Enterovirus molecular detection and typing

Cell culture and neutralization have been considered the gold standard for enterovirus detection and identification for more than 50 years, but molecular amplification technologies are rapidly replacing the traditional methods in clinical and public health laboratories. Assays based on reverse transcription–polymerase chain reaction or nucleic acid sequence-based amplification may be used to detect enterovirus genome in all types of clinical specimens. More recently, nucleotide sequence has been used as a surrogate for antigenic typing (determination of serotype) by targeting parts of the enterovirus capsid-coding region that contain serotype-specific neutralization epitopes. This review will describe the molecular methods currently being used to diagnose enterovirus infection and disease, starting with the broadest level (family/genus detection) and proceeding through species/serotype identification to genotyping and molecular epidemiology. The commonly used molecular assays are usually more sensitive and more specific than cell culture and antigenic typing. They can reduce the turnaround time for testing of clinical diagnostic specimens to a clinically relevant timeframe and should supplant culture/neutralization as the gold standard in the near future. However, further evaluation and, in particular, more rigorous validation are required before a molecular diagnostic standard can be established.