The application of molecular techniques to diagnosis of viral respiratory tract infections

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Respiratory viruses are a well-recognized cause of severe (and life-threatening) infections in the elderly, the immunocompromised, the very young and those with underlying disorders such as asthma. They are also responsible for more ‘trivial’ asymptomatic infections and mild symptomology in a community setting. Seasonal outbreaks of respiratory virus infections account for a considerable proportion of medical consultations. Respiratory virus infections are currently under-diagnosed, particularly in a community setting, despite the fact that accurate diagnosis is important to ensure appropriate patient management and to avoid unnecessary burden on health resources. Conventional methods for respiratory virus diagnosis include culture-based procedures and direct antigen detection methods. These have proved successful when aspirate samples are obtained from young babies who shed lots of virus during infection. Antigen detection methods and culture, however, when only acellular samples are available or samples are taken from adults in the community. The advent of molecular amplification methods has led to a resurgence in interest in the development of assays for detection and analysis of respiratory viruses. Such methods have the advantage of speed and sensitivity over culture-based procedures but tend to be expensive and technically demanding. They are being used increasingly for correct identification of virus infection in a time-scale suitable for use of antiviral therapy (for an individual) and to assess the performance of prophylaxis, isolation procedures and novel therapies in hospital and community settings. This article reviews the current molecular approaches for respiratory virus diagnosis and discusses the potential health-economic impact of their use in hospitalized ‘at risk’ individuals and in community surveillance studies.

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