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Zhou Y, Zhou C, Wang K, Qiu Q, Cheng Y, Li Y, Cui P, Liang L, Li P, Deng X, Wang L, Zheng W, Gong H, Wang F, Xu M, Chu JJH, Turtle L, Yu H. Diagnostic performance of different specimens in detecting enterovirus A71 in children with hand, foot and mouth disease. Virol Sin 2022; 38:268-275. [PMID: 36371008 PMCID: PMC10176262 DOI: 10.1016/j.virs.2022.11.004] [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: 07/20/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Hand, foot and mouth disease (HFMD) is a major public health problem among children in the Asia-Pacific region. The optimal specimen for HFMD virological diagnosis remains unclear. Enterovirus A71 (EV-A71) neutralizing antibody titres detected in paired sera were considered the reference standard for calculating the sensitivity, specificity, positive and negative predictive value of throat swabs, rectal swabs, stool, blood samples and cerebrospinal fluid (CSF) by RT-PCR or ELISA assay. In this study, clinical samples from 276 HFMD patients were collected for analysing the sensitivity of different kind of specimens. Our results showed that stool had the highest sensitivity (88%, 95% CI: 74%-96%) and agreement with the reference standard (91%). The order of diagnostic yield for EV-A71 infection was stool sample ≥ rectal swab > throat swab > blood sample > CSF sample, and using a combination of clinical samples improved sensitivity for enterovirus detection. The sensitivity of ELISA for IgM antibody detection in sterile-site specimens was significantly higher than that of RT-PCR (serum/plasma: 62% vs. 2%, CSF: 47% vs. 0%) (P < 0.002). In conclusion, our results suggest that stool has the highest diagnostic yield for EV-A71-infected HFMD. If stool is unavailable, rectal swabs can be collected to achieve a similar diagnostic yield. Otherwise, throat swabs may be useful in detecting positive samples. Although IgM in blood or CSF is diagnostically accurate, it lacks sensitivity, missing 40%-50% of cases. The higher proportion of severe cases and shorter interval between onset and sampling contributed to the increase in congruency between clinical testing and the serological reference standard.
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Affiliation(s)
- Yonghong Zhou
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Chongchen Zhou
- Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, 450003, China
| | - Kai Wang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Qi Qiu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Yibing Cheng
- Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, 450003, China
| | - Yu Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, 102206, China
| | - Peng Cui
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Lu Liang
- West China School of Public Health, Sichuan University, Chengdu, 610041, China
| | - Peng Li
- Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, 450003, China
| | - Xiaowei Deng
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Lili Wang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Wen Zheng
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Hui Gong
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Fang Wang
- Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, 450003, China
| | - Meng Xu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Justin Jang Hann Chu
- Laboratory of Molecular RNA Virology and Antiviral Strategies, Department of Microbiology and Immunology and Infectious Disease Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Lance Turtle
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, L69 7BE, UK; Tropical & Infectious Disease Unit, Royal Liverpool University Hospital (member of Liverpool Health Partners), Liverpool, L7 8XP, UK
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China.
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Cho S, Kim WK, No JS, Lee SH, Jung J, Yi Y, Park HC, Lee GY, Park K, Kim JA, Kim J, Lee J, Lee D, Song DH, Gu SH, Jeong ST, Song JW. Urinary genome detection and tracking of Hantaan virus from hemorrhagic fever with renal syndrome patients using multiplex PCR-based next-generation sequencing. PLoS Negl Trop Dis 2021; 15:e0009707. [PMID: 34582439 PMCID: PMC8478167 DOI: 10.1371/journal.pntd.0009707] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background Hantavirus infection occurs through the inhalation of aerosolized excreta, including urine, feces, and saliva of infected rodents. The presence of Hantaan virus (HTNV) RNA or infectious particles in urine specimens of patient with hemorrhagic fever with renal syndrome (HFRS) remains to be investigated. Methodology/Principal findings We collected four urine and serum specimens of Republic of Korea Army (ROKA) patients with HFRS. We performed multiplex PCR-based next-generation sequencing (NGS) to obtain the genome sequences of clinical HTNV in urine specimens containing ultra-low amounts of viral genomes. The epidemiological and phylogenetic analyses of HTNV demonstrated geographically homogenous clustering with those in Apodemus agrarius captured in highly endemic areas, indicating that phylogeographic tracing of HTNV genomes reveals the potential infection sites of patients with HFRS. Genetic exchange analyses showed a genetic configuration compatible with HTNV L segment exchange in nature. Conclusion/Significance Our results suggest that whole or partial genome sequences of HTNV from the urine enabled to track the putative infection sites of patients with HFRS by phylogeographically linking to the zoonotic HTNV from the reservoir host captured at endemic regions. This report raises awareness among physicians for the presence of HTNV in the urine of patients with HFRS. Hantavirus transmission to humans occurs via inhalation of aerosolized excreta, including urine, feces, and saliva of infected rodents. Currently, no report for the etiological evidence associated with urinary Hantaan virus (HTNV) from patients with hemorrhagic fever with renal syndrome (HFRS) is available. Here, we conducted multiplex PCR-based next-generation sequencing (NGS) using urine and serum specimens from four Republic of Korea Army (ROKA) patients with HFRS. The epidemiological and phylogenetic analyses using whole or partial genome sequences of HTNV from urine and serum demonstrated homogenous genetic clustering with HTNV from clinical specimens, circulating at highly endemic sites of patient infection. Among the sequences from ROKA patients, the genomic configuration of ROKA16-10 demonstrated occurrences of the genetic reassortment. Our results suggest that whole or partial genome sequences of HTNV from the urine enabled to track the putative infection sites of patients with HFRS by phylogeographically linking to the zoonotic HTNV from the reservoir host captured at endemic regions. This result provides new insights into presence of HTNV in the urine of patients with HFRS among physicians.
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Affiliation(s)
- Seungchan Cho
- Department of Microbiology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Won-Keun Kim
- Department of Microbiology, College of Medicine, Hallym University, Chuncheon, Republic of Korea
- Institute of Medical Science, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Jin Sun No
- Division of High-risk Pathogens, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Seung-Ho Lee
- Department of Microbiology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jaehun Jung
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yongjin Yi
- Division of Nephrology, Department of Internal Medicine, Dankook University Hospital, Cheonan, Republic of Korea
| | - Hayne Cho Park
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Geum-Young Lee
- Department of Microbiology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyungmin Park
- Department of Microbiology, Korea University College of Medicine, Seoul, Republic of Korea
- BK21 Graduate Program, Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ah Kim
- Division of High-risk Pathogens, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Jongwoo Kim
- Department of Microbiology, Korea University College of Medicine, Seoul, Republic of Korea
- BK21 Graduate Program, Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jingyeong Lee
- Department of Microbiology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Daesang Lee
- 4th R&D Institute, Agency for Defense Development, Daejeon, Republic of Korea
| | - Dong Hyun Song
- 4th R&D Institute, Agency for Defense Development, Daejeon, Republic of Korea
| | - Se Hun Gu
- 4th R&D Institute, Agency for Defense Development, Daejeon, Republic of Korea
| | - Seong Tae Jeong
- 4th R&D Institute, Agency for Defense Development, Daejeon, Republic of Korea
| | - Jin-Won Song
- Department of Microbiology, Korea University College of Medicine, Seoul, Republic of Korea
- BK21 Graduate Program, Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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