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Poelman R, der Meer JV, der Spek CV, Riezebos-Brilman A, Knoester M, Leer-Buter CV, Friedrich AW, Niesters HG. Improved diagnostic policy for respiratory tract infections essential for patient management in the emergency department. Future Microbiol 2020; 15:623-632. [PMID: 32490688 PMCID: PMC7426768 DOI: 10.2217/fmb-2019-0119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim: Establishing an optimal diagnostic policy for patients with respiratory tract infections, at the emergency department (ED) of a university hospital in The Netherlands. Methods: Adult patients were sampled at admission, during the respiratory season (2014–2015). The FilmArray-RP was implemented at the clinical virology laboratory. Diagnostics were provided from 8 am to 10 pm, weekends included. Results: 436/492 (89%) results were available while patients were still at the ED. Median TAT from admission to test result was 165 min (IQR: 138–214). No antibiotics were prescribed in 94/207 (45%) patients who tested positive for a virus. 185/330 (56%) hospitalized patients did not need admission with isolation measures. The value-based measure, expressed in euro–hour (€h), increased to tenfold compared with previous policy. Conclusion: An optimal policy is essential for patient management, by providing timely, reliable diagnostics.
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Affiliation(s)
- Randy Poelman
- The University of Groningen, University Medical Center Groningen, Department of Medical Microbiology & Infection Prevention, Division of Clinical Virology, Groningen, The Netherlands
| | - Johan van der Meer
- University Medical Center Groningen, Emergency Department, Groningen, The Netherlands
| | - Corina van der Spek
- University Medical Center Groningen, University Medical Center Staff, Groningen, The Netherlands
| | - Annelies Riezebos-Brilman
- The University of Groningen, University Medical Center Groningen, Department of Medical Microbiology & Infection Prevention, Division of Clinical Virology, Groningen, The Netherlands.,Currently: University Medical Center Utrecht, Department of Medical Microbiology, Utrecht, The Netherlands
| | - Marjolein Knoester
- The University of Groningen, University Medical Center Groningen, Department of Medical Microbiology & Infection Prevention, Division of Clinical Virology, Groningen, The Netherlands
| | - Coretta Van Leer-Buter
- The University of Groningen, University Medical Center Groningen, Department of Medical Microbiology & Infection Prevention, Division of Clinical Virology, Groningen, The Netherlands
| | - Alexander W Friedrich
- The University of Groningen, University Medical Center Groningen, Department of Medical Microbiology & Infection Prevention, Division of Clinical Virology, Groningen, The Netherlands
| | - Hubert G Niesters
- The University of Groningen, University Medical Center Groningen, Department of Medical Microbiology & Infection Prevention, Division of Clinical Virology, Groningen, The Netherlands
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2
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Rao S, Yanni E, Moss A, Lamb MM, Schuind A, Bekkat-Berkani R, Innis BL, Cotter J, Mistry RD, Asturias EJ. Evaluation of a New Clinical Endpoint for Moderate to Severe Influenza Disease in Children: A Prospective Cohort Study. J Pediatric Infect Dis Soc 2019; 9:460-467. [PMID: 31724050 PMCID: PMC7495912 DOI: 10.1093/jpids/piz075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/07/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND A moderate to severe (M/S) influenza clinical endpoint has been proposed in children, defined as fever >39°C, otitis media, lower respiratory tract infection, or serious extrapulmonary manifestations. The objective of the study was to evaluate the M/S measure against clinically relevant outcomes including hospitalization, emergency room visits, antimicrobial use, and child/parental absenteeism. METHODS We conducted a prospective observational study of children aged 6 months-8 years at the Children's Hospital Colorado emergency department (ED) and urgent care site during 2016-2017 and 2017-2018. Children with influenza-like illness (ILI) underwent influenza testing by polymerase chain reaction (PCR); children who tested positive and a subset of matched test-negative controls underwent follow-up at 2 weeks. The primary outcome was the proportion of children who were hospitalized. Secondary outcomes included recurrent ED visits, antimicrobial use, hospital charges, and child/parental absenteeism within 14 days. RESULTS Among 1478 children enrolled with ILI, 411 (28%) tested positive for influenza by PCR. Of children with influenza illness, 313 (76%) met the M/S definition. Children with M/S influenza were younger (3.8 years vs 4.8 years), infected with influenza A (59% vs 44%), and more frequently hospitalized (unadjusted risk difference [RD], 6.3%; 95% confidence interval [CI], 2.1-10.4; P = .03) and treated with antibiotics (unadjusted RD, 13.3%; 95% CI, 4.3-22.4; P < .01) compared to those with mild disease. CONCLUSIONS Children with M/S influenza have a higher risk of hospitalization and antibiotic use compared with mild disease. This proposed definition may be a useful clinical endpoint to study the public health and clinical impact of influenza interventions in children. CLINICAL TRIALS REGISTRATION NCT02979626.
