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Lunar MM, Markočič P, Fujs Komloš K, Štamol T, Poljak M. Sporadic Hepatitis A Virus PCR False-Positive Results Observed during Reflex Testing of Serum Samples Previously Tested for Anti-HAV Antibodies and Caused by Contamination with HAV RNA Present in the Reagents of the Commercial Anti-HAV Immunoassay. Microbiol Spectr 2023; 11:e0012223. [PMID: 37162362 PMCID: PMC10269866 DOI: 10.1128/spectrum.00122-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/21/2023] [Indexed: 05/11/2023] Open
Abstract
Hepatitis A diagnosis relies on serology and occasionally on hepatitis A virus (HAV) RNA detection. For timely diagnosis and the avoidance of drawing additional blood, molecular testing is often performed as reflex testing by using blood specimens that were initially sent for anti-HAV serology. Reflex molecular testing is preferably performed from different sample aliquots, but, for limited sample quantities, it uses samples that have been preprocessed in an immunoassay analyzer. In 2012, we first observed sporadic HAV RNA-positive cases that were inconsistent with patients' serological profiles and/or medical histories, suggesting that occasional laboratory contamination was causing false-positive PCR results. Multiple external quality assurance (EQA) and laboratory surface contamination checks were performed, questionable specimens were tested with various HAV RNA tests, and follow-up serum/stool samples were collected. All contamination-check samples and samples from healthy individuals tested HAV RNA-negative, and the laboratory successfully passed all EQAs. The HAV RNA-positive results were reproducible with various HAV RNA assays. No patients seroconverted, and their follow-up samples were consistently HAV RNA-negative. Finally, a detailed review of testing protocols revealed a correlation between HAV RNA false positivity and preceding anti-HAV testing with the Cobas-e411 automated immunoassay analyzer. HAV RNA was detected in the Cobas-e411 anti-HAV reagents, with the HAV sequences matching those from the false-positive samples. Preceding anti-HAV testing using two other immunoassay analyzers did not result in subsequent HAV RNA false positivity during reflex testing. The Cobas-e411 pipetting procedure with a single pipette tip collecting samples and anti-HAV reagents contaminated the original sample with the HAV RNA that was present in the immunoassay's reagents, thereby resulting in HAV RNA false positivity during the reflex testing. IMPORTANCE We present the first report of sporadic HAV PCR false-positive results that have been observed during the reflex testing of serum samples that have previously been tested for anti-HAV antibodies and have been caused by contamination with HAV RNA that is present in the reagents of the commercial anti-HAV immunoassay, with potentially serious clinical consequences. Although HAV RNA was consistently detected in the anti-HAV reagents of all three automated immunoassay analyzers that were in use in our laboratory, only the use of one analyzer and the corresponding commercial anti-HAV immunoassay reagents resulted in contamination that led to false positive HAV RNA results, and this was due to a peculiar pipetting mode of action in which the analyzer uses a single pipette tip to collect both anti-HAV reagents and a sample, which consequently causes the permanent contamination of the original sample with HAV RNA. Manufacturers should strongly consider the occasional need for reflex molecular testing from preprocessed samples and design their analyzers in a way that prevents contamination.
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Affiliation(s)
- Maja M. Lunar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Petra Markočič
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Kristina Fujs Komloš
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tina Štamol
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Kozak RA, Rutherford C, Richard-Greenblatt M, Chau NYE, Cabrera A, Biondi M, Borlang J, Day J, Osiowy C, Ramachandran S, Mayer N, Glaser L, Smieja M. Development and Evaluation of a Molecular Hepatitis A Virus Assay for Serum and Stool Specimens. Viruses 2022; 14:v14010159. [PMID: 35062362 PMCID: PMC8777614 DOI: 10.3390/v14010159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/02/2022] [Accepted: 01/06/2022] [Indexed: 11/26/2022] Open
Abstract
Hepatitis A virus (HAV) is an emerging public health concern and there is an urgent need for ways to rapidly identify cases so that outbreaks can be managed effectively. Conventional testing for HAV relies on anti-HAV IgM seropositivity. However, studies estimate that 10–30% of patients may not be diagnosed by serology. Molecular assays that can directly detect viral nucleic acids have the potential to improve diagnosis, which is key to prevent the spread of infections. In this study, we developed a real-time PCR (RT-PCR) assay to detect HAV RNA for the identification of acute HAV infection. Primers were designed to target the conserved 5′-untranslated region (5′-UTR) of HAV, and the assay was optimized on both the Qiagen Rotor-Gene and the BD MAX. We successfully detected HAV from patient serum and stool samples with moderate differences in sensitivity and specificity depending on the platform used. Our results highlight the clinical utility of using a molecular assay to detect HAV from various specimen types that can be implemented in hospitals to assist with diagnostics, treatment and prevention.
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Affiliation(s)
- Robert A. Kozak
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (R.A.K.); (N.Y.E.C.)
| | - Candace Rutherford
- St. Joseph’s Healthcare, Hamilton, ON L8N 4A6, Canada; (C.R.); (M.R.-G.)
| | - Melissa Richard-Greenblatt
- St. Joseph’s Healthcare, Hamilton, ON L8N 4A6, Canada; (C.R.); (M.R.-G.)
