A Smartphone-Based Rapid Telemonitoring System for Ebola and Marburg Disease Surveillance

Virus Detection: From State-of-the-Art Laboratories to Smartphone-Based Point-of-Care Testing

Infectious virus outbreaks pose a significant challenge to public healthcare systems. Early and accurate virus diagnosis is critical to prevent the spread of the virus, especially when no specific vaccine or effective medicine is available. In clinics, the most commonly used viral detection methods are molecular techniques that involve the measurement of nucleic acids or proteins biomarkers. However, most clinic-based methods require complex infrastructure and expensive equipment, which are not suitable for low-resource settings. Over the past years, smartphone-based point-of-care testing (POCT) has rapidly emerged as a potential alternative to laboratory-based clinical diagnosis. This review summarizes the latest development of virus detection. First, laboratory-based and POCT-based viral diagnostic techniques are compared, both of which rely on immunosensing and nucleic acid detection. Then, various smartphone-based POCT diagnostic techniques, including optical biosensors, electrochemical biosensors, and other types of biosensors are discussed. Moreover, this review covers the development of smartphone-based POCT diagnostics for various viruses including COVID-19, Ebola, influenza, Zika, HIV, et al. Finally, the prospects and challenges of smartphone-based POCT diagnostics are discussed. It is believed that this review will aid researchers better understand the current challenges and prospects for achieving the ultimate goal of containing disease-causing viruses worldwide.

Nanobioengineering: A promising approach for early detection of COVID-19

Unique pneumonia due to an unknown source emerged in December 2019 in the city of Wuhan, China. Consequently, the World Health Organization (WHO) declared this condition as a new coronavirus disease-19 also known as COVID-19 on February 11, 2020, which on March 13, 2020 was declared as a pandemic. The virus that causes COVID-19 was found to have a similar genome (80% similarity) with the previously known acute respiratory syndrome also known as SARS-CoV. The novel virus was later named Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 falls in the family of Coronaviridae which is further divided into Nidovirales and another subfamily called Orthocoronavirinae. The four generations of the coronaviruses belongs to the Orthocoronavirinae family that consists of alpha, beta, gamma and delta coronavirus which are denoted as α-CoV, β-CoV, γ-CoV, δ-CoV respectively. The α-CoV and β-CoVs are mainly known to infect mammals whereas γ-CoV and δ-CoV are generally found in birds. The β-CoVs also comprise of SARS-CoV and also include another virus that was found in the Middle East called the Middle East respiratory syndrome virus (MERS-CoV) and the cause of current pandemic SARS-CoV-2. These viruses initially cause the development of pneumonia in the patients and further development of a severe case of acute respiratory distress syndrome (ARDS) and other related symptoms that can be fatal leading to death.

Nanotechnology against COVID-19: Immunization, diagnostic and therapeutic studies

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in early 2020 soon led to the global pandemic of Coronavirus Disease 2019 (COVID-19). Since then, the clinical and scientific communities have been closely collaborating to develop effective strategies for controlling the ongoing pandemic. The game-changing fields of recent years, nanotechnology and nanomedicine have the potential to not only design new approaches, but also to improve existing methods for the fight against COVID-19. Nanomaterials can be used in the development of highly efficient, reusable personal protective equipment, and antiviral nano-coatings in public settings could prevent the spread of SARS-CoV-2. Smart nanocarriers have accelerated the design of several therapeutic, prophylactic, or immune-mediated approaches against COVID-19. Some nanovaccines have even entered Phase IΙ/IIΙ clinical trials. Several rapid and cost-effective COVID-19 diagnostic techniques have also been devised based on nanobiosensors, lab-on-a-chip systems, or nanopore technology. Here, we provide an overview of the emerging role of nanotechnology in the prevention, diagnosis, and treatment of COVID-19.

Data and Digital Solutions to Support Surveillance Strategies in the Context of the COVID-19 Pandemic

