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Li L, Chen QY, Li YY, Wang YF, Yang ZF, Zhong NS. Comparison among nasopharyngeal swab, nasal wash, and oropharyngeal swab for respiratory virus detection in adults with acute pharyngitis. BMC Infect Dis 2013; 13:281. [PMID: 23786598 PMCID: PMC3698019 DOI: 10.1186/1471-2334-13-281] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 06/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute pharyngitis is frequently seen in primary care. Acute viral pharyngitis may be easily misdiagnosed as acute bacterial pharyngitis. Laboratory-confirmed diagnosis of respiratory viruses is recommended. The purpose of this study was to compare the sensitivities among oropharyngeal swab (OPS), nasopharyngeal swab (NPS), and nasal wash (NW) in adults with acute pharyngitis. METHODS OPS, NPS, and NW were obtained from each participant with acute pharyngitis. The specimens were tested for 15 respiratory viruses by TaqMan real-time polymerase chain reaction. A sample was considered to be a true positive if any of the specimens was positive. The sensitivities among samples were compared by chi-square test or Fisher's exact test, as appropriate. RESULTS One hundred three triple samples collected consecutively by OPS, NPS, and NW were obtained. In 73 patients, one or more viruses were detected by any of the three methods. Among all viruses, the sensitivity of NPS was significantly higher than that of NW (74% vs. 49%, respectively; p < 0.01) and OPS (74% vs. 49%, respectively; p < 0.01). CONCLUSIONS Flocked NPS collection may be the most effective alternative to NW and OPS for detection of respiratory viruses in adults with acute pharyngitis using TaqMan real-time polymerase chain reaction.
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Affiliation(s)
- Li Li
- Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases (Guangzhou Medical University), The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou 510120, China
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Real-time detection of influenza a, influenza B, and respiratory syncytial virus a and B in respiratory specimens by use of nanoparticle probes. J Clin Microbiol 2010; 48:3997-4002. [PMID: 20826644 DOI: 10.1128/jcm.01118-10] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Seasonal epidemics of influenza and respiratory syncytial virus are responsible for significant morbidity and mortality worldwide. Infrequently, novel or reemergent strains of influenza A virus have caused rapid, severe global pandemics resulting in millions of fatalities. The ability to efficiently and accurately detect and differentiate respiratory viruses is paramount for effective treatment, infection control, and epidemiological surveillance. We evaluated the ability of two FDA-cleared nucleic acid-based tests, the semiautomated respiratory virus nucleic acid test (VRNAT) and the fully automated respiratory virus nucleic acid test SP (RVNAT(SP)) (Nanosphere Inc., Northbrook, IL) to detect influenza A virus, influenza B virus, and respiratory syncytial virus A and B (RSV A/B) from clinical nasopharyngeal swab specimens. Detection of viral RNA in both tests is based on nucleic acid amplification followed by hybridization to capture probes immobilized on a glass slide. A novel technology utilizing gold nanoparticle-conjugated probes is utilized to detect the presence of captured target DNA. This microarray-based approach to detection has proven to be more sensitive than the traditional culture/direct fluorescent-antibody assay (DFA) method for detecting RSV and influenza viruses in clinical specimens, including the novel 2009 H1N1 strain. Specifically, we report 98.0% sensitivity and 96.5% specificity for the VRNAT compared to culture/DFA. Further, the VRNAT detected virus in an additional 58% of specimens that were culture negative. These data were confirmed using bidirectional sequencing. Evaluation of the fully automated RVNAT(SP), which is built on the same detection technology as the VRNAT but contains an updated processor enabling complete automation, revealed the two tests to be functionally equivalent. Thus, the RVNAT(SP) is a fully automated sample-to-result test capable of reliable detection of select respiratory viruses directly from clinical specimens in 3.5 h.
