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Expert Review of Molecular Diagnostics最新文献

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Maintaining point of care testing capacity and pandemic preparedness in the post-COVID-19 era. 在后COVID-19时代保持护理点检测能力和大流行准备。
IF 5.1 3区 医学 Q1 PATHOLOGY Pub Date : 2024-03-01 Epub Date: 2023-09-24 DOI: 10.1080/14737159.2023.2260743
Jennifer L Rakeman-Cagno, David H Persing, Michael J Loeffelholz

Introduction: Testing at the point of care (we also refer to the 'point of need'), with rapid, actionable results reported to the patient and provider within hours can impact the individual as well as public health. Faster testing is good for patients and public health outcomes during 'peace time' (outside of the pandemic setting).

Areas covered: Testing at the point of need was important during the COVID-19 pandemic to meet testing capacity demands, providing actionable results, and for providing testing within communities to increase access for all populations. Resources were acquired and built up dramatically during the pandemic as part of the response. With the end of the COVID-19 public health emergency and transition back to 'peace time' some testing sites have successfully shifted to using this capacity for testing for other critical needs, like sexually transmitted infection (STI) testing, and response to other seasonal diseases and for outbreak response.

Expert opinion: The increased testing capacity added to handle unprecedented testing volume during the COVID-19 pandemic can be repurposed for other critical infectious diseases during 'peace time' (post-COVID-19 pandemic). This maintains testing capacity for the next pandemic.

引言:在护理点(我们也指“需求点”)进行检测,在数小时内向患者和提供者报告快速、可操作的结果,可以影响个人和公众健康。在“和平时期”(疫情环境之外),更快的检测有利于患者和公共卫生结果。涵盖的领域:在新冠肺炎大流行期间,在需要的时候进行检测对于满足检测能力需求、提供可操作的结果以及在社区内提供检测以增加所有人群的机会至关重要。作为应对措施的一部分,在疫情期间获得并大量积累了资源。随着新冠肺炎公共卫生紧急状态的结束和向“和平时期”的过渡,一些检测点已成功地将这种能力用于检测其他关键需求,如性传播感染(STI)检测,以及应对其他季节性疾病和疫情应对。专家意见:在新冠肺炎大流行期间,为应对前所未有的检测量而增加的检测能力可以在“和平时期”(新冠肺炎大流行后)用于其他关键传染病。这为下一次疫情保持了检测能力。
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引用次数: 0
The diagnosis of central nervous system infections in resource-limited settings and the use of novel and molecular diagnostic platforms to improve diagnosis. 在资源有限的环境中诊断中枢神经系统感染,利用新型分子诊断平台改进诊断。
IF 5.1 3区 医学 Q1 PATHOLOGY Pub Date : 2024-03-01 Epub Date: 2024-02-19 DOI: 10.1080/14737159.2024.2317414
James Milburn, Rachita Suresh, Ronan Doyle, Joseph N Jarvis

Introduction: Central nervous system infections (CNSI) disproportionately affect individuals in low-resource settings where diagnosis is challenging; large proportions of patients never receive a confirmed microbiological diagnosis resulting in inadequate management and high mortality. The epidemiology of CNSI varies globally and conventional diagnostics deployed in resource-limited settings have significant limitations, with an urgent need for improved diagnostic strategies.

Areas covered: This review describes molecular platforms and other novel diagnostics used in the diagnosis of CNSI that are applicable to resource-limited settings. An extensive literature search of Medline and PubMed was performed. The emphasis is on investigations targeting infections of relevance to resource-limited settings either due to variation in regional CNSI epidemiology or due to increased prevalence in patients with immunosuppression. This includes commercially available multiplex PCR platforms, mycobacterial PCR platforms, and rapid diagnostics tests. To offer a framework for the optimal implementation in clinical settings, existing evidence highlighting the advantages and limitations of available platforms is reviewed.

Expert opinion: The implementation of molecular platforms and other novel diagnostics has the potential to transform CNSI diagnosis in resource-limited settings, with several examples of successful rollout of novel diagnostics such as Xpert MTB/RIF Ultra and cryptococcal antigen testing.

