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Ginn C, Ateh D, Martin J. The use of point-of-care testing to establish cause of death in the autopsy setting. J Forensic Leg Med 2020; 71:101933. [DOI: 10.1016/j.jflm.2020.101933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
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Kim M, Nguyen DV, Heo Y, Park KH, Paik HD, Kim YB. Antiviral Activity of Fritillaria thunbergii Extract against Human Influenza Virus H1N1 (PR8) In Vitro, In Ovo and In Vivo. J Microbiol Biotechnol 2020; 30:172-177. [PMID: 31752057 PMCID: PMC9728163 DOI: 10.4014/jmb.1908.08001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Influenza viruses cause respiratory diseases in humans and animals with high morbidity and mortality rates. Conventional anti-influenza drugs are reported to exert side effects and newly emerging viral strains tend to develop resistance to these commonly used agents. Fritillaria thunbergii (FT) is traditionally used as an expectorant for controlling airway inflammatory disorders. Here, we evaluated the therapeutic effects of FT extracts against influenza virus type A (H1N1) infection in vitro, in ovo, and in vivo. In the post-treatment assay, FT extracts showed high CC50 (7,500 µg/ml), indicating low toxicity, and exerted moderate antiviral effects compared to oseltamivir (SI 50.6 vs. 222) in vitro. Antiviral activity tests in ovo revealed strong inhibitory effects of both FT extract and oseltamivir against H1N1 replication in embryonated eggs. Notably, at a treatment concentration of 150 mg/kg, only half the group administered oseltamivir survived whereas the FT group showed 100% survival, clearly demonstrating the low toxicity of FT extracts. Consistent with these findings, FT-administered mice showed a higher survival rate with lower body weight reduction relative to the oseltamivir group upon treatment 24 h after viral infection. Our collective results suggest that FT extracts exert antiviral effects against influenza H1N1 virus without inducing toxicity in vitro, in ovo or in vivo, thereby supporting the potential utility of FT extract as a novel candidate therapeutic drug or supplement against influenza.
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Affiliation(s)
- Minjee Kim
- Department of Biomedical Science and Engineering, Konkuk University, Seoul 05029, Republic of Korea
| | - Dinh-Van Nguyen
- Department of Biomedical Science and Engineering, Konkuk University, Seoul 05029, Republic of Korea
| | - Yoonki Heo
- Department of Biomedical Science and Engineering, Konkuk University, Seoul 05029, Republic of Korea
| | - Ki Hoon Park
- Department of Biomedical Science and Engineering, Konkuk University, Seoul 05029, Republic of Korea
| | - Hyun-Dong Paik
- Department of Food Science and Biotechnology of Animal Resources, Konkuk University, Seoul 0509, Republic of Korea
| | - Young Bong Kim
- Department of Biomedical Science and Engineering, Konkuk University, Seoul 05029, Republic of Korea,Corresponding author Phone: +82-2-450-4208 Fax: +82-2-455-1044 E-mail:
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Tsutsui M, Yamazaki T, Tatematsu K, Yokota K, Esaki Y, Kubo Y, Deguchi H, Arima A, Kuroda S, Kawai T. High-throughput single nanoparticle detection using a feed-through channel-integrated nanopore. NANOSCALE 2019; 11:20475-20484. [PMID: 31647092 DOI: 10.1039/c9nr07039g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The outstanding sensitivity of solid-state nanopore sensors comes at a price of low detection efficiency due to the lack of active means to transfer objects into the nanoscale sensing zone. Here we report on a key technology for high-throughput single-nanoparticle detection which exploits mutual effects of microfluidics control and multipore electrophoresis in nanopore-in-channel units integrated on a thin Si3N4 membrane. Using this novel nanostructure, we demonstrated a proof-of-concept for influenza viruses via hydropressure regulation of mass transport in the fluidic channel for continuous feeding of biosamples into the effective electric field extending out from the nanopores, wherein the feed-through mechanism allowed us to selectively detect charged objects in physiological media such as human saliva. With the versatility of nanopore sensing technologies applicable to analytes of virtually any size from cells to polynucleotides, the present integration strategy may open new avenues for practical ultrasensitive bioanalytical tools.
