Bottieau, E.

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Point-of-care testing: filling the diagnostic gaps in tropical medicine? 

Point-of-care testing: ﬁlling the diagnostic gaps in tropical medicine?
E. Bottieau
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
E-mail: ebottieau@itg.be
Article published online: 4 March 2013
Many infectious diseases require timely diagnosis and early
appropriate treatment to prevent death and sequelae. The
clinical management of patients suspected of having serious
infections often consists of providing empirical treatment that
targets the most relevant conditions while waiting for
aetiological results obtained within hours, days or weeks by
conventional microbiology. This strategy requires compre-
hensive epidemiological information, good clinical skills, and
adequate laboratory facilities, and leads unavoidably to missed
diagnoses on the one hand and unnecessary prescriptions on
the other. In the past decade, major efforts have been made
by the scientiﬁc community and industry to bring diagnostics
closer to the care provider and to the patient. The concept of
point-of-care (POC) testing has emerged for infectious
diseases, as reviewed in a previous themed section of Clinical
Microbiology and Infection [1–3]. Although no universal deﬁni-
tion exists, POC testing refers to any diagnostic technique
used at or near the patient and providing results within a very
short time frame in order to allow decision-making (triage,
referral, and treatment prescription or withholding) ‘during
the same clinical encounter’ [4]. POC testing in developed
countries may therefore comprise very diverse technologies
(from simple immunoassays to more sophisticated nucleic
acid ampliﬁcation tests), users (lay persons to highly trained
staff), and settings (homes to ‘near-care’ reference laborato-
ries).
In the deprived settings of developing countries, this need
for rapid diagnostic testing is even more pressing, because
patients often seek care late and cannot easily come back to
obtain results and speciﬁc treatments [3]. Major patient and
health system delays are observed before diagnosis [5]. To
be effective in poorly staffed, ill-equipped tropical settings,
POC tests should ideally meet the ‘ASSURED’ characteristics
—affordable, sensitive, speciﬁc, user-friendly, rapid and
robust, equipment-free, and delivered—according to inter-
national recommendations issued about ten years ago [6].
For the time being, almost only lateral-ﬂow immunochro-
matographic assays fulﬁl these stringent technical require-
ments, and other formats, requiring multiple steps or cold
chains (ﬂocculation, agglutination, and vertical ﬂow-through
immunochromatography), are progressively being abandoned.
In tropical settings, the so-called rapid diagnostic tests
(RDTs) are now almost exclusively such immunoassays,
which are usually performed near the patient in primary-care
laboratories, although some of them, e.g. for malaria, are
increasingly being used in the community as well. Field
diagnosis of malaria or human immunodeﬁciency virus has
been greatly simpliﬁed over the past decade by the
development of these RDTs, and countless commercial kits
are now available at reasonable cost. More recently, major
progress has been made for other infections, such as dengue
and syphilis, and new tests are regularly being evaluated or
entering clinical care.
This themed section is aimed at reviewing current RDT
development and perspectives for several major clinical
scenarios in tropical and travel medicine. Maltha et al. present,
in two companion articles, the current performances and
persisting pitfalls of RDTs for malaria diagnosis in endemic
settings and in non-immune travellers. In their second review,
the authors also discuss the potential use of new malaria RDTs
for self-diagnosis or peer diagnosis during travel to tropical
areas. In a third article, Mbanya describes the challenges in
donating safe blood in low-resource tropical hospitals, and
reviews the role of RDTs in detecting the major transfusion-
transmissible infections in blood banks where western models
of infectious screening are not affordable. Finally, in an attempt
to address the growing challenge of non-malarial febrile illness
in the tropics [7], Chappuis et al. review the currently available
or near-term RDTs that could be used within integrated
syndromic algorithms. Beyond the undeniable progress, read-
ers will also realize that many gaps and challenges persist in
terms of pathogen detection, clinical use, and operational
implementation. It is also important not only to focus on a
fragmented single-disease approach, but also to coordinate
research efforts to enable patient-centred management. For a
variety of similar challenging syndromes such as neurological
disorders (Yansouni C et al., Lancet Infect Dis, in press) or
persistent diarrhoea [8], clinical and diagnostic studies should
be conducted in various epidemiological contexts in order to
elaborate and validate innovative and integrated RDT-based
ª2013 The Author
Clinical Microbiology and Infection ª2013 European Society of Clinical Microbiology and Infectious Diseases
EDITORIAL 10.1111/1469-0691.12200
diagnosis/treatment pathways. While we are waiting for more
accurate technologies and adequately trained microbiologists
in the low-resource settings, pertinent use of quality RDTs
may substantially help to improve clinical care and epidemio-
logical surveillance for the people in most need.
Transparency Declaration
The author has no conﬂict of interest related to the present
article.
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ª2013 The Author
Clinical Microbiology and Infection ª2013 European Society of Clinical Microbiology and Infectious Diseases, CMI, 19, 397–398
398 Clinical Microbiology and Infection, Volume 19 Number 5, May 2013 CMI


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Point-of-care testing: filling the diagnostic gaps in tropical medicine?

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