External Quality Assurance (EQA) in Diagnostic Electron Microscopy (DEM) of Infectious Diseases: Aims and Roots, Results and Perspectives

Abstract

During the 1970s–80s, besides virus culture diagnostic electron microscopy (DEM)1 became a prime technique in clinical virology and laboratory diagnosis of infectious diseases. Today DEM appears on the retreat for several reasons, e.g., routine DEM is often replaced by molecular, highly sensitive and high throughput methods. Nevertheless, DEM needs to be kept in the diagnostic repertoire to cope with emerging infections, clinical emergencies, quality control (QC), and potential bioterrorism (Biel and Gelderblom, 1999 a; Curry et al., 2006; Gelderblom, 2003 a, b; Gelderblom, 2012; Gentile and Gelderblom, 2005; Hazelton and Gelderblom, 2003; Miller, 2003). As the consequences of an infection or an attack with biological weapons are amenable to intervention only for some hours, the speed of DEM is an essential advantage (Gentile and Gelderblom, 2014; Biel and Madeley, 2001; Madeley, 2003). Speed and “open view” of DEM allow an early and/or a differential diagnosis and also the diagnosis of multiple and/or unexpected infections down to the family level (Almeida, 1963, 1980; Hazelton and Gelderblom, 2003; Goldsmith and Miller, 2009), occasionally also beyond the family level (Goldsmith, 2014). As the quality of DEM depends to a great extent on expertise and personal skills, it is essential to run DEM in a quality controlled way and supported by continuous practicing and education (Gelderblom, 2001, PDF). After a brief description of historic aspects of QC in DEM of infectious diseases, of its principles and aims, this review focuses on the external quality assurance scheme in DEM (EQA-EMV) and the system of meetings and DEM lab courses run by the Robert Koch Institute (RKI) in Berlin since 1993. This field is depicted on the wider background of the history of the EM group in Virology, founded in 1971 at the RKI.