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Foo H, Blyth C, van Hal S, McPhie K, Ratnamohan M, Fennell M, Ba Alawi F, Rawlinson W, Adamson S, Armstrong P, Dwyer D. Laboratory test performance in young adults during influenza outbreaks at World Youth Day 2008. J Clin Virol 2009; 46:384-6. [DOI: 10.1016/j.jcv.2009.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 09/03/2009] [Accepted: 09/14/2009] [Indexed: 11/30/2022]
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Identification of respiratory viruses in adults: nasopharyngeal versus oropharyngeal sampling. J Clin Microbiol 2009; 47:3439-43. [PMID: 19726607 DOI: 10.1128/jcm.00886-09] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The optimal method for identifying respiratory viruses in adults has not been established. The objective of the study was to compare the sensitivities of three sampling methods for this purpose. One thousand participants (mean age, 63.1 +/- 17.8 years) were included. Of these, 550 were patients hospitalized for acute febrile lower respiratory tract infections and 450 were controls. Oropharyngeal swabs (OPS), nasopharyngeal swabs (NPS), and nasopharyngeal washings (NPW) were obtained from each participant and were tested for 12 respiratory viruses by a multiplex hydrolysis probes-based quantitative real-time reverse transcription-PCR. Patients were defined as positive for a specific virus if the virus was identified by at least one sampling method. In all, 251 viruses were identified in 244 participants. For the detection of any virus, the sensitivity rates for OPS, NPS, and NPW were 54.2%, 73.3%, and 84.9%, respectively (for OPS versus NPS and NPW, P < 0.00001; for NPS versus NPW, P < 0.003). Maximal sensitivity was obtained only with sampling by all three methods. The same gradation of sensitivity for the three sampling methods was found when influenza viruses, coronaviruses, and rhinoviruses were analyzed separately. The three sampling methods yielded equal sensitivity rates for respiratory syncytial virus. We conclude that nasopharyngeal sampling has a higher rate of sensitivity than oropharyngeal sampling and that the use of NPW has a higher rate of sensitivity than the use of NPS with a rigid cotton swab for the identification of respiratory viruses in adults. Sampling by all three methods is required for the maximal detection of respiratory viruses.
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Optimal sampling sites and methods for detection of pathogens possibly causing community-acquired lower respiratory tract infections. J Clin Microbiol 2008; 47:21-31. [PMID: 19020070 DOI: 10.1128/jcm.02037-08] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Petric M, Comanor L, Petti CA. Role of the laboratory in diagnosis of influenza during seasonal epidemics and potential pandemics. J Infect Dis 2007; 194 Suppl 2:S98-110. [PMID: 17163396 DOI: 10.1086/507554] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Laboratory diagnosis of influenza is critical to its treatment and surveillance. With the emergence of novel and highly pathogenic avian influenza viruses, the role of the laboratory has been further extended to include isolation and subtyping of the virus to monitor its appearance and facilitate appropriate vaccine development. Recent progress in enhancing testing for influenza promises to both improve the management of patients with influenza and decrease associated health care costs. The present review covers the technological characteristics and utilization features of currently available diagnostic tests, the factors that influence the selection of such tests, and the developments that are essential for pandemic preparedness.
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Affiliation(s)
- Martin Petric
- British Columbia Centre for Disease Control, Vancouver, Canada
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Mehlmann M, Bonner AB, Williams JV, Dankbar DM, Moore CL, Kuchta RD, Podsiad AB, Tamerius JD, Dawson ED, Rowlen KL. Comparison of the MChip to viral culture, reverse transcription-PCR, and the QuickVue influenza A+B test for rapid diagnosis of influenza. J Clin Microbiol 2007; 45:1234-7. [PMID: 17301287 PMCID: PMC1865827 DOI: 10.1128/jcm.02202-06] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The performance of a diagnostic microarray (the MChip assay) for influenza was compared in a blind study to that of viral culture, reverse transcription (RT)-PCR, and the QuickVue Influenza A+B test. The patient sample data set was composed of 102 respiratory secretion specimens collected between 29 December 2005 and 2 February 2006 at Scott & White Hospital and Clinic in Temple, Texas. Samples were collected from a wide range of age groups by using direct collection, nasal/nasopharyngeal swabs, or nasopharyngeal aspiration. Viral culture and the QuickVue assay were performed at the Texas site at the time of collection. Aliquots for each sample, identified only by study numbers, were provided to the University of Colorado and Vanderbilt University teams for blinded analysis. When referenced to viral culture, the MChip exhibited a clinical sensitivity of 98% and a clinical specificity of 98%. When referenced to RT-PCR, the MChip assay exhibited a clinical sensitivity of 92% and a clinical specificity of 98%. While the MChip assay currently requires 7 to 8 h to complete the analysis, a significant advantage of the test for influenza virus-positive samples is simultaneous detection and full subtype identification for the two subtypes currently circulating in humans (A/H3N2 and A/H1N1) and avian (A/H5N1) viruses.
