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Mousavi-Sagharchi SMA, Afrazeh E, Seyyedian-Nikjeh SF, Meskini M, Doroud D, Siadat SD. New insight in molecular detection of Mycobacterium tuberculosis. AMB Express 2024; 14:74. [PMID: 38907086 PMCID: PMC11192714 DOI: 10.1186/s13568-024-01730-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 06/06/2024] [Indexed: 06/23/2024] Open
Abstract
Mycobacterium tuberculosis, the causative agent of tuberculosis, is a pathogenic bacterium that has claimed millions of lives since the Middle Ages. According to the World Health Organization's report, tuberculosis ranks among the ten deadliest diseases worldwide. The presence of an extensive array of genes and diverse proteins within the cellular structure of this bacterium has provided us with a potent tool for diagnosis. While the culture method remains the gold standard for tuberculosis diagnosis, it is possible that molecular diagnostic methods, emphasis on the identification of mutation genes (e.g., rpoB and gyrA) and single nucleotide polymorphisms, could offer a safe and reliable alternative. Over the past few decades, as our understanding of molecular genetics has expanded, methods have been developed based on gene expansion and detection. These methods typically commence with DNA amplification through nucleic acid targeted techniques such as polymerase chain reaction. Various molecular compounds and diverse approaches have been employed in molecular assays. In this review, we endeavor to provide an overview of molecular assays for the diagnosis of tuberculosis with their properties (utilization, challenges, and functions). The ultimate goal is to explore the potential of replacing traditional bacterial methods with these advanced molecular diagnostic techniques.
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Affiliation(s)
| | - Elina Afrazeh
- Department of Marine Biology, Faculty of Marine Science, Khorramshahr University of Marine Science and Technology, Khorramshahr, Iran
| | | | - Maryam Meskini
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran.
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran.
- Department of Genetics, Faculty of Natural and Agricultural Sciences, University of the Free State, Bloemfontein, 9301, South Africa.
- Student Research Committee, Pasteur Institute of Iran, Tehran, Iran.
| | - Delaram Doroud
- Department of Immunotherapy and Leishmania Vaccine Research, Pasteur Institute of Iran, Tehran, Iran
| | - Seyed Davar Siadat
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran.
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran.
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2
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Nikaein A, Chemmalakuzhy A, Khan S, Hunt J, Haumpy D, Choudhary A, Pinter A, Sanchez A, Lerman M. Monitored COVID-19 vaccine humoral response in immunocompromised solid organ transplant recipients. Hum Immunol 2024; 85:110760. [PMID: 38310028 DOI: 10.1016/j.humimm.2024.110760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/28/2023] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
The SARS-CoV-2 pandemic has resulted in rapid research and vaccine development to help curtail unchecked transmission. However, these studies cannot be applied as easily among every population, such as immunocompromised individuals. In this study, we observed the humoral response of 70 total heart and renal transplant patients to mRNA SARS-CoV-2 vaccinations to help further understand the effectiveness of vaccination in post-transplant patients following second or booster vaccinations. Antibodies were measured by bead technology to detect IgG, as well as IgG/IgM Rapid Cassette tests for confirmation. Immunocompromised patients had a noticeably lower humoral response than non-immunocompromised populations, with an even lower response among Black patients. Our findings also show for the first time various antibody responses to different motifs of the virus, with the lowest being against the S2 motif. A potential link between the duration of immunosuppression and vaccine response was also observed, where patients on immunosuppressants for longer had a stronger response to vaccination compared to recent transplant patients in our study. In addition, younger transplant recipients had a better humoral response to vaccination, and vaccine effectiveness was disproportionate between races. This finding reinforces the continuation of the guidelines for accelerated vaccination schedules for immunocompromised patients.
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Affiliation(s)
- Afzal Nikaein
- Texas Medical Specialty, Inc, 7777 Forest Lane, Dallas, TX 75230, United States.
| | | | - Salman Khan
- Medical City Dallas, 7777 Forest Lane, Dallas, TX 75230, United States
| | - Judson Hunt
- Medical City Dallas, 7777 Forest Lane, Dallas, TX 75230, United States
| | - Derek Haumpy
- Texas Medical Specialty, Inc, 7777 Forest Lane, Dallas, TX 75230, United States
| | - Alok Choudhary
- Public Health Research Institute, New Jersey Medical School, Rutgers University, 185 S Orange Ave, Newark, NJ 07130, United States
| | - Abraham Pinter
- Public Health Research Institute, New Jersey Medical School, Rutgers University, 185 S Orange Ave, Newark, NJ 07130, United States
| | - Ayrton Sanchez
- Texas Medical Specialty, Inc, 7777 Forest Lane, Dallas, TX 75230, United States
| | - Mark Lerman
- Medical City Dallas, 7777 Forest Lane, Dallas, TX 75230, United States
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3
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de Araujo WR, Lukas H, Torres MDT, Gao W, de la Fuente-Nunez C. Low-Cost Biosensor Technologies for Rapid Detection of COVID-19 and Future Pandemics. ACS NANO 2024; 18:1757-1777. [PMID: 38189684 DOI: 10.1021/acsnano.3c01629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Many systems have been designed for the detection of SARS-CoV-2, which is the virus that causes COVID-19. SARS-CoV-2 is readily transmitted, resulting in the rapid spread of disease in human populations. Frequent testing at the point of care (POC) is a key aspect for controlling outbreaks caused by SARS-CoV-2 and other emerging pathogens, as the early identification of infected individuals can then be followed by appropriate measures of isolation or treatment, maximizing the chances of recovery and preventing infectious spread. Diagnostic tools used for high-frequency testing should be inexpensive, provide a rapid diagnostic response without sophisticated equipment, and be amenable to manufacturing on a large scale. The application of these devices should enable large-scale data collection, help control viral transmission, and prevent disease propagation. Here we review functional nanomaterial-based optical and electrochemical biosensors for accessible POC testing for COVID-19. These biosensors incorporate nanomaterials coupled with paper-based analytical devices and other inexpensive substrates, traditional lateral flow technology (antigen and antibody immunoassays), and innovative biosensing methods. We critically discuss the advantages and disadvantages of nanobiosensor-based approaches compared to widely used technologies such as PCR, ELISA, and LAMP. Moreover, we delineate the main technological, (bio)chemical, translational, and regulatory challenges associated with developing functional and reliable biosensors, which have prevented their translation into the clinic. Finally, we highlight how nanobiosensors, given their unique advantages over existing diagnostic tests, may help in future pandemics.