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Affiliation(s)
- Makusu Tsutsui
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka 567-0047, Japan.
| | - Tomoko Yamazaki
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka 567-0047, Japan.
| | - Kenji Tatematsu
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka 567-0047, Japan.
| | - Kazumichi Yokota
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka 567-0047, Japan. and National Institute of Advanced Industrial Science and Technology, Takamatsu, Kagawa 761-0395, Japan
| | - Yuko Esaki
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka 567-0047, Japan.
| | - Yukari Kubo
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka 567-0047, Japan.
| | - Hiroko Deguchi
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka 567-0047, Japan.
| | - Akihide Arima
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka 567-0047, Japan.
| | - Shun'ichi Kuroda
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka 567-0047, Japan.
| | - Tomoji Kawai
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka 567-0047, Japan.
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Arima A, Tsutsui M, Harlisa IH, Yoshida T, Tanaka M, Yokota K, Tonomura W, Taniguchi M, Okochi M, Washio T, Kawai T. Selective detections of single-viruses using solid-state nanopores. Sci Rep 2018; 8:16305. [PMID: 30390013 PMCID: PMC6214978 DOI: 10.1038/s41598-018-34665-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/23/2018] [Indexed: 01/31/2023] Open
Abstract
Rapid diagnosis of flu before symptom onsets can revolutionize our health through diminishing a risk for serious complication as well as preventing infectious disease outbreak. Sensor sensitivity and selectivity are key to accomplish this goal as the number of virus is quite small at the early stage of infection. Here we report on label-free electrical diagnostics of influenza based on nanopore analytics that distinguishes individual virions by their distinct physical features. We accomplish selective resistive-pulse sensing of single flu virus having negative surface charges in a physiological media by exploiting electroosmotic flow to filter contaminants at the Si3N4 pore orifice. We demonstrate identifications of allotypes with 68% accuracy at the single-virus level via pattern classifications of the ionic current signatures. We also show that this discriminability becomes >95% under a binomial distribution theorem by ensembling the pulse data of >20 virions. This simple mechanism is versatile for point-of-care tests of a wide range of flu types.
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Affiliation(s)
- Akihide Arima
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka, 567-0047, Japan
| | - Makusu Tsutsui
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka, 567-0047, Japan.
| | - Ilva Hanun Harlisa
- Department of Chemical Science and Engineering, School of Materials and Chemical Technology, Tokyo Institute of Technology, 2-12-1, O-okayama, Meguro-ku, Tokyo, 152-8552, Japan
| | - Takeshi Yoshida
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka, 567-0047, Japan
| | - Masayoshi Tanaka
- Department of Chemical Science and Engineering, School of Materials and Chemical Technology, Tokyo Institute of Technology, 2-12-1, O-okayama, Meguro-ku, Tokyo, 152-8552, Japan
| | - Kazumichi Yokota
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka, 567-0047, Japan
| | - Wataru Tonomura
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka, 567-0047, Japan
| | - Masateru Taniguchi
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka, 567-0047, Japan
| | - Mina Okochi
- Department of Chemical Science and Engineering, School of Materials and Chemical Technology, Tokyo Institute of Technology, 2-12-1, O-okayama, Meguro-ku, Tokyo, 152-8552, Japan
| | - Takashi Washio
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka, 567-0047, Japan.
| | - Tomoji Kawai
- The Institute of Scientific and Industrial Research, Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka, 567-0047, Japan.
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Yang JH, Huang PY, Shie SS, Yang S, Tsao KC, Wu TL, Wu TS, Huang CT. Diagnostic performance of the Sofia® influenza A+B fluorescent immunoassay in adult outpatients in Northern Taiwan. J Med Virol 2018; 90:1010-1018. [PMID: 29424435 DOI: 10.1002/jmv.25043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/27/2018] [Indexed: 11/09/2022]
Abstract
To evaluate the diagnostic performance of the Sofia influenza A+B fluorescent immunoassay (Sofia FIA), we performed a prospective study at the Chang Gung Memorial Hospital in Taiwan from January 2012 to December 2013. Patients who presented at out-patient clinics or the emergency department with influenza-like illness were included. Upper respiratory tract specimens were collected from oropharynx or nasopharynx. Performance of the Sofia FIA was compared to that of the Formosa One Sure Flu A/B Rapid Test. A Real-time reverse transcriptase-polymerase chain reaction assay (RT-PCR) and/or virus culture were used as reference standards. Of the 109 enrolled patients, the sensitivity, specificity, positive, and negative predictive values of the Sofia FIA to detect influenza A virus were 82%, 89%, 77%, and 89%, respectively. These parameters were 100% when the samples were from nasopharynx. The positive predictive value for influenza B virus detection was 29%. The sensitivity of the Sofia FIA for detection of influenza A virus was 93% between days 2 and 4 after onset of symptoms. For specimens with low viral loads (RT-PCR cycle threshold between 30 and 34.9), the sensitivity of The Sofia FIA was 83% (10/12). The Sofia FIA performed effectively in detecting influenza A virus infection. With nasopharyngeal samples, the performance was comparable to RT-PCR. Although influenza viral load typically decreases with time, the Sofia FIA was sensitive enough to identify influenza infecting patients presenting after several days of illness. However, a high false positive rate limits the assay's usefulness to identify influenza B virus infection.