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Affiliation(s)
- Suchitra Rao
- Department of Pediatrics (Infectious Diseases, Hospital Medicine and Epidemiology), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA,Corresponding Author: Suchitra Rao, MBBS, MSCS, Department of Pediatrics (Infectious Diseases, Hospital Medicine, Epidemiology), University of Colorado School of Medicine and Children’s Hospital Colorado, Box 055, 13123 E 16th Ave, Aurora, CO 80045.
| | | | - Angela Moss
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado and Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, Colorado, USA
| | - Molly M Lamb
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado, USA
| | | | | | - Bruce L Innis
- GSK, Rockville, Maryland, USA,Present affiliation: PATH, Washington, District of Columbia, USA
| | - Jillian Cotter
- Department of Pediatrics (Hospital Medicine), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Rakesh D Mistry
- Department of Pediatrics (Emergency Medicine), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Edwin J Asturias
- Department of Pediatrics, University of Colorado School of Medicine, Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado, USA
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3
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Rabaan AA, Bazzi AM, Alshaikh SA. Comparison of Cepheid® Xpert Flu and Roche RealTime Ready Influenza A/H1N1 Detection Set for detection of influenza A/H1N1. Diagn Microbiol Infect Dis 2018; 90:280-285. [PMID: 29329754 PMCID: PMC7132748 DOI: 10.1016/j.diagmicrobio.2017.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 11/06/2022]
Abstract
Objective To compare two influenza polymerase chain reaction (PCR) methods. Methods A total of 749 suspected MERS-CoV patients presenting at Johns Hopkins Aramco Healthcare, Saudi Arabia, each submitted a clinical sample for influenza A reflex testing using the on-site Cepheid® Xpert Flu assay and at the Ministry of Health laboratory by the Roche PCR assay. Results There was 92.12% overall agreement between the two methods. Specificity of the Cepheid® Xpert Flu was 95.8% for H1N1 and 94.4% for total influenza A. Cepheid® Xpert Flu sensitivity for influenza A was 100% for younger patients (0–19-year age group) but significantly lower both for older patients (68.2% for 60–79-year and 50% for ≥80-year age groups) and overall for males compared to females (72.6% and 94.0%, respectively). Conclusions Specificity of the Cepheid® Xpert Flu test was high; however, sensitivity for total influenza A was lower particularly in males and older patients. 92.12% agreement between assays for FluA/FluA (H1N1) pdm09 detection Specificity of FluA/FluA (H1N1) pdm09 detection high for Cepheid assay Sensitivity of total FluA detection significantly lower in males and older patients
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4
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Leibl M, Robinson C, Schuurmans MM. Comparison of diagnostic performance of rapid and standard polymerase chain reaction laboratory test for influenza and respiratory syncytial virus detection in nasopharyngeal swabs from symptomatic lung transplant recipients. Infect Dis (Lond) 2017; 50:476-478. [PMID: 29275668 DOI: 10.1080/23744235.2017.1420222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- M Leibl
- a Division of Pulmonology , University Hospital Zurich , Zurich , Switzerland.,b Division of Pulmonology , Zurcher RehaZentrum Wald , Zurich , Switzerland
| | - C Robinson
- a Division of Pulmonology , University Hospital Zurich , Zurich , Switzerland
| | - M M Schuurmans
- a Division of Pulmonology , University Hospital Zurich , Zurich , Switzerland
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5
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Beal SG, Assarzadegan N, Rand KH. Sample-to-result molecular infectious disease assays: clinical implications, limitations and potential. Expert Rev Mol Diagn 2016; 16:323-41. [PMID: 26689497 PMCID: PMC7103687 DOI: 10.1586/14737159.2016.1134325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/17/2015] [Indexed: 01/01/2023]
Abstract
Molecular infectious disease diagnostic tests have undergone major advances in the past decade and will continue to rapidly evolve. Assays have become extraordinarily simple to perform, eliminating the need for pre-analytic sample preparation and post-amplification analysis. This allows these tests to be performed in settings without sophisticated expertise in molecular biology, including locations with limited resources. Additionally, the sensitivity and specificity of these assays is superb and many offer extremely fast turn-around times. These tests have major impacts on patient care, but also have some limitations.