导言:中枢神经系统感染(CNSI)对资源匮乏地区的患者造成的影响尤为严重,因为那里的诊断难度很大;大部分患者从未得到过微生物学确诊,导致治疗不当和死亡率居高不下。CNSI 的流行病学在全球范围内各不相同,在资源有限的环境中使用的传统诊断方法有很大的局限性,因此迫切需要改进诊断策略:本综述介绍了用于诊断 CNSI 的分子平台和其他适用于资源有限环境的新型诊断方法。对 Medline 和 PubMed 进行了广泛的文献检索。重点放在针对与资源有限环境相关的感染的研究上,这些感染或是由于地区性 CNSI 流行病学的变化,或是由于免疫抑制患者患病率的增加。其中包括市售的多重 PCR 平台、分枝杆菌 PCR 平台和快速诊断检测。为了给临床环境中的最佳实施提供一个框架,本文回顾了现有证据,强调了可用平台的优势和局限性:专家意见:分子平台和其他新型诊断方法的应用有可能改变资源有限环境中的 CNSI 诊断,Xpert MTB/RIF Ultra 和隐球菌抗原检测等新型诊断方法已有多个成功推广的实例。
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引用次数: 0
Point-of-care testing for viral-associated pulmonary aspergillosis. 病毒性肺曲霉菌病的护理点检测。
IF 5.1 3区 医学 Q1 PATHOLOGY Pub Date : 2024-03-01 Epub Date: 2023-09-21 DOI: 10.1080/14737159.2023.2257597
Robina Aerts, Brice Autier, Maximilian Gornicec, Juergen Prattes, Katrien Lagrou, Jean-Pierre Gangneux, Martin Hoenigl

Introduction: Over the last years, severe respiratory viral infections, particularly those caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the influenza virus, have emerged as risk factor for viral-associated pulmonary aspergillosis (VAPA) among critically ill patients. Delays in diagnosis of VAPA are associated with increased mortality. Point-of-care-tests may play an important role in earlier diagnosis of VAPA and thus improve patient outcomes.

Areas covered: The following review will give an update on point-of-care tests for VAPA, analyzing performances in respiratory and blood specimens.

Expert opinion: Point-of-care tests have emerged, and particularly the IMMY Aspergillus galactomannan lateral flow assay (LFA) shows performances comparable to the galactomannan ELISA for diagnosis of VAPA. Notably, nearly all evaluations of POC tests for VAPA have been performed in COVID-19 patients, with very limited data in influenza patients. For early diagnosis of COVID associated pulmonary aspergillosis (CAPA), the LFA has shown promising performances in respiratory samples, particularly in bronchoalveolar lavage fluid, and may thereby help in improving patient outcomes. In contrast, serum LFA testing may not be useful for early diagnosis of disease, except in cases with invasive tracheobronchial aspergillosis.

引言:在过去几年中,严重呼吸道病毒感染,特别是由严重急性呼吸综合征冠状病毒2型(严重急性呼吸系统综合征冠状病毒冠状病毒2型)和流感病毒引起的感染,已成为危重患者中病毒相关肺曲霉菌病(VAPA)的风险因素。VAPA诊断延迟与死亡率增加有关。护理点测试可能在VAPA的早期诊断中发挥重要作用,从而改善患者的预后。涵盖的领域:以下综述将提供VAPA护理点测试的最新情况,分析呼吸和血液样本的表现。专家意见:已经出现了护理点测试,特别是IMMY曲霉半乳甘露聚糖侧流分析(LFA)在诊断VAPA方面显示出与半乳甘露聚糖ELISA相当的性能。值得注意的是,几乎所有的VAPA POC测试评估都是在新冠肺炎患者中进行的,流感患者的数据非常有限。对于新冠肺炎相关肺曲霉菌病(CAPA)的早期诊断,LFA在呼吸样本中,特别是在支气管肺泡灌洗液中表现出了良好的表现,从而可能有助于改善患者的预后。相反,血清LFA检测可能对疾病的早期诊断无效,除非是侵袭性气管支气管曲霉菌病。
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引用次数: 0
An overview of point-of-care testing for infections in critically ill patients. 重症患者感染的护理点检测概述。
IF 5.1 3区 医学 Q1 PATHOLOGY Pub Date : 2024-03-01 Epub Date: 2024-02-27 DOI: 10.1080/14737159.2024.2322146
Alena Moerman, Jan J De Waele, Jerina Boelens

Introduction: Molecular diagnostic systems for point-of-care (POC) testing are nowadays routinely used and are part of many labs. Although often intended for bedside use outside of the microbiology lab, there is still room for expansion.

Areas covered: This review discusses the two techniques that are currently the most widespread, real-time polymerase-chain reaction (RT-PCR) and loop-mediated isothermal amplification (LAMP). An overview is provided of the various manufacturers and products as well as the evidence and current use in clinical practice. The article further sheds light on some newer techniques, such as CRISPR-based diagnostics and lab-on-a-chip, which are still in development.

Expert opinion: With many new platforms and techniques still in the pipeline and their potential currently not yet fully exploited, we expect the use of molecular POC testing to increase in the years to come. However, even when used in hospital - in lab, the main advantages of the tests being fast and easy to perform already provide significant benefits in terms of patient outcome.

