluidics, on-chip nucleic acid analysis, biosensors, and will facilitate the development of hand-held POC tests that can provide positive results in 20 minutes. These rapid POC tests will facilitate the detection of infectious diseases in a range of clinical and non-clinical settings including field use providing health care workers with a rapid, actionable result leading to improved patient management. The use of multiplex POC tests for detecting multiple pathogens will increase our understanding of the epidemiology of less prevalent infections, some of which may go undiagnosed in some settings.
Point-of-care; Molecular diagnostics
Stone C, Mahony JB. Point-of-care (POC) Tests for Infectious Diseases– The Next Generation!. Ann Infect Dis Epidemiol. 2018;3(1):1025.