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Affiliation(s)
- Jeng-How Yang
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Po-Yen Huang
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shian-Sen Shie
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shuan Yang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chien Tsao
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tsu-Lan Wu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Shu Wu
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Tai Huang
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Clinical and laboratory predictors of influenza infection among individuals with influenza-like illness presenting to an urban Thai hospital over a five-year period. PLoS One 2018. [PMID: 29513698 PMCID: PMC5841736 DOI: 10.1371/journal.pone.0193050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Early diagnosis of influenza infection maximizes the effectiveness of antiviral medicines. Here, we assess the ability for clinical characteristics and rapid influenza tests to predict PCR-confirmed influenza infection in a sentinel, cross-sectional study for influenza-like illness (ILI) in Thailand. Participants meeting criteria for acute ILI (fever > 38°C and cough or sore throat) were recruited from inpatient and outpatient departments in Bangkok, Thailand, from 2009-2014. The primary endpoint for the study was the occurrence of virologically-confirmed influenza infection (based upon detection of viral RNA by RT-PCR) among individuals presenting for care with ILI. Nasal and throat swabs were tested by rapid influenza test (QuickVue) and by RT-PCR. Vaccine effectiveness (VE) was calculated using the case test-negative method. Classification and Regression Tree (CART) analysis was used to predict influenza RT-PCR positivity based upon symptoms reported. We enrolled 4572 individuals with ILI; 32.7% had detectable influenza RNA by RT-PCR. Influenza cases were attributable to influenza B (38.6%), A(H1N1)pdm09 (35.1%), and A(H3N2) (26.3%) viruses. VE was highest against influenza A(H1N1)pdm09 virus and among adults. The most important symptoms for predicting influenza PCR-positivity among patients with ILI were cough, runny nose, chills, and body aches. The accuracy of the CART predictive model was 72.8%, with an NPV of 78.1% and a PPV of 59.7%. During epidemic periods, PPV improved to 68.5%. The PPV of the QuickVue assay relative to RT-PCR was 93.0% overall, with peak performance during epidemic periods and in the absence of oseltamivir treatment. Clinical criteria demonstrated poor predictive capability outside of epidemic periods while rapid tests were reasonably accurate and may provide an acceptable alternative to RT-PCR testing in resource-limited areas.
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Performance of a rapid test versus real-time PCR for diagnosis of H1N1 swine flu. J Egypt Public Health Assoc 2016; 89:96-9. [PMID: 25162742 DOI: 10.1097/01.epx.0000452224.96616.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE For effective control and treatment of swine influenza, rapid and cost-effective diagnosis is important. Although the gold-standard method for the diagnosis of influenza virus is culture isolation, it is not routinely used in outpatient settings because of the cost and the time needed to complete the assay. This has led to the development of an array of rapid influenza diagnostic tests. The aim of this study was to compare between the performance of CerTest Swine Flu card and RT-PCR in the detection of H1N1 infection. MATERIALS AND METHODS This study included 40 clinically suspected cases of H1N1. Nasal and throat swabs were collected from patients, placed in viral transport medium, and kept at 4°C until being tested on the same day for the presence of H1N1, using the CerTest Swine Flu test and real-time PCR. RESULTS Of these 40 suspected cases, seven (17.5%) were found to be positive by the PCR technique, whereas 33 (82.5%) were found to be negative. Of the seven positive cases by the PCR technique, six were found to be positive by the rapid test, and thus the sensitivity of the rapid test was found to be 85.7%, and the specificity was 100%. CONCLUSION CerTest Swine Flu card rapid test was found to have reliable sensitivity and specificity compared with the gold-standard RT-PCR.