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (N.M.); (L.G.)
| | - N. Y. Elizabeth Chau
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (R.A.K.); (N.Y.E.C.)
| | - Ana Cabrera
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada;
| | - Mia Biondi
- Toronto Centre for Liver Disease, University Health Network, Toronto, ON M6H 3M1, Canada;
| | - Jamie Borlang
- National Microbiology Laboratory, Winnipeg, MB R3E 3PG, Canada; (J.B.); (J.D.); (C.O.)
| | - Jaqueline Day
- National Microbiology Laboratory, Winnipeg, MB R3E 3PG, Canada; (J.B.); (J.D.); (C.O.)
| | - Carla Osiowy
- National Microbiology Laboratory, Winnipeg, MB R3E 3PG, Canada; (J.B.); (J.D.); (C.O.)
| | - Sumathi Ramachandran
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;
| | - Nancy Mayer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (N.M.); (L.G.)
| | - Laurel Glaser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (N.M.); (L.G.)
| | - Marek Smieja
- St. Joseph’s Healthcare, Hamilton, ON L8N 4A6, Canada; (C.R.); (M.R.-G.)
- Correspondence: ; Tel.: +1-905-521-6083
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Hernández‐Huerta MT, Pérez‐Campos Mayoral L, Romero Díaz C, Martínez Cruz M, Mayoral‐Andrade G, Sánchez Navarro LM, Pina‐Canseco MDS, Cruz Parada E, Martínez Cruz R, Pérez‐Campos Mayoral E, Pérez Santiago AD, Vásquez Martínez G, Pérez‐Campos E, Matias‐Cervantes CA. Analysis of SARS-CoV-2 mutations in Mexico, Belize, and isolated regions of Guatemala and its implication in the diagnosis. J Med Virol 2021; 93:2099-2114. [PMID: 33049069 PMCID: PMC7675408 DOI: 10.1002/jmv.26591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/15/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022]
Abstract
The genomic sequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) worldwide are publicly available and are derived from studies due to the increase in the number of cases. The importance of study of mutations is related to the possible virulence and diagnosis of SARS-CoV-2. To identify circulating mutations present in SARS-CoV-2 genomic sequences in Mexico, Belize, and Guatemala to find out if the same strain spread to the south, and analyze the specificity of the primers used for diagnosis in these samples. Twenty three complete SARS-CoV-2 genomic sequences, available in the GISAID database from May 8 to September 11, 2020 were analyzed and aligned versus the genomic sequence reported in Wuhan, China (NC_045512.2), using Clustal Omega. Open reading frames were translated using the ExPASy Translate Tool and UCSF Chimera (v.1.12) for amino acid substitutions analysis. Finally, the sequences were aligned versus primers used in the diagnosis of COVID-19. One hundred and eighty seven distinct variants were identified, of which 102 are missense, 66 synonymous and 19 noncoding. P4715L and P5828L substitutions in replicase polyprotein were found, as well as D614G in spike protein and L84S in ORF8 in Mexico, Belize, and Guatemala. The primers design by CDC of United States showed a positive E value. The genomic sequences of SARS-CoV-2 in Mexico, Belize, and Guatemala present similar mutations related to a virulent strain of greater infectivity, which could mean a greater capacity for inclusion in the host genome and be related to an increased spread of the virus in these countries, furthermore, its diagnosis would be affected.
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Affiliation(s)
| | - Laura Pérez‐Campos Mayoral
- Centro de Investigación Facultad de Medicina UNAM‐UABJO, Facultad de Medicina y Cirugía, Universidad Autónoma “Benito Juárez” de OaxacaOaxacaMexico
| | - Carlos Romero Díaz
- Centro de Investigación Facultad de Medicina UNAM‐UABJO, Facultad de Medicina y Cirugía, Universidad Autónoma “Benito Juárez” de OaxacaOaxacaMexico
| | | | - Gabriel Mayoral‐Andrade
- Centro de Investigación Facultad de Medicina UNAM‐UABJO, Facultad de Medicina y Cirugía, Universidad Autónoma “Benito Juárez” de OaxacaOaxacaMexico
| | | | - María Del Socorro Pina‐Canseco
- Centro de Investigación Facultad de Medicina UNAM‐UABJO, Facultad de Medicina y Cirugía, Universidad Autónoma “Benito Juárez” de OaxacaOaxacaMexico
| | | | - Ruth Martínez Cruz
- Centro de Investigación Facultad de Medicina UNAM‐UABJO, Facultad de Medicina y Cirugía, Universidad Autónoma “Benito Juárez” de OaxacaOaxacaMexico
| | - Eduardo Pérez‐Campos Mayoral
- Centro de Investigación Facultad de Medicina UNAM‐UABJO, Facultad de Medicina y Cirugía, Universidad Autónoma “Benito Juárez” de OaxacaOaxacaMexico
| | | | | | - Eduardo Pérez‐Campos
- Centro de Investigación Facultad de Medicina UNAM‐UABJO, Facultad de Medicina y Cirugía, Universidad Autónoma “Benito Juárez” de OaxacaOaxacaMexico
- Tecnológico Nacional de México/IT de OaxacaOaxacaMexico
- Laboratorio de Patología Clínica “Dr. Eduardo Pérez Ortega”OaxacaMexico
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Hu X, Collier MG, Xu F. Hepatitis A Outbreaks in Developed Countries: Detection, Control, and Prevention. Foodborne Pathog Dis 2020; 17:166-171. [DOI: 10.1089/fpd.2019.2648] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Xiaotong Hu
- The First Affiliated Hospital, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | | | - Fujie Xu
- The First Affiliated Hospital, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, P.R. China
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