导言:如今,用于护理点(POC)检测的分子诊断系统已成为许多实验室的常规设备。虽然该系统通常用于微生物实验室以外的床边使用,但仍有扩展的空间:本综述讨论了目前最普遍的两种技术:实时聚合酶链反应(RT-PCR)和环介导等温扩增(LAMP)。文章概述了各种制造商和产品以及证据和目前在临床实践中的使用情况。文章还进一步揭示了一些仍在开发中的新技术,如基于 CRISPR 的诊断技术和芯片实验室:专家观点:由于许多新平台和新技术仍在研发过程中,而且其潜力目前尚未得到充分挖掘,我们预计分子 POC 检测的使用在未来几年会越来越多。不过,即使是在医院实验室中使用,检测快速、简便的主要优势也能为患者带来显著的疗效。
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引用次数: 0
A fast-track to fungal diagnosis: the potential of molecular diagnostics for fungi at the point of care. 真菌诊断的快速通道:真菌分子诊断在护理点的潜力。
IF 5.1 3区 医学 Q1 PATHOLOGY Pub Date : 2024-03-01 Epub Date: 2023-11-29 DOI: 10.1080/14737159.2023.2287504
Paul Trubin, Marwan M Azar
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引用次数: 0
Fast detection of bacterial gut pathogens on miniaturized devices: an overview. 微型设备上细菌肠道病原体的快速检测:概述。
IF 5.1 3区 医学 Q1 PATHOLOGY Pub Date : 2024-03-01 Epub Date: 2024-02-13 DOI: 10.1080/14737159.2024.2316756
Gratiela Gradisteanu Pircalabioru, Mina Raileanu, Mihai Viorel Dionisie, Irina-Oana Lixandru-Petre, Ciprian Iliescu

Introduction: Gut microbes pose challenges like colon inflammation, deadly diarrhea, antimicrobial resistance dissemination, and chronic disease onset. Development of early, rapid and specific diagnosis tools is essential for improving infection control. Point-of-care testing (POCT) systems offer rapid, sensitive, low-cost and sample-to-answer methods for microbe detection from various clinical and environmental samples, bringing the advantages of portability, automation, and simple operation.

Areas covered: Rapid detection of gut microbes can be done using a wide array of techniques including biosensors, immunological assays, electrochemical impedance spectroscopy, mass spectrometry and molecular biology. Inclusion of Internet of Things, machine learning, and smartphone-based point-of-care applications is an important aspect of POCT. In this review, the authors discuss various fast diagnostic platforms for gut pathogens and their main challenges.

Expert opinion: Developing effective assays for microbe detection can be complex. Assay design must consider factors like target selection, real-time and multiplex detection, sample type, reagent stability and storage, primer/probe design, and optimizing reaction conditions for accuracy and sensitivity. Mitigating these challenges requires interdisciplinary collaboration among scientists, clinicians, engineers, and industry partners. Future efforts are essential to enhance sensitivity, specificity, and versatility of POCT systems for gut microbe detection and quantification, advancing infectious disease diagnostics and management.

导言:肠道微生物带来了结肠发炎、致命腹泻、抗菌药耐药性传播和慢性病发病等挑战。开发早期、快速和特异性诊断工具对于改善感染控制至关重要。床旁检测(POCT)系统为从各种临床和环境样本中检测微生物提供了快速、灵敏、低成本和从样本到答案的方法,具有便携、自动化和操作简单等优点:肠道微生物的快速检测可采用多种技术,包括生物传感器、免疫测定、电化学阻抗光谱、质谱分析和分子生物学。纳入物联网、机器学习和基于智能手机的护理点应用是 POCT 的一个重要方面。在这篇综述中,作者讨论了各种肠道病原体快速诊断平台及其主要挑战:开发有效的微生物检测方法可能很复杂。检测设计必须考虑目标选择、实时和多重检测、样本类型、试剂稳定性和储存、引物/探针设计以及优化反应条件以提高准确性和灵敏度等因素。应对这些挑战需要科学家、临床医生、工程师和行业合作伙伴之间的跨学科合作。未来的努力对于提高用于肠道微生物检测和定量的 POCT 系统的灵敏度、特异性和多功能性,推进传染病诊断和管理至关重要。
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引用次数: 0
Opportunities and challenges of point of care testing paradigms in the post-COVID era. 后 COVID 时代医疗点检测模式的机遇与挑战。
IF 5.1 3区 医学 Q1 PATHOLOGY Pub Date : 2024-03-01 Epub Date: 2024-03-19 DOI: 10.1080/14737159.2024.2330774
Barbara Van Der Pol
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引用次数: 0
We have reached single-visit testing, diagnosis, and treatment for hepatitis C infection, now what? 我们已经实现了丙型肝炎感染的单次检测、诊断和治疗,现在该怎么办?
IF 5.1 3区 医学 Q1 PATHOLOGY Pub Date : 2024-03-01 Epub Date: 2024-01-04 DOI: 10.1080/14737159.2023.2292645
Jason Grebely, Susan Matthews, Louise M Causer, Jordan J Feld, Philip Cunningham, Gregory J Dore, Tanya L Applegate