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Drews SJ. The Role of Clinical Virology Laboratory and the Clinical Virology Laboratorian in Ensuring Effective Surveillance for Influenza and Other Respiratory Viruses: Points to Consider and Pitfalls to Avoid. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016; 8:165-176. [PMID: 32226325 PMCID: PMC7100664 DOI: 10.1007/s40506-016-0081-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Influenza and respiratory viruses have a global impact on public health. Clinical virology laboratories and laboratorians play an important role in not only the diagnosis but also the surveillance of these pathogens. Surveillance for influenza and other respiratory pathogens is important, as it informs public health decision making in terms of influenza vaccine and antiviral effectiveness, informs clinicians and public health practitioners about the pathogenicity of specific viral strains, guides clinical practice, and supports laboratory panning activities. Key background issues include the following: the fact that the laboratory is only one of several data providers to a surveillance system, the biologic nature of influenza and respiratory viruses and the laboratory needs to keep up to date on the diagnosis of these agents, the need for laboratorians to be involved in case definition development, the impact of push and pull data flow models on laboratory resources, and the fact that laboratories may be asked to provide more than just test results to surveillance programs. This review also identifies some key issues or questions that arise during the pre-analytic, analytic, and post-analytic phases that could impact on the ability of the laboratory to link to surveillance programs. Finally, issues surrounding virus characterization programs and how they link to surveillance programs are identified and discussed.
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Affiliation(s)
- Steven J. Drews
- Provincial Laboratory for Public Health (ProvLab), 2B1.03 WMC, University of Alberta Hospital, Edmonton, Alberta T6G 2J2 Canada
- Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, Alberta Canada
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9
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Variability in the diagnostic performance of a bedside rapid diagnostic influenza test over four epidemic seasons in a pediatric emergency department. Diagn Microbiol Infect Dis 2016; 85:334-337. [DOI: 10.1016/j.diagmicrobio.2016.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 03/10/2016] [Accepted: 03/16/2016] [Indexed: 01/12/2023]
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Using Clinical Trial Simulators to Analyse the Sources of Variance in Clinical Trials of Novel Therapies for Acute Viral Infections. PLoS One 2016; 11:e0156622. [PMID: 27332704 PMCID: PMC4917234 DOI: 10.1371/journal.pone.0156622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/17/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND About 90% of drugs fail in clinical development. The question is whether trials fail because of insufficient efficacy of the new treatment, or rather because of poor trial design that is unable to detect the true efficacy. The variance of the measured endpoints is a major, largely underestimated source of uncertainty in clinical trial design, particularly in acute viral infections. We use a clinical trial simulator to demonstrate how a thorough consideration of the variability inherent in clinical trials of novel therapies for acute viral infections can improve trial design. METHODS AND FINDINGS We developed a clinical trial simulator to analyse the impact of three different types of variation on the outcome of a challenge study of influenza treatments for infected patients, including individual patient variability in the response to the drug, the variance of the measurement procedure, and the variance of the lower limit of quantification of endpoint measurements. In addition, we investigated the impact of protocol variation on clinical trial outcome. We found that the greatest source of variance was inter-individual variability in the natural course of infection. Running a larger phase II study can save up to $38 million, if an unlikely to succeed phase III trial is avoided. In addition, low-sensitivity viral load assays can lead to falsely negative trial outcomes. CONCLUSIONS Due to high inter-individual variability in natural infection, the most important variable in clinical trial design for challenge studies of potential novel influenza treatments is the number of participants. 100 participants are preferable over 50. Using more sensitive viral load assays increases the probability of a positive trial outcome, but may in some circumstances lead to false positive outcomes. Clinical trial simulations are powerful tools to identify the most important sources of variance in clinical trials and thereby help improve trial design.