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Affiliation(s)
- Martin Mehlmann
- Department of Chemistry and Biochemistry, UCB 215, University of Colorado at Boulder, Boulder, CO 80309, USA
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Leland DS, Ginocchio CC. Role of cell culture for virus detection in the age of technology. Clin Microbiol Rev 2007; 20:49-78. [PMID: 17223623 PMCID: PMC1797634 DOI: 10.1128/cmr.00002-06] [Citation(s) in RCA: 303] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Viral disease diagnosis has traditionally relied on the isolation of viral pathogens in cell cultures. Although this approach is often slow and requires considerable technical expertise, it has been regarded for decades as the "gold standard" for the laboratory diagnosis of viral disease. With the development of nonculture methods for the rapid detection of viral antigens and/or nucleic acids, the usefulness of viral culture has been questioned. This review describes advances in cell culture-based viral diagnostic products and techniques, including the use of newer cell culture formats, cryopreserved cell cultures, centrifugation-enhanced inoculation, precytopathogenic effect detection, cocultivated cell cultures, and transgenic cell lines. All of these contribute to more efficient and less technically demanding viral detection in cell culture. Although most laboratories combine various culture and nonculture approaches to optimize viral disease diagnosis, virus isolation in cell culture remains a useful approach, especially when a viable isolate is needed, if viable and nonviable virus must be differentiated, when infection is not characteristic of any single virus (i.e., when testing for only one virus is not sufficient), and when available culture-based methods can provide a result in a more timely fashion than molecular methods.
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Affiliation(s)
- Diane S Leland
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
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Ohmit SE, Monto AS. Symptomatic predictors of influenza virus positivity in children during the influenza season. Clin Infect Dis 2006; 43:564-8. [PMID: 16886147 DOI: 10.1086/506352] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Accepted: 05/28/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Symptomatic predictors of the etiology of infectious diseases are necessary when quick action is required in treatment, as with cases of influenza or anthrax, or for when patient isolation is required, as with cases of severe acute respiratory syndrome (SARS). Predictors of influenza virus infection during the influenza season have previously been evaluated in adult studies of the antiviral agent zanamivir; cough and temperature > or =37.8 degrees C predicted influenza virus positivity in 79% of those evaluated. METHODS Fever and other respiratory symptoms were examined to determine their value in predicting influenza virus-positive status in children. Data analyzed were from a clinical trial of zanamivir in children 5-12 years of age and from a trial of oseltamivir in children 1-12 years of age. RESULTS In the pediatric study of zanamivir, as in the adult zanamivir study, cough and fever were the best predictors of influenza virus infection; a temperature > or =38.2 degrees C plus cough predicted 83% (95% CI, 79%-88%) of illnesses that were determined to be influenza virus positive. Cough (positive predictive value, 70%; 95% CI, 64%-75%), but not fever, was the best predictor of influenza virus-positive status in children aged 5-12 years in the oseltamivir trials, but neither cough nor fever were successful predictors in young children 1-4 years of age. The latter findings appeared to be the result of less symptomatic diversity among patients recruited for this trial, such that subjects who were determined to be influenza virus positive and subjects who were influenza virus negative had similar symptoms. CONCLUSIONS The results of these studies suggest that, during the influenza season, symptomatic predictors of influenza virus infection are applicable to identification of cases in children, although confirmation of predictive values in subjects 1-4 years of age may require further study of additional signs/symptoms.
