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Rachmat A, Kelly GC, Tran LK, Christy N, Supaprom C, Heang V, Dul S, Garcia-Rivera JA, Prom S, Sopheab H, Brooks JS, Sutherland IJ, Corson KS, Letizia AG. Clinical Presentation, Risk Factors, and Comparison of Laboratory Diagnostics for Seasonal Influenza Virus Among Cambodians From 2007 to 2020. Open Forum Infect Dis 2024; 11:ofae062. [PMID: 38524221 PMCID: PMC10960604 DOI: 10.1093/ofid/ofae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Background Despite its global significance, challenges associated with understanding the epidemiology and accurately detecting, measuring, and characterizing the true burden of seasonal influenza remain in many resource-poor settings. Methods A prospective observational study was conducted in Cambodia at 28 health facilities between 2007 and 2020 utilizing passive surveillance data of patients presenting with acute undifferentiated febrile illness (AUFI) to describe the prevalence of influenza A and B and characterize associated risk factors and symptoms using a questionnaire. A comparison of rapid influenza diagnostic tests (RIDTs) and real-time reverse transcription polymerase chain reaction (rRT-PCR) results was also conducted. Results Of 30 586 total participants, 5634 (18.4%) tested positive for either influenza A or B, with 3557 (11.6%) positive for influenza A and 2288 (7.5%) positive for influenza B during the study. Influenza A and B were strongly associated with the rainy season (odds ratio [OR], 2.30; P < .001) and being from an urban area (OR, 1.45; P < .001). Analysis of individual symptoms identified cough (OR, 2.8; P < .001), chills (OR, 1.4; P < .001), and sore throat (OR, 1.4; P < .001) as having the strongest positive associations with influenza among patients with AUFI. Analysis comparing RIDTs and rRT-PCR calculated the overall sensitivity of rapid tests to be 0.492 (95% CI, 0.479-0.505) and specificity to be 0.993 (95% CI, 0.992-0.994) for both influenza type A and B. Conclusions Findings from this 14-year study include describing the epidemiology of seasonal influenza over a prolonged time period and identifying key risk factors and clinical symptoms associated with infection; we also demonstrate the poor sensitivity of RIDTs in Cambodia.
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Affiliation(s)
- Agus Rachmat
- AC Investment Co, contractor for NAMRU INDO PACIFIC, Phnom Penh, Cambodia
| | | | | | | | - Chonthida Supaprom
- AC Investment Co, contractor for NAMRU INDO PACIFIC, Phnom Penh, Cambodia
| | - Vireak Heang
- AC Investment Co, contractor for NAMRU INDO PACIFIC, Phnom Penh, Cambodia
| | - Sokha Dul
- AC Investment Co, contractor for NAMRU INDO PACIFIC, Phnom Penh, Cambodia
| | | | - Satharath Prom
- Department of Health, Ministry of National Defense, Phnom Penh, Cambodia
| | - Heng Sopheab
- National Institute of Public Health, Ministry of Health, Phnom Penh, Cambodia
| | - John S Brooks
- US Naval Medical Research Unit INDO PACIFIC, Cambodia
| | | | - Karen S Corson
- US Naval Medical Research Unit INDO PACIFIC, Singapore
- US Naval Medical Research Unit INDO PACIFIC, Cambodia
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Yang C, Gan X, Zeng Y, Xu Z, Xu L, Hu C, Ma H, Chai B, Hu S, Chai Y. Advanced design and applications of digital microfluidics in biomedical fields: An update of recent progress. Biosens Bioelectron 2023; 242:115723. [PMID: 37832347 DOI: 10.1016/j.bios.2023.115723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
Significant breakthroughs have been made in digital microfluidic (DMF)-based technologies over the past decades. DMF technology has attracted great interest in bioassays depending on automatic microscale liquid manipulations and complicated multi-step processing. In this review, the recent advances of DMF platforms in the biomedical field were summarized, focusing on the integrated design and applications of the DMF system. Firstly, the electrowetting-on-dielectric principle, fabrication of DMF chips, and commercialization of the DMF system were elaborated. Then, the updated droplets and magnetic beads manipulation strategies with DMF were explored. DMF-based biomedical applications were comprehensively discussed, including automated sample preparation strategies, immunoassays, molecular diagnosis, blood processing/testing, and microbe analysis. Emerging applications such as enzyme activity assessment and DNA storage were also explored. The performance of each bioassay was compared and discussed, providing insight into the novel design and applications of the DMF technology. Finally, the advantages, challenges, and future trends of DMF systems were systematically summarized, demonstrating new perspectives on the extensive applications of DMF in basic research and commercialization.
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Affiliation(s)
- Chengbin Yang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.
| | - Xiangyu Gan
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.
| | - Yuping Zeng
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.
| | - Zhourui Xu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.
| | - Longqian Xu
- CAS Key Laboratory of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.
| | - Chenxuan Hu
- CAS Key Laboratory of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.
| | - Hanbin Ma
- CAS Key Laboratory of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China; Guangdong ACXEL Micro & Nano Tech Co., Ltd, Foshan, China.
| | - Bao Chai
- Department of Dermatology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China; Department of Dermatology, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China.
| | - Siyi Hu
- CAS Key Laboratory of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.
| | - Yujuan Chai
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.
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Ito K, Y Inoue K, Ino K, Shiku H. High-Sensitivity Amperometric Dual Immunoassay Using Two Cascade Reactions with Signal Amplification of Redox Cycling in Nanoscale Gap. Anal Chem 2022; 94:16451-16460. [DOI: 10.1021/acs.analchem.2c03921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kentaro Ito
- Graduate School of Environmental Studies, Tohoku University, 6-6-11-604 Aramaki Aoba, Sendai, Miyagi 980-8579, Japan
| | - Kumi Y Inoue
- Graduate School of Environmental Studies, Tohoku University, 6-6-11-604 Aramaki Aoba, Sendai, Miyagi 980-8579, Japan
- Center for Basic Education, Faculty of Engineering, Graduate Faculty of Interdisciplinary Research, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Kosuke Ino
- Department of Biomolecular Engineering, Graduate School of Engineering, Tohoku University, 6-6-11-604 Aramaki Aoba, Sendai, Miyagi 980-8579, Japan
| | - Hitoshi Shiku
- Department of Biomolecular Engineering, Graduate School of Engineering, Tohoku University, 6-6-11-604 Aramaki Aoba, Sendai, Miyagi 980-8579, Japan
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Mardian Y, Menur Naysilla A, Lokida D, Farida H, Aman AT, Karyana M, Lukman N, Kosasih H, Kline A, Lau CY. Approach to Identifying Causative Pathogens of Community-Acquired Pneumonia in Children Using Culture, Molecular, and Serology Tests. Front Pediatr 2021; 9:629318. [PMID: 34123961 PMCID: PMC8193353 DOI: 10.3389/fped.2021.629318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/04/2021] [Indexed: 01/29/2023] Open
Abstract
Determining the causative pathogen(s) of community-acquired pneumonia (CAP) in children remains a challenge despite advances in diagnostic methods. Currently available guidelines generally recommend empiric antimicrobial therapy when the specific etiology is unknown. However, shifts in epidemiology, emergence of new pathogens, and increasing antimicrobial resistance underscore the importance of identifying causative pathogen(s). Although viral CAP among children is increasingly recognized, distinguishing viral from bacterial etiologies remains difficult. Obtaining high quality samples from infected lung tissue is typically the limiting factor. Additionally, interpretation of results from routinely collected specimens (blood, sputum, and nasopharyngeal swabs) is complicated by bacterial colonization and prolonged shedding of incidental respiratory viruses. Using current literature on assessment of CAP causes in children, we developed an approach for identifying the most likely causative pathogen(s) using blood and sputum culture, polymerase chain reaction (PCR), and paired serology. Our proposed rules do not rely on carriage prevalence data from controls. We herein share our perspective in order to help clinicians and researchers classify and manage childhood pneumonia.
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Affiliation(s)
- Yan Mardian
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | | | - Dewi Lokida
- Tangerang District Hospital, Tangerang, Indonesia
| | - Helmia Farida
- Dr. Kariadi Hospital/Diponegoro University, Semarang, Indonesia
| | - Abu Tholib Aman
- Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Muhammad Karyana
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Nurhayati Lukman
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Ahnika Kline
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Chuen-Yen Lau
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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Abstract
Influenza infection poses significant risk for solid organ transplant recipients who often experience more severe infection with increased rates of complications, including those relating to the allograft. Although symptoms of influenza experienced by transplant recipients are similar to that of the general population, fever is not a ubiquitous symptom and lymphopenia is common. Annual inactivated influenza vaccine is recommended for all transplant recipients. Newer strategies such as using a higher dose vaccine or multiple doses in the same season appear to provide greater immunogenicity. Neuraminidase inhibitors are the mainstay of treatment and chemoprophylaxis although resistance may occur in the transplant setting. Influenza therapeutics are advancing, including the recent licensure of baloxavir; however, many remain to be evaluated in transplant recipients and are not yet in routine clinical use. Further population-based studies spanning multiple influenza seasons are needed to enhance our understanding of influenza epidemiology in solid organ transplant recipients. Specific assessment of newer influenza therapeutics in transplant recipients and refinement of prevention strategies are vital to reducing morbidity and mortality.
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Affiliation(s)
- Tina M Marinelli
- Division of Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
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Salvesen HA, Whitelaw CBA. Current and prospective control strategies of influenza A virus in swine. Porcine Health Manag 2021; 7:23. [PMID: 33648602 PMCID: PMC7917534 DOI: 10.1186/s40813-021-00196-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Influenza A Viruses (IAV) are endemic pathogens of significant concern in humans and multiple keystone livestock species. Widespread morbidity in swine herds negatively impacts animal welfare standards and economic performance whilst human IAV pandemics have emerged from pigs on multiple occasions. To combat the rising prevalence of swine IAV there must be effective control strategies available. MAIN BODY The most basic form of IAV control on swine farms is through good animal husbandry practices and high animal welfare standards. To control inter-herd transmission, biosecurity considerations such as quarantining of pigs and implementing robust health and safety systems for workers help to reduce the likelihood of swine IAV becoming endemic. Closely complementing the physical on-farm practices are IAV surveillance programs. Epidemiological data is critical in understanding regional distribution and variation to assist in determining an appropriate response to outbreaks and understanding the nature of historical swine IAV epidemics and zoonoses. Medical intervention in pigs is restricted to vaccination, a measure fraught with the intrinsic difficulties of mounting an immune response against a highly mutable virus. It is the best available tool for controlling IAV in swine but is far from being a perfect solution due to its unreliable efficacy and association with an enhanced respiratory disease. Because IAV generally has low mortality rates there is a reticence in the uptake of vaccination. Novel genetic technologies could be a complementary strategy for IAV control in pigs that confers broad-acting resistance. Transgenic pigs with IAV resistance are useful as models, however the complexity of these reaching the consumer market limits them to research models. More promising are gene-editing approaches to prevent viral exploitation of host proteins and modern vaccine technologies that surpass those currently available. CONCLUSION Using the suite of IAV control measures that are available for pigs effectively we can improve the economic productivity of pig farming whilst improving on-farm animal welfare standards and avoid facing the extensive social and financial costs of a pandemic. Fighting 'Flu in pigs will help mitigate the very real threat of a human pandemic emerging, increase security of the global food system and lead to healthier pigs.
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Affiliation(s)
- Hamish A. Salvesen
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Edinburgh, UK
| | - C. Bruce A. Whitelaw
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Edinburgh, UK
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McIlwain DR, Chen H, Apkarian M, Affrime M, Bock B, Kim K, Mukherjee N, Nolan GP, McNeal MM. Performance of BioFire array or QuickVue influenza A + B test versus a validation qPCR assay for detection of influenza A during a volunteer A/California/2009/H1N1 challenge study. Virol J 2021; 18:45. [PMID: 33632249 PMCID: PMC7905982 DOI: 10.1186/s12985-021-01516-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/18/2021] [Indexed: 01/01/2023] Open
Abstract
Background Influenza places a significant burden on global health and economics. Individual case management and public health efforts to mitigate the spread of influenza are both strongly impacted by our ability to accurately and efficiently detect influenza viruses in clinical samples. Therefore, it is important to understand the performance characteristics of available assays to detect influenza in a variety of settings. We provide the first report of relative performance between two products marketed to streamline detection of influenza virus in the context of a highly controlled volunteer influenza challenge study. Methods Nasopharyngeal swab samples were collected during a controlled A/California/2009/H1N1 influenza challenge study and analyzed for detection of virus shedding using a validated qRT-PCR (qPCR) assay, a sample-to-answer qRT-PCR device (BioMerieux BioFire FilmArray RP), and an immunoassay based rapid test kit (Quidel QuickVue Influenza A + B Test). Results Relative to qPCR, the sensitivity and specificity of the BioFire assay was 72.1% [63.7–79.5%, 95% confidence interval (CI)] and 93.5% (89.3–96.4%, 95% CI) respectively. For the QuickVue rapid test the sensitivity was 8.5% (4.8–13.7%, 95% CI) and specificity was 99.2% (95.6–100%, 95% CI). Conclusion Relative to qPCR, the BioFire assay had superior performance compared to rapid test in the context of a controlled influenza challenge study. Supplementary Information The online version contains supplementary material available at 10.1186/s12985-021-01516-0.
