Zika virus diagnosis: challenges and solutions.

BACKGROUND: Since its sudden appearance and link to microcephaly in 2015, the number of PubMed references for Zika virus (ZIKV) has risen from 181 to 5163, at time of writing, with a vast proportion focused on the consequences of ZIKV infection during pregnancy. This level of attention underlies increased demand for sensitive and specific diagnostic tools able to assess risk to an unborn child, as well as to understand the dynamics and consequences of viral persistence. AIM: Review the expanding knowledge on ZIKV persistence and diagnostic challenges and summarize current advancements in detection. SOURCES: Peer-reviewed articles based on the search terms 'Zika' and 'ZIKV' combined with the terms 'diagnostics' 'point-of-care diagnostics' 'viral load' 'persistence' 'detection' 'treatment' 'nucleic acid amplification testing' 'microsphere' 'PVRT' 'RVNT' 'RT-LAMP' 'NASBA' SIBA' 'RPA' 'SHERLOCK' 'ELISA', and 'TMA' as well as laboratory experience of the authors. CONTENT: Topics covered include the emergence of the ZIKV epidemic, pathogenesis of ZIKV infection, the nature of ZIKV persistence, complications in serological diagnosis, tried and novel diagnostic laboratory techniques, and a recent accounting of point-of-care testing (POCT) methods. IMPLICATIONS: Surveillance and research in the case of ZIKV has shifted into a more rapid and coordinated worldwide directive than has occurred with most viral epidemics to date. The particular concentration of outbreaks in resource-limited settings increases the need for simple assays capable of reliable, inexpensive, high-throughput ZIKV diagnosis. This review serves to both catalogue current diagnostic options and consider their suitability at point-of-care.