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Huo X, Liu X, Liu J, Sukumaran P, Alwarappan S, Wong DKY. Strategic Applications of Nanomaterials as Sensing Platforms and Signal Amplification Markers at Electrochemical Immunosensors. ELECTROANAL 2016. [DOI: 10.1002/elan.201600166] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Xiaohe Huo
- Institute of Environmental and Analytical Sciences, College of Chemistry and Chemical Engineering; Henan University; Kaifeng, Henan Province 475004 P. R. China
| | - Xiaoqiang Liu
- Institute of Environmental and Analytical Sciences, College of Chemistry and Chemical Engineering; Henan University; Kaifeng, Henan Province 475004 P. R. China
| | - Jin Liu
- Institute of Environmental and Analytical Sciences, College of Chemistry and Chemical Engineering; Henan University; Kaifeng, Henan Province 475004 P. R. China
| | - Preethi Sukumaran
- Bio-electrochemistry Group; CSIR-Central Electrochemical Research Institute; Karaikudi 630006, Tamilnadu India
| | - Subbiah Alwarappan
- Bio-electrochemistry Group; CSIR-Central Electrochemical Research Institute; Karaikudi 630006, Tamilnadu India
| | - Danny K. Y. Wong
- Department of Chemistry and Biomolecular Sciences; Macquarie University; Sydney NSW 2109 Australia
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Wang Z, Lee S, Koo K, Kim K. Nanowire-Based Sensors for Biological and Medical Applications. IEEE Trans Nanobioscience 2016; 15:186-99. [PMID: 26978831 DOI: 10.1109/tnb.2016.2528258] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Nanomaterials such as nanowires, carbon nanotubes, and nanoparticles have already led to breakthroughs in the field of biological and medical sensors. The quantum size effects of the nanomaterials and their similarity in size to natural and synthetic nanomaterials are anticipated to improve sensor sensitivity dramatically. Nanowires are considered as key nanomaterials because of their electrical controllability for accurate measurement, and chemical-friendly surface for various sensing applications. This review covers the working principles and fabrication of silicon nanowire sensors. Furthermore, we review their applications for the detection of viruses, biomarkers, and DNA, as well as for drug discovery. Advances in the performance and functionality of nanowire sensors are also surveyed to highlight recent progress in this area. These advances include the improvements in reusability, sensitivity in high ionic strength solvent, long-term stability, and self-powering. Overall, with the advantages of ultra-sensitivity and the ease of fabrication, it is expected that nanowires will contribute significantly to the development of biological and medical sensors in the immediate future.
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Yamanaka T, Nemoto M, Bannai H, Tsujimura K, Kondo T, Matsumura T, Gildea S, Cullinane A. Evaluation of twenty-two rapid antigen detection tests in the diagnosis of Equine Influenza caused by viruses of H3N8 subtype. Influenza Other Respir Viruses 2016; 10:127-33. [PMID: 26568369 PMCID: PMC4746556 DOI: 10.1111/irv.12358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2015] [Indexed: 11/26/2022] Open
Abstract
Background Equine influenza (EI) is a highly contagious disease caused by viruses of the H3N8 subtype. The rapid diagnosis of EI is essential to reduce the disease spread. Many rapid antigen detection (RAD) tests for diagnosing human influenza are available, but their ability to diagnose EI has not been systematically evaluated. Objectives The aim of this study was to compare the performance of 22 RAD tests in the diagnosis of EI. Methods The 22 RAD tests were performed on fivefold serial dilutions of EI virus to determine their detection limits. The four most sensitive RAD tests (ImmunoAce Flu, BD Flu examan, Quick chaser Flu A, B and ESPLINE Influenza A&B‐N) were further evaluated using nasopharyngeal samples collected from experimentally infected and naturally infected horses. The results were compared to those obtained using molecular tests. Results The detection limits of the 22 RAD tests varied hugely. Even the four RAD tests showing the best sensitivity were 125‐fold less sensitive than the molecular techniques. The duration of virus detection in the experimentally infected horses was shorter using the RAD tests than using the molecular techniques. The RAD tests detected between 27% and 73% of real‐time RT‐PCR‐positive samples from naturally infected horses. Conclusions The study demonstrated the importance of choosing the right RAD tests as only three of 22 were fit for diagnosing EI. It was also indicated that even RAD tests with the highest sensitivity serve only as an adjunct to molecular tests because of the potential for false‐negative results.