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Affiliation(s)
- David R McIlwain
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA. .,WCCT Global, Cypress, CA, USA.
| | - Han Chen
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | - Nilanjan Mukherjee
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Garry P Nolan
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Monica M McNeal
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Velasco JM, Valderama MT, Diones PC, Navarro FC, Develos M, Lopez MN, Liao C, Chua D, Macareo L, Fernandez S. Performance of a Rapid Diagnostic Test for Influenza in a Tertiary Military Hospital, Philippines. Mil Med 2021; 187:e197-e200. [PMID: 33480421 DOI: 10.1093/milmed/usab006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/03/2020] [Accepted: 01/12/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION It is important to evaluate the performance of existing rapid influenza diagnostic tests (RIDTs) and the factors that can affect performance especially when the circulation dynamics of influenza strains change such as the displacement and replacement of the circulating seasonal influenza strains. MATERIALS AND METHODS Nasal swabs were collected from patients presenting at V Luna Medical Center, Armed Forces of the Philippines Health Service Command, with influenza-like illness (ILI) with one swab tested using Quickvue (QV) influenza A+B RIDT (Quidel) and the other swab tested using the ABI 7500 (Applied Biosystems) real-time reverse transcriptase-polymerase chain reaction. Sensitivity, specificity, positive predictive value, and negative predictive value were estimated. We identified clinical symptoms predictive of influenza subtype and evaluated the independence of QV sensitivity on (1) Cycle threshold (Ct) value, controlling for timing of collection; (2) timing of collection, controlling for Ct value; and (3) Ct value and timing of collection taken together. RESULTS Between August 2011 and October 2016, patients presenting with ILI (n = 2333) underwent testing. Quickvue sensitivity across all subtypes was significantly correlated with lower Ct values (higher virus titers) (P <.001) and, except for flu A/H3 (P = .974), was also significantly associated with timing of specimen collection (P <.05). No statistically significant difference was noted in QV sensitivity for Flu A/H3 (P = .130), pandemic H1/N1 (P = .207), Flu A/H3 + pandemic H1/N1 (P = .341), and Flu B (P = .103) across different age groups but sensitivity of QV significantly differed (P <.001) across the different influenza subtypes. CONCLUSION Overall specificity of QV was high across all flu subtypes, but overall sensitivity was low (Flu A/pdm H1) to moderate (Flu A/H3 and Flu B). The findings highlight the need to develop more sensitive influenza RDTs to detect circulating influenza strains and the use of the quadrivalent flu vaccine during the annual influenza vaccination.
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Affiliation(s)
- John Mark Velasco
- Department of Virology, U.S. Army Medical Directorate-Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand.,University of the Philippines Manila, Ermita, Manila, 1000, Philippines
| | - Maria Theresa Valderama
- Department of Virology, U.S. Army Medical Directorate-Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | - Paula Corazon Diones
- Department of Virology, U.S. Army Medical Directorate-Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | - Fatima Claire Navarro
- V Luna Medical Center, Armed Forces of the Philippines Health Service Command, Quezon City, 0840, Philippines
| | - Maribel Develos
- V Luna Medical Center, Armed Forces of the Philippines Health Service Command, Quezon City, 0840, Philippines
| | - Ma Nila Lopez
- V Luna Medical Center, Armed Forces of the Philippines Health Service Command, Quezon City, 0840, Philippines
| | - Cynthia Liao
- V Luna Medical Center, Armed Forces of the Philippines Health Service Command, Quezon City, 0840, Philippines
| | - Domingo Chua
- V Luna Medical Center, Armed Forces of the Philippines Health Service Command, Quezon City, 0840, Philippines
| | - Louis Macareo
- Department of Virology, U.S. Army Medical Directorate-Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | - Stefan Fernandez
- Department of Virology, U.S. Army Medical Directorate-Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
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Velasco JM, Shrestha S, Valderama MT, Shrestha J, Shrestha B, Diones PC, Leonardia S, Poolpanichupatam Y, Hussem K, Chua D, Navarro FC, Develos M, Macareo L, Ellison D, Fernandez S, Klungthong C. A multi-country field validation of the FluChip-8G Insight Assay. J Virol Methods 2020; 289:114029. [PMID: 33271255 DOI: 10.1016/j.jviromet.2020.114029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION It is critical to rapidly detect novel and non-seasonal influenza strains. Currently available assays have limited sensitivity in detecting novel influenza subtypes. We performed a multi-country field validation of the FluChip-8G Insight, an assay able to detect and characterize influenza A/B viruses and non-seasonal influenza viruses. MATERIALS AND METHODS We evaluated the performance of the FluChip-8G Insight on nasal and throat swab clinical samples from Thailand, Philippines and Nepal. Influenza PCR positive and negative samples tested using the US CDC Human Influenza Dx Panel reference standard were selected for testing using the FluChip-8G Influenza Insight. RESULTS A total of 909 specimens were included in the analysis. The overall sensitivity and specificity of the FluChip-8G Insight to detect combined influenza A+B was 86 % and 100%, respectively. PPV and NPV were estimated at 100 % (95 % CI 99-100) and 73 % (95 % CI 68-78), respectively. Sensitivity across all influenza subtypes was 100% for specimens with <20 and 20-25 Ct values, respectively, but as Ct values increased, sensitivity across all influenza subtypes decreased significantly (p < 0.001) for specimens with Ct values ≥32. CONCLUSION The FluChip-8G Insight showed good precision and reproducibility among all 3 sites with robust identification of both influenza A and B targets with Ct values <32 and in the absence of co-infection. Positioning this platform in countries considered as hotspots for the emergence of novel/zoonotic influenza strains can increase the lead time in detecting and containing novel influenza strains with pandemic potential.
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Affiliation(s)
- John Mark Velasco
- U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; University of the Philippines Manila, Ermita, Manila, Philippines.
| | - Sanjaya Shrestha
- Walter Reed/AFRIMS Research Unit Nepal (WARUN), Kathmandu, Nepal
| | - Maria Theresa Valderama
- U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Jasmin Shrestha
- Walter Reed/AFRIMS Research Unit Nepal (WARUN), Kathmandu, Nepal
| | - Binob Shrestha
- Walter Reed/AFRIMS Research Unit Nepal (WARUN), Kathmandu, Nepal
| | - Paula Corazon Diones
- U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Susie Leonardia
- U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Yongyuth Poolpanichupatam
- U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Kittinun Hussem
- U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Domingo Chua
- V Luna Medical Center, Armed Forces of the Philippines Health Service Command, Quezon City, Philippines
| | - Fatima Claire Navarro
- V Luna Medical Center, Armed Forces of the Philippines Health Service Command, Quezon City, Philippines
| | - Maribel Develos
- V Luna Medical Center, Armed Forces of the Philippines Health Service Command, Quezon City, Philippines
| | - Louis Macareo
- U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Damon Ellison
- U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Stefan Fernandez
- U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Chonticha Klungthong
- U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
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The Latest Achievements in the Construction of Influenza Virus Detection Aptasensors. Viruses 2020; 12:v12121365. [PMID: 33265901 PMCID: PMC7760490 DOI: 10.3390/v12121365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/14/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
Aptamers are short fragments of nucleic acids, DNA or RNA that have the ability to bind selected proteins with high specificity and affinity. These properties allow them to be used as an element of biosensors for the detection of specific proteins, including viral ones, which makes it possible to design valuable diagnostic tools. The influenza virus causes a huge number of human and animal deaths worldwide every year, and contributes to remarkable economic losses. In addition, in 2020, a new threat appeared-the SARS-Cov-2 pandemic. Both disease entities, especially in the initial stage of infection, are almost identical in terms of signs and symptoms. Therefore, a diagnostic solution is needed that will allow distinguishing between both pathogens, with high sensitivity and specificity; it should be cheap, quick and possible to use in the field, for example, in a doctor's office. All the mentioned properties are met by aptasensors in which the detection elements are specific aptamers. We present here the latest developments in the construction of various types of aptasensors for the detection of influenza virus. Aptasensor operation is based on the measurement of changes in electric impedance, fluorescence or electric signal (impedimetric, fluorescence and electrochemical aptasensors, respectively); it allows both qualitative and quantitative determinations. The particularly high advancement for detecting of influenza virus concerns impedimetric aptasensors.
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Oktapodas Feiler M, Caserta MT, van Wijngaarden E, Thevenet-Morrison K, Hardy DJ, Zhang YV, Dozier AM, Lawrence BP, Jusko TA. Environmental Lead Exposure and Influenza and Respiratory Syncytial Virus Diagnoses in Young Children: A Test-Negative Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207625. [PMID: 33086756 PMCID: PMC7590174 DOI: 10.3390/ijerph17207625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 01/05/2023]
Abstract
Experimental and epidemiological evidence suggests that environmental toxicants may influence susceptibility to influenza and respiratory syncytial virus (RSV). The objective of the present study was to estimate the association between blood lead concentrations and the odds of child influenza or RSV infection. A test-negative, case-control study was conducted among 617 children, <4 years of age, tested for influenza/RSV from 2012-2017 in Rochester, NY. There were 49 influenza cases (568 controls) and 123 RSV cases (494 controls). Blood lead concentrations reported in children's medical records were linked with influenza/RSV lab test results. Covariables were collected from medical records, birth certificates, and U.S. census data. In this sample, evidence of an association between blood lead levels and RSV or influenza diagnosis was not observed. Children with a lead level ≥1 μg/dL vs. <1 μg/dL had an adjusted odds ratio (aOR) and 95% confidence limit of 0.95 (0.60, 1.49) for RSV and 1.34 (0.65, 2.75) for influenza. In sex-specific analyses, boys with lead concentrations ≥1 μg/dL vs. <1 μg/dL had an aOR = 1.89 (1.25, 2.86) for influenza diagnosis, while the estimates were inconsistent for girls. These results are suggestive of sex-specific associations between blood lead levels and the risk of influenza, although the sample size was small.
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Affiliation(s)
- Marina Oktapodas Feiler
- Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA; (E.v.W.); (B.P.L.); (T.A.J.)
- Correspondence:
| | - Mary T. Caserta
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA;
| | - Edwin van Wijngaarden
- Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA; (E.v.W.); (B.P.L.); (T.A.J.)
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, 265 Crittenden Blvd, Rochester, NY 14620, USA; (K.T.-M.); (A.M.D.)
| | - Kelly Thevenet-Morrison
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, 265 Crittenden Blvd, Rochester, NY 14620, USA; (K.T.-M.); (A.M.D.)
| | - Dwight J. Hardy
- Department of Microbiology and Immunology, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA;
| | - Yan Victoria Zhang
- Department of Pathology and Laboratory Medicine, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA;
| | - Ann M. Dozier
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, 265 Crittenden Blvd, Rochester, NY 14620, USA; (K.T.-M.); (A.M.D.)
| | - B. Paige Lawrence
- Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA; (E.v.W.); (B.P.L.); (T.A.J.)
- Department of Microbiology and Immunology, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA;
| | - Todd A. Jusko
- Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA; (E.v.W.); (B.P.L.); (T.A.J.)
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA;
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, 265 Crittenden Blvd, Rochester, NY 14620, USA; (K.T.-M.); (A.M.D.)
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12
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Ji M, Xia Y, Loo JFC, Li L, Ho HP, He J, Gu D. Automated multiplex nucleic acid tests for rapid detection of SARS-CoV-2, influenza A and B infection with direct reverse-transcription quantitative PCR (dirRT-qPCR) assay in a centrifugal microfluidic platform. RSC Adv 2020; 10:34088-34098. [PMID: 35519051 PMCID: PMC9056731 DOI: 10.1039/d0ra04507a] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/06/2020] [Indexed: 12/24/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has posed a threat to public health worldwide. Also, influenza virus has caused a large number of deaths annually. Since co-infection of SARS-CoV-2 and influenza virus, which share similar symptoms, hampers current treatment efficiency, multiple simultaneous detection of these viruses is needed to provide the right treatment for patients. We developed a microfluidic disc-direct RT-qPCR (dirRT-qPCR) assay for rapid multiplex detection of SARS-CoV-2, influenza A and B viral infection in pharyngeal swab samples in an automated manner. Choices of the DNA polymerase, concentrations of dTPs and MgCl2 were characterized to optimize the assay. A detection limit of 2 × 101 copies per reaction was found in all three viral RNAs with as little as 2 μL of swab samples. The accuracy of our assay was evaluated with 2127 clinical swab samples of infection with these three viruses and healthy controls, and it possessed a consistency rate of 100, 99.54 and 99.25% in SARS-CoV-2, influenza A and B detection in comparison to standard RT-qPCR. The reported scheme of our assay is capable of screening other viral infections for up to 16 targets simultaneously. The whole diagnosis could be completed in 1.5 hours after simple sample loading by a non-technical expert. This constitutes an enabling strategy for large-scale point-of-care screening of multiple viral infections, which ultimately lead to a pathway for resolving the critical issue of early diagnosis for the prevention and control of viral outbreaks.