Background: In order to prevent spread and improve control of infectious diseases, public health experts need to closely monitor human and animal populations. Infectious disease surveillance is an established, routine data collection process essential for early warning, rapid response, and disease control. The quantity of data potentially useful for early warning and surveillance has increased exponentially due to social media and other big data streams. Digital epidemiology is a novel discipline that includes harvesting, analysing, and interpreting data that were not initially collected for healthcare needs to enhance traditional surveillance. During the current COVID-19 pandemic, the importance of digital epidemiology complementing traditional public health approaches has been highlighted. Objective: The aim of this paper is to provide a comprehensive overview for the application of data and digital solutions to support surveillance strategies and draw implications for surveillance in the context of the COVID-19 pandemic and beyond. Methods: A search was conducted in PubMed databases. Articles published between January 2005 and May 2020 on the use of digital solutions to support surveillance strategies in pandemic settings and health emergencies were evaluated. Results: In this paper, we provide a comprehensive overview of digital epidemiology, available data sources, and components of 21st-century digital surveillance, early warning and response, outbreak management and control, and digital interventions. Conclusions: Our main purpose was to highlight the plausible use of new surveillance strategies, with implications for the COVID-19 pandemic strategies and then to identify opportunities and challenges for the successful development and implementation of digital solutions during non-emergency times of routine surveillance, with readiness for early-warning and response for future pandemics. The enhancement of traditional surveillance systems with novel digital surveillance methods opens a direction for the most effective framework for preparedness and response to future pandemics.

Towards Fully Integrated Portable Sensing Devices for COVID-19 and Future Global Hazards: Recent Advances, Challenges, and Prospects

Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, this fatal disease has been the leading cause of the death of more than 3.9 million people around the world. This tragedy taught us that we should be well-prepared to control the spread of such infectious diseases and prevent future hazards. As a consequence, this pandemic has drawn the attention of many researchers to the development of portable platforms with short hands-on and turnaround time suitable for batch production in urgent pandemic situations such as that of COVID-19. Two main groups of diagnostic assays have been reported for the detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) including nucleic acid-based and protein-based assays. The main focus of this paper is on the latter, which requires a shorter time duration, less skilled technicians, and faces lower contamination. Furthermore, this paper gives an overview of the complementary metal-oxide-semiconductor (CMOS) biosensors, which are potentially useful for implementing point-of-care (PoC) platforms based on such assays. CMOS technology, as a predominant technology for the fabrication of integrated circuits, is a promising candidate for the development of PoC devices by offering the advantages of reliability, accessibility, scalability, low power consumption, and distinct cost.

Herpesviruses in Reptiles

Since the 1970s, several species of herpesviruses have been identified and associated with significant diseases in reptiles. Earlier discoveries placed these viruses into different taxonomic groups on the basis of morphological and biological characteristics, while advancements in molecular methods have led to more recent descriptions of novel reptilian herpesviruses, as well as providing insight into the phylogenetic relationship of these viruses. Herpesvirus infections in reptiles are often characterised by non-pathognomonic signs including stomatitis, encephalitis, conjunctivitis, hepatitis and proliferative lesions. With the exception of fibropapillomatosis in marine turtles, the absence of specific clinical signs has fostered misdiagnosis and underreporting of the actual disease burden in reptilian populations and hampered potential investigations that could lead to the effective control of these diseases. In addition, complex life histories, sampling bias and poor monitoring systems have limited the assessment of the impact of herpesvirus infections in wild populations and captive collections. Here we review the current published knowledge of the taxonomy, pathogenesis, pathology and epidemiology of reptilian herpesviruses.

A scope of mobile health solutions in COVID-19 pandemics

Background and aim

COVID-19 has become an international emergency. The use of digital solutions can be effective in managing, preventing, and overcoming the further spread of infectious disease outbreaks. Accordingly, the use of mobile-health (m-health) technologies has the potential to promote public health. This review aimed to study the application of m-health solutions for the management of the COVID-19 outbreak.

Methods

The search strategy was done in Medline (PubMed), Embase, IEEE, and Google Scholar by using related keywords to m-health and COVID-19 on July 6, 2020. English papers that used m-health technologies for the COVID-19 outbreak were included.

Results

Of the 2046 papers identified, 16 were included in this study. M-health had been used for various aims such as early detection, fast screening, patient monitoring, information sharing, education, and treatment in response to the COVID-19 outbreak. M-health solutions were classified into four use case categories: prevention, diagnosis, treatment, and protection. The mobile phone-based app and short text massaging were the most frequently used modalities, followed by wearables, portable screening devices, mobile-telehealth, and continuous telemetry monitor during the pandemics.

Conclusion

It appears that m-health technologies played a positive role during the COVID-19 outbreak. Given the extensive capabilities of m-health solutions, investigation and use of all potential applications of m-health should be considered for combating the current Epidemics and mitigating its negative impacts.