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Affiliation(s)
- Takashi Yamanaka
- Equine Research Institute, Japan Racing Association, Shimotsuke, Tochigi, Japan
| | - Manabu Nemoto
- Equine Research Institute, Japan Racing Association, Shimotsuke, Tochigi, Japan
| | - Hiroshi Bannai
- Equine Research Institute, Japan Racing Association, Shimotsuke, Tochigi, Japan
| | - Koji Tsujimura
- Equine Research Institute, Japan Racing Association, Shimotsuke, Tochigi, Japan
| | - Takashi Kondo
- Equine Research Institute, Japan Racing Association, Shimotsuke, Tochigi, Japan
| | - Tomio Matsumura
- Equine Research Institute, Japan Racing Association, Shimotsuke, Tochigi, Japan
| | - Sarah Gildea
- Virology Unit, Irish Equine Centre, Johnstown, Naas, Co. Kildare, Ireland
| | - Ann Cullinane
- Virology Unit, Irish Equine Centre, Johnstown, Naas, Co. Kildare, Ireland
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Audet GN, Quinn CM, Leon LR. Point-of-care cardiac troponin test accurately predicts heat stroke severity in rats. Am J Physiol Regul Integr Comp Physiol 2015; 309:R1264-72. [PMID: 26290107 DOI: 10.1152/ajpregu.00286.2015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/14/2015] [Indexed: 12/28/2022]
Abstract
Heat stroke (HS) remains a significant public health concern. Despite the substantial threat posed by HS, there is still no field or clinical test of HS severity. We suggested previously that circulating cardiac troponin (cTnI) could serve as a robust biomarker of HS severity after heating. In the present study, we hypothesized that (cTnI) point-of-care test (ctPOC) could be used to predict severity and organ damage at the onset of HS. Conscious male Fischer 344 rats (n = 16) continuously monitored for heart rate (HR), blood pressure (BP), and core temperature (Tc) (radiotelemetry) were heated to maximum Tc (Tc,Max) of 41.9 ± 0.1°C and recovered undisturbed for 24 h at an ambient temperature of 20°C. Blood samples were taken at Tc,Max and 24 h after heat via submandibular bleed and analyzed on ctPOC test. POC cTnI band intensity was ranked using a simple four-point scale via two blinded observers and compared with cTnI levels measured by a clinical blood analyzer. Blood was also analyzed for biomarkers of systemic organ damage. HS severity, as previously defined using HR, BP, and recovery Tc profile during heat exposure, correlated strongly with cTnI (R(2) = 0.69) at Tc,Max. POC cTnI band intensity ranking accurately predicted cTnI levels (R(2) = 0.64) and HS severity (R(2) = 0.83). Five markers of systemic organ damage also correlated with ctPOC score (albumin, alanine aminotransferase, blood urea nitrogen, cholesterol, and total bilirubin; R(2) > 0.4). This suggests that cTnI POC tests can accurately determine HS severity and could serve as simple, portable, cost-effective HS field tests.
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Affiliation(s)
- Gerald N Audet
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Carrie M Quinn
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Lisa R Leon
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
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15
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Sanchez JL, Cooper MJ, Myers CA, Cummings JF, Vest KG, Russell KL, Sanchez JL, Hiser MJ, Gaydos CA. Respiratory Infections in the U.S. Military: Recent Experience and Control. Clin Microbiol Rev 2015; 28:743-800. [PMID: 26085551 PMCID: PMC4475643 DOI: 10.1128/cmr.00039-14] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This comprehensive review outlines the impact of military-relevant respiratory infections, with special attention to recruit training environments, influenza pandemics in 1918 to 1919 and 2009 to 2010, and peacetime operations and conflicts in the past 25 years. Outbreaks and epidemiologic investigations of viral and bacterial infections among high-risk groups are presented, including (i) experience by recruits at training centers, (ii) impact on advanced trainees in special settings, (iii) morbidity sustained by shipboard personnel at sea, and (iv) experience of deployed personnel. Utilizing a pathogen-by-pathogen approach, we examine (i) epidemiology, (ii) impact in terms of morbidity and operational readiness, (iii) clinical presentation and outbreak potential, (iv) diagnostic modalities, (v) treatment approaches, and (vi) vaccine and other control measures. We also outline military-specific initiatives in (i) surveillance, (ii) vaccine development and policy, (iii) novel influenza and coronavirus diagnostic test development and surveillance methods, (iv) influenza virus transmission and severity prediction modeling efforts, and (v) evaluation and implementation of nonvaccine, nonpharmacologic interventions.
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Affiliation(s)
- Jose L Sanchez
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Michael J Cooper
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | | | - James F Cummings
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kelly G Vest
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Joyce L Sanchez
- Mayo Clinic, Division of General Internal Medicine, Rochester, Minnesota, USA
| | - Michelle J Hiser
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA Oak Ridge Institute for Science and Education, Postgraduate Research Participation Program, U.S. Army Public Health Command, Aberdeen Proving Ground, Aberdeen, Maryland, USA
| | - Charlotte A Gaydos
- International STD, Respiratory, and Biothreat Research Laboratory, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
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16
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Abstract
We review studies that quantify newly discovered forces from single enzymatic reactions. These forces arise from the conversion of chemical energy to kinetic energy, which can be harnessed to direct diffusion of the enzyme up a concentration gradient of substrate, a novel phenomenon of molecular chemotaxis. When immobilized, enzymes can move fluid around them and perform directional pumping in microfluidic chambers. Because of the extensive array of enzymes in biological cells, we also develop three new hypotheses: that enzymatic self diffusion can assist in organizing signaling pathways in cells, can assist in pumping of fluid in cells, and can impose biologically significant forces on organelles, which will be manifested as stochastic motion not explained by thermal forces or myosin II. Such mechanochemical phenomena open up new directions in research in mechanobiology in which all enzymes, in addition to their primary function as catalysts for reactions, may have secondary functions as initiators of mechanosensitive transduction pathways.