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Affiliation(s)
- Minghui Ji
- School of Nursing, Nanjing Medical University Nanjing 211166 P. R. China
| | - Yun Xia
- Shenzhen International Travel Health Care Center, Shenzhen Academy of Inspection and Quarantine Shenzhen Customs District Shenzhen 518033 P. R. China
| | - Jacky Fong-Chuen Loo
- Department of Biomedical Engineering, The Chinese University of Hong Kong Hong Kong SAR P. R. China
| | - Lang Li
- Shenzhen Bao'an Traditional Chinese Medicine Hospital (Group), Guangzhou University of Chinese Medicine Shenzhen 518133 P. R. China
| | - Ho-Pui Ho
- Department of Biomedical Engineering, The Chinese University of Hong Kong Hong Kong SAR P. R. China
| | - Jianan He
- Shenzhen International Travel Health Care Center, Shenzhen Academy of Inspection and Quarantine Shenzhen Customs District Shenzhen 518033 P. R. China
| | - Dayong Gu
- Department of Laboratory Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Health Science Center Shenzhen 518035 P. R. China
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13
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Miesler T, Wimschneider C, Brem A, Meinel L. Frugal Innovation for Point-of-Care Diagnostics Controlling Outbreaks and Epidemics. ACS Biomater Sci Eng 2020; 6:2709-2725. [PMID: 33463254 DOI: 10.1021/acsbiomaterials.9b01712] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Today epidemics of infectious diseases occur more often and spread both faster and further due to globalization and changes in our lifestyle. One way to meet these biological threats are so-called "Frugal Innovations", which focus on the development of affordable, rapid, and easy-to-use diagnostics with widespread use. In this context, point-of-care-tests (POCTs), performed at the patient's bedside, reduce extensive waiting times and unnecessary treatments and enable effective containment measures. This Perspective covers advances in POCT diagnostics on the basis of frugal innovation characteristics that will enable a faster, less expensive, and more convenient reaction to upcoming epidemics. Established POCT systems on the health care market, as well as currently evolving technological advancements in that sector are discussed. Progress in POCT technology and insights on how to most effectively use them allows the handling of more patients in a shorter time frame and consequently improves clinical outcomes at lower cost.
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Affiliation(s)
- Tobias Miesler
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, 97074 Würzburg Germany
| | - Christine Wimschneider
- Chair of Technology Management, FAU Erlangen-Nürnberg, Dr.-Mack-Str. 81, 90762 Fürth, Germany
| | - Alexander Brem
- Institute of Entrepreneurship & Innovation, University of Stuttgart, Pfaffenwaldring 19, 70569 Stuttgart, Germany.,Mads Clausen Institute, University of Southern Denmark, Alsion 1, 6400 Sonderborg, Denmark
| | - Lorenz Meinel
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, 97074 Würzburg Germany.,Helmholtz Institute for RNA-based Infection Research (HIRI), Helmholtz Center for Infection Research (HZI), Würzburg, Germany
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14
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Lu PH, Ma YD, Fu CY, Lee GB. A structure-free digital microfluidic platform for detection of influenza a virus by using magnetic beads and electromagnetic forces. LAB ON A CHIP 2020; 20:789-797. [PMID: 31956865 DOI: 10.1039/c9lc01126a] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
H1N1, a subtype of influenza A virus, has emerged as a global threat in the past decades. Due to its highly infectious nature, an accurate and rapid detection assay is urgently required. Therefore, this study presents a new type of digital microfluidic platform for H1N1 virus detection by utilizing a one-aptamer/two-antibodies assay on magnetic beads. The droplets containing magnetic beads were driven by electromagnetic forces on a structure-free, super-hydrophobic surface to automate the entire assay within 40 min. With different levels of hydrophobic modification, the droplets could be easily controlled and positioned without any assisted microstructure. The tunable electromagnetic forces could be adjusted for three kinds of operating modes for the manipulations of beads and droplets, including movement of droplets containing magnetic beads, mixing of two droplets and beads extraction out of droplets. When compared with previous studies, the manipulations of droplets and magnetic particles in this study are more flexible as they can be easily adjusted by fine-tuning the magnetic flux density. Furthermore, the magnetic beads also served as three-dimensional substrates for the new enzyme-linked immunosorbent assay (ELISA)-like assay. The magnetic beads were conjugated with aptamers, which have high specificity towards H1N1 viruses such that they could be specifically captured and detected. The horseradish peroxidase-conjugated secondary antibody was then used to activate tyramide-tetramethylrhodamine (TTMR) such that fluorescent signals could be amplified. With this approach, the limit of detection was experimentally found to be 0.032 hemagglutination units/reaction, which is sensitive enough for clinical diagnostics. This kind of digital microfluidic platform with the ELISA-like assay could effectively reduce the consumption of samples and reagents such that the volume of all droplets including the H1N1 sample, antibodies, TTMR and wash buffers was only 20 μL. This is the first time that a digital microfluidic platform was demonstrated such that the entire diagnostic process for influenza A H1N1 viruses could be performed by using electromagnetic forces, which could be promising for rapid and accurate diagnosis of influenza.
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Affiliation(s)
- Po-Hsien Lu
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, 30013, Taiwan.
| | - Yu-Dong Ma
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, 30013, Taiwan.
| | - Chien-Yu Fu
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, 30013, Taiwan.
| | - Gwo-Bin Lee
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, 30013, Taiwan. and Institute of NanoEngineering and Microsystems, National Tsing Hua University, Hsinchu, 30013, Taiwan and Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, 30013, Taiwan
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15
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Vandamme S, Van Cleempoel S, Michiels M, Goossens H, Jansens H, Matheeussen V. Comparison of the Coris Influ A + B K-SeT® and BD Veritor Flu A + B® for rapid detection of influenza viruses in respiratory samples from 3 consecutive flu seasons in Belgium. Diagn Microbiol Infect Dis 2019; 94:227-230. [PMID: 30827806 DOI: 10.1016/j.diagmicrobio.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Sarah Vandamme
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
| | - Shauni Van Cleempoel
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Mindy Michiels
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Herman Goossens
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Hilde Jansens
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Veerle Matheeussen
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
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16
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Fowler JC, Madan A, Allen JG, Oldham JM, Frueh BC. Differentiating bipolar disorder from borderline personality disorder: Diagnostic accuracy of the difficulty in emotion regulation scale and personality inventory for DSM-5. J Affect Disord 2019; 245:856-860. [PMID: 30699870 DOI: 10.1016/j.jad.2018.11.079] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/02/2018] [Accepted: 11/11/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Confusion abounds when differentiating the diagnoses of bipolar disorder (BD) from borderline personality disorder (BPD). This study explored the relative clinical utility of affective instability and self-report personality trait measures for accurate identification of BD and BPD. METHODS Receiver operator characteristics and diagnostic efficiency statistics were calculated to ascertain the relative diagnostic efficiency of self-report measures. Inpatients with research-confirmed diagnoses of BD (n = 341) or BPD (n = 381) completed the Difficulty in Emotion Regulation Scale (DERS) and Personality Inventory for DSM-5 (PID-5). RESULTS The total score for DERS evidenced relatively poor accuracy for differentiating the disorders (AUC = 0.72, SE = 0.02, p < .0001), while subscales of affective instability measures yielded fair discrimination (AUC range = 0.70-0.59). The PID-5 BPD algorithm (consisting of emotional lability, anxiousness, separation insecurity, hostility, depressivity, impulsivity, and risk taking) evidenced moderate-to-excellent accuracy (AUC = 0.83, SE = 0.04, p < .0001) with a good balance of specificity (SP = 0.79) and sensitivity (SN = 0.77). CONCLUSION Findings support the use of the PID-5 algorithm for differentiating BD from BPD. Furthermore, findings support the accuracy of the DSM-5 alternative model Criteria B trait constellation for differentiating these two disorders with overlapping features.
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Affiliation(s)
- J Christopher Fowler
- Houston Methodist Behavioral Health, 6550 Fannin St Houston, TX 77030, United States.
| | - Alok Madan
- Houston Methodist Behavioral Health, 6550 Fannin St Houston, TX 77030, United States
| | - Jon G Allen
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
| | - John M Oldham
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
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17
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Aoyama S, Akiyama Y, Monden K, Yamada M, Seki M. Thermally imprinted microcone structure-assisted lateral-flow immunoassay platforms for detecting disease marker proteins. Analyst 2019; 144:1519-1526. [DOI: 10.1039/c8an01903g] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Lateral-flow immunoassay devices, incorporating thermally-imprinted microcone array structures, have been developed for detecting disease marker proteins.
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Affiliation(s)
| | | | | | - Masumi Yamada
- Department of Applied Chemistry and Biotechnology
- Graduate School of Engineering
- Chiba University
- Chiba 263-8522
- Japan
| | - Minoru Seki
- Department of Applied Chemistry and Biotechnology
- Graduate School of Engineering
- Chiba University
- Chiba 263-8522
- Japan
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18
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Fowler JC, Madan A, Allen JG, Patriquin M, Sharp C, Oldham JM, Frueh BC. Clinical utility of the DSM-5 alternative model for borderline personality disorder: Differential diagnostic accuracy of the BFI, SCID-II-PQ, and PID-5. Compr Psychiatry 2018; 80:97-103. [PMID: 29069625 DOI: 10.1016/j.comppsych.2017.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/10/2017] [Accepted: 09/07/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND With the publication of DSM 5 alternative model for personality disorders it is critical to assess the components of the model against evidence-based models such as the five factor model and the DSM-IV-TR categorical model. This study explored the relative clinical utility of these models in screening for borderline personality disorder (BPD). METHODS Receiver operator characteristics and diagnostic efficiency statistics were calculated for three personality measures to ascertain the relative diagnostic efficiency of each measure. A total of 1653 adult inpatients at a specialist psychiatric hospital completed SCID-II interviews. Sample 1 (n=653) completed the SCID-II interviews, SCID-II Questionnaire (SCID-II-PQ) and the Big Five Inventory (BFI), while Sample 2 (n=1,000) completed the SCID-II interviews, Personality Inventory for DSM5 (PID-5) and the BFI. RESULTS BFI measure evidenced moderate accuracy for two composites: High Neuroticism+ low agreeableness composite (AUC=0.72, SE=0.01, p<0.001) and High Neuroticism+ Low+Low Conscientiousness (AUC=0.73, SE=0.01, p<0.0001). The SCID-II-PQ evidenced moderate-to-excellent accuracy (AUC=0.86, SE=0.02, p<0.0001) with a good balance of specificity (SP=0.80) and sensitivity (SN=0.78). The PID-5 BPD algorithm (consisting of elevated emotional lability, anxiousness, separation insecurity, hostility, depressivity, impulsivity, and risk taking) evidenced moderate-to-excellent accuracy (AUC=0.87, SE=0.01, p<0.0001) with a good balance of specificity (SP=0.76) and sensitivity (SN=0.81). CONCLUSIONS Findings generally support the use of SCID-II-PQ and PID-5 BPD algorithm for screening purposes. Furthermore, findings support the accuracy of the DSM 5 alternative model Criteria B trait constellation for diagnosing BPD. Limitations of the study include the single inpatient setting and use of two discrete samples to assess PID-5 and SCID-II-PQ.
