Department of Pathology, PNS Hafeez, Islamabad, Pakistan.
Department of Pathology, Karachi Institute of Medical Sciences, Karachi, Pakistan.
J Pak Med Assoc. 2022 Jun;72(6):1166-1174. doi: 10.47391/JPMA.2324.
COVID-19 infection has emerged as an unparalleled pandemic with morbidity and mortality tolls challenging diagnostic approaches and therapeutic interventions, and raising serious questions for healthcare policy-makers. From the diagnostic perspective, Reverse transcriptase polymerase chain reaction remains the gold standard. However, issues associated with gene primer variation in different countries, low analytical sensitivity, cross-reactivity with certain human coronaviruses have raised serious concerns within the scientific community. Alongside longer turnaround times, requirements of sophisticated equipment and trained technicians are the other challenges for conventional reverse transcriptase polymerase chain reaction testing. The recent biotechnological boom has now allowed newer nucleic acid testing options for diagnosing severe acute respiratory syndrome Coronovairus 2 (SARS-CoV2) with much better diagnostic efficiency, reduced turnaround times and possible benefit for use as a point-of-care test. Isothermal techniques with simple equipment requirements along with uniform temperature for analysis have emerged to be more sensitive and specific with turnaround times as low as 10-15 minutes. Similarly, Cluster Regularly Interspaced Short Palindromic Repeats have also been seen to play a very decisive role in COVID-19 diagnostics with much superior diagnostic efficiency and feasibility as a point-of-care test and its possible use for sequencing. The current narrative review was planned to consolidate data for all possible nucleic acid testing options under research/clinical use, and to provide a comparative assessment from the perspective of both the clinician and the laboratory.
COVID-19 感染已成为一种前所未有的大流行病，其发病率和死亡率给诊断方法和治疗干预带来了挑战，并给医疗保健政策制定者提出了严峻的问题。从诊断的角度来看，逆转录聚合酶链反应仍然是金标准。然而，与不同国家的基因引物变异、分析灵敏度低、与某些人类冠状病毒的交叉反应相关的问题引起了科学界的严重关注。除了较长的周转时间外，对复杂设备和经过培训的技术人员的要求也是常规逆转录聚合酶链反应测试的其他挑战。最近的生物技术繁荣现在为诊断严重急性呼吸系统综合征冠状病毒 2（SARS-CoV2）提供了新的核酸检测选择，这些选择具有更高的诊断效率、缩短了周转时间，并可能有利于用作即时检测。具有简单设备要求的等温技术以及用于分析的统一温度已被证明更敏感和更特异，周转时间低至 10-15 分钟。同样，簇状规律间隔短回文重复序列（CRISPR）也被证明在 COVID-19 诊断中发挥了非常决定性的作用，作为即时检测，其诊断效率和可行性都非常优越，并且可能用于测序。本综述旨在整合所有研究/临床应用中的核酸检测选择的数据，并从临床医生和实验室的角度提供比较评估。