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Affiliation(s)
- William Reis de Araujo
- Portable Chemical Sensors Lab, Department of Analytical Chemistry, Institute of Chemistry, State University of Campinas - UNICAMP, Campinas, SP 13083-970, Brazil
| | - Heather Lukas
- Andrew and Peggy Cherng Department of Medical Engineering, Division of Engineering and Applied Science, California Institute of Technology, Pasadena, California 91125, United States
| | - Marcelo D T Torres
- Machine Biology Group, Departments of Psychiatry and Microbiology, Institute for Biomedical Informatics, Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Departments of Bioengineering and Chemical and Biomolecular Engineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Penn Institute for Computational Science, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Wei Gao
- Andrew and Peggy Cherng Department of Medical Engineering, Division of Engineering and Applied Science, California Institute of Technology, Pasadena, California 91125, United States
| | - Cesar de la Fuente-Nunez
- Machine Biology Group, Departments of Psychiatry and Microbiology, Institute for Biomedical Informatics, Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Departments of Bioengineering and Chemical and Biomolecular Engineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Penn Institute for Computational Science, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
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4
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Niecwietajewa I, Frączek M, Mroczkowska M, Frączek M. Identifying Predominant Causes of Death Among Hospitalized COVID-19 Patients During Poland's Second and Third Waves. Med Sci Monit 2023; 29:e941455. [PMID: 37880930 PMCID: PMC10617245 DOI: 10.12659/msm.941455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/09/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Number of confirmed COVID-19 deaths per million population in Poland between November 2020 and May 2021 was one of the largest in Europe. This retrospective study was conducted at a single center in Poland between November 2020 and May 2021to evaluate the morbidity and mortality rates in 581 patients hospitalized with COVID-19. MATERIAL AND METHODS A retrospective single-center study was conducted in a dedicated COVID-19 hospital from November, 2020 to May, 2021. The data of 581 hospitalized patients were analyzed. Multimorbidity was assessed using the Charlson Comorbidity Index, including chronic kidney, respiratory, cardiovascular diseases, diabetes mellitus, cancer, and dementia. The observation period covered admission to the hospital for severe COVID-19 until discharge or death. Diagnosis of COVID-19 was confirmed by quantitative reverse transcription polymerase chain reaction test. Statistical analysis was carried out in the IBM SPSS Statistics program. RESULTS The mortality rate was 35% of all admitted patients. Lung damage was the cause of death in 60%, bacterial superinfection in 26%, arterial thrombosis or thromboembolism in 9%, and heart failure in 5% of patients. The chi-square test showed a significant relationship between sex and the cause of death related to COVID-19 pneumonia and bacterial ventilator-associated pneumonia (VAP). CONCLUSIONS The findings from this study supports findings from other countries that between November 2020 and May 2021, before SARS-CoV-2 vaccination programs were fully implemented and before effective medications and antiviral agents were developed, patients with severe COVID-19 had high rates of morbidity and mortality.
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Affiliation(s)
- Irina Niecwietajewa
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Frączek
- Department of Radiology and Diagnostic Imaging, National Institute of the Ministry of Interior and Administration in Warsaw, Warsaw, Poland
| | - Maria Mroczkowska
- Department of General, Vascular and Oncological Surgery, Czerniakowski Hospital, Warsaw, Poland
| | - Mariusz Frączek
- Department of General, Vascular and Oncological Surgery, Czerniakowski Hospital, Warsaw, Poland
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5
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Dong T, Wang M, Liu J, Ma P, Pang S, Liu W, Liu A. Diagnostics and analysis of SARS-CoV-2: current status, recent advances, challenges and perspectives. Chem Sci 2023; 14:6149-6206. [PMID: 37325147 PMCID: PMC10266450 DOI: 10.1039/d2sc06665c] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/03/2023] [Indexed: 06/17/2023] Open
Abstract
The disastrous spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has induced severe public healthcare issues and weakened the global economy significantly. Although SARS-CoV-2 infection is not as fatal as the initial outbreak, many infected victims suffer from long COVID. Therefore, rapid and large-scale testing is critical in managing patients and alleviating its transmission. Herein, we review the recent advances in techniques to detect SARS-CoV-2. The sensing principles are detailed together with their application domains and analytical performances. In addition, the advantages and limits of each method are discussed and analyzed. Besides molecular diagnostics and antigen and antibody tests, we also review neutralizing antibodies and emerging SARS-CoV-2 variants. Further, the characteristics of the mutational locations in the different variants with epidemiological features are summarized. Finally, the challenges and possible strategies are prospected to develop new assays to meet different diagnostic needs. Thus, this comprehensive and systematic review of SARS-CoV-2 detection technologies may provide insightful guidance and direction for developing tools for the diagnosis and analysis of SARS-CoV-2 to support public healthcare and effective long-term pandemic management and control.
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Affiliation(s)
- Tao Dong
- Institute for Chemical Biology & Biosensing, College of Life Sciences, Qingdao University 308 Ningxia Road Qingdao 266071 China
- School of Pharmacy, Medical College, Qingdao University 308 Ningxia Road Qingdao 266071 China
| | - Mingyang Wang
- Institute for Chemical Biology & Biosensing, College of Life Sciences, Qingdao University 308 Ningxia Road Qingdao 266071 China
| | - Junchong Liu
- Institute for Chemical Biology & Biosensing, College of Life Sciences, Qingdao University 308 Ningxia Road Qingdao 266071 China
| | - Pengxin Ma
- Institute for Chemical Biology & Biosensing, College of Life Sciences, Qingdao University 308 Ningxia Road Qingdao 266071 China
| | - Shuang Pang
- Institute for Chemical Biology & Biosensing, College of Life Sciences, Qingdao University 308 Ningxia Road Qingdao 266071 China
| | - Wanjian Liu
- Qingdao Hightop Biotech Co., Ltd 369 Hedong Road, Hi-tech Industrial Development Zone Qingdao 266112 China
| | - Aihua Liu
- Institute for Chemical Biology & Biosensing, College of Life Sciences, Qingdao University 308 Ningxia Road Qingdao 266071 China
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6
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Moon SH, Kim SC, Kim BW, Park GJ, Chai HS, Kim YM, Kim HS, Park HS. SARS-CoV-2 molecular diagnostic point-of-care testing based on loop-mediated isothermal amplification: A prospective, single-center validation study. Heliyon 2023; 9:e14564. [PMID: 36942218 PMCID: PMC10014123 DOI: 10.1016/j.heliyon.2023.e14564] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
Objectives Rapid and accurate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic tests are crucial for controlling the spread of infections in emergency settings. This study evaluated the diagnostic accuracy of a point-of-care (POC) test based on loop-mediated isothermal amplification (LAMP) that produces rapid results within 30 min. Methods We prospectively included adult patients (age >19 years) who were diagnosed with SARS-CoV-2 infection within the last 3 days and symptomatic patients who had visited the emergency room. Posterior nasopharyngeal (PNP) swabs and throat swabs collected by physicians were used to test the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Cohen's Kappa coefficient (k) of the POC index and reference reverse transcription quantitative polymerase chain reaction (RT-qPCR) test devices. Results Of the 352 participants, 102 (29.0%) tested positive via the RT-PCR-based reference test device; the RT-LAMP-based POC test had a sensitivity of 70.6% and specificity of 98.0%, with 93.5% PPV, 89.1% NPV, 35.5% PLR, and 3.4% NLR. Cohen's k correlation of results from the two devices was 0.74. The cycle threshold value between the positive and negative POC test results differed (17.6 vs. 24.6, p < 0.001). Conclusions The RT-LAMP POC test in the emergency medical setting has a fair predictive value in high viral load cases in terms of infectivity.