Point-of-care diagnostics for infectious diseases: From methods to devices

The current widespread of COVID-19 all over the world, which is caused by SARS-CoV-2 virus, has again emphasized the importance of development of point-of-care (POC) diagnostics for timely prevention and control of the pandemic. Compared with labor- and time-consuming traditional diagnostic methods, POC diagnostics exhibit several advantages such as faster diagnostic speed, better sensitivity and specificity, lower cost, higher efficiency and ability of on-site detection. To achieve POC diagnostics, developing POC detection methods and correlated POC devices is the key and should be given top priority. The fast development of microfluidics, micro electro-mechanical systems (MEMS) technology, nanotechnology and materials science, have benefited the production of a series of portable, miniaturized, low cost and highly integrated POC devices for POC diagnostics of various infectious diseases. In this review, various POC detection methods for the diagnosis of infectious diseases, including electrochemical biosensors, fluorescence biosensors, surface-enhanced Raman scattering (SERS)-based biosensors, colorimetric biosensors, chemiluminiscence biosensors, surface plasmon resonance (SPR)-based biosensors, and magnetic biosensors, were first summarized. Then, recent progresses in the development of POC devices including lab-on-a-chip (LOC) devices, lab-on-a-disc (LOAD) devices, microfluidic paper-based analytical devices (μPADs), lateral flow devices, miniaturized PCR devices, and isothermal nucleic acid amplification (INAA) devices, were systematically discussed. Finally, the challenges and future perspectives for the design and development of POC detection methods and correlated devices were presented. The ultimate goal of this review is to provide new insights and directions for the future development of POC diagnostics for the management of infectious diseases and contribute to the prevention and control of infectious pandemics like COVID-19.

Applications of CMOS Devices for the Diagnosis and Control of Infectious Diseases

Emerging infectious diseases such as coronavirus disease of 2019 (COVID-19), Ebola, influenza A, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) in recent years have threatened the health and security of the global community as one of the greatest factors of mortality in the world. Accurate and immediate diagnosis of infectious agents and symptoms is a key to control the outbreak of these diseases. Rapid advances in complementary metal-oxide-semiconductor (CMOS) technology offers great advantages like high accuracy, high throughput and rapid measurements in biomedical research and disease diagnosis. These features as well as low cost, low power and scalability of CMOS technology can pave the way for the development of powerful devices such as point-of-care (PoC) systems, lab-on-chip (LoC) platforms and symptom screening devices for accurate and timely diagnosis of infectious diseases. This paper is an overview of different CMOS-based devices such as optical, electrochemical, magnetic and mechanical sensors developed by researchers to mitigate the problems associated with these diseases.

Emerging Molecular Prospective of SARS-CoV-2: Feasible Nanotechnology Based Detection and Inhibition

The rapid dissemination of SARS-CoV-2 demonstrates how vulnerable it can make communities and is why it has attained the status of global pandemic. According to the estimation from Worldometer, the SARS-CoV-2 affected cases and deaths are exponentially increasing worldwide, marking the mortality rate as ∼3.8% with no probability of its cessation till now. Despite massive attempts and races among scientific communities in search of proper therapeutic options, the termination of this breakneck outbreak of COVID-19 has still not been made possible. Therefore, this review highlights the diverse molecular events induced by a viral infection, such as autophagy, unfolded protein response (UPR), and inflammasome, illustrating the intracellular cascades regulating viral replication inside the host cell. The SARS-CoV-2-mediated endoplasmic reticulum stress and apoptosis are also emphasized in the review. Additionally, host's immune response associated with SARS-CoV-2 infection, as well as the genetic and epigenetic changes, have been demonstrated, which altogether impart a better understanding of its epidemiology. Considering the drawbacks of available diagnostics and medications, herein we have presented the most sensitive nano-based biosensors for the rapid detection of viral components. Moreover, conceptualizing the viral-induced molecular changes inside its target cells, nano-based antiviral systems have also been proposed in this review.

Smartphone-based sickle cell disease detection and monitoring for point-of-care settings

Sickle cell disease (SCD) is a worldwide hematological disorder causing painful episodes, anemia, organ damage, stroke, and even deaths. It is more common in sub-Saharan Africa and other resource-limited countries. Conventional laboratory-based diagnostic methods for SCD are time-consuming, complex, and cannot be performed at point-of-care (POC) and home settings. Optical microscope-based classification and counting demands a significant amount of time, extensive setup, and cost along with the skilled human labor to distinguish the normal red blood cells (RBCs) from sickled cells. There is an unmet need to develop a POC and home-based test to diagnose and monitor SCD and reduce mortality in resource-limited settings. An early-stage and timely diagnosis of SCD can help in the effective management of the disease. In this article, we utilized a smartphone-based image acquisition method for capturing RBC images from the SCD patients in normoxia and hypoxia conditions. A computer algorithm is developed to differentiate RBCs from the patient's blood before and after cell sickling. Using the developed smartphone-based technique, we obtained similar percentage of sickle cells in blood samples as analyzed by conventional method (standard microscope). The developed method of testing demonstrates the potential utility of the smartphone-based test for reducing the overall cost of screening and management for SCD, thus increasing the practicality of smartphone-based screening technique for SCD in low-resource settings. Our setup does not require any special storage requirements. This is the characteristic advantage of our technique as compared to other hemoglobin-based POC diagnostic techniques.

