Point of care testing for infectious diseases

Abstract

Infectious diseases are caused by pathogenic microorganisms and can be transmitted between individuals and populations thus threatening the general public health and potentially the economy. Efficient diagnostic tools are needed to provide accurate and timely guidance for case identification, transmission disruption and appropriate treatment administration. Point of care (POC) tests provide actionable results near the patient and thereby serve as a personal "radar". In this review, we review clinical needs for POC testing for several major pathogens, including malaria parasites, human immunodeficiency virus (HIV), human papillomavirus (HPV), dengue, Ebola and Zika viruses and Mycobacterium tuberculosis (TB). We compare different molecular approaches, including pathogen nucleic acid and protein, circulating microRNA and antibodies, used in the POC tests. Finally, we review recent advances in novel POC technologies focusing on microfluidic and plasmonic-based approaches.

Figure 1.

Point of Care Tests (POCT) (such as com pact molecular diagnostic systems, lateral flow assays, microfluidics, plasmonic technologies and paper-based assays etc.) detect a variety of infectious diseases-related biomarkers, including virus particles, nucleic acids, proteins and antibodies. They serve as the foundation of “patient centralized” diagnosis and treatment of infectious diseases. Partly adapted from [5] with permission.

Figure 2.

(A) Different biomarkers used for the diagnosis and monitoring of HIV infection. (B) Kinetics of different biomarkers during HIV infection. Refer to [77] for further information. Partly remade from [77].

Figure 3.

(A) Schematic of an ideal microfluidic system with: “Sample-to-answer” characteristic for POCT [109]. (B) Working principle of microfluidic device for the separation of malaria infected red blood cells (iRBC) with the concept of margination. Less deformable iRBCs are concentrated to the peripheral walls of microfluidic channel [118]. (C) An integrated microfluidic chip for sensitive detection of DNA from M. tuberculosis with on-chip PCR [120]. Reproduced with permission. (D) Microfluidic dongle for the sensitive detection of HIV [122]. Reproduced with permission. (E) Microfluidic device for the sensitive detection of HIV via electrical impedance measurement [123]. Reproduced with permission. (F) Magnetic microbeads-assisted microfluidic device for the sensitive detection of anti-dengue antibodies [124]. Refer to [4, 122] for further information.

Figure 4.

(A) Illustration of nanoplasmonic viral load platform for the detection of intact virus. Reproduced with permission from [138]. (B) Schematic representation of SPR-based protein sandwich assay. Reproduced with permission from [139]. (C) Schematic representing the LSPR-based biosensor with peptide recognition elements. Reproduced with permission from [141]. (D) Illustration of the configuration of SERS-based lateral flow assay for detection of staphylococcal enterotoxin B. Reproduced with permission from [143].