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LIBERTY UNIVERSITY
FALL 2020
BIOM 625
MICROBIAL PATHOGENESIS AND VIOLOGY
DISCUSSION BOARD FORUM 3
Rapid Viral Detection and Diagnosis
Preparing for your Thread and Reply
As the Clinical Laboratory Director of a very prestigious hospital, you are responsible for the
overall operation and administration of the laboratory, including the employment of competent
qualified personnel. Even though you have the option to delegate some of your responsibilities,
you remain ultimately responsible and must ensure that all the duties are properly performed and
that applicable Clinical Laboratory Improvement Amendment (CLIA) regulations are met. It is
your responsibility to ensure that your laboratory develops and uses a quality system approach to
laboratory testing that provides rapid, accurate, and reliable patient test results.
Traditionally, viral diagnostic techniques, especially cell culture, are slow, expensive, and often
peripheral to clinical decision-making, particularly when no therapeutic agents are available. The
availability of antiviral therapeutic agents such as acyclovir, ganciclovir, foscarnet, cidofovir,
antiretroviral drugs, neuraminidase inhibitors, and IFN-α that are effective for specific viral
infections but expensive (and in some cases potentially toxic), has created an obvious need for
specific viral diagnosis. However, your laboratory has a daily backlog (in hours and sometimes
days) of patient samples that prevents the attending physician from making a diagnosis and
ultimately treating the patient. Your administration’s patience is being tested because the “turn
around” for sample analysis is too long and the “turn over” of hospital beds is slow – patients are
not being treated and released in a timely fashion – and the cost to the hospital is increasing due
to lack of coverage by insurance companies.
The trend for viral diagnostic testing is to accelerate the diagnostic process while keeping the
associated costs low without compromising the accuracy of the diagnosis and/or the patient’s
health. As the Clinical Laboratory Director, your task is to decrease the time and cost needed for
1) sample analysis, 2) viral detection, and 3) diagnosis.
In general, diagnostic tests can be grouped into 3 categories. Each of the 3 categories contains
various diagnostic tests (not all inclusive) that you will use to evaluate and compare with your
classmates.
1. Direct Examination of Specimen
a. Electron and Light Microscopy
b. Antigen detection immunofluorescence, ELISA, etc.
c. Molecular techniques for the direct detection of viral genomes
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2. Indirect Examination
a. Cell Culture - cytopathic effect (CPE), haemadsorption, confirmation by
neutralization, interference, immunofluorescence, etc.
b. Eggs pocks on CAM - haemagglutination, inclusion bodies
c. Animals disease or death confirmation by neutralization
3. Serology – Classical and Newer Techniques
a. Radioimmunoassay
b. Western blot
c. Complement fixation test
The title of your thread must begin with your choice to use one or more of the diagnostic
techniques described and select 1 of the three categories listed above. Then, describe or argue
your answer to support your reasoning for the technique(s) you selected against the following
criteria: 1) sample analysis, 2) viral detection, and 3) diagnosis.
After other threads have been posted, reply to at least 1 other classmate’s thread whose position,
for any 2 of the 3 categories, is different from your own. The objective is to sway your classmate
to your side. If most classmates' threads are sympathetic to your own, critique their arguments
rather than their conclusion. This makes the group's overall conclusion stronger. In each case,
your reply should consist of at least 2 concise sentences. If few threads contain category
selections different from your own, then your reply may identify a weakness or omission in a
thread that supports the same category as your own.
ANSWER
From the several techniques described, I have decided to choose the following
techniques: Molecular techniques for the direct detection of viral genomes, Eggs pocks
on CAM, Western blot. Below is the reasoning for the techniques selected.
For sample analysis, I believe the best method to use is the “Molecular techniques
for the direct detection of viral genomes”. The molecular diagnostic of viral genome
is consumes less time and costs less compared to other methods. In this technique, we
need to consider the common viral genome marker and make a primer for that specific
gene. When using Polymerase chain reaction (PCR), we can detect the viral gene
marker and its presence in the patient blood sample. When comparing the chosen
technique to other two techniques from the same category (Direct Examination of
Specimen category), we find that electron and light microscope technique and Antigen
detection immunofluorescence (ELISA) technique may produce false result.
For viral detection, the best method to use is “Eggs pocks on CAM -
haemagglutination, inclusion bodies”. This method is the best to use because most
viruses affect cells by inserting their RNA into the cell and affecting its platelet.
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As for the diagnosis purposes, I believe that the best method to use is Western
Blot because the viral protein marker is easy to identify through this method. Another
privilege of using western blot is that it is inexpesnsive and consumes much less time
compared to other methods. It takes around two days to the results to show in order to
diagnose. For example, when diagnosing HIV the Western blot test separates the blood
proteins and detects the specific proteins ( HIV antibodies) that indicate an HIV
infection. In the Western blot test, the sample is separated with an electrical current and
transferred onto a piece of blotting paper. And an enzyme is added to cause color
changes that signal the presence of HIV antibodies. The Western blot is followed by an
ELISA test, and the combined tests are 99.9% accurate.
Each technique has its pros and cons. However, in certain aspects some techniques
may be better to use than others. I have chosen ,in my opinion , the best viral diagnostic
testing to accelerate the diagnostic process while keeping the associated costs low
without compromising the accuracy of the diagnosis and/or the patient’s health.