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Affiliation(s)
- Sung Hun Moon
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, 1st Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
| | - Sang-Chul Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, 1st Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Chungbuk National University, 1 Chungdae-ro, Seowongu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
| | - Byung Woo Kim
- Department of Paramedic Science, Korea National University of Transportation, 61, Daehak-ro, Jeungpyeong-gun, Chungcheongbuk-do, 27909, Republic of Korea
| | - Gwan-Jin Park
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, 1st Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
| | - Hyun-Seok Chai
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, 1st Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
| | - Young Min Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, 1st Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
| | - Hee Sung Kim
- Department of Internal Medicine, Chungbuk National University Hospital, 776, 1st Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
- College of Medicine and Medical Research Institute, Chungbuk National University, 1 Chungdae-ro, Seowongu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
| | - Hee Sue Park
- Department of Laboratory Medicine, Chungbuk National University Hospital, 776, 1st Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
- Department of Laboratory Medicine, College of Medicine, Chungbuk National University, 1 Chungdae-ro, Seowongu, Cheongju-si, Chungcheongbuk-do 28646, Republic of Korea
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7
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Quraishi E, Jibuaku C, Lisik D, Wennergren G, Lötvall J, Nyberg F, Ekerljung L, Rådinger M, Kankaanranta H, Nwaru BI. Comparison of clinician diagnosis of COVID-19 with real time polymerase chain reaction in an adult-representative population in Sweden. Respir Res 2023; 24:10. [PMID: 36631852 PMCID: PMC9832414 DOI: 10.1186/s12931-023-02315-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Due to the high transmissibility of SARS-CoV-2, accurate diagnosis is essential for effective infection control, but the gold standard, real-time reverse transcriptase-polymerase chain reaction (RT-PCR), is costly, slow, and test capacity has at times been insufficient. We compared the accuracy of clinician diagnosis of COVID-19 against RT-PCR in a general adult population. METHODS COVID-19 diagnosis data by 30th September 2021 for participants in an ongoing population-based cohort study of adults in Western Sweden were retrieved from registers, based on positive RT-PCR and clinician diagnosis using recommended ICD-10 codes. We calculated accuracy measures of clinician diagnosis using RT-PCR as reference for all subjects and stratified by age, gender, BMI, and comorbidity collected pre-COVID-19. RESULTS Of 42,621 subjects, 3,936 (9.2%) and 5705 (13.4%) had had COVID-19 identified by RT-PCR and clinician diagnosis, respectively. Sensitivity and specificity of clinician diagnosis against RT-PCR were 78% (95%CI 77-80%) and 93% (95%CI 93-93%), respectively. Positive predictive value (PPV) was 54% (95%CI 53-55%), while negative predictive value (NPV) was 98% (95%CI 98-98%) and Youden's index 71% (95%CI 70-72%). These estimates were similar between men and women, across age groups, BMI categories, and between patients with and without asthma. However, while specificity, NPV, and Youden's index were similar between patients with and without chronic obstructive pulmonary disease (COPD), sensitivity was slightly higher in patients with (84% [95%CI 74-90%]) than those without (78% [95%CI 77-79%]) COPD. CONCLUSIONS The accuracy of clinician diagnosis for COVID-19 is adequate, regardless of gender, age, BMI, and asthma, and thus can be used for screening purposes to supplement RT-PCR.
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Affiliation(s)
- Eman Quraishi
- grid.8761.80000 0000 9919 9582Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Chiamaka Jibuaku
- grid.8761.80000 0000 9919 9582Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Daniil Lisik
- grid.8761.80000 0000 9919 9582Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Göran Wennergren
- grid.8761.80000 0000 9919 9582Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Department of Paediatrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Lötvall
- grid.8761.80000 0000 9919 9582Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Nyberg
- grid.8761.80000 0000 9919 9582School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Linda Ekerljung
- grid.8761.80000 0000 9919 9582Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Madeleine Rådinger
- grid.8761.80000 0000 9919 9582Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Hannu Kankaanranta
- grid.8761.80000 0000 9919 9582Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden ,grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland ,grid.415465.70000 0004 0391 502XDepartment of Respiratory Medicine, Seinäjoki Central Hospital, Tampere, Finland
| | - Bright I. Nwaru
- grid.8761.80000 0000 9919 9582Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
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8
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Zhu Y, Zhang M, Jie Z, Tao S. Nucleic acid testing of SARS-CoV-2: A review of current methods, challenges, and prospects. Front Microbiol 2022; 13:1074289. [PMID: 36569096 PMCID: PMC9780671 DOI: 10.3389/fmicb.2022.1074289] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has brought a huge threat to public health and the global economy. Rapid identification and isolation of SARS-CoV-2-infected individuals are regarded as one of the most effective measures to control the pandemic. Because of its high sensitivity and specificity, nucleic acid testing has become the major method of SARS-CoV-2 detection. A deep understanding of different diagnosis methods for COVID-19 could help researchers make an optimal choice in detecting COVID-19 at different symptom stages. In this review, we summarize and evaluate the latest developments in current nucleic acid detection methods for SARS-CoV-2. In particular, we discuss biosensors and CRISPR-based diagnostic systems and their characteristics and challenges. Furthermore, the emerging COVID-19 variants and their impact on SARS-CoV-2 diagnosis are systematically introduced and discussed. Considering the disease dynamics, we also recommend optional diagnostic tests for different symptom stages. From sample preparation to results readout, we conclude by pointing out the pain points and future directions of COVID-19 detection.
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Affiliation(s)
- Yuanshou Zhu
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China,School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Meng Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Zhijun Jie
- Department of Pulmonary and Critical Care Medicine, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China,Center of Community-Based Health Research, Fudan University, Shanghai, China,*Correspondence: Zhijun Jie,
| | - Shengce Tao
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China,School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China,Shengce Tao,
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9
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Development and Clinical Validation of RT-LAMP-Based Lateral-Flow Devices and Electrochemical Sensor for Detecting Multigene Targets in SARS-CoV-2. Int J Mol Sci 2022; 23:ijms232113105. [DOI: 10.3390/ijms232113105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
Consistently emerging variants and the life-threatening consequences of SARS-CoV-2 have prompted worldwide concern about human health, necessitating rapid and accurate point-of-care diagnostics to limit the spread of COVID-19. Still, However, the availability of such diagnostics for COVID-19 remains a major rate-limiting factor in containing the outbreaks. Apart from the conventional reverse transcription polymerase chain reaction, loop-mediated isothermal amplification-based (LAMP) assays have emerged as rapid and efficient systems to detect COVID-19. The present study aims to develop RT-LAMP-based assay system for detecting multiple targets in N, ORF1ab, E, and S genes of the SARS-CoV-2 genome, where the end-products were quantified using spectrophotometry, paper-based lateral-flow devices, and electrochemical sensors. The spectrophotometric method shows a LOD of 10 agµL−1 for N, ORF1ab, E genes and 100 agµL−1 for S gene in SARS-CoV-2. The developed lateral-flow devices showed an LOD of 10 agµL−1 for all four gene targets in SARS-CoV-2. An electrochemical sensor developed for N-gene showed an LOD and E-strip sensitivity of log 1.79 ± 0.427 pgµL−1 and log 0.067 µA/pg µL−1/mm2, respectively. The developed assay systems were validated with the clinical samples from COVID-19 outbreaks in 2020 and 2021. This multigene target approach can effectively detect emerging COVID-19 variants using combination of various analytical techniques at testing facilities and in point-of-care settings.
