Surface-enhanced Raman scattering (SERS) has recently gained increasing attention for the detection of trace quantities of biomolecules due to its excellent molecular specificity, ultrasensitivity, and quantitative multiplex ability. Specific single or multiple biomarkers in complex biological environments generate strong and distinct SERS spectral signals when they are in the vicinity of optically active nanoparticles (NPs). When multivariate chemometrics are applied to decipher underlying biomarker patterns, SERS provides qualitative and quantitative information on the inherent biochemical composition and properties that may be indicative of healthy or diseased states. Moreover, SERS allows for differentiation among many closely-related causative agents of diseases exhibiting similar symptoms to guide early prescription of appropriate, targeted and individualised therapeutics. This review provides an overview of recent progress made by the application of SERS in the diagnosis of cancers, microbial and respiratory infections. It is envisaged that recent technology development will help realise full benefits of SERS to gain deeper insights into the pathological pathways for various diseases at the molecular level.