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Affiliation(s)
- Suzanne E Ohmit
- University of Michigan School of Public Health, Ann Arbor, Michigan 48109-2029, USA
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Ito Y, Sumi H, Kato T. Evaluation of influenza vaccination in health-care workers, using rapid antigen detection test. J Infect Chemother 2006; 12:70-2. [PMID: 16648945 DOI: 10.1007/s10156-005-0424-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Accepted: 12/16/2005] [Indexed: 11/29/2022]
Abstract
A study was conducted to assess the effectiveness of trivalent influenza vaccine in preventing influenza and reducing absenteeism in health-care workers of Gifu Red Cross Hospital during the 2002-2003 influenza season. Questionnaires were distributed to 370 health-care workers, and 366 were returned showing that 237 had received influenza vaccine and 129 were unvaccinated. The criterion for influenza was febrile episodes with a positive reaction on a rapid antigen detection test. Among vaccine recipients, the number of influenza infections was 3.4 per 100 subjects, compared with 8.5 per 100 subjects in nonrecipients (P = 0.034), and the number of days absent from work per 100 subjects was 9.5, compared with 15.1 per 100 subjects in nonrecipients (P = 0.0003). The prevalence of adverse reactions to the vaccine was rather low. No serious adverse reactions were recorded and no one was absent from work because of adverse reactions. It is concluded that influenza vaccine is effective in preventing influenza and reducing absenteeism in health-care workers. The results of this study support recommendations for influenza vaccination in health-care workers.
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Affiliation(s)
- Yoichiro Ito
- Department of Internal Medicine, Gifu Red Cross Hospital, 3-36 Iwakura-cho, Gifu 502-8511, Japan.
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Fader RC. Comparison of the Binax NOW Flu A enzyme immunochromatographic assay and R-Mix shell vial culture for the 2003-2004 influenza season. J Clin Microbiol 2006; 43:6133-5. [PMID: 16333112 PMCID: PMC1317202 DOI: 10.1128/jcm.43.12.6133-6135.2005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Binax NOW Flu A enzyme immunochromatographic assay was compared to viral culture with R-Mix shell vials for 455 nasal-wash or nasal-aspirate specimens. The overall sensitivity, specificity, positive predictive value, and negative predictive value of the assay were 64.9%, 98.4%, 89.3%, and 93.2%, respectively. However, the assay sensitivity decreased significantly with increasing patient age.
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Affiliation(s)
- Robert C Fader
- Microbiology, Scott and White Memorial Hospital, 2401 South 31st Street, Temple, TX 76508, USA.
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Yan X, Schielke EG, Grace KM, Hassell C, Marrone BL, Nolan JP. Microsphere-based duplexed immunoassay for influenza virus typing by flow cytometry. J Immunol Methods 2004; 284:27-38. [PMID: 14736414 DOI: 10.1016/j.jim.2003.09.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We have developed a rapid, duplexed microsphere-based immunoassay for the characterization of influenza virus types that has the potential to overcome many of the limitations of current detection methods. The assay uses microspheres of two sizes, each coupled to an influenza type A- or type B-specific monoclonal antibody (MAb), to capture influenza viruses in the sample. A cocktail of fluorescently labeled, influenza-specific polyclonal antibodies then binds the captured viruses. The sandwich complexes are measured using a multiparameter flow cytometer. The assay can distinguish between influenza types A and B in a single reaction with good reproducibility and high sensitivity. Detection sensitivity is much higher than that of commercially available influenza diagnosis quick kits: the FLU OIA (Thermo Biostar) kit and the Directigen Flu A+B kit (Becton Dickinson). The multiplexing capabilities of the current assay, which are not possible with enzyme-linked immunosorbent assay (ELISA) and the commercially available kits, reduce sample handling and consume fewer costly reagents. This assay represents a more efficient and sensitive method of characterizing influenza types. With inclusion of influenza subtype-specific antibodies as capture antibodies, this microsphere-based immunoassay can be expanded to differentiate among influenza types and subtypes in a single reaction to improve world-wide influenza surveillance.
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Affiliation(s)
- Xiaomei Yan
- Bioscience Division, MS M888, Los Alamos National Laboratory, Los Alamos, NM 87545, USA.