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Affiliation(s)
- J Christopher Fowler
- The Menninger Clinic, 12301 Main Street, Houston, TX 77035, United States; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States.
| | - Alok Madan
- The Menninger Clinic, 12301 Main Street, Houston, TX 77035, United States; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
| | - Jon G Allen
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
| | - Michelle Patriquin
- The Menninger Clinic, 12301 Main Street, Houston, TX 77035, United States; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
| | | | - John M Oldham
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
| | - B Christopher Frueh
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States; University of Hawaii, 200 West Kawili St., Hilo, HI 96720, United States
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19
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Krammer F, Smith GJD, Fouchier RAM, Peiris M, Kedzierska K, Doherty PC, Palese P, Shaw ML, Treanor J, Webster RG, García-Sastre A. Influenza. Nat Rev Dis Primers 2018; 4:3. [PMID: 29955068 PMCID: PMC7097467 DOI: 10.1038/s41572-018-0002-y] [Citation(s) in RCA: 799] [Impact Index Per Article: 133.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Influenza is an infectious respiratory disease that, in humans, is caused by influenza A and influenza B viruses. Typically characterized by annual seasonal epidemics, sporadic pandemic outbreaks involve influenza A virus strains of zoonotic origin. The WHO estimates that annual epidemics of influenza result in ~1 billion infections, 3–5 million cases of severe illness and 300,000–500,000 deaths. The severity of pandemic influenza depends on multiple factors, including the virulence of the pandemic virus strain and the level of pre-existing immunity. The most severe influenza pandemic, in 1918, resulted in >40 million deaths worldwide. Influenza vaccines are formulated every year to match the circulating strains, as they evolve antigenically owing to antigenic drift. Nevertheless, vaccine efficacy is not optimal and is dramatically low in the case of an antigenic mismatch between the vaccine and the circulating virus strain. Antiviral agents that target the influenza virus enzyme neuraminidase have been developed for prophylaxis and therapy. However, the use of these antivirals is still limited. Emerging approaches to combat influenza include the development of universal influenza virus vaccines that provide protection against antigenically distant influenza viruses, but these vaccines need to be tested in clinical trials to ascertain their effectiveness.
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Affiliation(s)
- Florian Krammer
- 0000 0001 0670 2351grid.59734.3cDepartment of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Gavin J. D. Smith
- 0000 0001 2180 6431grid.4280.eDuke–NUS Medical School, Singapore, Singapore ,0000 0004 1936 7961grid.26009.3dDuke Global Health Institute, Duke University, Durham, NC USA
| | - Ron A. M. Fouchier
- 000000040459992Xgrid.5645.2Department of Viroscience, Erasmus MC, Rotterdam, Netherlands
| | - Malik Peiris
- 0000000121742757grid.194645.bWHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China ,0000000121742757grid.194645.bCenter of Influenza Research, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Katherine Kedzierska
- 0000 0001 2179 088Xgrid.1008.9Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria Australia
| | - Peter C. Doherty
- 0000 0001 2179 088Xgrid.1008.9Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria Australia ,0000 0001 0224 711Xgrid.240871.8Department of Immunology, St Jude Children’s Research Hospital, Memphis, TN USA
| | - Peter Palese
- 0000 0001 0670 2351grid.59734.3cDepartment of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY USA ,0000 0001 0670 2351grid.59734.3cDivision of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Megan L. Shaw
- 0000 0001 0670 2351grid.59734.3cDepartment of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - John Treanor
- 0000 0004 1936 9166grid.412750.5Division of Infectious Diseases, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY USA
| | - Robert G. Webster
- 0000 0001 0224 711Xgrid.240871.8Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, TN USA
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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20
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Das A, Gurale BP, Dhawane AN, Iyer SS. Synthesis of biotinylated bivalent zanamivir analogs as probes for influenza viruses. HETEROCYCL COMMUN 2017. [DOI: 10.1515/hc-2017-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractThe synthesis of a biotinylated bivalent zanamivir analog as a probe for influenza viruses is reported. The compound was used in a ‘glycan’ based sandwich assay; where glycans were immobilized on glass slides to capture strains of influenza A H1N1, A/Brisbane/59/2007 virus; the biotinylated bivalent zanamivir analog-labeled streptavidin complex was used as reporter. This research strongly suggests that glycans can be used for capturing and reporting influenza viruses and the biotinylated compounds can be used as probes for capturing and isolating influenza viruses from complex mixtures.
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Affiliation(s)
- Amrita Das
- Department of Chemistry, 788 Petit Science Center, Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, GA 30302, USA
| | - Bharat P. Gurale
- Department of Chemistry, 788 Petit Science Center, Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, GA 30302, USA
| | - Abasaheb N. Dhawane
- Department of Chemistry, 788 Petit Science Center, Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, GA 30302, USA
| | - Suri S. Iyer
- Department of Chemistry, 788 Petit Science Center, Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, GA 30302, USA
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21
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Davis S, Allen AJ, O'Leary R, Power M, Price DA, Simpson AJ, Tunbridge A, Vale L, Whiteside M, Evans C, Raza M. Diagnostic accuracy and cost analysis of the Alere™ i Influenza A&B near-patient test using throat swabs. J Hosp Infect 2017; 97:301-309. [PMID: 28558954 DOI: 10.1016/j.jhin.2017.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical diagnostic sensitivity alone is inadequate in the diagnosis of influenza. Polymerase chain reaction (PCR) testing is sensitive but the inherent delays in result availability potentially prolong time to isolation and treatment. Until recently no near-patient test (NPT) has demonstrated adequate sensitivity for routine clinical use. AIM To evaluate diagnostic accuracy, time to result availability, clinical impact, and cost consequences of Alere™ i Influenza A&B NPT (Alere Inc., Waltham, MA, USA) using off-label throat swabs. METHODS Prospective, multi-centre [four UK National Health Service (NHS) hospitals], diagnostic accuracy cohort study with cost modelling. Throat swab samples from suspected influenza patients were tested for influenza using the reference standard of PCR; a second throat swab was tested using NPT. FINDINGS A total of 827 participants were recruited; 589 were suitable for analysis: sensitivity was 75.8% [95% confidence interval (CI): 67.0-84.6]; specificity was 96.8% (95% CI: 95.2-98.3). Sensitivity varied between Sheffield (Northern General Hospital: 82.1%; Royal Hallamshire Hospital: 83.3%) and other sites (Doncaster Royal Infirmary: 71.4%; Newcastle's Royal Victoria Infirmary: 50.0%) whereas specificity was high (92-100%). Positive predictive value (PPV) was 81.2% (95% CI: 72.9-89.5) with negative predictive value 95.6% (95% CI: 93.9-97.4) with observed prevalence of 15.4%. Median time to result for PCR was 1.1 days (on-site laboratories) and 5.2 days (remote laboratories). Isolation findings: 75% influenza positive not isolated; 69% of isolated participants did not have influenza. For a cohort of 1000 participants, annual estimated non-diagnostic cost savings with NPT are £215,040. CONCLUSION This first prospective study of the Alere i NPT using throat swabs demonstrates high specificity, high PPV during seasonal epidemics, and rapid result availability which could lead to substantial cost savings.
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Affiliation(s)
- S Davis
- Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - A J Allen
- National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Newcastle, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - R O'Leary
- National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Newcastle, Newcastle upon Tyne, UK
| | - M Power
- National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Newcastle, Newcastle upon Tyne, UK
| | - D A Price
- Department of Infectious Diseases, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - A J Simpson
- National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Newcastle, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - A Tunbridge
- Department of Infectious Diseases, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - L Vale
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK
| | - M Whiteside
- Department of Acute Medicine, Doncaster Royal Infirmary, Doncaster, UK
| | - C Evans
- Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M Raza
- Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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22
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Anderson CE, Holstein CA, Strauch EM, Bennett S, Chevalier A, Nelson J, Fu E, Baker D, Yager P. Rapid Diagnostic Assay for Intact Influenza Virus Using a High Affinity Hemagglutinin Binding Protein. Anal Chem 2017; 89:6608-6615. [PMID: 28499086 DOI: 10.1021/acs.analchem.7b00769] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Influenza is a ubiquitous and recurring infection that results in approximately 500 000 deaths globally each year. Commercially available rapid diagnostic tests are based upon detection of the influenza nucleoprotein, which are limited in that they are unable to differentiate by species and require an additional viral lysis step. Sample preprocessing can be minimized or eliminated by targeting the intact influenza virus, thereby reducing assay complexity and leveraging the large number of hemagglutinin proteins on the surface of each virus. Here, we report the development of a paper-based influenza assay that targets the hemagglutinin protein; the assay employs a combination of antibodies and novel computationally designed, recombinant affinity proteins as the capture and detection agents. This system leverages the customizability of recombinant protein design to target the conserved receptor-binding pocket of the hemagglutinin protein and to match the trimeric nature of hemagglutinin for improved avidity. Using this assay, we demonstrate the first instance of intact influenza virus detection using a combination of antibody and affinity proteins within a porous network. The recombinant head region binder based assays yield superior analytical sensitivity as compared to the antibody based assay, with lower limits of detection of 3.54 × 107 and 1.34 × 107 CEID50/mL for the mixed and all binder stacks, respectively. Not only does this work describe the development of a novel influenza assay, it also demonstrates the power of recombinant affinity proteins for use in rapid diagnostic assays.
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Affiliation(s)
- Caitlin E Anderson
- Department of Bioengineering, University of Washington , Seattle, Washington 98195-5061, United States
| | - Carly A Holstein
- Department of Bioengineering, University of Washington , Seattle, Washington 98195-5061, United States
| | - Eva-Maria Strauch
- Department of Biochemistry, University of Washington , Seattle, Washington 98195-7350, United States
| | - Steven Bennett
- Department of Bioengineering, University of Washington , Seattle, Washington 98195-5061, United States
| | - Aaron Chevalier
- Department of Bioengineering, University of Washington , Seattle, Washington 98195-5061, United States.,Department of Biochemistry, University of Washington , Seattle, Washington 98195-7350, United States
| | - Jorgen Nelson
- Department of Biochemistry, University of Washington , Seattle, Washington 98195-7350, United States
| | - Elain Fu
- School of Chemical, Biological, and Environmental Engineering, Oregon State University , Corvallis, Oregon 97331, United States
| | - David Baker
- Department of Biochemistry, University of Washington , Seattle, Washington 98195-7350, United States
| | - Paul Yager
- Department of Bioengineering, University of Washington , Seattle, Washington 98195-5061, United States
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23
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Huang S, Abe K, Bennett S, Liang T, Ladd PD, Yokobe L, Anderson CE, Shah K, Bishop J, Purfield M, Kauffman PC, Paul S, Welch AE, Strelitz B, Follmer K, Pullar K, Sanchez-Erebia L, Gerth-Guyette E, Domingo G, Klein E, Englund JA, Fu E, Yager P. Disposable Autonomous Device for Swab-to-Result Diagnosis of Influenza. Anal Chem 2017; 89:5776-5783. [PMID: 28445636 DOI: 10.1021/acs.analchem.6b04801] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A prototype of a self-contained, automated, disposable device for chemically amplified protein-based detection of influenza virus from nasal swab specimens was developed and evaluated in a clinical setting. The device required only simple specimen manipulation without any dedicated instrumentation or specialized training by the operator for interpretation. The device was based on a sandwich immunoassay for influenza virus nucleoprotein; it used an enzyme-labeled antibody and a chromogenic substrate to provide an amplified visible signal, in a two-dimensional paper network format. All reagents were stored within the device. Device performance was assessed at Seattle Children's Hospital; clinical staff collected nasal swab samples from 25 patients and then operated test devices on site to detect influenza A and B in those specimens. The total test time from device initiation to result was approximately 35 min. Device performance for influenza A detection was ∼70% accurate using in-house qRT-PCR influenza A as a gold-standard comparison. The ratio of valid to total completed device runs yielded a success rate of 92%, and the negative predictive value for both the influenza A and B assay was 81%. The ability to diagnose respiratory infections rapidly and close to the patient was well received by hospital staff, inspiring further optimization of device function.
