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Chapter 78 : Algorithms for Detection and Identification of Viruses
This chapter analyses methods focused on conventional cell cultures, classical serologic techniques, and light and electron microscopy. Novel detection methods have permitted the diagnosis of multiple respiratory viruses in a single multiplex PCR test. Quantitative monitoring of viral load in blood has become more widely applied due to implementation of real-time PCR techniques. As tests become more sensitive, low levels of clinically irrelevant or nonviable viruses may be detected and can be misleading to clinicians. Similarly, interpreting the clinical relevance of multiple viral pathogens in the same sample when relative quantification is not available is problematic. Laboratories need to choose which tests to offer. Selecting the appropriate test will depend on the viruses sought, sample site, clinical presentation, clinical purpose, patient characteristics, and disease prevalence. Laboratories must recognize the uses and also the limitations of each test in order to guide clinicians in interpreting the results. Due to the speed of methodological change and the continuing discovery of new viruses and new therapies, keeping abreast of the most recent literature is strongly recommended.