Introduction: Progress toward hepatitis C virus (HCV) elimination is impeded by low testing and treatment due to the current diagnostic pathway requiring multiple visits leading to loss to follow-up. Point-of-care testing technologies capable of detecting current HCV infection in one hour are a 'game-changer.' These tests enable diagnosis and treatment in a single visit, overcoming the barrier of multiple visits that frequently leads to loss to follow-up. Combining point-of-care HCV antibody and RNA tests should improve cost-effectiveness, patient/provider acceptability, and testing efficiency. However, implementing HCV point-of-care testing programs at scale requires multiple considerations.

Areas covered: This commentary explores the need for point-of-care HCV tests, diagnostic strategies to improve HCV testing, key considerations for implementing point-of-care HCV testing programs, and remaining challenges for point-of-care testing (including operator training, quality management, connectivity and reporting systems, regulatory approval processes, and the need for more efficient tests).

Expert opinion: It is exciting that single-visit testing, diagnosis, and treatment for HCV infection have been achieved. Innovations afforded through COVID-19 should facilitate the accelerated development of low-cost, rapid, and accurate tests to improve HCV testing. The next challenge will be to address barriers and facilitators for implementing point-of-care testing to deliver them at scale.

导言:由于目前的诊断途径需要多次就诊,导致患者失去随访机会,因此检测和治疗率较低,阻碍了消除丙型肝炎病毒(HCV)的进程。能够在一小时内检测出当前丙型肝炎病毒感染情况的床旁检测技术是一种 "改变游戏规则的技术"。这些检测可在一次就诊中完成诊断和治疗,克服了多次就诊经常导致失去随访的障碍。结合床旁 HCV 抗体和 RNA 检测可提高成本效益、患者/医疗服务提供者的接受度和检测效率。然而,大规模实施 HCV 床旁检测项目需要多方面的考虑:本评论探讨了对HCV床旁检测的需求、改进HCV检测的诊断策略、实施HCV床旁检测项目的主要考虑因素,以及床旁检测仍面临的挑战(包括操作员培训、质量管理、连接和报告系统、监管审批流程,以及对更高效检测的需求):令人振奋的是,HCV 感染的单次检测、诊断和治疗已经实现。COVID-19 所带来的创新应有助于加快开发低成本、快速、准确的检测方法,从而改善 HCV 检测。下一个挑战将是解决实施护理点检测的障碍和促进因素,以大规模提供这些检测。
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引用次数: 0
Lessons from the pandemic: new best practices in selecting molecular diagnostics for point-of-care testing of infectious diseases in sub-Saharan Africa. 疫情的教训:撒哈拉以南非洲传染病护理点检测选择分子诊断的新最佳实践。
IF 5.1 3区 医学 Q1 PATHOLOGY Pub Date : 2024-03-01 Epub Date: 2023-11-09 DOI: 10.1080/14737159.2023.2277368
Mamadu Baldeh, Flavia K Bawa, Faiza U Bawah, Martin Chamai, Francis Dzabeng, Waleed M A Jebreel, Jean-Bertin B Kabuya, Shola K Molemodile Dele-Olowu, Erick Odoyo, Dimbintsoa Rakotomalala Robinson, Aubrey J Cunnington

Introduction: Point-of-care molecular diagnostics offer solutions to the limited diagnostic availability and accessibility in resource-limited settings. During the COVID-19 pandemic, molecular diagnostics became essential tools for accurate detection and monitoring of SARS-CoV-2. The unprecedented demand for molecular diagnostics presented challenges and catalyzed innovations which may provide lessons for the future selection of point-of-care molecular diagnostics.

Areas covered: We searched PubMed from January 2020 to August 2023 to identify lessons learned from the COVID-19 pandemic which may impact the selection of point-of-care molecular diagnostics for future use in sub-Saharan Africa. We evaluated this in the context of REASSURED criteria (Real-time connectivity; Ease of specimen collection; Affordable; Sensitive; Specific; User-friendly; Rapid and robust; Equipment free; and Deliverable to users at the point of need) for point-of-care diagnostics for resource-limited settings.