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Affiliation(s)
- Shichu Huang
- Department of Bioengineering, University of Washington , Seattle, Washington 98195, United States
| | - Koji Abe
- Department of Bioengineering, University of Washington , Seattle, Washington 98195, United States
| | - Steven Bennett
- Department of Bioengineering, University of Washington , Seattle, Washington 98195, United States
| | - Tinny Liang
- Department of Bioengineering, University of Washington , Seattle, Washington 98195, United States
| | - Paula D Ladd
- Department of Bioengineering, University of Washington , Seattle, Washington 98195, United States
| | | | - Caitlin E Anderson
- Department of Bioengineering, University of Washington , Seattle, Washington 98195, United States
| | - Kamal Shah
- Department of Bioengineering, University of Washington , Seattle, Washington 98195, United States
| | - Josh Bishop
- Department of Bioengineering, University of Washington , Seattle, Washington 98195, United States
| | - Mike Purfield
- Department of Bioengineering, University of Washington , Seattle, Washington 98195, United States
| | - Peter C Kauffman
- Department of Bioengineering, University of Washington , Seattle, Washington 98195, United States
| | - Sai Paul
- Department of Bioengineering, University of Washington , Seattle, Washington 98195, United States
| | - AnneMarie E Welch
- Department of Bioengineering, University of Washington , Seattle, Washington 98195, United States
| | - Bonnie Strelitz
- Center for Clinical and Translational Research, Seattle Children's Hospital , Seattle, Washington 98105, United States
| | - Kristin Follmer
- Center for Clinical and Translational Research, Seattle Children's Hospital , Seattle, Washington 98105, United States
| | - Kelsey Pullar
- Center for Clinical and Translational Research, Seattle Children's Hospital , Seattle, Washington 98105, United States
| | - Luis Sanchez-Erebia
- Center for Clinical and Translational Research, Seattle Children's Hospital , Seattle, Washington 98105, United States
| | | | | | - Eileen Klein
- Center for Clinical and Translational Research, Seattle Children's Hospital , Seattle, Washington 98105, United States
| | - Janet A Englund
- Center for Clinical and Translational Research, Seattle Children's Hospital , Seattle, Washington 98105, United States
| | - Elain Fu
- Chemical, Biological, and Environmental Engineering, Oregon State University , Corvallis, Oregon 97331, United States
| | - Paul Yager
- Department of Bioengineering, University of Washington , Seattle, Washington 98195, United States
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Pitt SJ, Phillips DIM. Diagnostic virology and patient care: from vaguely interesting to vitally important. Br J Biomed Sci 2017; 74:16-23. [PMID: 28206853 DOI: 10.1080/09674845.2016.1264706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The existence of pathogenic viruses was inferred by experiments at the turn of the twentieth century. Key developments in detection of viruses, including electron microscopy and monolayer cell culture, were made in the middle of that century. However, in terms of patient care, the results from the virology laboratory often arrived the patient was 'better or dead'. The advent of molecular techniques, particularly polymerase chain reaction and more recently whole genome sequencing made timely and accurate diagnosis of viral infections feasible. A range of approaches have been taken to identify and characterise new viruses. Vaccines against viruses have made it possible to eliminate two pathogenic mammalian viruses altogether, with several others close to eradication. The role of biomedical scientists working in diagnostic virology is more relevant to patient care than ever.
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Affiliation(s)
- Sarah J Pitt
- a School of Pharmacy and Biomolecular Sciences , University of Brighton , Brighton , UK
| | - D Ian M Phillips
- b Public Health Wales Microbiology and Health Protection , Cardiff University Hospital of Wales , Cardiff , UK
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25
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Otto CC, Kaplan SE, Stiles J, Mikhlina A, Lee C, Babady NE, Tang YW. Rapid Molecular Detection and Differentiation of Influenza Viruses A and B. J Vis Exp 2017. [PMID: 28190065 DOI: 10.3791/54312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Influenza is a contagious respiratory illness caused by influenza viruses A and B in humans and causes a significant amount of morbidity and mortality every year. The Influenza A and B assay was the first CLIA-waived molecular rapid flu test available. The Influenza A and B test works by employing isothermal amplification with influenza-specific primers followed by target detection with molecular beacon probes. Here, the performance of the Influenza A and B assay on frozen, archived nasopharyngeal swab (NPS) specimens stored in viral transport medium (VTM) were compared to a respiratory panel assay. The performance of the Influenza A and B assay was evaluated by comparing the results to the respiratory panel reference method. The sensitivity for total influenza virus A was 67.5% (95% CI (CI), 56.6-78.5) and the specificity was 86.9% (CI, 71.0-100). For influenza virus B testing, the sensitivity and specificity were 90.2% (CI, 68.5-100) and 98.8% (CI, 68.5-100), respectively. This system has the advantage of a significantly shorter test time than any other currently available molecular assay and the simple, pipette-free procedure runs on a fully integrated, closed, small-footprint system. Overall, the Influenza A and B assay evaluated in this study has the potential to serve as a point-of-care rapid influenza diagnostic test.
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Affiliation(s)
- Caitlin C Otto
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center
| | - Samuel E Kaplan
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center
| | - Jeffrey Stiles
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center
| | - Albina Mikhlina
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center
| | - Cindy Lee
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center
| | - N Esther Babady
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center
| | - Yi-Wei Tang
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center;
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26
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The use of saliva specimens for detection of influenza A and B viruses by rapid influenza diagnostic tests. J Virol Methods 2017; 243:15-19. [PMID: 28111058 DOI: 10.1016/j.jviromet.2017.01.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Diagnostic tests for influenza infection commonly use nasopharyngeal swabs (NPS) even though these are invasive to obtain. As an alternative specimen, we evaluated the diagnostic usefulness of saliva samples with rapid influenza diagnostic tests (RIDTs). STUDY DESIGN Both NPS and saliva samples were collected from 385 influenza suspected patients and analyzed using Sofia Influenza A+B Fluorescence Immunoassay (Quidel Corporation, San Diego, CA, USA), ichroma TRIAS Influenza A+B (Boditech, Chuncheon, Korea), SD Bioline Influenza Ag (Standard Diagnostic, Yonggin, Korea), BinaxNOW Influenza A/B antigen kit (Alere Inc., Waltham, MA, USA), and real-time reverse transcriptase PCR (RT-PCR). RESULTS Of the 385 patients, 31.2% (120/385) were positive for influenza A, and 7.5% (29/385) were positive for influenza B virus with saliva or NPS by RT-PCR. The diagnostic sensitivity was slightly higher in NPS than in saliva samples for both influenza A and B by all of the four RIDTs. The diagnostic sensitivities of Sofia and ichroma TRIAS were significantly superior to those of the other conventional influenza RIDTs with both types of sample. The sensitivities of Sofia and ichroma TRIAS with saliva specimens were comparable to the sensitivities of the other two conventional RIDTs with NPS specimens. The simultaneous use of saliva and NPS samples exhibited improved sensitivity from 10.0% to 13.3% for influenza A and from 10.3% to 17.2% for influenza B compared to using NPS alone. CONCLUSIONS This study demonstrates that saliva is a useful specimen for influenza detection, and that the combination of saliva and NPS could improve the sensitivities of influenza RIDTs.
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28
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Park HJ, Yang SC, Choo J. Early Diagnosis of Influenza Virus A Using Surface-enhanced Raman Scattering-based Lateral Flow Assay. B KOREAN CHEM SOC 2016. [DOI: 10.1002/bkcs.11021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hyun Ji Park
- Department of Bionano Technology; Hanyang University; Ansan South Korea
| | - Sung Chul Yang
- School of Architectural Engineering; Hongik University; Sejong South Korea
| | - Jaebum Choo
- Department of Bionano Technology; Hanyang University; Ansan South Korea
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29
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Busson L, Mahadeb B, De Foor M, Vandenberg O, Hallin M. Contribution of a rapid influenza diagnostic test to manage hospitalized patients with suspected influenza. Diagn Microbiol Infect Dis 2016; 87:238-242. [PMID: 27939284 DOI: 10.1016/j.diagmicrobio.2016.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 11/21/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
Abstract
AIM To evaluate the performances of the Alere i influenza A&B test and to appraise its contribution to patient management. METHODS In total, 267 samples were tested. Influenza A and B PCR was performed as the reference. For each positive result, the supervising physician was contacted to collect data regarding patient management. FINDINGS The overall sensitivity and specificity of the Alere i were 91.4% and 97.6% for influenza A and 54.5% and 98.8% for influenza B, respectively. More specifically, when used in the emergency room (ER), the test helped avoid 10.7% of hospitalizations, 46.4% of antibiotic prescriptions and 42.9% of additional investigations for positive patients. The test was also helpful in instituting the prescription of oseltamivir and patient isolation. CONCLUSION Alere i influenza A&B is a rapid, sensitive and specific diagnostic test for influenza A. Sensitivity for influenza B was poor. Its usefulness was more important when patients were still in the ER.
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Affiliation(s)
- Laurent Busson
- Department of Microbiology, Iris-Lab, Brussels, Belgium.
| | | | - Marc De Foor
- Department of Microbiology, Iris-Lab, Brussels, Belgium
| | - Olivier Vandenberg
- Department of Microbiology, Iris-Lab, Brussels, Belgium; Infectious Diseases Epidemiological Unit, Public Health School, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie Hallin
- Department of Molecular Biology, Iris-Lab, Brussels, Belgium
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30
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Iha Y, Kinjo T, Parrott G, Higa F, Mori H, Fujita J. Comparative epidemiology of influenza A and B viral infection in a subtropical region: a 7-year surveillance in Okinawa, Japan. BMC Infect Dis 2016; 16:650. [PMID: 27821090 PMCID: PMC5100171 DOI: 10.1186/s12879-016-1978-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 10/27/2016] [Indexed: 12/16/2023] Open
Abstract
BACKGROUND The epidemic patterns of influenza B infection and their association with climate conditions are not well understood. Influenza surveillance in Okinawa is important for clarifying transmission patterns in both temperate and tropical regions. Using surveillance data, collected over 7 years in the subtropical region of Japan, this study aims to characterize the epidemic patterns of influenza B infection and its association with ambient temperature and relative humidity, in a parallel comparison with influenza A. METHODS From January 2007 until March 2014, two individual influenza surveillance datasets were collected from external sources. The first dataset, included weekly rapid antigen test (RAT) results from four representative general hospitals, located in the capital city of Okinawa. A nation-wide surveillance of influenza, diagnosed by RAT results and/or influenza-like illness symptoms, included the age distribution of affected patients and was used as the second dataset. To analyze the association between infection and local climate conditions, ambient temperature and relative humidity during the study period were retrieved from the Japanese Meteorological Agency website. RESULTS Although influenza A maintained high number of infections from December through March, epidemics of influenza B infection were observed annually from March through July. The only observed exception was 2010, when the pandemic strain of 2009 dominated. During influenza B outbreaks, influenza patients aged 5 to 9 years old and 10 to 14 years old more frequently visited sentinel sites. Although both ambient temperature and relative humidity are inversely associated with influenza A infection, influenza B infection was found to be directly associated with high relative humidity. CONCLUSION Further studies are needed to elucidate the complex epidemiology of influenza B and its relationship with influenza A. In the subtropical setting of Okinawa, epidemics of influenza B infection occur from March to July following the influenza A epidemic, and primarily affect school-age children. These findings help to define unknown aspects of influenza B and can inform healthcare decisions for patients located outside temperate regions.
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Affiliation(s)
- Yoshikazu Iha
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
- Department of Nursing, University of the Ryukyus Hospital, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Takeshi Kinjo
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Gretchen Parrott
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Futoshi Higa
- Department of Respiratory Medicine, National Hospital Organization Okinawa Hospital, 3-20-14 Ganeko, Ginowan, Okinawa 901-2214 Japan
| | - Hideaki Mori
- Clinical Laboratory Center, Medical Association of Naha City, 26-1 Higashimachi, Naha, Okinawa 900-0034 Japan
| | - Jiro Fujita
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
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31
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Voermans JJC, Seven-Deniz S, Fraaij PLA, van der Eijk AA, Koopmans MPG, Pas SD. Performance evaluation of a rapid molecular diagnostic, MultiCode based, sample-to-answer assay for the simultaneous detection of Influenza A, B and respiratory syncytial viruses. J Clin Virol 2016; 85:65-70. [PMID: 27835760 DOI: 10.1016/j.jcv.2016.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/24/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Clinical signs and symptoms of different airway pathogens are generally indistinguishable, making laboratory tests essential for clinical decisions regarding isolation and antiviral therapy. Immunochromatographic tests (ICT) and direct immunofluorescence assays (DFA) have lower sensitivities and specificities than molecular assays, but have the advantage of quick turnaround times and ease-of-use. OBJECTIVE To evaluate the performance of a rapid molecular assay, ARIES FluA/B & RSV, using laboratory developed RT-PCR assays (LDA), ICT (BinaxNOW) and DFA. METHODS Analytical and clinical performance were evaluated in a retrospective study arm (stored respiratory samples obtained between 2006-2015) and a prospective study arm (unselected fresh clinical samples obtained between December 2015 and March 2016 tested in parallel with LDAs). RESULTS Genotype inclusivity and analytical specificity was 100%. However, ARIES was 0.5 log, 1-2logs and 2.5logs less sensitive for fluA, RSV and fluB respectively, compared to LDA. In total, 447 clinical samples were included, of which 15.4% tested positive for fluA, 9.2% for fluB and 26.0% for RSV, in both LDA and ARIES. ARIES clinical sensitivity compared to LDA was 98.6% (fluA), 93.3% (fluB) and 95.1% (RSV). Clinical specificity was 100% for all targets. ARIES detected 10.6% (4 fluA, 8 fluB, 11 RSV) and 26.9% (7 fluA, 3 fluB, 22 RSV) more samples compared to DFA and ICT, all confirmed by LDA. CONCLUSION Although analytically ARIES is less sensitive than LDA, the clinical performance of the assay in our tertiary care setting was comparable, and significantly better than that of the established rapid assays.