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10
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Zhang D, Guo Y, Zhang L, Wang Y, Peng S, Duan S, Geng L, Zhang X, Wang W, Yang M, Wu G, Chen J, Feng Z, Wang X, Wu Y, Jiang H, Zhang Q, Sun J, Li S, He Y, Xiao M, Xu Y, Wang H, Liu P, Zhou Q, Luo H. Integrated System for On-Site Rapid and Safe Screening of COVID-19. Anal Chem 2022; 94:13810-13819. [PMID: 36184789 PMCID: PMC9578365 DOI: 10.1021/acs.analchem.2c02337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/22/2022] [Indexed: 12/04/2022]
Abstract
Since the outbreak of coronavirus disease 2019 (COVID-19), the epidemic has been spreading around the world for more than 2 years. Rapid, safe, and on-site detection methods of COVID-19 are in urgent demand for the control of the epidemic. Here, we established an integrated system, which incorporates a machine-learning-based Fourier transform infrared spectroscopy technique for rapid COVID-19 screening and air-plasma-based disinfection modules to prevent potential secondary infections. A partial least-squares discrimination analysis and a convolutional neural network model were built using the collected infrared spectral dataset containing 857 training serum samples. Furthermore, the sensitivity, specificity, and prediction accuracy could all reach over 94% from the results of the field test regarding 968 blind testing samples. Additionally, the disinfection modules achieved an inactivation efficiency of 99.9% for surface and airborne tested bacteria. The proposed system is conducive and promising for point-of-care and on-site COVID-19 screening in the mass population.
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Affiliation(s)
- Dongheyu Zhang
- Department
of Electrical Engineering, Tsinghua University, Beijing100084, China
| | - Yuntao Guo
- Department
of Electrical Engineering, Tsinghua University, Beijing100084, China
| | - Liyang Zhang
- Department
of Electrical Engineering, Tsinghua University, Beijing100084, China
| | - Yao Wang
- Department
of Clinical Laboratory, Peking Union Medical
College Hospital, Chinese Academy of Medical Sciences, Beijing100730, China
| | - Siqi Peng
- Department
of Electrical Engineering, Tsinghua University, Beijing100084, China
| | - Simeng Duan
- Department
of Clinical Laboratory, Peking Union Medical
College Hospital, Chinese Academy of Medical Sciences, Beijing100730, China
| | - Lin Geng
- JINSP
Co., Ltd., Beijing100083, China
| | | | - Wei Wang
- Shanghai
Customs Port Clinic, Shanghai International
Travel Healthcare Center, Shanghai200335, China
| | - Mengjie Yang
- Chinese
Center for Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, Beijing102206, China
| | - Guizhen Wu
- Chinese
Center for Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, Beijing102206, China
| | - Jiayi Chen
- Department
of Electrical Engineering, Tsinghua University, Beijing100084, China
| | - Zihao Feng
- Department
of Electrical Engineering, Tsinghua University, Beijing100084, China
| | - Xinyuan Wang
- Holy-shine
Technology Co., Ltd., Beijing100045, China
| | - Yue Wu
- Holy-shine
Technology Co., Ltd., Beijing100045, China
| | - Haotian Jiang
- Department
of Electrical Engineering, Tsinghua University, Beijing100084, China
| | - Qikang Zhang
- Department
of Electrical Engineering, Tsinghua University, Beijing100084, China
| | - Jingjun Sun
- Department
of Electrical Engineering, Tsinghua University, Beijing100084, China
| | - Shenwei Li
- Shanghai
Customs Port Clinic, Shanghai International
Travel Healthcare Center, Shanghai200335, China
| | - Yuping He
- Shanghai
Customs Port Clinic, Shanghai International
Travel Healthcare Center, Shanghai200335, China
| | - Meng Xiao
- Department
of Clinical Laboratory, Peking Union Medical
College Hospital, Chinese Academy of Medical Sciences, Beijing100730, China
| | - Yingchun Xu
- Department
of Clinical Laboratory, Peking Union Medical
College Hospital, Chinese Academy of Medical Sciences, Beijing100730, China
| | | | - Peipei Liu
- Chinese
Center for Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, Beijing102206, China
| | - Qun Zhou
- Department
of Chemistry, Tsinghua University, Beijing100084, China
| | - Haiyun Luo
- Department
of Electrical Engineering, Tsinghua University, Beijing100084, China
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11
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Song Y, Wang X, Xiao Y, Wang H. A review of pooled‐sample strategy: Does complexity lead to better performance? VIEW 2022. [DOI: 10.1002/viw.20210005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Yu Song
- Department of Molecular Biology Shanghai Centre for Clinical Laboratory Shanghai China
| | - XueLiang Wang
- Department of Molecular Biology Shanghai Centre for Clinical Laboratory Shanghai China
| | - YanQun Xiao
- Department of Molecular Biology Shanghai Centre for Clinical Laboratory Shanghai China
| | - Hualiang Wang
- Department of Molecular Biology Shanghai Centre for Clinical Laboratory Shanghai China
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12
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The Detection of SARS-CoV-2 in the Environment: Lessons from Wastewater. WATER 2022. [DOI: 10.3390/w14040599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Wastewater has historically been an important source of enteric pathogens, as well as a source of unconventational or unexpected pathogens, including those present in the respiratory tract, saliva, urine, and blood. This is the case with SARS-CoV-2, the causative agent of the most recent pandemic. SARS-CoV-2 has been identified in wastewater across various geographical regions prior to, and during, the report of cases. The detection of SARS-CoV-2 in wastewater is usually performed using molecular techniques targeting specific genomic regions. High-throughput sequencing techniques, both untargeted and targeted or amplicon-based, are also being applied in combination with molecular techniques for the detection of SARS-CoV-2 variants to determine the genetic diversity and phylogenetic relatedness. The identification of SARS-CoV-2 in wastewater has a number of epidemiological, biological, and ecological applications, which can be incorporated into future outbreaks, epidemics, or pandemics.
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13
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Lateral flow-based nucleic acid detection of SARS-CoV-2 using enzymatic incorporation of biotin-labeled dUTP for POCT use. Anal Bioanal Chem 2022; 414:3177-3186. [PMID: 35044487 PMCID: PMC8766626 DOI: 10.1007/s00216-022-03880-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 12/29/2022]
Abstract
The degree of detrimental effects inflicted on mankind by the COVID-19 pandemic increased the need to develop ASSURED (Affordable, Sensitive, Specific, User-friendly, Rapid and Robust, Equipment-free, and Deliverable) POCT (point of care testing) to overcome the current and any future pandemics. Much effort in research and development is currently advancing the progress to overcome the diagnostic pressure built up by emerging new pathogens. LAMP (loop-mediated isothermal amplification) is a well-researched isothermal technique for specific nucleic acid amplification which can be combined with a highly sensitive immunochromatographic readout via lateral flow assays (LFA). Here we discuss LAMP-LFA robustness, sensitivity, and specificity for SARS-CoV-2 N-gene detection in cDNA and clinical swab-extracted RNA samples. The LFA readout is designed to produce highly specific results by incorporation of biotin and FITC labels to 11-dUTP and LF (loop forming forward) primer, respectively. The LAMP-LFA assay was established using cDNA for N-gene with an accuracy of 95.65%. To validate the study, 82 SARS-CoV-2-positive RNA samples were tested. Reverse transcriptase (RT)-LAMP-LFA was positive for the RNA samples with an accuracy of 81.66%; SARS-CoV-2 viral RNA was detected by RT-LAMP-LFA for as low as CT-33. Our method reduced the detection time to 15 min and indicates therefore that RT-LAMP in combination with LFA represents a promising nucleic acid biosensing POCT platform that combines with smartphone based semi-quantitative data analysis.
