The evolution of rapid antigen detection systems and their application for COVID-19 and other serious respiratory infectious diseases

Making the correct diagnosis of a patient seeking medical attention is the ultimate goal of a practicing physician, irrespective of whether the cause of the patient's condition is infectious or non-infectious. Antigen detection tests can be used to aid in the diagnosis of various infectious-related disorders including COVID-19 where it has become especially important due to the serious nature of this disease and its worldwide prevalence. These tests closely mimic one of the earliest prototypes – the urine pregnancy test – and as a result they have gained wide acceptance based on their overall simplicity, low cost and relative accuracy. In some situations, especially as a screening test, they can be used instead of the more technically demanding and complex molecular and serologic assays that are still useful and helpful under many different circumstances. Antigen detection systems are based on finding a particular immunogenic component, typically a protein or polysaccharide molecule, that is both unique and an integral part of the pathogen or other biological entity. Because these tests generally provide only qualitative results, they often need to be supplemented with other and sometimes more sophisticated laboratory-based diagnostic procedures to corroborate the initial test result. In this review, we first describe general background information on antigen-detection methods, including any unique aspects of their overall design, and then follow with an extensive description on the merits and limitations of these tests for detecting COVID-19 and, to a lesser extent, for other serious respiratory diseases caused by three common bacterial pathogens – Streptococcus pyogenes, Streptococcus pneumoniae and Legionella pneumophila.