TABLE 1.

Cost, turnaround time, advantages, and disadvantages of various virus detection approaches

MethodCosta/avg turnaround timeAdvantagesDisadvantages
Cell culturesb
    Traditional tubes$1.50-$4.00 per tube for nonprimary cells and $2.15-$6.15 per tube for primary cells; use 2 to 6 tubes per culture/5-10 daysIsolate wide variety of viruses (including unanticipated agents, mixed cultures); provide isolate for additional studies: antiviral susceptibility testing, serotyping, and epidemiologic studies; increased sensitivity over rapid antigen testsTechnical expertise needed to read CPE; long incubation period for some viruses, need for purchasing/maintaining a variety of cell culture types in-house
    Shell vials with centrifugation/ pre-CPE stainSame as comparable cell culture tubes; use at least 2 vials of each cell line/24-48 hShort turnaround time for detection; take up less space than tubes; some available as cryopreserved cells; may isolate viruses that replicate poorly or not at all in standard tube cell cultures; require less technical expertise than tube cultures if pre-CPE staining is usedNot as sensitive as traditional cultures for culturing blood samples for CMV; reading stained preparations is time-consuming and labor-intensive; unanticipated agents may be missed when pre-CPE staining targets only one or a few viruses; isolates not available from fixed/stained vials
    Cocultivated cellsApprox. $1.25 more per vial than standard shell vials; use 3 vials for each culture/ 24-48 hSame as for shell vials plus decreased need for maintaining wide variety of cell cultures, support growth of a wider range of viruses, most results finalized in 2-3 days when pre-CPE staining is used, may be more sensitive than tube cultures for some virusesSame as for shell vials
    Transgenic cells (ELVIS)$2.35-$3.00 more per vial than standard shell vials; use 2 vials for each culture/ 24-48 hSame as for shell vials plus detection by color change rather than application of MAbs, simplify identification because of specificity for a single virus, can be used to type HSV-1 and HSV-2Targeted for detection of only a single virus group (HSV)
Nonculturec
    Antigen detection by IF$2-$7.00 for MAbs for each sample/40 minGenerally good sensitivity (which varies with virus detected); excellent specificity; CMV antigenemia is more sensitive than traditional or shell vial cultures for CMV in bloodGenerally not as sensitive as cell cultures; requires expertise in reading; not useful for all viruses; adenovirus sensitivity especially poor
    Antigen detection, non-IF$10-$22 for each sample/30 minGenerally good specificity for RSV and influenza A and B viruses; no special technical expertise required; results available very rapidly; most cleared for point-of-care testingGenerally poor sensitivity compared to cell culture; currently available for RSV and influenza A and B viruses only; additional testing of negative samples by cell culture is recommended
    Nucleic acid detection (molecular)$35-$125 for each sample tested with ASR or FDA-cleared kits; $10-$35 for each in-house developed assay (may require patent royalties)/2 h for real-time PCR; 8 h for traditional PCRExcellent sensitivity and specificity; short turnaround with real-time PCR; useful for viruses that cannot be cultured in traditional cell culturesFDA-cleared kits and standardized protocols not widely available for most viruses; technical expertise required in-house for developing and standardizing methods; expensive due to costs of instrumentation (especially for low-vol testing); probes and primers extremely specific (may miss mutated virus); detects only viruses sought (will miss unanticipated agents and mixed infections in most cases); many assays available at reference/research laboratories only
  • a Cost includes reagents only.

  • b All types of cell cultures require viable virus in order to produce a positive result. This allows these methods to differentiate viable from nonviable virus. Because viable virus is required, specimens must be handled carefully to preserve viral infectivity.

  • c None of the nonculture methods requires viable virus in order to produce a positive result; therefore, these methods cannot differentiate viable and nonviable virus. Because viability is not required, specimen handling is not as critical. No viral isolate is available upon completion of testing.