Department of Chemical Pathology. National Health Laboratory Services and University of Witwatersrand, Johannesburg, South Africa.
Wits Diagnostic and Innovation Hub, University of Witwatersrand, Johannesburg, South Africa.
Adv Exp Med Biol. 2023;1412:141-158. doi: 10.1007/978-3-031-28012-2_7.
The identification and genetic sequencing of a novel coronavirus was key to the diagnosis and management of the global pandemic. An understanding of the SARS-CoV-2 structure and mechanism of injury is vital to explaining the disease course and the pathophysiology of the signs and symptoms observed. This particularly as the presentation, disease course, and severity are noted to be highly variable. The role of the spike protein and angiotensin-converting enzyme 2 (ACE-2) receptor in immune response and viral entry provides great insight into current and future diagnostics and therapeutics. This article reviews the traditional diagnostic methods, which include molecular testing methods, antigen testing, and antibody testing. The gold standard for diagnosis of COVID-19 is reverse transcriptase polymerase chain reaction (RT-PCR). There have been multiple improvements to these principles to help optimize the sensitivity, specificity, and user friendliness of the method. In addition, advancements in gene sequencing and identification have been integral to identifying variants and managing outbreaks. Serological and immunological testing have made significant contributions to the management of the COVID-19 pandemic, each with its unique benefits and limitations. A growing role of the laboratory is in triaging patients to determine which patients will most benefit from hospitalization and specialized care. This is imperative for rationalizing resources during outbreaks. As we learn to live with the pandemic, novel testing methods include the use of multiomic technologies and the greater utility of point of care.
新型冠状病毒的鉴定和基因测序是诊断和管理全球大流行的关键。了解 SARS-CoV-2 的结构和损伤机制对于解释疾病过程和观察到的症状的病理生理学至关重要。特别是因为其表现、病程和严重程度都被认为是高度可变的。刺突蛋白和血管紧张素转换酶 2（ACE-2）受体在免疫反应和病毒进入中的作用为当前和未来的诊断和治疗提供了重要的见解。本文回顾了传统的诊断方法，包括分子检测方法、抗原检测和抗体检测。COVID-19 的诊断金标准是逆转录聚合酶链反应（RT-PCR）。为了帮助提高方法的灵敏度、特异性和易用性，已经对这些原则进行了多次改进。此外，基因测序和鉴定的进步对于识别变体和管理疫情至关重要。血清学和免疫学检测对 COVID-19 大流行的管理做出了重大贡献，每种方法都有其独特的优势和局限性。实验室的作用越来越大，在于对患者进行分诊，以确定哪些患者最需要住院和专业护理。这对于在疫情期间合理分配资源至关重要。随着我们学会与大流行共存，新型检测方法包括使用多组学技术和更多地使用即时护理。