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Affiliation(s)
- Stacy G. Beal
- Department of Pathology, Immunology and Laboratory Medicine,
University of Florida College of Medicine, Gainesville, FL,
USA
| | - Naziheh Assarzadegan
- Department of Pathology, Immunology and Laboratory Medicine,
University of Florida College of Medicine, Gainesville, FL,
USA
| | - Kenneth H. Rand
- Department of Pathology, Immunology and Laboratory Medicine,
University of Florida College of Medicine, Gainesville, FL,
USA
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6
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Leonard DG. Respiratory Infections. MOLECULAR PATHOLOGY IN CLINICAL PRACTICE 2016. [PMCID: PMC7123443 DOI: 10.1007/978-3-319-19674-9_52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The majority of respiratory tract infections (RTIs) are community acquired and are the single most common cause of physician office visits and among the most common causes of hospitalizations. The morbidity and mortality associated with RTIs are significant and the financial and social burden high due to lost time at work and school. The scope of clinical symptoms can significantly overlap among the respiratory pathogens, and the severity of disease can vary depending on patient age, underlying disease, and immune status, thereby leading to inaccurate presumptions about disease etiology. The rapid and accurate diagnosis of the causative agent of RTIs improves patient care, reduces morbidity and mortality, promotes effective hospital bed utilization and antibiotic stewardship, and reduces length of stay. This chapter focuses on the clinical utility, advantages, and disadvantages of viral and bacterial tests cleared by the Food and Drug Administration (FDA), and new promising technologies for the detection of bacterial agents of pneumonia currently in development or in US FDA clinical trials are briefly reviewed.
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Affiliation(s)
- Debra G.B. Leonard
- Pathology and Laboratory Medicine, University of Vermont College of Medicine and University of Vermont Medical Center, Burlington, Vermont USA
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7
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Microbiologic Diagnosis of Lung Infection. MURRAY AND NADEL'S TEXTBOOK OF RESPIRATORY MEDICINE 2016. [PMCID: PMC7152380 DOI: 10.1016/b978-1-4557-3383-5.00017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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8
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9
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Evaluation of the Xpert Flu rapid PCR assay in high-risk emergency department patients. J Clin Microbiol 2014; 52:4353-5. [PMID: 25253792 DOI: 10.1128/jcm.02343-14] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
We prospectively evaluated the performance of Cepheid's GeneXpert Xpert Flu assay in a target population of 281 adults presenting to the emergency department with an acute respiratory illness who met Centers for Disease Control and Prevention (CDC) criteria for recommended antiviral treatment. Compared with the Prodesse ProFlu+ assay, Xpert Flu had an overall sensitivity of 95.3% and specificity of 99.2%.
