Molecular diagnosis of infectious diseases

Introduction
Identification of the causative pathogen is a corner stone for subsequent choice of treatment for
most infectious diseases. Microscopic examination in combination with staining and
immunological techniques is usually simple and fast. Pathogen culture is also a useful tool for
infectious disease diagnosis. However, not every pathogen can be identified by microscopy and
many pathogens cannot grow outside their hosts and hence culture will not yield positive results.
Serology is often not very useful for acute infections. However, Molecular diagnosis, which is
generally more sensitive and specific, has become the method of choice to identify certain
pathogens, particularly viruses. The advent of molecular diagnosis has continued to
revolutionalize management of infectious diseases world over.
Current advancements in diagnostic microbiology has transformed practice from antibody to
nucleic acid based assays, from single to multiple pathogen detection, and from clinical
laboratory to point-of-care tests. Consequently, there are now many user-friendly commercial
assays have been developed for molecular diagnostics.

Available techniques for molecular diagnosis

Currently available techniques for molecular diagnosis of infectious diseases include the
followings:

1. Microarray

2. Nucleic acid amplification

3. DNA probe

4. Immunofluorescence

5. Enzyme immunoassay
Microarray

Unlike most existing diagnostic techniques, which requires experience and prior knowledge of
the suspect organism, microarray is a newly developed flexible technology used for host and
pathogen gene expression profiling and genotyping. This concept has been employed in
infectious diseases to study polymorphisms of the HIV protease gene to detect drug resistance.
Perhaps the most astonishing breakthrough in using microarray technology is its’ application in
detecting unsuspected or unknown pathogens, a phenomenon which has been demonstrated in
many scientific findings. Using microarray technology, several hundreds to even thousands of
probes can be done simultaneously on a tiny surface area. Although, this alone may not be
enough for early pathogen detection, which may result in more efficient interventions. Methods
that can be universally applied for various known and even unknown causative agents with great
sensitivity are critical for this goal.

Nucleic acid amplification Test (NAAT)

NAAT is an assay that uses purified enzymes to isolate and then replicate specific nucleic acids
to levels where they can be detected, examples are PCR, TMA and NASBA, NAAT is now one
of the fast commercially available methods of diagnosis of infectious diseases. In detecting M.
tuberculosis (MTB) complex for instance, with traditional laboratory culture methods takes 1 to
8 weeks; however, direct molecular methods using nucleic acid amplification can detect MTB
genetic material directly from specimens within 3 to 5 hours.

DNA probe

In DNA probing, a single-stranded DNA molecule is used to detect the presence of

a complementary sequence among a mixture of other singled-stranded DNA molecules. ie a
labeled segment of DNA or RNA is used to find a specific sequence of nucleotides in a DNA
molecule. Probes may be synthesized in the laboratory, with a sequence complementary to the
target DNA sequence. DNA probing has been shown to be much more sensitive and specific than
Culture in making diagnosis of infectious disease agents.
Immunofluorescence

Immunofluorescence is a technique allowing the visualization of a specific protein or antigen in

cells or tissue sections by binding a specific antibody chemically conjugated with a fluorescent
dye such as fluorescein isothiocyanate (FITC). There are two major types of
immunofluorescence staining methods: 1) direct immunofluorescence staining in which the
primary antibody is labeled with fluorescence dye, and 2) indirect immunofluorescence staining
in which a secondary antibody labeled with fluorochrome is used to recognize a primary
antibody. Immunofluorescence staining can be performed on cells fixed on slides and tissue
sections. Immunofluorescence stained samples are examined under a fluorescence microscope or
confocal microscope.

Enzyme immunoassay

Enzyme immunoassay also called ELISA, is an assay that uses an enzyme-bound antibody to
detect antigen. The enzyme catalyzes a color reaction when exposed to substrate. Enzyme
immunoassay (EIA) and enzyme-linked immunosorbent assay (ELISA) have become household
names for medical laboratories, manufacturers of in vitro diagnostic products, regulatory
bodies, and external quality assessment and proficiency-testing organizations. They are widely
used in both diagnosis and screening of infectious diseases, especially viruses.

CONCLUSION
Molecular methods are no doubt advancing rapidly and are increasingly gaining an important
place in all aspects of diagnosis and management of infectious diseases. The wide spread use of
this methods is itself a recognition of the vital role of molecular diagnosis. It can therefore be
easily deduced that molecular diagnosis has impart positively in the dynamic fields of managing
infectious diseases.