The field of clinical microbiology has evolved dramatically over the past decade, with undeniable advancements in the area of direct-from-specimen pathogen detection via syndromic panel nucleic acid amplification testing (NAAT) and, more recently, through the advent of metagenomic next generation sequencing (mNGS). Despite these advances, there are numerous diseases for which serologic testing remains the preferred diagnostic method. By definition, serology is the “diagnostic examination of blood serum, especially with regard to response of the immune system to pathogens.” However, in practice, serologic testing encompasses both detection of the immune response (humoral and cellular) against and, antigens released from infectious pathogens in a wide variety of specimen types [e.g., cerebrospinal fluid (CSF), bronchoalveolar lavage (BAL) fluid, urine, etc.] (1). The infectious diseases that fall into this “serology-dependent diagnostic” category are broad, ranging from vector-borne agents, to select sexually transmitted organisms, to pathogens associated with latency and reactivation (Table 1a). Our continued reliance on serologic methods to detect these infections is due to an interplay of factors, including microorganism-specific pathogenesis characteristics, host-related responses, and limitations associated with the currently available direct detection techniques.

中文翻译：

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回归基础：何时订购（以及何时不订购）用于诊断传染病的血清学检测

在过去的十年中，临床微生物学领域发生了巨大的变化，通过综合核酸扩增测试 (NAAT) 直接从标本病原体检测领域取得了不可否认的进步，最近，通过下一代宏基因组测序的出现(mNGS)。尽管取得了这些进展，但仍有许多疾病的血清学检测仍然是首选的诊断方法。根据定义，血清学是“血清的诊断检查，特别是关于免疫系统对病原体的反应。” 然而，在实践中，血清学检测包括检测免疫反应（体液和细胞），以及从多种标本类型中感染性病原体释放的抗原（例如，脑脊液 (CSF)、支气管肺泡灌洗液 (BAL)、尿等] (1)．属于这种“血清学依赖性诊断”类别的传染病范围很广，从媒介传播的病原体到选择性的性传播生物，再到与潜伏期和再激活相关的病原体（表 1a）。我们继续依赖血清学方法来检测这些感染是由于多种因素的相互作用，包括微生物特异性发病机制特征、宿主相关反应以及与目前可用的直接检测技术相关的限制。