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10
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Cho HJ, Jang JW, Ko SY, Choi SH, Lim CS, An SSA. Evaluation and verification of the nanosphere Verigene RV+ assay for detection of influenza A/B and H1/H3 subtyping. J Med Virol 2014; 87:18-24. [DOI: 10.1002/jmv.23970] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Han Jin Cho
- Department of Emergency Medicine; Korea University; Seoul Republic of Korea
| | - Jin Woo Jang
- Department of Laboratory Medicine; College of Medicine; Korea University; Seoul Republic of Korea
| | - Sun Young Ko
- Department of Laboratory Medicine; College of Medicine; Korea University; Seoul Republic of Korea
| | - Sung Hyuk Choi
- Department of Emergency Medicine; Korea University; Seoul Republic of Korea
| | - Chae Seung Lim
- Department of Laboratory Medicine; College of Medicine; Korea University; Seoul Republic of Korea
| | - Seong Soo A. An
- College of Bionanotechnology & Gachon Medical Research Institute; Gachon University & Gil Medical Center; Seongnam-si Gyeonggi Do Republic of Korea
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11
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Salez N, Nougairede A, Ninove L, Zandotti C, de Lamballerie X, Charrel RN. Xpert Flu for point-of-care diagnosis of human influenza in industrialized countries. Expert Rev Mol Diagn 2014; 14:411-8. [PMID: 24707995 DOI: 10.1586/14737159.2014.901152] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Respiratory infections, particularly those caused by influenza viruses, represent the third-most important cause of death in the world due to infectious diseases. Nevertheless, despite the enormous publicity attracted by epidemics due to these viruses, laboratory diagnosis, documentation and recording of respiratory diseases is still unsatisfactory. Available diagnostic tests capable of providing results rapidly are either limited and insufficiently sensitive or highly sensitive and specific but insufficiently rapid. Considerable investment and research efforts have been made towards the development of new diagnostics for influenza A and B viruses and the Xpert(®) Flu assay (Cepheid(®), CA, USA) has emerged as one of the most promising. In this article, we review current knowledge of the Xpert Flu test, discuss its potential value as a point-of-care test and outline the potential leads for future development.
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Affiliation(s)
- Nicolas Salez
- Aix Marseille Université, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", and IHU Méditerranée Infection, APHM Public Hospitals of Marseille 13385, Marseille, France
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12
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Improved sensitivity of the novel Xpert flu test for detection of influenza B virus. J Clin Microbiol 2013; 51:4277-8. [PMID: 24068015 DOI: 10.1128/jcm.02125-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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13
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Ko SY, Jang JW, Song DJ, Lim CS, Kim WJ. Evaluation of the Simplexa Flu A/B and RSV test for the rapid detection of influenza viruses. J Med Virol 2013; 85:2160-4. [PMID: 23959434 DOI: 10.1002/jmv.23712] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2013] [Indexed: 11/09/2022]
Abstract
Recently, various molecular systems have been introduced for the detection of influenza viruses. Among these, the Simplexa Flu A/B and respiratory syncytial virus (RSV) test can provide results in approximately 2 hr. Nasopharyngeal swabs from 241 patients (influenza A, n = 81; influenza B, n = 80; influenza A and influenza B mixed, n = 1; influenza A and RSV A mixed, n = 2; and influenza and RSV negative, n = 77) were analyzed using the Simplexa Flu A/B and RSV test, a conventional reverse-transcription polymerase chain reaction (RT-PCR) assay, and a real-time RT-PCR assay. Compared to conventional RT-PCR, the Simplexa test had respective sensitivities and specificities of 100% and 100% for influenza A and 100% and 99.4% for influenza B with extracted RNA samples, and 91.7% and 99.4% for influenza A, and 97.5% and 98.1% for influenza B with unprocessed patient specimens. All RSV A specimens were successfully detected by the Simplexa test using both extracted RNA samples and unprocessed patient specimens. The real-time RT-PCR assay had respective sensitivities and specificities of 96.4% and 99.4% for influenza A, and 98.8% and 99.4% for influenza B. The Simplexa test was effective at detecting influenza viruses from extracted RNA samples as well as from unprocessed patient specimens. The assay was not only simple and rapid for influenza detection, but the performance was also comparable to that of other conventional molecular methods.
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Affiliation(s)
- Sun-Young Ko
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
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14
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Fournier PE, Drancourt M, Colson P, Rolain JM, Scola BL, Raoult D. Modern clinical microbiology: new challenges and solutions. Nat Rev Microbiol 2013; 11:574-85. [PMID: 24020074 PMCID: PMC7097238 DOI: 10.1038/nrmicro3068] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the twenty-first century, the clinical microbiology laboratory plays a central part in optimizing the management of infectious diseases and surveying local and global epidemiology. This pivotal role is made possible by the adoption of rational sampling, point-of-care tests, extended automation and new technologies, including mass spectrometry for colony identification, real-time genomics for isolate characterization, and versatile and permissive culture systems. When balanced with cost, these developments can improve the workflow and output of clinical microbiology laboratories and, by identifying and characterizing microbial pathogens, provide significant input to scientific discovery.