Expert opinion: The diagnostic challenges and successes during the COVID-19 pandemic affirmed the importance of the REASSURED criteria but demonstrated that these are not sufficient to ensure new diagnostics will be appropriate for public health emergencies. Capacity for rapid scale-up of diagnostic testing and transferability of assays, data, and technology are also important, resulting in updated REST-ASSURED criteria. Few diagnostics will meet all criteria, and trade-offs between criteria will need to be context-specific.

简介:护理点分子诊断为资源有限的环境中有限的诊断可用性和可访问性提供了解决方案。在新冠肺炎大流行期间,分子诊断成为准确检测和监测SARS-CoV-2的重要工具。对分子诊断的空前需求带来了挑战和催化创新,这可能为未来选择护理点分子诊断提供经验教训。涵盖的领域:我们从2020年1月至2023年8月搜索了PubMed,以确定从新冠肺炎大流行中吸取的教训,这可能会影响撒哈拉以南非洲未来使用的定点分子诊断的选择。我们在资源有限的环境下,根据合理的护理点诊断标准(实时连接;易于采集样本;价格合理;敏感;特定;用户友好;快速可靠;无设备;可在需要时交付给用户)对此进行了评估。专家意见:新冠肺炎大流行期间的诊断挑战和成功肯定了合理标准的重要性,但表明这些标准不足以确保新的诊断方法适用于公共卫生紧急情况。快速扩大诊断测试的能力以及分析、数据和技术的可转移性也很重要,从而更新REST-ASSURED标准。很少有诊断能够满足所有标准,标准之间的权衡需要根据具体情况进行。
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引用次数: 0
The potential for rapid antigen testing for mucormycosis in the context of COVID-19. 在 COVID-19 的背景下进行粘孢子虫病快速抗原检测的潜力。
IF 5.1 3区 医学 Q1 PATHOLOGY Pub Date : 2024-03-01 Epub Date: 2023-07-07 DOI: 10.1080/14737159.2023.2233906
Christopher R Thornton

Introduction: Mucormycosis is a highly aggressive angio-invasive disease of humans caused by Mucorales fungi. Prior to the COVID-19 pandemic, mucormycosis was a rare mycosis typically seen in immunocompromised patients with hematological malignancies or in transplant recipients. During the second wave of the pandemic, there was a dramatic increase in the disease, especially in India where a unique set of circumstances led to large numbers of life-threatening and disfiguring rhino-orbital-cerebral mucormycosis (ROCM) infections.

Areas covered: The review examines mucormycosis as a super-infection of COVID-19 patients, and the risk factors for COVID-19-associated mucormycosis (CAM) that drove the ROCM epidemic in India. The limitations of current diagnostic procedures are identified, and the measures needed to improve the speed and accuracy of detection discussed.

Expert opinion: Despite increased awareness, global healthcare systems remain unprepared for further outbreaks of ROCM. Current diagnosis of the disease is slow and inaccurate, negatively impacting on patient survival. This is most evident in low- to middle-income countries which lack suitably equipped diagnostic facilities for rapid identification of the infecting pathogens. Rapid antigen testing using point-of-care lateral-flow assays could potentially have aided in the quick and accurate diagnosis of the disease, allowing earlier intervention with surgery and Mucorales-active antifungal drugs.

简介粘孢子菌病是由粘孢子菌引起的一种侵袭性很强的血管侵袭性疾病。在 COVID-19 大流行之前,粘孢子菌病是一种罕见的真菌病,通常见于免疫力低下的血液恶性肿瘤患者或移植受者。在第二波大流行期间,这种疾病急剧增加,尤其是在印度,那里的一系列特殊情况导致了大量危及生命和毁容的鼻-眶-脑粘孢子菌病(ROCM)感染:综述探讨了作为 COVID-19 患者超级感染的粘孢子菌病,以及导致印度 ROCM 流行的 COVID-19 相关粘孢子菌病 (CAM) 的风险因素。确定了当前诊断程序的局限性,并讨论了提高检测速度和准确性所需的措施:专家观点:尽管人们对该疾病的认识有所提高,但全球医疗保健系统仍未做好应对 ROCM 进一步爆发的准备。目前对该疾病的诊断既缓慢又不准确,对患者的生存造成了负面影响。这种情况在中低收入国家最为明显,这些国家缺乏设备齐全的诊断设施,无法快速识别感染病原体。使用护理点侧向流检测法进行快速抗原检测可能有助于快速、准确地诊断该疾病,从而可以更早地进行手术和使用黏菌类抗真菌药物。
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引用次数: 0
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Expert Review of Molecular Diagnostics
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