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Affiliation(s)
| | - S Seven-Deniz
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - P L A Fraaij
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - M P G Koopmans
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Suzan D Pas
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.
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Evaluation of the rapid influenza detection tests GOLD SIGN FLU and Quick Navi-Flu for the detection of influenza A and B virus antigens in adults during the influenza season. Int J Infect Dis 2016; 52:55-58. [DOI: 10.1016/j.ijid.2016.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/17/2016] [Accepted: 10/02/2016] [Indexed: 11/21/2022] Open
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Mese S, Akan H, Badur S, Uyanik A. Analytical performance of the BD veritor™ system for rapid detection of influenza virus A and B in a primary healthcare setting. BMC Infect Dis 2016; 16:481. [PMID: 27612949 PMCID: PMC5016879 DOI: 10.1186/s12879-016-1811-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 08/26/2016] [Indexed: 11/10/2022] Open
Abstract
Background Infections with influenza A virus cannot be clinically differentiated from infections caused by influenza B virus or other respiratory viruses. Additionally, although antiviral treatment is available for influenza A virus, it is not effective for the other viruses and must be initiated early in the course of disease for it to be effective. For these reasons, there is a need for a rapid, accurate diagnostic test for use in physicians’ offices at the time patients are seen. We report the first field performance of BD Veritor™ System for Rapid Detection of Flu A + B test compared to real time PCR. The performance of this test was compared to real time PCR performed in the Istanbul University Influenza Reference Laboratory. Method A single-blinded cross sectional study was conducted in nine different family medicine centers in Istanbul, Turkey between 01 November 2014 and 01 May 2015. For every patient, two specimens were collected, one for real time PCR and one for the Veritor test. Specimens for the Veritor test were immediately tested at the participating clinic according to the manufacturer’s instructions. The specimens for real time PCR were transferred to the reference laboratory. Results A total of 238 persons were included in the study: 72 (30 %) of the patients included in the study were below 19 years old and accepted as childhood group. Mean age of adults was 42.4 and children 10.2 years. A total of 122 patients out of 238 were positive for influenza. The clinical sensitivity and specificity of the Veritor test in all age groups was determined to be 80 and 94 %, respectively. Positive predictive value was 93 % and the negative one was 81 %. Conclusion Field performance of the rapid influenza test was high and found to be useful with respect to rational antiviral use, avoiding unnecessary antibiotic usage and the management of cases by the family physicians.
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Affiliation(s)
- Sevim Mese
- Department of Microbiology and Clinical Microbiology, Virology and Fundamental Immunology Unit, National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Hulya Akan
- Department of Family Medicine, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Selim Badur
- Department of Microbiology and Clinical Microbiology, Virology and Fundamental Immunology Unit, National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysun Uyanik
- Department of Microbiology and Clinical Microbiology, Virology and Fundamental Immunology Unit, National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Wang Y, Qu J, Ba Q, Dong J, Zhang L, Zhang H, Wu A, Wang D, Xia Z, Peng D, Shu Y, Cao B, Jiang T. Detection and typing of human-infecting influenza viruses in China by using a multiplex DNA biochip assay. J Virol Methods 2016; 234:178-85. [PMID: 27150046 DOI: 10.1016/j.jviromet.2016.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 04/29/2016] [Accepted: 04/30/2016] [Indexed: 01/27/2023]
Abstract
Rapid identification of the infections of specific subtypes of influenza viruses is critical for patient treatment and pandemic control. Here we report the application of multiplex reverse transcription polymerase chain reaction (RT-PCR) coupled with membrane-based DNA biochip to the detection and discrimination of the type (A and B) and subtype (human H1N1, human H3N2, avian H5N1 and avian H7N9) of influenza viruses in circulation in China. A multiplex one-step RT-PCR assay was designed to simultaneously amplify the HA and NA genes of the four subtypes of influenza A viruses and NS genes to discriminate type A and B viruses. PCR products were analyzed by a membrane-based biochip. The analytical sensitivity of the assay was determined at a range of 2-100 copies/reactions for each of the gene transcripts. Eighty one clinical samples, containing 66 positive samples with evident seasonal influenza virus infections, were tested, which gives the clinical sensitivity and specificity of 95.5% and 100% respectively. For the avian influenza samples, 3 out of 4 H5N1 samples and 2 out of 2 H7N9 avian samples were correctly identified. We argue this method could allow a rapid, reliable and inexpensive detection and differentiation of human-infecting influenza viruses.
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Affiliation(s)
- Yongqiang Wang
- Key Laboratory of Protein and Peptide Pharmaceuticals, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jiuxin Qu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China
| | - Qi Ba
- Key Laboratory of Protein and Peptide Pharmaceuticals, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Jiuhong Dong
- Key Laboratory of Protein and Peptide Pharmaceuticals, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Liang Zhang
- Translational Medicine Center, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| | - Hong Zhang
- Key Laboratory of Protein and Peptide Pharmaceuticals, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Aiping Wu
- Center for Systems Medicine, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China; Suzhou Institute of Systems Medicine, Suzhou, Jiangsu 215123, China
| | - Dayan Wang
- State Key Laboratory for Molecular Virology and Genetic Engineering, National Institute for Viral Infectious Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Zanxian Xia
- State Key Laboratory of Medical Genetics & School of Life Sciences, Central South University, Changsha, Hunan 410078, China
| | - Daxin Peng
- College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu 225009, China
| | - Yuelong Shu
- State Key Laboratory for Molecular Virology and Genetic Engineering, National Institute for Viral Infectious Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Bin Cao
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China; Lab of Clinical Microbiology and Infectious diseases, Centre of Respiratory and Critical Care Medicine, China Japan Friendship Hospital, Beijing 100029, China.
| | - Taijiao Jiang
- Key Laboratory of Protein and Peptide Pharmaceuticals, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China; Center for Systems Medicine, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China; Suzhou Institute of Systems Medicine, Suzhou, Jiangsu 215123, China.
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Optimizing Virus Identification in Critically Ill Children Suspected of Having an Acute Severe Viral Infection. Pediatr Crit Care Med 2016; 17:279-86. [PMID: 26895562 DOI: 10.1097/pcc.0000000000000661] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Multiplex rapid viral tests and nasopharyngeal flocked swabs are increasingly used for viral testing in PICUs. This study aimed at evaluating how the sampling site and the type of diagnostic test influence test results in children with suspected severe viral infection. DESIGN Prospective cohort study. SETTING PICUs at 21 tertiary pediatric referral centers in the United States. PATIENTS During the 2010-2011 and 2011-2012 influenza seasons, we enrolled children (6 mo to 17 yr old) who were suspected to have severe viral infection. INTERVENTIONS We collected samples by using a standardized protocol for nasopharyngeal aspirate and nasopharyngeal flocked swabs in nonintubated patients and for endotracheal tube aspirate and nasopharyngeal flocked swabs in intubated patients. MEASUREMENTS AND MAIN RESULTS Viral testing included a single reverse transcription-polymerase chain reaction influenza test and the GenMark Respiratory Viral Panel (20 viruses). We enrolled 90 endotracheally intubated and 133 nonintubated children. We identified influenza in 45 patients with reverse transcription-polymerase chain reaction testing; the multiplex panel was falsely negative for influenza in two patients (4.4%). Six patients (13.3%) had not been diagnosed with influenza in the PICU. Non-influenza viruses were identified in 172 of 223 children (77.1%). In nonintubated children, the same virus was identified by nasopharyngeal flocked swabs and nasopharyngeal aspirate in 133 of 183 paired samples (72.7%), with +nasopharyngeal aspirate/-nasopharyngeal flocked swabs in 32 of 183 paired samples (17.4%). In intubated children, the same virus was identified by nasopharyngeal flocked swabs and endotracheal tube aspirate in 67 of 94 paired samples (71.3%), with +nasopharyngeal flocked swabs/- endotracheal tube aspirate in 22 of 94 paired samples (23.4%). Most discrepancies were either adenovirus or rhinovirus in both groups. CONCLUSIONS Standardized specimen collection and sensitive diagnostic testing with a reverse transcription-polymerase chain reaction increased the identification of influenza in critically ill children. For most pathogenic viruses identified, results from nasopharyngeal flocked swabs agreed with those from nasopharyngeal or endotracheal aspirates.
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Tseng YT, Wang CH, Chang CP, Lee GB. Integrated microfluidic system for rapid detection of influenza H1N1 virus using a sandwich-based aptamer assay. Biosens Bioelectron 2016; 82:105-11. [PMID: 27054814 DOI: 10.1016/j.bios.2016.03.073] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 03/27/2016] [Accepted: 03/29/2016] [Indexed: 01/20/2023]
Abstract
The rapid spread of influenza-associated H1N1 viruses has caused serious concern in recent years. Therefore, there is an urgent need for the development of automatic, point-of-care devices for rapid diagnosis of the influenza virus. Conventional approaches suffer from several critical issues; notably, they are time-consuming, labor-intensive, and are characterized by relatively low sensitivity. In this work, we present a new approach for fluorescence-based detection of the influenza A H1N1 virus using a sandwich-based aptamer assay that is automatically performed on an integrated microfluidic system. The entire detection process was shortened to 30min using this chip-based system which is much faster than the conventional viral culture method. The limit of detection was significantly improved to 0.032 hemagglutination unit due to the high affinity and high specificity of the H1N1-specific aptamers. The results showed that the two-aptamer microfluidic system had about 10(3) times higher sensitivity than the conventional serological diagnosis. It was demonstrated that the developed microfluidic system may play as a powerful tool in the detection of the H1N1 virus.
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Affiliation(s)
- Yi-Ting Tseng
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Chih-Hung Wang
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Chih-Peng Chang
- Department of Microbiology and Immunology, National Cheng Kung University, Tainan, Taiwan
| | - Gwo-Bin Lee
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, Taiwan; Institute of NanoEngineering and Microsystems, National Tsing Hua University, Hsinchu, Taiwan; Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan.
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Moesker FM, van Kampen JJA, Aron G, Schutten M, van de Vijver DAMC, Koopmans MPG, Osterhaus ADME, Fraaij PLA. Diagnostic performance of influenza viruses and RSV rapid antigen detection tests in children in tertiary care. J Clin Virol 2016; 79:12-17. [PMID: 27045454 PMCID: PMC7185377 DOI: 10.1016/j.jcv.2016.03.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 11/30/2022]
Abstract
The here studied rapid antigen detection test (RADT) BinaxNOW RSV has a high sensitivity and positive predictive value. RADT BinaxNOW Influenza A&B has a relatively low sensitivity and positive predictive value. We advise a restricted use of RADT BinaxNOW Influenza A&B in a tertiary paediatric care setting.
Background Rapid antigen detection tests (RADTs) are increasingly used to detect influenza viruses and respiratory syncytial virus (RSV). However, their sensitivity and specificity are a matter of debate, challenging their clinical usefulness. Objectives Comparing diagnostic performances of BinaxNow Influenza AB® (BNI) and BinaxNow RSV® (BNR), to those of real-time reverse transcriptase PCR (RT-PCR), virus isolation and direct immunofluorescence (D-IF) in paediatric patients. Study design Between November 2005 and September 2013, 521 nasal washings from symptomatic children (age <5 years) attending our tertiary care centre were tested, with a combination of the respective assays using RT-PCR as gold standard. Results Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of BNI were 69% (confidence interval [CI] [51–83]), 96% [94–97], 55% [39–70] and 98% [96–99] respectively. Of eleven false-negative samples, RT-PCR Ct-values were higher than all RT-PCR positive test results (27 vs 22, p = 0.012). Of twenty false-positive samples, none were culture positive and two tested positive in D-IF. Sensitivity, specificity, PPV and NPV for BNR were 79% [73–85], 98% [96–99], 97% [93–99] and 88% [84–91]. Of the 42 false-negative samples the median Ct-value was higher than that of all RT-PCR positive samples (31 vs 23, p < 0.0001). Five false-positive samples were detected. Three of these tested positive for RSV in virus isolation and D-IF. Conclusions RADTs have a high specificity with BNR being superior to BNI. However, their relative low sensitivity limits their usefulness for clinical decision making in a tertiary care paediatric hospital.