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14
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Carbone F, Ministrini S, Garbarino S, Vischi G, Carpaneto V, Sobrero M, Monti C, De Stefano D, Saccomanno B, Massone M, Liberale L, Piccardo A, Calvia A, Vischi F, Bagnasco M, Magnani O, Caiti M, Cenni E, Ballarino P, Giuntini P, Barreca A, Tognoni C, Pirisi F, Canepa P, Cerminara D, Pelanconi L, Strozzi M, Thneibat A, Stabile M, Felix E, Dasso S, Casini C, Minetti A, Gonella R, Ferrando F, Bellodi A, Ballestrero A, Barbera P, Poggi AL, Arboscello E, Pende A, Moscatelli P, Piana M, Montecucco F. Clinical predictors of late SARS-CoV-2 positivity in Italian internal medicine wards. Eur J Clin Invest 2022; 52:e13705. [PMID: 34747515 PMCID: PMC8646747 DOI: 10.1111/eci.13705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/22/2021] [Accepted: 10/28/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Federico Carbone
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Stefano Ministrini
- Internal Medicine Department, "Santa Maria della Misericordia" Hospital, University of Perugia, Sant'Andrea delle Fratte, Perugia, Italy.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Sara Garbarino
- Dipartimento di Matematica, LISCOMPLab, University of Genoa, Italy
| | - Giulia Vischi
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, Genoa, Italy
| | - Valeria Carpaneto
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, Genoa, Italy
| | - Matteo Sobrero
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, Genoa, Italy
| | - Chiara Monti
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, Genoa, Italy
| | - Daria De Stefano
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, Genoa, Italy
| | - Benedetta Saccomanno
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, Genoa, Italy
| | - Marcella Massone
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Luca Liberale
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Arianna Piccardo
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Calvia
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federica Vischi
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maddalena Bagnasco
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ottavia Magnani
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Caiti
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisabetta Cenni
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Ballarino
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Patrizia Giuntini
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Barreca
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Tognoni
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federica Pirisi
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Canepa
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Domenico Cerminara
- Department of Internal Medicine, Clinic of Internal Medicine for Oncology, University of Genoa School of Medicine, Genoa, Italy
| | - Lisa Pelanconi
- Department of Internal Medicine, Clinic of Internal Medicine for Oncology, University of Genoa School of Medicine, Genoa, Italy
| | - Michele Strozzi
- Department of Internal Medicine, Clinic of Internal Medicine for Oncology, University of Genoa School of Medicine, Genoa, Italy
| | - Amedeo Thneibat
- Department of Internal Medicine, Clinic of Internal Medicine for Oncology, University of Genoa School of Medicine, Genoa, Italy
| | - Mario Stabile
- Department of Internal Medicine, Clinic of Internal Medicine for Oncology, University of Genoa School of Medicine, Genoa, Italy
| | - Edineia Felix
- Department of Internal Medicine, Clinic of Internal Medicine for Oncology, University of Genoa School of Medicine, Genoa, Italy
| | - Selena Dasso
- Department of Internal Medicine, Clinic of Internal Medicine for Oncology, University of Genoa School of Medicine, Genoa, Italy
| | - Cecilia Casini
- Department of Internal Medicine, Clinic of Internal Medicine for Oncology, University of Genoa School of Medicine, Genoa, Italy
| | - Alberto Minetti
- Department of Internal Medicine, Clinic of Internal Medicine for Oncology, University of Genoa School of Medicine, Genoa, Italy
| | - Roberta Gonella
- Department of Internal Medicine, Clinic of Internal Medicine for Oncology, University of Genoa School of Medicine, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa, Genoa, Italy
| | - Fabio Ferrando
- Department of Internal Medicine, Clinic of Internal Medicine for Oncology, University of Genoa School of Medicine, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa, Genoa, Italy
| | - Andrea Bellodi
- IRCCS Ospedale Policlinico San Martino Genoa, Genoa, Italy
| | - Alberto Ballestrero
- Department of Internal Medicine, Clinic of Internal Medicine for Oncology, University of Genoa School of Medicine, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa, Genoa, Italy
| | - Paolo Barbera
- Emergency Department, IRCCS Ospedale Policlinico San Martino Genoa, Genoa, Italy
| | - Andrea Lorenzo Poggi
- Emergency Department, IRCCS Ospedale Policlinico San Martino Genoa, Genoa, Italy
| | - Eleonora Arboscello
- Emergency Department, IRCCS Ospedale Policlinico San Martino Genoa, Genoa, Italy
| | - Aldo Pende
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Moscatelli
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michele Piana
- Dipartimento di Matematica, LISCOMPLab, University of Genoa, Italy
| | - Fabrizio Montecucco
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
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15
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Shen ZY, Yan XC, You XD, Zhang XW. CT Imaging Research Progress in COVID-19. Curr Med Imaging 2022; 18:267-274. [PMID: 34465280 PMCID: PMC8972255 DOI: 10.2174/1573405617666210816091217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/01/2021] [Accepted: 07/14/2021] [Indexed: 11/22/2022]
Abstract
The highly contagious novel Coronavirus Disease 2019 (COVID-19) broke out at the end of 2019 and has lasted for nearly one year, and the pandemic is still rampant around the world. The diagnosis of COVID-19 is on the basis of the combination of epidemiological history, clinical symptoms, and laboratory and imaging examinations. Among them, imaging examination is of importance in the diagnosis of patients with suspected clinical cases, the investigation of asymptomatic infections and family clustering, the judgment of patient recovery, rediagnosis after disease recurrence, and prognosis prediction. This article reviews the research progress of CT imaging examination in the COVID-19 pandemic.