Current and Perspective Diagnostic Techniques for COVID-19

Since late December 2019, the coronavirus pandemic (COVID-19; previously known as 2019-nCoV) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been surging rapidly around the world. With more than 1,700,000 confirmed cases, the world faces an unprecedented economic, social, and health impact. The early, rapid, sensitive, and accurate diagnosis of viral infection provides rapid responses for public health surveillance, prevention, and control of contagious diffusion. More than 30% of the confirmed cases are asymptomatic, and the high false-negative rate (FNR) of a single assay requires the development of novel diagnostic techniques, combinative approaches, sampling from different locations, and consecutive detection. The recurrence of discharged patients indicates the need for long-term monitoring and tracking. Diagnostic and therapeutic methods are evolving with a deeper understanding of virus pathology and the potential for relapse. In this Review, a comprehensive summary and comparison of different SARS-CoV-2 diagnostic methods are provided for researchers and clinicians to develop appropriate strategies for the timely and effective detection of SARS-CoV-2. The survey of current biosensors and diagnostic devices for viral nucleic acids, proteins, and particles and chest tomography will provide insight into the development of novel perspective techniques for the diagnosis of COVID-19.

A smartphone-based biomedical sensory system

Disease diagnostics, food safety monitoring and environmental quality monitoring are the key means to safeguard human health. However, conventional detection devices for health care are costly, bulky and complex, restricting their applications in resource-limited areas of the world. With the rapid development of biosensors and the popularization of smartphones, smartphone-based sensing systems have emerged as novel detection devices that combine the sensitivity of biosensors and diverse functions of smartphones to provide a rapid, low-cost and convenient detection method. In these systems, a smartphone is used as a microscope to observe and count cells, as a camera to record fluorescence images, as an analytical platform to analyze experimental data, and as an effective tool to connect detection devices and online doctors. These systems are widely used for cell analysis, biochemical analysis, immunoassays, and molecular diagnosis, which are applied in the fields of disease diagnostics, food safety monitoring and environmental quality monitoring. Therefore, we discuss four types of smartphone-based sensing systems in this review paper, specifically in terms of the structure, performance and efficiency of these systems. Finally, we give some suggestions for improvement and future prospective trends.

Mobile-based and open-source case detection and infectious disease outbreak management systems: a review

In this paper we perform a rapid review of existing mobile-based, open-source systems for infectious disease outbreak data collection and management. Our inclusion criteria were designed to match the PANDORA-ID-NET consortium’s goals for capacity building in sub-Saharan Africa, and to reflect the lessons learned from the 2014–16 West African Ebola outbreak. We found eight candidate systems that satisfy some or most of these criteria, but only one (SORMAS) fulfils all of them. In addition, we outline a number of desirable features that are not currently present in most outbreak management systems.

Virus detection using nanosensors

A smart city has a bright and sustainable way to integrate services together and can monitor/control them using intelligent devices called sensors to preserve the efficient utilization of resources. Sensors are distributed everywhere in smart cities. They can be employed to monitor health care, transportation, infrastructure, building, surveillance, government, etc. Especially, nanosensors hold great impact to turn the current techniques for the detection of viruses. With the facility of real-time sensing, there is no need for regular inspections for maintenance and surveying, which results in reduced costs and time wastage. Definitely, common sensing platforms need persistent updates to address increasing doubts in the detection of viruses as they modify quickly and spread from person to person, pointing the urgency of early detection. In this chapter the introduction is briefly described in Section 30.1. The fundamental of nanosensors is explained in Section 30.2. The significance and applications of nanosensors in virus detection are extensively discussed in Sections 30.3 and 30.4. Section 30.5 consists of various challenges and outlook.