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Abstract
BACKGROUND Clinical diagnosis and empiric therapy have been strategies for treatment of suspected influenza in high-risk patients, but rapid tests for influenza have been introduced to help confirm cases. The aim of this study was to determine when rapid testing, empiric treatment, or no treatment is most cost-beneficial for high-risk adults with influenzalike respiratory tract illnesses. METHODS We performed a cost-benefit analysis evaluating the comparative advantage of the strategies of empiric therapy, no treatment, or test and treat patients whose tests are positive. The analysis focused on a hypothetical population of patients who are at a high-risk for complications of influenza. Our main outcome was the cost of care for an episode of influenza taken from the human capital perspective. RESULTS For older anti-influenza drugs (amantadine and rimantadine), rapid testing is not as cost-beneficial as empiric treatment, even when the prevalence of influenza is low. For the neuraminidase inhibitors, there is a narrow window of disease prevalence between 30% and 40% where testing is most cost-beneficial. When the disease likelihood is above this window, empiric treatment is preferred. Below this window, no treatment is more cost-beneficial. Even under the most favorable conditions, testing is preferred only for a small range of prevalence rates of influenza. CONCLUSION When clinicians are planning to use the nonneuraminidase inhibitors to treat influenza, rapid testing is not the most cost-beneficial approach. Even when the more expensive neuraminidase inhibitors will be used, testing has a limited role in managing influenza in high-risk patients.
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Affiliation(s)
- William J Hueston
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
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Abstract
Influenza is the most important cause of acute respiratory illness leading to hospitalization among children during community epidemics. This illness can cause extensive nosocomial outbreaks with serious morbidity and mortality among specific groups of children. Paediatric patients with community-acquired influenza and healthcare workers are the main reservoir for the nosocomial spread of the virus. During epidemics in the community, testing for influenza should be requested in all children with compatible symptoms admitted in the hospital, and measures should be introduced for the prevention or early control of an outbreak. Recent advances in the management of influenza include rapid diagnoses based on antigen detection and the identification of the new neuraminidase inhibitors zanamivir and oseltamivir. Annual vaccination against influenza of children with high-risk conditions, their family members and healthcare workers is the principle measure for the prevention of nosocomial outbreaks. Although vaccination against influenza appears to be cost-effective at all ages in terms of prevention of illness, related hospitalizations, deaths, reduction of healthcare costs and productivity loss, vaccination coverage among target groups is limited.
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Affiliation(s)
- H C Maltezou
- Second Department of Pediatrics, P. & A. Kyriakou Children's Hospital, University of Athens, 11527, Athens, Greece.
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Ruest A, Michaud S, Deslandes S, Frost EH. Comparison of the Directigen flu A+B test, the QuickVue influenza test, and clinical case definition to viral culture and reverse transcription-PCR for rapid diagnosis of influenza virus infection. J Clin Microbiol 2003; 41:3487-93. [PMID: 12904343 PMCID: PMC179849 DOI: 10.1128/jcm.41.8.3487-3493.2003] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The diagnostic performances of the clinical case definition of influenza virus infection based on the combination of fever and cough and of two rapid influenza diagnostic tests, the Directigen Flu A+B test (Directigen; BD Diagnostic Systems, Sparks, Md.) and the QuickVue influenza test (QuickVue; Quidel, San Diego, Calif.), were compared to those of viral culture and an in-house reverse transcription (RT)-PCR during the 2000-2001 flu season. Two hundred consecutive nasopharyngeal aspirates were analyzed from 192 patients, including 122 adults and 70 children. Viral culture identified influenza virus A in 16 samples and influenza virus B in 55 samples, whereas RT-PCR identified influenza virus A in 21 samples and influenza virus B in 64 samples. When RT-PCR was used as the reference standard, the likelihood ratios for a positive test were 40.0 for Directigen, 8.6 for QuickVue, and 1.4 for the combination of fever and cough, whereas the likelihood ratios for a negative test were 0.22, 0.16, and 0.48, respectively. Our study suggests that (i). the poor specificity (35 to 58%) and the poor positive predictive value (41 to 60%) of the clinical case definition of influenza preclude its use for prediction of influenza virus infections during epidemics, especially when infection control decision making in the hospital setting is considered; (ii). Directigen has a higher diagnostic yield than QuickVue but is associated with a larger number of invalid results; (iii). the sensitivities of the rapid diagnostic tests are significantly lower with samples from adults than with samples from children, with the rates of false-negative results reaching up to 29%; and (iv). RT-PCR detects more cases of influenza than viral culture, and this greater accuracy makes it a more useful reference standard.