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Affiliation(s)
- Zhi Yong Shen
- Department of Radiology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Jiangsu 226361, PR China
| | - Xun Cheng Yan
- Department of Radiology, Affiliated Rugao Hospital of Nantong University, Jiangsu 226500, PR China
| | - Xiao Dong You
- Department of Ear-Nose-Throat, Affiliated Hospital of Nantong University, Jiangsu 226001, PR China
| | - Xue Wen Zhang
- Department of Ear-Nose-Throat, Huai'an Second People's Hospital, Affiliated Huai'an Hospital of Xuzhou Medical University, Jiangsu 223002, PR China
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16
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Klaczko ME, Lucas K, Salminen AT, McCloskey MC, Ozgurun B, Ward BM, Flax J, McGrath JL. Rapid and specific detection of intact viral particles using functionalized microslit silicon membranes as a fouling-based sensor. Analyst 2021; 147:213-222. [PMID: 34933322 DOI: 10.1039/d1an01504d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic demonstrated the public health benefits of reliable and accessible point-of-care (POC) diagnostic tests for viral infections. Despite the rapid development of gold-standard reverse transcription polymerase chain reaction (RT-PCR) assays for SARS-CoV-2 only weeks into the pandemic, global demand created logistical challenges that delayed access to testing for months and helped fuel the spread of COVID-19. Additionally, the extreme sensitivity of RT-PCR had a costly downside as the tests could not differentiate between patients with active infection and those who were no longer infectious but still shedding viral genomes. To address these issues for the future, we propose a novel membrane-based sensor that only detects intact virions. The sensor combines affinity and size based detection on a membrane-based sensor and does not require external power to operate or read. Specifically, the presence of intact virions, but not viral debris, fouls the membrane and triggers a macroscopically visible hydraulic switch after injection of a 40 μL sample with a pipette. The device, which we call the μSiM-DX (microfluidic device featuring a silicon membrane for diagnostics), features a biotin-coated microslit membrane with pores ∼2-3× larger than the intact virus. Streptavidin-conjugated antibody recognizing viral surface proteins are incubated with the sample for ∼1 hour prior to injection into the device, and positive/negative results are obtained within ten seconds of sample injection. Proof-of-principle tests have been performed using preparations of vaccinia virus. After optimizing slit pore sizes and porous membrane area, the fouling-based sensor exhibits 100% specificity and 97% sensitivity for vaccinia virus (n = 62). Moreover, the dynamic range of the sensor extends at least from 105.9 virions per mL to 1010.4 virions per mL covering the range of mean viral loads in symptomatic COVID-19 patients (105.6-107 RNA copies per mL). Forthcoming work will test the ability of our sensor to perform similarly in biological fluids and with SARS-CoV-2, to fully test the potential of a membrane fouling-based sensor to serve as a PCR-free alternative for POC containment efforts in the spread of infectious disease.
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Affiliation(s)
- Michael E Klaczko
- Department of Chemistry, University of Rochester, Rochester, NY, 14627 USA
| | - Kilean Lucas
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, 14627 USA.
| | - Alec T Salminen
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, 14627 USA.
| | - Molly C McCloskey
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, 14627 USA.
| | - Baturay Ozgurun
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, 14627 USA.
| | - Brian M Ward
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY, 14642 USA
| | - Jonathan Flax
- Department of Urology, University of Rochester Medical Center, Rochester, NY, 14642 USA
| | - James L McGrath
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, 14627 USA.
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17
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Lau CS, Aw TC. Disease Prevalence Matters: Challenge for SARS-CoV-2 Testing. Antibodies (Basel) 2021; 10:antib10040050. [PMID: 34940002 PMCID: PMC8698426 DOI: 10.3390/antib10040050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/23/2021] [Accepted: 12/13/2021] [Indexed: 01/03/2023] Open
Abstract
While sensitivity and specificity are important characteristics for any diagnostic test, the influence of prevalence is equally, if not more, important when such tests are used in community screening. We review the concepts of positive/negative predictive values (PPV/NPV) and how disease prevalence affects false positive/negative rates. In low-prevalence situations, the PPV decreases drastically. We demonstrate how using two tests in an orthogonal fashion can be especially beneficial in low-prevalence settings and greatly improve the PPV of the diagnostic test results.
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Affiliation(s)
- Chin-Shern Lau
- Department of Laboratory Medicine, Changi General Hospital, Singapore 529889, Singapore;
| | - Tar-Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore 529889, Singapore;
- Department of Medicine, National University of Singapore, Singapore 119077, Singapore
- Academic Pathology Program, Duke-NUS Medical School, Singapore 169857, Singapore
- Correspondence: ; Tel.: +65-68504927; Fax: +65-64269507
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18
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Fast, Reliable, and Simple Point-of-Care-like Adaptation of RT-qPCR for the Detection of SARS-CoV-2 for Use in Hospital Emergency Departments. Viruses 2021; 13:v13122413. [PMID: 34960682 PMCID: PMC8707628 DOI: 10.3390/v13122413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022] Open
Abstract
During COVID-19 pandemics, the availability of testing has often been a limiting factor during patient admissions into the hospital. To circumvent this problem, we adapted an existing diagnostic assay, Seegene Allplex SARS-CoV-2, into a point-of-care-style direct qPCR (POC dqPCR) assay and implemented it in the Emergency Department of Clinical Hospital Center Rijeka, Croatia. In a 4-month analysis, we tested over 10,000 patients and demonstrated that POC-dqPCR is robust and reliable and can be successfully implemented in emergency departments and similar near-patient settings and can be performed by medical personnel with little prior experience in qPCR.
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19
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Tripathy S, Supraja P, Mohanty S, Sai VM, Agrawal T, Chowdary CG, Taranikanti M, Bandaru R, Mudunuru AK, Tadi LJ, Suravaram S, Siddiqui IA, Maddur S, Guntuka RK, Singh R, Singh V, Singh SG. Artificial Intelligence-Based Portable Bioelectronics Platform for SARS-CoV-2 Diagnosis with Multi-nucleotide Probe Assay for Clinical Decisions. Anal Chem 2021; 93:14955-14965. [PMID: 34694783 DOI: 10.1021/acs.analchem.1c01650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In the context of the recent pandemic, the necessity of inexpensive and easily accessible rapid-test kits is well understood and need not be stressed further. In light of this, we report a multi-nucleotide probe-based diagnosis of SARS-CoV-2 using a bioelectronics platform, comprising low-cost chemiresistive biochips, a portable electronic readout, and an Android application for data acquisition with machine-learning-based decision making. The platform performs the desired diagnosis from standard nasopharyngeal and/or oral swabs (both on extracted and non-extracted RNA samples) without amplifying the viral load. Being a reverse transcription polymerase chain reaction-free hybridization assay, the proposed approach offers inexpensive, fast (time-to-result: ≤ 30 min), and early diagnosis, as opposed to most of the existing SARS-CoV-2 diagnosis protocols recommended by the WHO. For the extracted RNA samples, the assay accounts for 87 and 95.2% test accuracies, using a heuristic approach and a machine-learning-based classification method, respectively. In case of the non-extracted RNA samples, 95.6% decision accuracy is achieved using the heuristic approach, with the machine-learning-based best-fit model producing 100% accuracy. Furthermore, the availability of the handheld readout and the Android application-based simple user interface facilitates easy accessibility and portable applications. Besides, by eliminating viral RNA extraction from samples as a pre-requisite for specific detection, the proposed approach presents itself as an ideal candidate for point-of-care SARS-CoV-2 diagnosis.
