g., serum or plasma), and some diseases are preferably diagnosed using other specimen types (Supplemental Table D). Evaluation of dried serum spots to detect HAV antibodies showed a sensitivity and specificity selleck bio of 100% compared with liquid serum,111 and HIV ELISA had a sensitivity of 83%.112 NAATs of dried serum spots perform very well for HAV (92.3% and 100%) and HCV (100% and 100%) sensitivity and specificity, respectively, versus liquid serum.111,113 Both hepatitis viruses showed a 10-fold fall in viral load after storage for 4 weeks on paper at room temperature.111,113 Three studies used dried plasma spots and one study used dried breast milk spots compared with liquid plasma for HIV quantitative PCR.114�C116 HIV RNA on filter paper was stable at room temperature for > 1 year.

Dried buffy coat spots may be used as a substrate to detect HIV proviral DNA. When dried on filter paper and compared with liquid samples, there was 100% concordance between results.117 Although bone marrow is a difficult sample to obtain, it is the most sensitive substrate for diagnosis of visceral leishmaniasis. In one small study, 34 of 35 patients suspected of having the disease on clinical grounds were positive by NAAT on dried bone marrow spots. This test was more sensitive than bone marrow microscopy.118 Cutaneous and mucocutaneous samples may be scraped, aspirated, or directly impressed onto filter paper to diagnose leishmaniasis and using slit skin smears, leprosy. The sensitivity of PCR on lesions impressed onto paper for leishmaniasis ranged from 92.

3% to 100% and specificity was 100% compared with PCR on tissue samples119,120; parasite speciation was also possible. Mycobacterium leprae was detected by PCR from slit skin smears on filter paper (60%) in patients with known leprosy as frequently as from slit skin smears stored in ethanol (58%).121 Sputum and saliva have been more widely examined. Only 67% of serologically positive measles patients were positive by PCR on dried saliva spots, which were inferior to whole-saliva and throat swabs.122 Detection of malaria DNA in dried saliva and dried urine spots was less sensitive than blood microscopy.123 Dried induced sputum and bronchoalveolar lavage fluid spots to identify Pneumocystis jirovecii by PCR had reported sensitivity of 67% and 90�C91%, respectively, compared with microscopic examination of liquid samples.

124 Drug_discovery Dried cervical smear fluid spots were evaluated for detection of Human Papilloma Virus by PCR. Concordance of 94�C100% was reported in two of three studies compared with PCR directly on smear or cytobrush samples.125�C127 Dried cerebrospinal fluid (CSF) spots in children with meningitis were assayed by PCR for Streptococcus pneumoniae and Haemophilus influenzae with a sensitivity of 92% and 70% and specificity of 99% and 100%, respectively, compared with direct CSF PCR.