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Affiliation(s)
- F M Moesker
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - J J A van Kampen
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - G Aron
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - M Schutten
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands; Viroclinics Biosciences BV, Rotterdam, The Netherlands
| | | | - M P G Koopmans
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - A D M E Osterhaus
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands; Viroclinics Biosciences BV, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine, Hannover, Germany.
| | - P L A Fraaij
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands; Department of Paediatrics, Erasmus MC-Sophia, Rotterdam, The Netherlands
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Gomez S, Prieto C, Folgueira L. A prospective study to assess the diagnostic performance of the Sofia(®) Immunoassay for Influenza and RSV detection. J Clin Virol 2016; 77:1-4. [PMID: 26872325 DOI: 10.1016/j.jcv.2016.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/14/2016] [Accepted: 01/30/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Respiratory viruses RSV and influenza A and B viruses are responsible for important disease outbreaks during the winter season in temperate climate regions. Rapid diagnostic tests (RDTs) are assays designed to yield a rapid diagnosis, which facilitates patient management. The Sofia Influenza A+B Fluorescence Immunoassay and Sofia RSV Fluorescence Immunoassay are RDTs for Influenza and RSV detection that employ a new technology to enhance their sensitivity. OBJECTIVES Sensitivity, specificity and positive and negative predictive values of the assays were calculated compared with the reference diagnostic method: real-time RT-PCR. STUDY DESIGN A prospective evaluation was carried out on 1065 respiratory samples for Sofia Influenza A+B FIA and on 261 samples for Sofia RSV FIA from November 2013 to April 2014. RESULTS The sensitivities of the Sofia Influenza A+B FIA for influenza A and influenza B detection were, respectively, 75.3% (244/324) and 50.0% (8/16). The sensitivity of the Sofia RSV FIA was 92.1% (128/139). There were no differences in Sofia FIA performance depending on the virus subtype. CONCLUSIONS The results showed high sensitivity and specificity values for influenza A and RSV detection, but values were lower for influenza B. More information is needed regarding the performance for influenza B given the small number of positive samples assessed.
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Affiliation(s)
- Sara Gomez
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Columbiana Prieto
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lola Folgueira
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
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Bowman AS, Nolting JM, Workman JD, Cooper M, Fisher AE, Marsh B, Forshey T. The Inability to Screen Exhibition Swine for Influenza A Virus Using Body Temperature. Zoonoses Public Health 2016; 63:34-9. [PMID: 25884907 PMCID: PMC4609228 DOI: 10.1111/zph.12201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Indexed: 11/28/2022]
Abstract
Agricultural fairs create an unconventional animal-human interface that has been associated with swine-to-human transmission of influenza A virus (IAV) in recent years. Early detection of IAV-infected pigs at agricultural fairs would allow veterinarians to better protect swine and human health during these swine exhibitions. This study assessed the use of swine body temperature measurement, recorded by infrared and rectal thermometers, as a practical method to detect IAV-infected swine at agricultural fairs. In our first objective, infrared thermometers were used to record the body surface temperature of 1,092 pigs at the time of IAV nasal swab collection at the end of the exhibition period of 55 agricultural fairs. IAV was recovered from 212 (19.4%) pigs, and the difference in mean infrared body temperature measurement of IAV-positive and IAV-negative pigs was 0.83°C. In a second objective, snout wipes were collected from 1,948 pigs immediately prior to the unloading of the animals at a single large swine exhibition. Concurrent to the snout wipe collection, owners took the rectal temperatures of his/her pigs. In this case, 47 (2.4%) pigs tested positive for IAV before they entered the swine barn. The mean rectal temperatures differed by only 0.19°C between IAV-positive and IAV-negative pigs. The low prevalence of IAV among the pigs upon entry to the fair in the second objective provides evidence that limiting intraspecies spread of IAV during the fairs will likely have significant impacts on the zoonotic transmission. However, in both objectives, the high degree of similarity in the body temperature measurements between the IAV-positive and IAV-negative pigs made it impossible to set a diagnostically meaningful cut point to differentiate IAV status of the individual animals. Unfortunately, body temperature measurement cannot be used to accurately screen exhibition swine for IAV.
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Affiliation(s)
- Andrew S. Bowman
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
| | - Jacqueline M. Nolting
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
| | - Jeffrey D. Workman
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
- Ohio State University Extension, The Ohio State University, Columbus, OH, USA
| | - Maria Cooper
- Indiana State Board of Animal Health, Indianapolis, IN, USA
| | - Aaron E Fisher
- Indiana 4-H Youth Development, Purdue University, West Lafayette, IN, USA
| | - Bret Marsh
- Indiana State Board of Animal Health, Indianapolis, IN, USA
| | - Tony Forshey
- Ohio Department of Agriculture, Reynoldsburg, OH, USA
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Thibaut HJ, Lacroix C, De Palma AM, Franco D, Decramer M, Neyts J. Toward antiviral therapy/prophylaxis for rhinovirus-induced exacerbations of chronic obstructive pulmonary disease: challenges, opportunities, and strategies. Rev Med Virol 2016; 26:21-33. [PMID: 26388447 PMCID: PMC7169185 DOI: 10.1002/rmv.1856] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 12/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a life-threatening lung illness characterized by persistent and progressive airflow limitation. Exacerbations of COPD contribute to the severity of this pathology and accelerate disease progression. To date, pharmacological treatment of both stable COPD patients and patients experiencing exacerbations is mainly symptomatic with bronchodilators and steroids as the mainstay of therapy. Bacteria trigger such exacerbations in a number of cases; hence, antibiotics might be included in the treatment as well. Several respiratory viruses are frequently detected in sputum from patients during COPD exacerbations. These include influenza viruses, respiratory syncytial virus, and, most often, rhinoviruses. In this review, we discuss the potential use of an anti-rhinovirus drug for the treatment and prophylaxis of rhinovirus-induced COPD exacerbations and the path forward toward the development and use of such a drug. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Hendrik Jan Thibaut
- Laboratory for Virology and Experimental Chemotherapy, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | - Céline Lacroix
- Laboratory for Virology and Experimental Chemotherapy, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | - Armando M De Palma
- Laboratory for Virology and Experimental Chemotherapy, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | - David Franco
- Laboratory for Virology and Experimental Chemotherapy, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | - Mark Decramer
- Respiratory Division, University Hospital, University of Leuven, Leuven, Belgium
| | - Johan Neyts
- Laboratory for Virology and Experimental Chemotherapy, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
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Chen L, Tian Y, Chen S, Liesenfeld O. Performance of the Cobas(®) Influenza A/B Assay for Rapid Pcr-Based Detection of Influenza Compared to Prodesse ProFlu+ and Viral Culture. Eur J Microbiol Immunol (Bp) 2015; 5:236-45. [PMID: 26716012 PMCID: PMC4681351 DOI: 10.1556/1886.2015.00046] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 11/13/2015] [Indexed: 12/18/2022] Open
Abstract
Rapid and accurate diagnosis of influenza is important for patient management and infection control. We determined the performance of the cobas® Influenza A/B assay, a rapid automated nucleic acid assay performed on the cobas® Liat System for qualitative detection of influenza A and influenza B from nasopharyngeal (NP) swab specimens. Retrospective frozen and prospectively collected NP swabs from patients with signs and symptoms of influenza collected in universal transport medium (UTM) were tested at multiple sites including CLIA-waived sites using the cobas® Influenza A/B assay. Results were compared to the Prodesse Pro-Flu+ assay and to viral culture. Compared to the Prodesse ProFlu+ Assay, sensitivities of the cobas® Influenza A/B assay for influenza A and B were 97.7 and 98.6%, respectively; specificity was 99.2 and 99.4%. Compared to viral culture, the cobas® Influenza A/B assay showed sensitivities of 97.5 and 96.9% for influenza virus A and B, respectively; specificities were 97.9% for both viruses. Polymerase chain reaction (PCR)/sequencing showed that the majority of viral culture negative but cobas® Influenza A/B positive results were true positive results, indicating that the cobas® Influenza A/B assay has higher sensitivity compared to viral culture. In conclusion, the excellent accuracy, rapid time to result, and remarkable ease of use make the cobas® Influenza A/B nucleic acid assay for use on the cobas® Liat System a highly suitable point-of-care solution for the management of patients with suspected influenza A and B infection.
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Affiliation(s)
- L Chen
- Roche Molecular Systems , Marlborough 01752, MA, USA
| | - Y Tian
- Roche Molecular Systems , Marlborough 01752, MA, USA
| | - S Chen
- Roche Molecular Systems , Marlborough 01752, MA, USA
| | - O Liesenfeld
- Medical and Scientific Affairs, Roche Molecular Systems , Pleasanton 94588, CA, USA
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López Pineda A, Ye Y, Visweswaran S, Cooper GF, Wagner MM, Tsui FR. Comparison of machine learning classifiers for influenza detection from emergency department free-text reports. J Biomed Inform 2015; 58:60-69. [PMID: 26385375 PMCID: PMC4684714 DOI: 10.1016/j.jbi.2015.08.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/28/2015] [Accepted: 08/21/2015] [Indexed: 12/31/2022]
Abstract
Influenza is a yearly recurrent disease that has the potential to become a pandemic. An effective biosurveillance system is required for early detection of the disease. In our previous studies, we have shown that electronic Emergency Department (ED) free-text reports can be of value to improve influenza detection in real time. This paper studies seven machine learning (ML) classifiers for influenza detection, compares their diagnostic capabilities against an expert-built influenza Bayesian classifier, and evaluates different ways of handling missing clinical information from the free-text reports. We identified 31,268 ED reports from 4 hospitals between 2008 and 2011 to form two different datasets: training (468 cases, 29,004 controls), and test (176 cases and 1620 controls). We employed Topaz, a natural language processing (NLP) tool, to extract influenza-related findings and to encode them into one of three values: Acute, Non-acute, and Missing. Results show that all ML classifiers had areas under ROCs (AUC) ranging from 0.88 to 0.93, and performed significantly better than the expert-built Bayesian model. Missing clinical information marked as a value of missing (not missing at random) had a consistently improved performance among 3 (out of 4) ML classifiers when it was compared with the configuration of not assigning a value of missing (missing completely at random). The case/control ratios did not affect the classification performance given the large number of training cases. Our study demonstrates ED reports in conjunction with the use of ML and NLP with the handling of missing value information have a great potential for the detection of infectious diseases.
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Affiliation(s)
- Arturo López Pineda
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, 5607 Baum Boulevard, Pittsburgh, PA, United States
| | - Ye Ye
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, 5607 Baum Boulevard, Pittsburgh, PA, United States; Intelligent System Program, University of Pittsburgh Dietrich School of Arts and Sciences, 210 South Bouquet Street, Pittsburgh, PA, United States
| | - Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, 5607 Baum Boulevard, Pittsburgh, PA, United States; Intelligent System Program, University of Pittsburgh Dietrich School of Arts and Sciences, 210 South Bouquet Street, Pittsburgh, PA, United States
| | - Gregory F Cooper
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, 5607 Baum Boulevard, Pittsburgh, PA, United States; Intelligent System Program, University of Pittsburgh Dietrich School of Arts and Sciences, 210 South Bouquet Street, Pittsburgh, PA, United States
| | - Michael M Wagner
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, 5607 Baum Boulevard, Pittsburgh, PA, United States; Intelligent System Program, University of Pittsburgh Dietrich School of Arts and Sciences, 210 South Bouquet Street, Pittsburgh, PA, United States
| | - Fuchiang Rich Tsui
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, 5607 Baum Boulevard, Pittsburgh, PA, United States; Intelligent System Program, University of Pittsburgh Dietrich School of Arts and Sciences, 210 South Bouquet Street, Pittsburgh, PA, United States.
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Koul PA, Mir H, Bhat MA, Khan UH, Khan MM, Chadha MS, Lal RB. Performance of rapid influenza diagnostic tests (QuickVue) for influenza A and B Infection in India. Indian J Med Microbiol 2015; 33 Suppl:26-31. [PMID: 25657152 DOI: 10.4103/0255-0857.148831] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Rapid point-of-care (POC) tests provide an economical alternative for rapid diagnosis and treatment of influenza, especially in public health emergency situations. OBJECTIVES To test the performance of a rapid influenza diagnostic test, QuickVue (Quidel) as a POC test against a real-time polymerase chain reaction (RT-PCR) assay for detection of influenza A and B in a developing country setting. STUDY DESIGN In a prospective observational design, 600 patients with influenza-like illness (ILI) or with severe acute respiratory illness (SARI) who were referred to the Influenza Clinic of a tertiary care hospital in Srinagar, India from September 2012 to April 2013, were enrolled for diagnostic testing for influenza using QuickVue or RT-PCR. All influenza A-positive patients by RT-PCR were further subtyped using primers and probes for A/H1pdm09 and A/H3. RESULTS Of the 600 patients, 186 tested positive for influenza A or B by RT-PCR (90 A/H1N1pdm09, 7 A/H3 and 89 influenza B), whereas only 43 tested positive for influenza (influenza A=22 and influenza B=21) by QuickVue. Thus, the sensitivity of the QuickVue was only 23% (95% confidence interval, CI: 17.3-29.8) and specificity was 100% (95% CI: 99.1-100) with a positive predictive value (PPV) of 100% (95% CI 91.8-100) and a negative predictive value (NPV) of 74.3% (95% CI: 70.5-77.9) as compared to RT-PCR. CONCLUSIONS The high specificity of QuickVue suggest that this POC test can be a useful tool for patient management or triaging during a public health crisis but a low sensitivity suggests that a negative test result need to be further tested using RT-PCR.