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Affiliation(s)
- Suryasnata Tripathy
- Indian Institute of Technology Hyderabad, Kandi, Sangareddy, Telangana 502285, India
| | - Patta Supraja
- Indian Institute of Technology Hyderabad, Kandi, Sangareddy, Telangana 502285, India
| | - Swati Mohanty
- Indian Institute of Technology Hyderabad, Kandi, Sangareddy, Telangana 502285, India
| | - Vallepu Mohan Sai
- Indian Institute of Technology Hyderabad, Kandi, Sangareddy, Telangana 502285, India
| | - Tushant Agrawal
- Indian Institute of Technology Hyderabad, Kandi, Sangareddy, Telangana 502285, India
| | | | - Madhuri Taranikanti
- All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana 508126, India
| | - Rajiv Bandaru
- ESIC Medical College, S R Nagar, Hyderabad, Telangana 500038, India
| | | | - Lakshmi Jyothi Tadi
- All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana 508126, India.,ESIC Medical College, S R Nagar, Hyderabad, Telangana 500038, India
| | - Swathi Suravaram
- ESIC Medical College, S R Nagar, Hyderabad, Telangana 500038, India
| | | | - Srinivas Maddur
- ESIC Medical College, S R Nagar, Hyderabad, Telangana 500038, India
| | | | - Ranjana Singh
- Indian Institute of Technology Hyderabad, Kandi, Sangareddy, Telangana 502285, India
| | - Vikrant Singh
- School of Medicine, University of California, 1 Shields Avenue, Davis, California 95616, United States
| | - Shiv Govind Singh
- Indian Institute of Technology Hyderabad, Kandi, Sangareddy, Telangana 502285, India
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20
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Hassani Nejad Z, Fatemi F, Ranaei Siadat SE. An outlook on coronavirus disease 2019 detection methods. J Pharm Anal 2021; 12:205-214. [PMID: 34777894 PMCID: PMC8578030 DOI: 10.1016/j.jpha.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/22/2021] [Accepted: 11/07/2021] [Indexed: 12/15/2022] Open
Abstract
Diagnostic testing plays a fundamental role in the mitigation and containment of coronavirus disease 2019 (COVID-19), as it enables immediate quarantine of those who are infected and contagious and is essential for the epidemiological characterization of the virus and estimating the number of infected cases worldwide. Confirmation of viral infections, such as COVID-19, can be achieved through two general approaches: nucleic acid amplification tests (NAATs) or molecular tests, and serological or antibody-based tests. The genetic material of the pathogen is detected in NAAT, and in serological tests, host antibodies produced in response to the pathogen are identified. Other methods of diagnosing COVID-19 include radiological imaging of the lungs and in vitro detection of viral antigens. This review covers different approaches available to diagnosing COVID-19 by outlining their advantages and shortcomings, as well as appropriate indications for more accurate testing. Diagnostic tests to detect coronavirus disease 2019 (COVID-19). Advantages and disadvantages associated with each detection method. Implications for a more accurate and rapid testing of COVID-19 or other similar future emergent viruses.
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Affiliation(s)
- Zahra Hassani Nejad
- Department of Biochemistry, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, 1417935840, Iran
| | - Fataneh Fatemi
- Department of Protein Research, Protein Research Center, Shahid Beheshti University, Tehran, 1983969411, Iran
- Corresponding author.
| | - Seyed Ehsan Ranaei Siadat
- Sobhan Recombinant Protein Company, Research and Development Department, Tehran, 1654120871, Iran
- Corresponding author.
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21
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Brukner I, Resendes A, Eintracht S, Papadakis AI, Oughton M. Sample Adequacy Control (SAC) Lowers False Negatives and Increases the Quality of Screening: Introduction of "Non-Competitive" SAC for qPCR Assays. Diagnostics (Basel) 2021; 11:diagnostics11071133. [PMID: 34206413 PMCID: PMC8305439 DOI: 10.3390/diagnostics11071133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/15/2021] [Accepted: 06/20/2021] [Indexed: 01/15/2023] Open
Abstract
Sample Adequacy Control (SAC) has critical analytical, clinical and epidemiological value that increases confidence in a negative test result. The SAC is an integral qPCR assay control, which ensures that all pre-analytical and analytical steps are adequate for accurate testing and reporting. As such, a negative SAC with a negative result on pathogen screen specifies that the result should be reported as inconclusive instead of negative. Despite this, many regulatory approved tests do not incorporate SAC into their assay design. Herein, we emphasize the universal value of SAC and offer for the first time, a simple technical strategy to introduce non-competitive SAC which does not interfere with the limit of detection for the screened pathogen. Integration of SAC can provide key benefits towards identifying, isolating, quarantining and contact tracing infected individuals and in turn can improve worldwide efforts in infection control.
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Affiliation(s)
- Ivan Brukner
- Lady Davis Institute for Medical Research, Montréal, QC H3T 1E2, Canada; (A.R.); (A.I.P.)
- Faculty of Medicine, McGill University, Montreal, QC H3A 0G4, Canada;
- Correspondence: (I.B.); (M.O.); Tel.: +1-514-8038782 (I.B.); +1-514-3408222 (ext. 22662) (M.O.)
| | - Alex Resendes
- Lady Davis Institute for Medical Research, Montréal, QC H3T 1E2, Canada; (A.R.); (A.I.P.)
| | - Shaun Eintracht
- Faculty of Medicine, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Andreas I. Papadakis
- Lady Davis Institute for Medical Research, Montréal, QC H3T 1E2, Canada; (A.R.); (A.I.P.)
| | - Matthew Oughton
- Faculty of Medicine, McGill University, Montreal, QC H3A 0G4, Canada;
- Correspondence: (I.B.); (M.O.); Tel.: +1-514-8038782 (I.B.); +1-514-3408222 (ext. 22662) (M.O.)
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22
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Mardian Y, Kosasih H, Karyana M, Neal A, Lau CY. Review of Current COVID-19 Diagnostics and Opportunities for Further Development. Front Med (Lausanne) 2021; 8:615099. [PMID: 34026773 PMCID: PMC8138031 DOI: 10.3389/fmed.2021.615099] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/06/2021] [Indexed: 12/15/2022] Open
Abstract
Diagnostic testing plays a critical role in addressing the coronavirus disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Rapid and accurate diagnostic tests are imperative for identifying and managing infected individuals, contact tracing, epidemiologic characterization, and public health decision making. Laboratory testing may be performed based on symptomatic presentation or for screening of asymptomatic people. Confirmation of SARS-CoV-2 infection is typically by nucleic acid amplification tests (NAAT), which requires specialized equipment and training and may be particularly challenging in resource-limited settings. NAAT may give false-negative results due to timing of sample collection relative to infection, improper sampling of respiratory specimens, inadequate preservation of samples, and technical limitations; false-positives may occur due to technical errors, particularly contamination during the manual real-time polymerase chain reaction (RT-PCR) process. Thus, clinical presentation, contact history and contemporary phyloepidemiology must be considered when interpreting results. Several sample-to-answer platforms, including high-throughput systems and Point of Care (PoC) assays, have been developed to increase testing capacity and decrease technical errors. Alternatives to RT-PCR assay, such as other RNA detection methods and antigen tests may be appropriate for certain situations, such as resource-limited settings. While sequencing is important to monitor on-going evolution of the SARS-CoV-2 genome, antibody assays are useful for epidemiologic purposes. The ever-expanding assortment of tests, with varying clinical utility, performance requirements, and limitations, merits comparative evaluation. We herein provide a comprehensive review of currently available COVID-19 diagnostics, exploring their pros and cons as well as appropriate indications. Strategies to further optimize safety, speed, and ease of SARS-CoV-2 testing without compromising accuracy are suggested. Access to scalable diagnostic tools and continued technologic advances, including machine learning and smartphone integration, will facilitate control of the current pandemic as well as preparedness for the next one.
