Emerging technologies for the detection of rabies virus: challenges and hopes in the 21st century.
Emerging technologies for the detection of rabies virus: challenges and hopes in the 21st century.
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DOI：
10.1371/journal.pntd.0000530
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发表时间：
2009-09-29
影响因子：
3.8
通讯作者：
Müller T
中科院分区：
文献类型：
--
作者：
Fooks AR;Johnson N;Freuling CM;Wakeley PR;Banyard AC;McElhinney LM;Marston DA;Dastjerdi A;Wright E;Weiss RA;Müller T
狂犬病的诊断通常基于临床和流行病学信息，特别是在狂犬病流行国家报告暴露时。即使在疾病晚期和尽管有临床诊断，使用传统化验法进行的诊断试验似乎是阴性的，有时也往往是不可靠的。这些测试很少是最佳的，完全取决于所提供样品的性质和质量。在过去的三十年中，分子生物学的应用帮助开发了能够更快地检测狂犬病病毒的检测方法。这些测试能够从临床标本中鉴定病毒株。目前，有许多分子检测可用于补充狂犬病诊断中的常规检测。事实上，21世纪狂犬病诊断发展面临的挑战不属于技术性质；现在可以进行这些测试。21世纪诊断测试开发人员面临的挑战是双重的：首先，实现国际上接受的测试验证，然后导致其被全球组织接受。第二，世界上需要这种测试的地区主要是发展中地区，这些地区的财政和后勤障碍阻碍了测试的实施。尽管卫生保健基础设施较差的发展中国家认识到，常规使用基于分子的诊断分析将负担不起，但仍应衡量成本/效益比。采用快速和负担得起的狂犬病诊断测试供发展中国家使用，突出了通过发达国家和发展中国家之间的实验室结对分享和转让技术的重要性。对发展中国家来说，重要的是，分子方法作为工具的好处是能够鉴别诊断具有类似临床症状的人类疾病。现在可以使用分子技术对人类狂犬病进行死前检测。这些障碍并非不可克服，我们期望，如果在最需要的地方接受并实施这种检测，它们将大大改善狂犬病的诊断和监测。分子生物学的出现以及将生物学的进步与其他学科相结合的新技术举措，将支持开发能够以较低的周转时间进行狂犬病诊断的高通量测试的技术。
The diagnosis of rabies is routinely based on clinical and epidemiological information, especially when exposures are reported in rabies-endemic countries. Diagnostic tests using conventional assays that appear to be negative, even when undertaken late in the disease and despite the clinical diagnosis, have a tendency, at times, to be unreliable. These tests are rarely optimal and entirely dependent on the nature and quality of the sample supplied. In the course of the past three decades, the application of molecular biology has aided in the development of tests that result in a more rapid detection of rabies virus. These tests enable viral strain identification from clinical specimens. Currently, there are a number of molecular tests that can be used to complement conventional tests in rabies diagnosis. Indeed the challenges in the 21st century for the development of rabies diagnostics are not of a technical nature; these tests are available now. The challenges in the 21st century for diagnostic test developers are two-fold: firstly, to achieve internationally accepted validation of a test that will then lead to its acceptance by organisations globally. Secondly, the areas of the world where such tests are needed are mainly in developing regions where financial and logistical barriers prevent their implementation. Although developing countries with a poor healthcare infrastructure recognise that molecular-based diagnostic assays will be unaffordable for routine use, the cost/benefit ratio should still be measured. Adoption of rapid and affordable rabies diagnostic tests for use in developing countries highlights the importance of sharing and transferring technology through laboratory twinning between the developed and the developing countries. Importantly for developing countries, the benefit of molecular methods as tools is the capability for a differential diagnosis of human diseases that present with similar clinical symptoms. Antemortem testing for human rabies is now possible using molecular techniques. These barriers are not insurmountable and it is our expectation that if such tests are accepted and implemented where they are most needed, they will provide substantial improvements for rabies diagnosis and surveillance. The advent of molecular biology and new technological initiatives that combine advances in biology with other disciplines will support the development of techniques capable of high throughput testing with a low turnaround time for rabies diagnosis.
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9.4
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