Smartphones as mobile microbiological laboratories

BACKGROUND

Point-of-care (POC) tests provide an alternative to traditional laboratory-based diagnostics due to reduced turnaround times, portability and no need for highly trained laboratory staff. Smartphones can be integrated into POC platforms because of their multifunctionality, enabled by high-quality digital cameras, computer processors, touchscreen interface and wireless data transfer. It is predicted that by 2020 about 80% of the world population will use smartphones.

OBJECTIVES

This review summarizes the current state of the art regarding smartphones as part of a mobile microbiological laboratory.

SOURCES

Selected peer-reviewed publications on smartphone-based microbiological testing published between January 2015 and August 2019.

CONTENT

Smartphones can be used as instrumental interfaces, dongles, microscopes or test result readers (brightfield, colorimetric and fluorescent measurements), or combined with amplification methods such as loop-mediated isothermal amplification (LAMP) tests in portable POC test platforms. Smartphone-based tests offer opportunities for microbiological diagnostics in remote areas and both resource-limited and resource-rich settings. Wireless connectivity may facilitate epidemiological studies and creation of spatiotemporal disease prevalence maps. However, the current analytical performance of many smartphone-based POC tests must be improved and carefully validated in clinical settings by comparison with current diagnostic standards.

IMPLICATIONS

Recent developments in smartphone-based POC tests for infectious diseases are promising, as evidenced by results from many proof-of-concept studies. Further progress will foster large-scale implementation of smartphone-based POC as mobile microbiological laboratories in the near future.

Design of a 3D printed smartphone microscopic system with enhanced imaging ability for biomedical applications

Portable, low-cost smartphone platform microscopic systems have emerged as a potential tool for imaging of various micron and submicron scale particles in recent years (Ozcan; Pirnstill and Coté; Breslauer et al.; Zhu et al.). In most of the reported works, it involves either the use of sophisticated optical set-ups along with a high-end computational tool for postprocessing of the captured images, or it requires a high-end configured smartphone to obtain enhanced imaging of the sample. Present work reports the working of a low-cost, field-portable 520× optical microscope using a smartphone. The proposed smartphone microscopic system has been designed by attaching a 3D printed compact optical set-up to the rear camera of a regular smartphone. By using cloud-based services, an image processing algorithm has been developed which can be accessed anytime through a mobile broadband network. Using this facility, the quality of the captured images can be further enhanced, thus obviating the need for dedicated computational tools for postprocessing of the images. With the designed microscopic system, an optical resolution ∼2 µm has been obtained. Upon postprocessing, the resolution of the captured images can be improved further. It is envisioned that with properly designed optical set-up in 3D printer and by developing an image processing application in the cloud, it is possible to obtain a low-cost, user-friendly, field-portable optical microscope on a regular smartphone that performs at par with that of a laboratory-grade microscope. LAY DESCRIPTION: With the ever-improving features both in hardware and software part, smartphone becomes ubiquitous in the modern civilised society with approximately 8.1 billion cell phone users across the world, and ∼40% of them can be considered as smartphones. This technology is undoubtedly the leading technology of the 21st century. Very recently, various researchers across the globe have utilised different sensing components embedded in the smartphone to convert it into a field-portable low-cost and user-friendly tool which can be used for different sensing and imaging purposes. By using simple optical components such as lens, pinhole, diffuser etc. and the camera of the smartphone, various groups have converted the phone into a microscopic imaging system. Again, by removing the camera lenses of the phone, holography images of microscopic particles by directly casting its shadows on the CMOS sensor on the phone has been demonstrated. The holographic images have subsequently been processed using the dedicated computational tool, and the original photos of the samples can be obtained. All the reported smartphone-based microscopic systems either suffer from relatively low field-of-view (FOV), resolution or it needs a high computational platform. Present work, demonstrate an alternative approach by which a reasonably good resolution (<2 µm) along with high optical magnification (520×) and a large FOV (150 µm) has been obtained on a regular smartphone. For postprocessing of the captured images an image processing algorithm has been developed in the cloud and the same can be accessed by the smartphone application, obviating the need of dedicated computational tool and a high-end configured smartphone for the proposed microscope. For the development of the proposed microscopic system, a simple optical set-up has been fabricated in a 3D printer. The set-up houses all the required optical components and the sample specimen with the 3D-printed XY stage, and it can be attached easily to the rear camera of the smartphone. Using the proposed microscopic system, enhanced imaging of USAF target and red blood cells have been successfully demonstrated. With the readily available optical components and a regular smartphone, the net cost involvement is significantly low (less than $250, including the smartphone). We envisioned that the designed system could be utilised for point-of-care diagnosis in resource-poor settings where access to the laboratory facilities is very limited.