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Affiliation(s)
- Peter J Butler
- Department of Biomedical Engineering, The Pennsylvania State University, 205 Hallowell Building, University Park, PA 16802, USA
| | - Krishna K Dey
- Department of Chemistry, The Pennsylvania State University, 104 Chemistry Building, University Park, PA 16802, USA
| | - Ayusman Sen
- Department of Chemistry, The Pennsylvania State University, 104 Chemistry Building, University Park, PA 16802, USA
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17
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Peters TR, Snively BM, Suerken CK, Blakeney E, Vannoy L, Poehling KA. Relative timing of influenza disease by age group. Vaccine 2014; 32:6451-6. [PMID: 25280434 PMCID: PMC4252244 DOI: 10.1016/j.vaccine.2014.09.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/22/2014] [Accepted: 09/22/2014] [Indexed: 11/18/2022]
Abstract
A detailed understanding of influenza movement in communities during yearly epidemics is needed to inform improved influenza control programs. We sought to determine the relative timing of influenza presentation and symptom onset by age group and influenza strain. Prospective, laboratory-confirmed surveillance was performed over three moderate influenza seasons in emergency departments and inpatient settings of both medical centers in Winston-Salem, NC. Influenza disease presented first in school age children through community epidemics of influenza A(H1N1)pdm09 and influenza B, and first in persons 5-49 years old for influenza A(H3N2). This finding indicates that influenza prevention in persons 5-49 years of age may be particularly important in influenza epidemic control.
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Affiliation(s)
- Timothy R Peters
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Beverly M Snively
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Cynthia K Suerken
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Elizabeth Blakeney
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Lauren Vannoy
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Katherine A Poehling
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; Department of Pediatrics and Epidemiology and Prevention, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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18
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Global gene expression changes in human peripheral blood after H7N9 infection. Gene 2014; 551:255-60. [PMID: 25192803 DOI: 10.1016/j.gene.2014.08.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/22/2014] [Accepted: 08/31/2014] [Indexed: 12/24/2022]
Abstract
A novel avian influenza A virus (H7N9) of human infection emerged in eastern China in 2013, causing mild to lethal human respiratory infections. However, the underlying molecular mechanism remains largely unknown. In this work, we attempt to gain insights into the underlying genetic basis of this disease at the transcription level. We collected peripheral blood samples from patients with H7N9 infection and healthy people, and then we performed transcriptome profiling to comprehensively investigate their expression signatures, which would help us to better understand the molecular basis of the etiology upon viral infection. By employing the high throughput RNA-seq analysis of samples with and without H7N9 viral infection, we totally identified 1091 significantly differentially expressed genes. We found that several biological pathways related to the immunity and inflammation response in the differentially expressed genes. A genome-wide screening of gene regulation between H7N9 virus carrier and healthy people provided some insights into understanding and responsiveness to this potential threat.
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19
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Wang L, Chang LS, Lee IK, Tang KS, Li CC, Eng HL, You HL, Yang KD. Clinical diagnosis of pandemic A(H1N1) 2009 influenza in children with negative rapid influenza diagnostic test by lymphopenia and lower C-reactive protein levels. Influenza Other Respir Viruses 2013; 8:91-8. [PMID: 24373294 PMCID: PMC4177802 DOI: 10.1111/irv.12182] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2013] [Indexed: 01/03/2023] Open
Abstract
Background The sensitivity of rapid influenza diagnostic test (RIDT) of children with influenza-like illness (ILI) remains low. Objective We compare the parameters between pandemic A(H1N1) 2009 influenza with negative RIDT and ILI not H1N1 for improving the low sensitivity of RIDT for children with ILI. Methods In a cohort of consecutive laboratory-confirmed H1N1 influenza, we identified 150 H1N1 children with positive RIDT, 152 H1N1 children with negative RIDT, and 75 children with ILI not H1N1. Viral load in throat, complete blood count (CBC), and C-reactive protein (CRP) levels between H1N1 children with negative RIDT and children with ILI not H1N1 were assessed. Results The diagnostic sensitivity of the RIDT was 45·5%. An analysis of CBC and CRP levels indicated that H1N1 children with negative RIDT had lower total leukocyte, neutrophil, lymphocyte, and basophil counts, and serum CRP levels (P < 0·01). Lymphocyte counts less than 1500 cells/mm3 and CRP levels <15 mg/l, determined by a receiver operating characteristic curve, showed a diagnostic sensitivity of 52·5% and 80·7%, respectively. Combining the lymphocyte counts and CRP levels provided a diagnostic sensitivity of 91·5%. Moreover, H1N1 children with negative RIDT had a lower viral load than those with positive RIDT (3·33 versus 4·48 log10 copies/ml, P < 0·001); the viral load was negatively correlated to the lymphocyte count (P < 0·001). Conclusions A combination of a low lymphocyte count and a low CRP level could, in the early disease phase, provide a useful screening for H1N1 children with false-negative RIDT, potentially facilitating differential diagnoses.