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Affiliation(s)
- Annie Ruest
- Department of Microbiology and Infectious Diseases, Faculté de Médecine de l'Université de Sherbrooke, Sherbrooke, Québec, Canada
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Wunderli W, Thomas Y, Müller DA, Dick M, Kaiser L. Rapid antigen testing for the surveillance of influenza epidemics. Clin Microbiol Infect 2003; 9:295-300. [PMID: 12667239 DOI: 10.1046/j.1469-0691.2003.00650.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the use of a 'near patient' test for rapid antigen detection to obtain the more timely acquisition of data for the surveillance of influenza epidemics. METHODS To the classical cell culture system used for the surveillance of influenza, a 'near patient' test was added. The cell culture method was applied for the detection of influenza virus in specimens sent to our laboratory. In contrast, the 'near patient' test was used directly by practitioners in their practices to screen patients for the presence of influenza virus antigen. RESULTS The results for two seasons are presented. The 'near patient' test was able to detect a developing influenza epidemic with the same reliability as clinical consultation reports for influenza-like illness or the conventional culture method. However, the results obtained were available 9 days earlier on average, compared with cell culture. Because of this, results concerning the epidemics could be announced via the internet more rapidly. Although the 'near patient' test demonstrated a lower sensitivity than detection by conventional cell culture, the sensitivity was still sufficiently high to reveal the characteristics of the epidemics in the community. CONCLUSIONS Rapid influenza testing is a reliable tool for influenza surveillance and, compared with traditional methods (virus detection on cell culture and monitoring of influenza-like illness), provides faster results. Although the 'near patient' test has limited sensitivity compared with cell culture, results were consistent over two seasons, and suggest that rapid testing should be part of a surveillance program.
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Affiliation(s)
- W Wunderli
- Central Laboratory of Virology, University Hospital of Geneva, Geneva, Switzerland.
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Abstract
In recent years, seven rapid tests for influenza have become commercially available. These tests offer the promise of making rapid influenza diagnosis much more widely available than in the past, when rapid diagnosis could be made only by fluorescent antibody staining, a demanding technique available only in advanced laboratories. Two of the rapid tests have waived status under the Clinical Laboratory Improvements Amendments of 1988. This article describes each of the seven tests and reviews English-language publications that have evaluated the performance of these tests on specimens from children. A discussion of the implications of the tests for clinical decision-making is included.
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Affiliation(s)
- Gregory A Storch
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Uyeki TM. Influenza diagnosis and treatment in children: a review of studies on clinically useful tests and antiviral treatment for influenza. Pediatr Infect Dis J 2003; 22:164-77. [PMID: 12586981 DOI: 10.1097/01.inf.0000050458.35010.b6] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prompt testing for influenza can help guide clinical management of patients with suspected influenza. Three antiviral medications, amantadine, oseltamivir and zanamivir, are approved for treatment of influenza in children. Rimantadine and ribavirin have also been used. OBJECTIVES To review the published evidence on clinically useful diagnostic tests and antiviral treatment for influenza virus infections in children. METHODS Studies published from 1966 through September 2002 were reviewed on clinical diagnosis, immunofluorescence and rapid influenza tests and on antiviral treatment of influenza virus infections among pediatric populations. RESULTS No studies assessed the accuracy of clinical diagnosis of influenza in children compared with viral culture. Compared with viral culture, direct immunofluorescence antibody and indirect immunofluorescence antibody tests for influenza had fair to moderate median sensitivities and high median specificities, whereas rapid influenza diagnostic tests had moderate median sensitivities and moderately high median specificities. No randomized, placebo-controlled studies were found of amantadine or rimantadine for treatment of influenza A. In a few separate controlled studies, oseltamivir, zanamivir and ribavirin each reduced symptom duration of influenza compared with placebo. CONCLUSIONS Additional data are needed about the accuracy of clinical diagnosis of influenza in children. Although direct immunofluorescence antibody staining, indirect immunofluorescence antibody staining and rapid tests are moderately to reasonably accurate in detecting influenza virus infections in children, physicians should use clinical judgment and local surveillance data about circulating influenza viruses when interpreting test results. Further controlled studies of the efficacy, adverse effects and emergence of antiviral resistance during treatment of influenza are needed for all of the antiviral drugs.
