Molecular Diagnosis of Infectious Diseases: edited by Udo Reischl

Abstract

Humana Press, 1998. $99.50 (hbk) / $69.50 (pbk) (xv + 629 pages)ISBN 0 89603 485 2 / 0 89603 398 8Currently, there is a rising wave of interest in the molecular diagnosis of infectious diseases for several reasons. It is comparatively rapid, provides increased sensitivity and specificity, might reduce costs, and provides better potential for automatization using defined molecular probes. Hence, a handbook providing insight into this field is urgently needed. The present book is an up-to-date and often very detailed protocol book, covering molecular techniques which have, or may have in future, some value in diagnosis. The chapters are all written by different experienced authors and consequently vary considerably in quality. Many established techniques are covered, with an emphasis on gene cloning, gene expression, and protein detection. The book also covers new fields, such as single-chain antibodies, complex phage and bacterial display systems, and biosensors. It is rather surprising, therefore, not to find a chapter on the rapidly evolving field of gene-chip technology.The title of the book led me to expect to be guided through molecular approaches for the diagnosis of various infectious diseases, and a review of the difficulties encountered when developing and applying molecular tools to the diagnostic business. Important questions, relevant to medics in this field, such as when to apply which technique, and the pros and cons of it, however, are not addressed. Any diagnosis can only be as good as the starting material, and this applies, in particular, when using highly sensitive molecular tools. Simple but important issues, such as how to isolate sample material, are not even mentioned. In my experience, standard protocols work fine with standard reagents, but as soon as, for example, RT-PCR has to be done from stool or blood samples, sample preparation and ‘the tricks of the trade’ are crucial. However, I found very little advice here. Similarly, the diagnosis of viruses requires different precautions and preparations than the diagnosis of bacteria or parasites, but again this issue is not addressed. There is no mention of how to select specific diagnostic primers for PCR or how to identify antigens that are really pathogen specific. Furthermore, crucial information on how to apply, validate or develop molecular diagnostic tests is missing, except for some issues raised in the excellent Chapter 26 on basic problems in serology.The book would have gained quality by providing detailed background and reasoning for the application of certain techniques in diagnosis, and should have provided protocols only where there is a need for special adaptation to the diagnostic needs. The usefulness of the book would have increased if alternatives for difficult questions had been discussed, or if the reader had been guided through the molecular diagnosis of some diseases by examples, instead of providing protocols, which very often occur as plain copies of those in commercially available kits. Why, for example, print protocols that are provided with any Qiagen kit (Chapter 16, 17)? And why copy GenHunter’s protocol (Chapter 1), when equally powerful tools such as representational difference analysis (RDA) or suppression subtraction hybridization are not mentioned?In times of rapid change and development of new techniques, a book providing detailed protocols might be quickly outdated in many aspects (eg. there is no mention of hot start PCR using inhibitory anti-taq antibodies). The newest and most updated protocols are now accessible for all laboratories via the worldwide web/the Internet, either through organizations or through the home pages of most molecular tool suppliers, but the book might provide a simple way to acquire an overview on the techniques used in the diagnostic field. Unfortunately, the index is incomplete and very limited. Under infectious pathogens it lists only HBV, HCV, HIV and measles, and within the text there is only further mention of Yaws, Dengue, HSV, Syphilis and Borrelia. Are these all infectious diseases?The chapter on basic problems of serology gives a glimpse of how good the book could have been if the editor had followed the many very important issues and questions connected with diagnostic tests.Notwithstanding the criticisms above, after navigating through the jungle of sometimes unrelated chapters, the book reveals a whole body of important information, which might well add to that available in standard laboratory manuals. It may serve as a valuable methodological book for molecular biologists in a hospital laboratory or in academia, and as a useful reference book for molecular biology laboratories that have no access to the standard laboratory manuals.