2. Requirements for an effective diagnosis of
Infectious diseases
Diagnostic tests that are rapid, reliable and highly
sensitive & specific
Direct cultivation of pathogen
Some pathogens are not cultivable
Cell lines suitable for virus culture
Development of immunoassay and DNA-based
diagnostic methods
3. Concept of DNA based methods
Each species of pathogen carries unique DNA or RNA
sequences that differentiates from other pathogens
These methods are highly sensitive and specific
Allows rapid detection of pathogens
Finds increasing use in diagnostic microbiology Lab
5. Polymerase Chain Reaction (PCR)
Thermally controlled, enzyme mediated, invitro
amplification of the target DNA, with the help of
Primers, deoxyribonucleotide triphosphates
(dNTPs) and buffers at optimal concentrations
6. Dr. Kary Mullis, wins Nobel Prize in 1993
Nobel Prize in chemistry
for his discovery of PCR
The process was
conceptualized in 1983
Considered as one of the
milestones among
scientific techniques of
the twentieth century
7. STEPS IN PCR
EXTRACTION OF DNA
AMPLIFICATION OF TARGET DNA
DETECTION OF THE AMPLICONS
13. Post Amplification Detection Methods
By agarose gel electrophoresis
Enzymatic detection of amplified product
(capture probe)
Reverse hybridization (oligonucleotide probe)
Sequencing of the amplicons
15. M Nce Pc 1 2 3 4 5
Detection of IS6110 gene in Mycobacterium tuberculosis
IC
IS6110
700
400
250
100
bp
16. Detection of PCR products by Capture Probes
Amount of signal is directly
proportional to the
amplicons present
E.g. viral load estimation
17. DNA sequencing
Common method for analyzing amplified product
Analysis of target generated amplicon – helps to
detect pathogen
Helps to detect mutations in viruses / bacteria
Genotyping of organism
18. TYPES OF PCR
Qualitative PCR
Quantitative PCR
Nested PCR
Multiplex PCR
Reverse transcriptase PCR
Real time PCR
19. TYPES OF PCR
QUALITATIVE PCR: To detect the presence or
absence of a specific gene
QUANTITATIVE PCR (qPCR): The amount of product
synthesized during a test PCR is compared with the
amounts synthesized during PCRs with known
quantities of starting DNA
Conventional method: Agarose gel electrophoresis
Real-Time PCR: Product is measured over time
20. NESTED PCR
•Two sets of primers
•First set of primer directed
against the target gene
•Second set of primers are
internal to the first set target
Types
Single step nested PCR
Two step nested PCR
Uses: HSV, CMV, Enterovirus
M.tuberculosis
21. Multiplex PCR
Multiple primer sets for simultaneous detection of several
targets within a single PCR reaction
Clinical application
To detect microorganism causing single type of disease
Meningitis
Diarrhoeagenic E. coli
Respiratory viruses
Virulence genes of STEC
Disadvantages
Sensitivity is decreased when compared to uniplex PCR
Primers may cross react
22. Multiplex PCR for the detection of
Shiga toxigenic Escherichia coli
kb
1000
700
400
200
hly
eae
stx1
stx2
M 1 2 3 4 Pc Nc
23. Reverse transcriptase PCR (RT-PCR)
RTase enzyme is used to synthesize DNA from RNA
Types
Single step RT PCR
Single termostable DNA polymerase that also possess
significant RTase activity is used
Two step RT PCR
Separate RTase enzyme is used prior to the addition of DNA
polymerase
Uses
detection of RNA viruses
detection of microbes – rRNA – viable
to study gene expression
quantitative RT PCR – viral load
24. REAL TIME PCR
Synthesis of the amplicons is measured over time,
as the PCR proceeds through its series of cycles
Amount of amplicons formed are directly
proportional to the target DNA in the starting
material
It enables both detection and quantification of a
specific DNA sequence in the sample
By using fluorescent dye or reporter molecule
25. REAL TIME PCR
Nonspecific detector system
SYBR Green gives fluorescent signal when it binds
to double-stranded DNA
This method measures the total amount of double-
stranded DNA in the PCR
Primer dimers
26. REAL TIME PCR - Specific detector system
Reporter probe gives fluorescent signal when it hybridizes to
the PCR product - Specific
Each reporter probe has pair of labels
A fluorescent dye at one end of the oligonucleotide and a
quenching compound to the other end
Two ends of oligonucleotides base pair to one another, placing
the quencher next to the dye – No fluorescence
Hybridization between the oligonucleotide and the PCR product
disrupts base pairing quencher moves away from the dye and
fluorescent signal generated
27. Uses of Real time PCR
Quantitation of gene expression
Pathogen detection
Viral quantitation
Array verification
Drug therapy efficacy
DNA damage measurement
Quality control and assay validation
Advantages of Real time PCR
1 Rapid
2 Quantitative measurement
3 Lower contamination rate
4 Higher sensitivity
5 Higher specificity
6 Easy standardization
28. Application of PCR in Clinical Microbiology
Detection of slow-growing or fastidious microorganisms
Detection of infectious agents that cannot be cultured
Recognition of newly emerging pathogen
Detection of RNA viruses
Diagnosis of viral encephalitis
Identification of Mycobacterium spp.
Estimation of viral load to monitor therapy
Detection of bacterial DNA for the diagnosis of septic arthritis
and reactive arthritis
Identification of antimicrobial resistance genes
29. Advantages of PCR
Speedy diagnosis
Ease of use
Sensitivity
Specificity
30. Disadvantages of PCR
Need for target DNA sequence information
Primer Designing for unexplored ones
Taq Pol – no Proof reading mech – Error 40% after 20
cycles
Short size genes Up to 40 Kb can be amplified
Technical expertise