Tarr Philip, Frei Reno
Infektiologie und Spitalhygiene, Medizinische Universitätsklinik, Kantonsspital Bruderholz.
Ther Umsch. 2010 Jul;67(7):381-6. doi: 10.1024/0040-5930/a000067.
The introduction of polymerase chain reaction (PCR)-based DNA amplification in the early nineties has revolutionized diagnosis of infectious diseases and has provided many fundamental insights regarding their epidemiology and clinical presentation. Compared to serology, PCR-based diagnosis may be more specific and sensitive, and may allow earlier diagnosis. Adequate patient specimens are important. Depending on the clinical setting, PCR amplification can be performed on blood samples, other clinical specimens or directly on histopathologic specimens. PCR detection of pathogen DNA is used to confirm serologic screening tests and to diagnose infections due to pathogens that are difficult to grow in culture. With chronically persistent agents, PCR may allow differentiation between clinically irrelevant and relevant infection. Suppression of viral DNA or RNA is a standard read-out of the efficacy of antiviral agents used to treat chronic hepatitis B, C, or HIV infection. Infectious disease consultation may be useful for interpretation of results. Genetic testing is increasingly being performed for antimicrobial susceptibility testing (MRSA, antitubercular treatment) and may in the future contribute to prediction of the host response to infectious disease and of antiretroviral toxicity. Increased future use of PCR-based diagnosis of infectious diseases is likely, based on increasingly automated and multiplex PCR technology.
20世纪90年代初基于聚合酶链反应（PCR）的DNA扩增技术的引入，彻底改变了传染病的诊断方式，并为其流行病学和临床表现提供了许多重要见解。与血清学相比，基于PCR的诊断可能更具特异性和敏感性，并且可能允许更早的诊断。合适的患者标本很重要。根据临床情况，PCR扩增可在血液样本、其他临床标本或直接在组织病理学标本上进行。病原体DNA的PCR检测用于确认血清学筛查试验，并诊断由难以在培养中生长的病原体引起的感染。对于慢性持续性病原体，PCR可能有助于区分临床无关和相关感染。病毒DNA或RNA的抑制是用于治疗慢性乙型、丙型肝炎或HIV感染的抗病毒药物疗效的标准指标。传染病咨询可能有助于结果的解释。基因检测越来越多地用于抗菌药物敏感性测试（耐甲氧西林金黄色葡萄球菌、抗结核治疗），并且未来可能有助于预测宿主对传染病的反应和抗逆转录病毒毒性。基于日益自动化和多重PCR技术，未来基于PCR的传染病诊断的使用可能会增加。