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Affiliation(s)
- Timothy M Uyeki
- Influenza Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Reina J, Padilla E, Alonso F, Ruiz De Gopegui E, Munar M, Mari M. Evaluation of a new dot blot enzyme immunoassay (directigen flu A+B) for simultaneous and differential detection of influenza a and B virus antigens from respiratory samples. J Clin Microbiol 2002; 40:3515-7. [PMID: 12202608 PMCID: PMC130707 DOI: 10.1128/jcm.40.9.3515-3517.2002] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a prospective evaluation of a new dot blot enzyme immunoassay (EIA) method for the direct, rapid, qualitative, simultaneous, and differential detection of the influenza A (IA) and B (IB) virus antigen in different respiratory samples. The EIA method was compared with the shell vial culture system (MDCK cell line) used with the same samples. We studied 160 samples from 93 (58.1%) pediatric patients (hospital emergency room) and from 67 (41.9%) adult patients (sentinel network). Seventy-four(46.2%) samples were considered positive; of them, 46 (62.2%) were from pediatric patients and 28 (37.8%) were from an adult group (P < 0.05), with overall positive values of 49.9% and 41.7%, respectively. All 74 (100%) of the positive samples were isolated in cell culture versus the 68.9% that were detected as positive by the new EIA method (P < 0.05). Of the 41 samples positive for the IA virus, the EIA detected 34 (82.9%) positive samples; of the 33 samples positive for the IB virus, the EIA detected 17 (51.5%) positive samples (P < 0.05). No false-positive reaction was detected with the EIA method (specificity and positive predictive value of 100%). The overall results obtained in the comparison between the new EIA and the shell vial culture had a sensibility of 82.9% and predictive negative values of 92.4% for the IA virus and 51.5% and 84.3%, respectively, for the IB virus. This evaluation shows sensitivity and specificity percentages for the new EIA method that is acceptable for routine use in IA virus detection. The results obtained were worse for IB virus detection, but this new EIA method is actually the only one with the capacity to differentiate between the two influenza viruses.
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Affiliation(s)
- Jordi Reina
- Virology Unit, Clinical Microbiology Service, University Hospital Son Dureta (Universitat Illes Balears), 07014 Palma de Mallorca, Spain.
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Hamilton MS, Abel DM, Ballam YJ, Otto MK, Nickell AF, Pence LM, Appleman JR, Shimasaki CD, Achyuthan KE. Clinical evaluation of the ZstatFlu-II test: a chemiluminescent rapid diagnostic test for influenza virus. J Clin Microbiol 2002; 40:2331-4. [PMID: 12089243 PMCID: PMC120541 DOI: 10.1128/jcm.40.7.2331-2334.2002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Exploiting the high sensitivity of the chemiluminescence phenomenon, an accurate and sensitive point-of-care test, called the ZstatFlu-II test (ZymeTx, Inc., Oklahoma City, Okla.), was developed to detect influenza virus infections. The ZstatFlu-II test takes 20 min and requires approximately 2 min of "hands-on" time for operational steps. The ZstatFlu-II test does not distinguish between infections with influenza virus types A and B. ZstatFlu-II test results are printed on Polaroid High-Speed Detector Film, allowing test results to be archived. A prototype version of the ZstatFlu-II test was evaluated during the 2000-to-2001 flu season with 300 nasal aspirate specimens from children at a pediatric hospital. Compared to culture, the ZstatFlu-II test had 88% sensitivity and 92% specificity. The Directigen test had a sensitivity of 75% and a specificity of 93%. The sensitivity of the ZstatFlu-II test was significantly higher than that of the Directigen test (P < 0.0574).
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Affiliation(s)
- Marilyn S Hamilton
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
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