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Affiliation(s)
- P A Koul
- Department of Internal and Pulmonary Medicine and MSM Project for Influenza, Sher I Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
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Fowler JC, Patriquin M, Madan A, Allen JG, Frueh BC, Oldham JM. Early identification of treatment non-response utilizing the Patient Health Questionnaire (PHQ-9). J Psychiatr Res 2015; 68:114-9. [PMID: 26228409 DOI: 10.1016/j.jpsychires.2015.06.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/19/2015] [Accepted: 06/20/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Treatment non-response among high-risk, psychiatric patients exposes those suffering to suicidal risk as well as persistent social and occupational difficulties. Strategies for identification of treatment non-response are limited. AIMS Diagnostic efficiency of a self-report, cross-cutting symptom measure was assessed as a marker of treatment non-response. METHOD 835 inpatients at a specialist psychiatric hospital completed the Patient Health Questionnaire - Depression (PHQ-9) at admission and every two weeks during hospitalization. RESULTS For patients admitted with severe depression (PHQ-9 ≥ 20), results indicated good accuracy of 2-week PHQ-9 change score in identifying treatment non-response (AUC = 0.80, SE = 0.04, p < .0001; sensitivity = 85%; specificity = 73%; OR = 14.91). CONCLUSIONS The search for predictors of non-response to psychiatric treatment has a long and generally unfulfilled history. The PHQ-9 change score holds promise as a cost-effective test with comparable diagnostic characteristics to other medical tests.
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Affiliation(s)
- J Christopher Fowler
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Michelle Patriquin
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Alok Madan
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Jon G Allen
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - B Christopher Frueh
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; University of Hawaii, Department of Psychology, 200 West Kawili St., Hilo, HI 96720, USA
| | - John M Oldham
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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Gómez S, Prieto C, Vera C, R Otero J, Folgueira L. Evaluation of a new rapid diagnostic test for the detection of influenza and RSV. Enferm Infecc Microbiol Clin 2015; 34:298-302. [PMID: 26139303 DOI: 10.1016/j.eimc.2015.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/08/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Influenza viruses and respiratory syncytial virus (RSV) can cause an acute respiratory disease that occurs seasonally in epidemic waves. This retrospective study was conducted to evaluate the Sofia(®) Influenza A+B and the Sofia(®) RSV fluorescence immunoassays (FIAs), two novel rapid detection tests (RDTs) for influenza A and B and RSV. METHODS Two hundred and nine breath samples were selected from patients with respiratory symptoms determined to be positive/negative for influenza A, influenza B or RSV using one of the reference diagnostic techniques, cell culture and/or RT-PCR (Simplexa™Flu A/B & RSV). The Sofia Influenza A+B FIA was tested on 123 samples (63 from children and 60 from adults) and the Sofia RSV FIA was tested on 86 pediatric samples. Sensitivity and specificity values of both assays were calculated assuming the reference techniques as the gold standard. RESULTS Sensitivity and specificity values for the Sofia Influenza A+B FIA were 73.1% and 97.8%, respectively. Sensitivity and specificity values for the Sofia RSV FIA were 87.5% and 86.7%, respectively. CONCLUSION The sensitivity results obtained for the two assays were considerably higher than those reported for other RDTs. In conclusion, the Sofia Influenza A+B and the Sofia RSV FIAs are appropriate tools for the rapid diagnosis of these viruses.
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Affiliation(s)
- Sara Gómez
- Laboratorio de Virología, Servicio de Microbiología Clínica, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Columbiana Prieto
- Laboratorio de Virología, Servicio de Microbiología Clínica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmen Vera
- Laboratorio de Virología, Servicio de Microbiología Clínica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Joaquín R Otero
- Laboratorio de Virología, Servicio de Microbiología Clínica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lola Folgueira
- Laboratorio de Virología, Servicio de Microbiología Clínica, Hospital Universitario 12 de Octubre, Madrid, Spain
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Economic analysis of rapid and sensitive polymerase chain reaction testing in the emergency department for influenza infections in children. Pediatr Infect Dis J 2015; 34:577-82. [PMID: 25973935 DOI: 10.1097/inf.0000000000000703] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Rapid multiplex polymerase chain reaction (PCR) assays simultaneously detect several respiratory viral pathogens with high sensitivity. Maximizing detection of influenza at the point of care has the potential to reduce unnecessary antibiotic use, laboratory tests and hospitalizations. However, the cost-effectiveness of rapid multiplex PCR assays for influenza has not been compared with other diagnostic methods in children. METHODS For children presenting to the emergency department with influenza-like illness, we compared costs and outcomes using 4 different testing strategies for detection of influenza: (1) a rapid multiplex PCR platform (FilmArray); (2) traditional PCR; (3) direct-fluorescent antibody and (4) rapid antigen tests. Costs were assessed from the hospital perspective, and effectiveness was defined as quality-adjusted life years (QALYs). Input parameters were obtained from previous studies, and the model was run separately for children aged 3-36 months and 3-18 years. RESULTS Rapid multiplex PCR testing was the most effective testing strategy for children in both age groups. The incremental cost-effectiveness when compared with rapid antigen tests was $115,556 per QALY for children aged 3-36 months and from $228,000 per QALY for children aged 3-18 years. The cost-effectiveness of rapid multiplex PCR was sensitive to estimates for influenza prevalence, the proportion of patients treated with antivirals and the cost per test. CONCLUSIONS Our model identifies scenarios in which identification of influenza in the emergency department using rapid multiplex PCR testing is a cost-effective strategy for infants and children 3 months through 18 years. Including detection of other respiratory viruses in the analysis would further improve cost-effectiveness.
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Eggers M, Enders M, Terletskaia-Ladwig E. Evaluation of the Becton Dickinson Rapid Influenza Diagnostic Tests in Outpatients in Germany during Seven Influenza Seasons. PLoS One 2015; 10:e0127070. [PMID: 26011531 PMCID: PMC4444080 DOI: 10.1371/journal.pone.0127070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 04/10/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND An extensive retrospective study spanning several seasons was undertaken to evaluate the diagnostic performance of the BD rapid influenza diagnostic test (RIDT) in comparison with the RT-PCR assay. METHODS A total of 2,179 respiratory samples were tested in parallel by in-house RT-PCR and the RIDT. During the 2003-2004, 2006-2007, 2007-2008, and 2008-2009 (n=1671) seasons, the BD Directigen Flu A+B test was used, and during the 2010-2011, 2011-2012 and 2012-2013 (n=508) seasons, the BD Directigen EZ Flu A+B test b was used. RESULTS The sensitivity, specificity, PPV and NPV for the BD Directigen Flu A+B test calculated for types A and B together were 39%, 99%, 98%, and 56%, respectively. For the BD Directigen EZ Flu A+B test, these values were 47%, 100%, 100%, 55%, respectively. The sensitivity of the BD Directigen Flu A+B test did not differ significantly from season to season or between types A (44%) and B (37%). The sensitivity of the BD Directigen EZ Flu A+B test calculated for type A only was 59%, which was considerably higher than the sensitivity of this test for type B (23%). The sensitivity of the RIDT was approximately 40-50% in children and teenagers, but it was only 18.% in adults aged 20 years and older. The specificity of both RIDTs was very high (>99%) during all seasons. CONCLUSIONS Due to their rapid turnaround time, RIDTs can help guide decisions about the clinical management of influenza. Because of the high specificity, a positive result can be interpreted as a true positive, and antiviral therapy as well as appropriate measures to prevent the transmission of influenza can be initiated. The best sensitivity of the RIDT is achieved in children. However, even in this group, the RIDT will only recognize influenza infection in approximately half of the cases, and influenza should still be considered in patients with negative results; negative RIDT results must be confirmed by PCR.
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Affiliation(s)
- Maren Eggers
- Prof. Gisela Enders & Kollegen MVZ GbR and the Institute of Virology, Infectious Diseases and Epidemiology e.V., Stuttgart, Rosenbergstr. 85, Stuttgart, Germany
| | - Martin Enders
- Prof. Gisela Enders & Kollegen MVZ GbR and the Institute of Virology, Infectious Diseases and Epidemiology e.V., Stuttgart, Rosenbergstr. 85, Stuttgart, Germany
| | - Elena Terletskaia-Ladwig
- Prof. Gisela Enders & Kollegen MVZ GbR and the Institute of Virology, Infectious Diseases and Epidemiology e.V., Stuttgart, Rosenbergstr. 85, Stuttgart, Germany
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Lee CC, Liao YC, Lai YH, Lee CCD, Chuang MC. Recognition of dual targets by a molecular beacon-based sensor: subtyping of influenza A virus. Anal Chem 2015; 87:5410-6. [PMID: 25879394 DOI: 10.1021/acs.analchem.5b00810] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A molecular beacon (MB)-based sensor to offer a decisive answer in combination with information originated from dual-target inputs is designed. The system harnesses an assistant strand and thermodynamically favored designation of unpaired nucleotides (UNs) to process the binary targets in "AND-gate" format and report fluorescence in "off-on" mechanism via a formation of a DNA four-way junction (4WJ). By manipulating composition of the UNs, the dynamic fluorescence difference between the binary targets-coexisting circumstance and any other scenario was maximized. Characteristic equilibrium constant (K), change of entropy (ΔS), and association rate constant (k) between the association ("on") and dissociation ("off") states of the 4WJ were evaluated to understand unfolding behavior of MB in connection to its sensing capability. Favorable MB and UNs were furthermore designed toward analysis of genuine genetic sequences of hemagglutinin (HA) and neuraminidase (NA) in an influenza A H5N2 isolate. The MB-based sensor was demonstrated to yield a linear calibration range from 1.2 to 240 nM and detection limit of 120 pM. Furthermore, high-fidelity subtyping of influenza virus was implemented in a sample of unpurified amplicons. The strategy opens an alternative avenue of MB-based sensors for dual targets toward applications in clinical diagnosis.
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Affiliation(s)
- Chun-Ching Lee
- †Department of Chemistry, Tunghai University, Taichung 40704, Taiwan
| | - Yu-Chieh Liao
- ‡Institute of Population Health Science, National Health Research Institutes, Zhunan, Miaoli County 35053, Taiwan
| | - Yu-Hsuan Lai
- †Department of Chemistry, Tunghai University, Taichung 40704, Taiwan
| | | | - Min-Chieh Chuang
- †Department of Chemistry, Tunghai University, Taichung 40704, Taiwan
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Quantitative RT-PCR evaluation of a rapid influenza antigen test for efficient diagnosis of influenza virus infection. J Virol Methods 2014; 212:76-9. [PMID: 25449113 DOI: 10.1016/j.jviromet.2014.10.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 10/20/2014] [Accepted: 10/28/2014] [Indexed: 01/22/2023]
Abstract
Influenza virus infection is diagnosed in most cases using a rapid influenza antigen diagnostic test (RIDT). However, false-negative results are a major concern. By contrast, the nucleic acid amplification test offers high sensitivity and therefore can aid the interpretation of negative RIDT results. In this study, influenza viral loads were quantified with quantitative reverse transcription-polymerase chain reaction (qRT-PCR) using viral suspensions left over after RIDT, and the performance of both methods was evaluated. qRT-PCR detected as few as 10(3)copies/mL of influenza viruses A and B, whereas RIDT showed negative results for viral loads less than 10(7) and 10(5)copies/mL of influenza viruses A and B, respectively. These results indicate that small quantities of the virus that cause false-negative RIDT results can be detected efficiently with qRT-PCR follow-up. In addition, influenza A virus subtype was determined using qRT-PCR.
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Abstract
Influenza A viruses (IAVs) cause epidemics and pandemics that result in considerable financial burden and loss of human life. To manage annual IAV epidemics and prepare for future pandemics, an improved understanding of how IAVs emerge, transmit, cause disease and acquire pandemic potential is urgently needed. Fundamental techniques essential for procuring such knowledge are IAV isolation and culture from experimental and surveillance samples. Here we present a detailed protocol for IAV sample collection and processing, amplification in chicken eggs or mammalian cells, and identification from samples containing unknown pathogens. This protocol is robust, and it allows for the generation of virus cultures that can be used for downstream analyses. Once experimental or surveillance samples are obtained, virus cultures can be generated and the presence of IAVs can be verified in 3-5 d via reverse-transcription (RT)-PCR or hemagglutination assay. Increased time frames may be required for less experienced laboratory personnel, or when large numbers of samples will be processed.
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