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Affiliation(s)
- Pierre-Edouard Fournier
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63, CNRS7278, IRD198, INSERMU1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Aix-Marseille Université, Faculté de Médecine, 27 Boulevard Jean Moulin, Marseille, 13385 France
| | - Michel Drancourt
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63, CNRS7278, IRD198, INSERMU1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Aix-Marseille Université, Faculté de Médecine, 27 Boulevard Jean Moulin, Marseille, 13385 France
| | - Philippe Colson
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63, CNRS7278, IRD198, INSERMU1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Aix-Marseille Université, Faculté de Médecine, 27 Boulevard Jean Moulin, Marseille, 13385 France
| | - Jean-Marc Rolain
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63, CNRS7278, IRD198, INSERMU1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Aix-Marseille Université, Faculté de Médecine, 27 Boulevard Jean Moulin, Marseille, 13385 France
| | - Bernard La Scola
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63, CNRS7278, IRD198, INSERMU1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Aix-Marseille Université, Faculté de Médecine, 27 Boulevard Jean Moulin, Marseille, 13385 France
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63, CNRS7278, IRD198, INSERMU1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Aix-Marseille Université, Faculté de Médecine, 27 Boulevard Jean Moulin, Marseille, 13385 France
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15
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Response letter to rapid diagnosis of influenza: An evaluation of two commercially available RT-PCR assays. J Infect 2013; 66:290-1. [DOI: 10.1016/j.jinf.2012.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 10/07/2012] [Indexed: 11/23/2022]
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Lee HK, Loh TP, Lee CK, Tang JWT, Chiu L, Koay ESC. A universal influenza A and B duplex real-time RT-PCR assay. J Med Virol 2013; 84:1646-51. [PMID: 22930514 PMCID: PMC7166972 DOI: 10.1002/jmv.23375] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A high throughput universal influenza A and B duplex real-time RT-PCR was developed to meet effectively the heightened surveillance and diagnostic needs essential in managing influenza infections and outbreaks. Primers and probes, designed to target highly conserved regions of the matrix protein of influenza A and the nucleoprotein of influenza B, were optimized using the high-throughput LightCycler 480 II system. Analytical sensitivity and specificity were characterized using RNA transcripts diluted serially, archived non-influenza respiratory viruses, and proficiency test samples. Eighty-nine clinical samples were tested in parallel against existing influenza A and B monoplex assays. Once validated, the duplex assay was applied prospectively on 2,458 clinical specimens that were later subtyped. In April 2011, the emergence of an influenza B variant necessitated the inclusion of an additional modified probe for influenza B and revalidation of the revised protocol. The lower detection limits of the assay were 50 copies/PCR. There was no cross-reactivity against any non-influenza respiratory virus and all proficiency testing materials were identified correctly. The parallel testing revealed a 98.9% overall agreement. Routine application of the assay revealed high sensitivity and specificity for the detection of influenza A/H1N1/2009, A/H3N2 and influenza B. Assay C(q) values correlated well between the pre- and post-revision protocols for influenza A (r(2) = 0.998) and B (r(2) = 0.999). The revised protocol detected three additional novel influenza B variant cases in 200 specimens reported previously as influenza B negative. This in-house assay offers a highly sensitive and specific option for laboratories seeking to expand their influenza testing capacity.
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Affiliation(s)
- Hong Kai Lee
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
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17
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Sohn JY, Park KS, Kim JY, Ki CS, Lee NY. Evaluation of the Xpert Flu for the Detection of Influenza A Virus and Influenza A/H1N1/2009 Strain. ANNALS OF CLINICAL MICROBIOLOGY 2013. [DOI: 10.5145/acm.2013.16.3.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ji Yeon Sohn
- Department of Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Sun Park
- Department of Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Youn Kim
- Center for Clinical Medicine, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nam Yong Lee
- Department of Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, Seoul, Korea
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18
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Cohen-Bacrie S, Halfon P. Prospects for molecular point-of-care diagnosis of lower respiratory infections at the hospital’s doorstep. Future Virol 2013. [DOI: 10.2217/fvl.12.124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Now that molecular assays have been simplified, they can be performed at the point of care (POC). As we aimed to evaluate POC detection of respiratory viruses, we have collected studies on the molecular detection of viruses in children and adults with a well-characterized diagnosis, made in hospital settings, of community-acquired acute bronchiolitis (AB) or pneumonia (CAP). We then present the epidemiological issues for each disease. The prevalence of 18 virus species and types was determined separately for each disease, virus by virus. Overall, the median detection rate of viruses was 90% (interquartile range [IQR]: 69.25–93.5%) and 71.8% (IQR: 69.25–74.25%) in children with AB and CAP, respectively, and 24.5% (IQR: 20–30%) in adults with CAP. The observations on the relationship between virological findings and severity of disease were conflicting in AB, while those for influenza-related CAP were significantly associated with high morbidity/mortality. There is evidence supporting the suggestion that molecular POC detection of targeted pathogens could optimize bed management in emergency departments, guide anti-infective therapies and prevent nosocomial outbreaks. However, further investigations are required to determine when the detection of a large panel of viruses should be processed in clinical practice.
