Sense and Nonsense in Viral Diagnosis — Past, Present, and Future

Abstract

Although infectious diseases have been recognized since the beginning of history, and diagnoses have been made for thousands of years from clinical signs or autopsy examinations, the first use of the laboratory to assist in the recognition of viral diseases awaited the development of the necessary tools: the light microscope and immunologic systems which would detect minute amounts of antigens or antibodies. The first laboratory-based diagnosis of a viral disease can probably be attributed to a Scotsman, James Brown Buist, who in 1886 stained the lymph obtained from the skin lesions of patients with smallpox and saw with almost miraculous acuity “elementary bodies”, which he took to be the cause of the disease (Gordon 1937). He called these the spores of micrococci and estimated their size to be 150 nm. We now know that he was seeing the aniline-stained poxvirus particles and underestimated their diameter by at least a factor of 2. This was 6 years before the discovery of viruses, for it was only in 1892 that Ivanovskidescribed a transmissable, filterable agent as the cause of tobacco mosaic disease. Buist had not only pioneered in laboratory viral diagnosis but even in “rapid” viral diagnosis, since his technique could be completed in hours and he was using the simple but even today somewhat unorthodox approach of examining clinical specimens directly by microscopy.