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Affiliation(s)
- Yan Mardian
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Muhammad Karyana
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Aaron Neal
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Chuen-Yen Lau
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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23
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Yadav S, Sadique MA, Ranjan P, Kumar N, Singhal A, Srivastava AK, Khan R. SERS Based Lateral Flow Immunoassay for Point-of-Care Detection of SARS-CoV-2 in Clinical Samples. ACS APPLIED BIO MATERIALS 2021; 4:2974-2995. [PMID: 35014387 PMCID: PMC7986978 DOI: 10.1021/acsabm.1c00102] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022]
Abstract
The current scenario, an ongoing pandemic of COVID-19, places a dreadful burden on the healthcare system worldwide. Subsequently, there is a need for a rapid, user-friendly, and inexpensive on-site monitoring system for diagnosis. The early and rapid diagnosis of SARS-CoV-2 plays an important role in combating the outbreak. Although conventional methods such as PCR, RT-PCR, and ELISA, etc., offer a gold-standard solution to manage the pandemic, they cannot be implemented as a point-of-care (POC) testing arrangement. Moreover, surface-enhanced Raman spectroscopy (SERS) having a high enhancement factor provides quantitative results with high specificity, sensitivity, and multiplex detection ability but lacks in POC setup. In contrast, POC devices such as lateral flow immunoassay (LFIA) offer rapid, simple-to-use, cost-effective, reliable platform. However, LFIA has limitations in quantitative and sensitive analyses of SARS-CoV-2 detection. To resolve these concerns, herein we discuss a unique modality that is an integration of SERS with LFIA for quantitative analyses of SARS-CoV-2. The miniaturization ability of SERS-based devices makes them promising in biosensor application and has the potential to make a better alternative of conventional diagnostic methods. This review also demonstrates the commercially available and FDA/ICMR approved LFIA kits for on-site diagnosis of SARS-CoV-2.
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Affiliation(s)
- Shalu Yadav
- Microfluidics & MEMS Centre,
CSIR−Advanced Materials and Processes Research Institute
(AMPRI), Hoshangabad Road, Bhopal 462026, India
- Academy of Scientific and Innovative Research
(AcSIR), Ghaziabad 201002, India
| | - Mohd. Abubakar Sadique
- Microfluidics & MEMS Centre,
CSIR−Advanced Materials and Processes Research Institute
(AMPRI), Hoshangabad Road, Bhopal 462026, India
| | - Pushpesh Ranjan
- Microfluidics & MEMS Centre,
CSIR−Advanced Materials and Processes Research Institute
(AMPRI), Hoshangabad Road, Bhopal 462026, India
- Academy of Scientific and Innovative Research
(AcSIR), Ghaziabad 201002, India
| | - Neeraj Kumar
- Microfluidics & MEMS Centre,
CSIR−Advanced Materials and Processes Research Institute
(AMPRI), Hoshangabad Road, Bhopal 462026, India
- Academy of Scientific and Innovative Research
(AcSIR), Ghaziabad 201002, India
| | - Ayushi Singhal
- Microfluidics & MEMS Centre,
CSIR−Advanced Materials and Processes Research Institute
(AMPRI), Hoshangabad Road, Bhopal 462026, India
- Academy of Scientific and Innovative Research
(AcSIR), Ghaziabad 201002, India
| | - Avanish K. Srivastava
- Microfluidics & MEMS Centre,
CSIR−Advanced Materials and Processes Research Institute
(AMPRI), Hoshangabad Road, Bhopal 462026, India
| | - Raju Khan
- Microfluidics & MEMS Centre,
CSIR−Advanced Materials and Processes Research Institute
(AMPRI), Hoshangabad Road, Bhopal 462026, India
- Academy of Scientific and Innovative Research
(AcSIR), Ghaziabad 201002, India
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24
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Teymouri M, Mollazadeh S, Mortazavi H, Naderi Ghale-Noie Z, Keyvani V, Aghababaei F, Hamblin MR, Abbaszadeh-Goudarzi G, Pourghadamyari H, Hashemian SMR, Mirzaei H. Recent advances and challenges of RT-PCR tests for the diagnosis of COVID-19. Pathol Res Pract 2021; 221:153443. [PMID: 33930607 PMCID: PMC8045416 DOI: 10.1016/j.prp.2021.153443] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/10/2021] [Accepted: 04/11/2021] [Indexed: 02/07/2023]
Abstract
Since the outbreak of the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the control of virus spread has remained challenging given the pitfalls of the current diagnostic tests. Nevertheless, RNA amplification techniques have been the gold standard among other diagnostic methods for monitoring clinical samples for the presence of the virus. In the current paper, we review the shortcomings and strengths of RT-PCR (real-time polymerase chain reaction) techniques for diagnosis of coronavirus disease (COVID)-19. We address the repercussions of false-negative and false-positive rates encountered in the test, summarize approaches to improve the overall sensitivity of this method. We discuss the barriers to the widespread use of the RT-PCR test, and some technical advances, such as RT-LAMP (reverse-transcriptase-loop mediated isothermal amplification). We also address how other molecular techniques, such as immunodiagnostic tests can be used to avoid incorrect interpretation of RT-PCR tests.
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Affiliation(s)
- Manoucher Teymouri
- Natural Products and Medicinal Plants Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Samaneh Mollazadeh
- Natural Products and Medicinal Plants Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran.
| | - Hamed Mortazavi
- Geriatric Care Research Center, Department of Geriatric Nursing, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Zari Naderi Ghale-Noie
- Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahideh Keyvani
- Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Farzaneh Aghababaei
- Department of Medical Biotechnology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, South Africa
| | - Ghasem Abbaszadeh-Goudarzi
- Department of Medical Biotechnology, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hossein Pourghadamyari
- Department of Clinical Biochemistry, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran; Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran.
| | - Seyed Mohammad Reza Hashemian
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran.
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25
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Bustin S, Mueller R, Shipley G, Nolan T. COVID-19 and Diagnostic Testing for SARS-CoV-2 by RT-qPCR-Facts and Fallacies. Int J Mol Sci 2021; 22:2459. [PMID: 33671091 PMCID: PMC7957603 DOI: 10.3390/ijms22052459] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 12/19/2022] Open
Abstract
Although molecular testing, and RT-qPCR in particular, has been an indispensable component in the scientific armoury targeting SARS-CoV-2, there are numerous falsehoods, misconceptions, assumptions and exaggerated expectations with regards to capability, performance and usefulness of the technology. It is essential that the true strengths and limitations, although publicised for at least twenty years, are restated in the context of the current COVID-19 epidemic. The main objective of this commentary is to address and help stop the unfounded and debilitating speculation surrounding its use.
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Affiliation(s)
- Stephen Bustin
- Medical Technology Research Centre, Anglia Ruskin University, Chelmsford CM1 1SQ, UK;
| | | | | | - Tania Nolan
- Medical Technology Research Centre, Anglia Ruskin University, Chelmsford CM1 1SQ, UK;
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