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Affiliation(s)
- Stéphan Cohen-Bacrie
- Clinical Microbiology, Alphabio Laboratory, 23 Rue de Friedland, 13006 Marseille, France
| | - Philippe Halfon
- Clinical Microbiology, Alphabio Laboratory, 23 Rue de Friedland, 13006 Marseille, France
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DiMaio MA, Sahoo MK, Waggoner J, Pinsky BA. Comparison of Xpert Flu rapid nucleic acid testing with rapid antigen testing for the diagnosis of influenza A and B. J Virol Methods 2012; 186:137-40. [PMID: 22841669 DOI: 10.1016/j.jviromet.2012.07.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 07/18/2012] [Accepted: 07/18/2012] [Indexed: 12/26/2022]
Abstract
Influenza infections are associated with thousands of hospital admissions and deaths each year. Rapid detection of influenza is important for prompt initiation of antiviral therapy and appropriate patient triage. In this study the Cepheid Xpert Flu assay was compared with two rapid antigen tests, BinaxNOW Influenza A & B and BD Directigen EZ Flu A+B, as well as direct fluorescent antibody testing for the rapid detection of influenza A and B. Using real-time, hydrolysis probe-based, reverse transcriptase PCR as the reference method, influenza A sensitivity was 97.3% for Xpert Flu, 95.9% for direct fluorescent antibody testing, 62.2% for BinaxNOW, and 71.6% for BD Directigen. Influenza B sensitivity was 100% for Xpert Flu and direct fluorescent antibody testing, 54.5% for BinaxNOW, and 48.5% for BD Directigen. Specificity for influenza A was 100% for Xpert Flu, BinaxNOW, and BD Directigen, and 99.2% for direct fluorescent antibody testing. All methods demonstrated 100% specificity for influenza B. These findings support the use of the Xpert Flu assay in settings requiring urgent diagnosis of influenza A and B.
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Affiliation(s)
- Michael A DiMaio
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
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Cordey S, Thomas Y, Suter P, Kaiser L. Pilot Evaluation of RT-PCR/Electrospray Ionization Mass Spectrometry (PLEX-ID/Flu assay) on Influenza-Positive Specimens. Open Virol J 2012; 6:64-7. [PMID: 22611461 PMCID: PMC3355350 DOI: 10.2174/1874357901206010064] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 03/12/2012] [Accepted: 03/22/2012] [Indexed: 12/27/2022] Open
Abstract
The PLEX-ID/Flu assay has been recently developed to enable the detection and typing of influenza viruses based on the RT-PCR/electrospray ionization mass spectrometry technology.This novel assay was evaluated for typing performance on 201 positive influenza A or B nasopharyngeal swab specimens (NPS) detected by real-time RT-PCR during the 2010-2011 season. The PLEX-ID/Flu assay detected and characterized 91.3% and 95.3% of all influenza A and B samples, respectively. All non-typeable influenza A and B specimens by the assay showed low viral loads with threshold cycle values ≥ 33. Taken together, and although our results need to be confirmed by further prospective studies, the PLEX-ID/Flu assay detected positively and gave a typing result for 93% of all NPS detected positively by real-time RT-PCR, thus suggesting a potential role for influenza virus surveillance among other techniques.
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Affiliation(s)
- Samuel Cordey
- Swiss National Reference Centre for Emerging Viral Diseases, University of Geneva Hospitals, Geneva, Switzerland
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