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Affiliation(s)
- Lin Wang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine (KCGMH-CGU), Kaohsiung, Taiwan
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20
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Wang KT, Lin CP, Fang YY, Kao MH, Shih DYC, Lo CF, Wang DY. Sensitivity and specificity of in vitro diagnostic device used for influenza rapid test in Taiwan. J Food Drug Anal 2013; 22:279-284. [PMID: 38620156 PMCID: PMC7128329 DOI: 10.1016/j.jfda.2013.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/17/2013] [Accepted: 06/28/2013] [Indexed: 11/26/2022] Open
Abstract
The pandemic influenza A/H1N1 outbreak resulted in 18,449 deaths in over 214 countries. In Taiwan, the influenza rapid test, an in vitro diagnostic device (Flu-IVD), only requires documented reviews for market approval by the Taiwan Food and Drug Administration. The purpose of this study was to investigate the analytical sensitivity and specificity of Flu-IVDs used in Taiwan. Analytical sensitivity and specificity tests were performed for influenza antigens A/California/7/2009 (H1N1) virus, A/Victoria/210/2009 (H3N2) virus, B/ Brisbane/60/08 virus, and human coronavirus OC43. A total of seven domestic and 31 imported Flu-IVD samples were collected, of which, 20 samples had inadequate labeling, including those with removed package inserts or incorrect insert information. The analytical sensitivity of Flu-IVDs for A/H1N1, A/H3N2, and Flu B was 500-1000 ng/mL, 1000 ng/mL, and 1000 ng/mL, respectively. For the 50% cell culture infective dose (CCID50) label, the average A/H1N1 and A/H3N2 sensitivity for Flu-IVDs was log10 5.8 ± 0.5 and log10 6.6 ± 0.5 CCID50/mL, respectively. As to the specificity test, no product cross-reacted with human coronavirus OC43. This study provides important information on the Flu-IVD regulation status and can thus help the government formulate policies for the regulation of in vitro diagnostic devices in Taiwan.
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Affiliation(s)
- Kun-Teng Wang
- Section of Biologics, Division of Research and Analysis, Food and Drug Administration, Ministry of Health and Welfare,
Taiwan, ROC
| | - Chia-Pei Lin
- Section of Biologics, Division of Research and Analysis, Food and Drug Administration, Ministry of Health and Welfare,
Taiwan, ROC
| | - Yi-Ya Fang
- Section of Biologics, Division of Research and Analysis, Food and Drug Administration, Ministry of Health and Welfare,
Taiwan, ROC
| | - Ming-Hui Kao
- Section of Biologics, Division of Research and Analysis, Food and Drug Administration, Ministry of Health and Welfare,
Taiwan, ROC
| | - Daniel Yang-Chih Shih
- Division of Research and Analysis, Food and Drug Administration, Ministry of Health and Welfare,
Taiwan, ROC
| | - Chi-Fang Lo
- Food and Drug Administration, Ministry of Health and Welfare,
Taiwan, ROC
| | - Der-Yuan Wang
- Section of Biologics, Division of Research and Analysis, Food and Drug Administration, Ministry of Health and Welfare,
Taiwan, ROC
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21
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Abstract
The recent emergence of influenza A virus (H7N9) emphasizes the need for its rapid detection. While commercial nucleic acid amplification tests (NAATs) are commonly used to detect seasonal influenza virus, this study demonstrated that the analytical sensitivity of commercial assays is highly variable compared to that of CDC-based in-house NAATs for the detection of H7N9.
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22
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Yi H, Kim YH, Kim JS, Lee NJ, Shin K, Choi JH, Kwon D, Lee JY, Kang C. Impact of influenza virus escape-mutations on influenza detection by the rapid influenza diagnostic test. J Med Virol 2013; 85:709-15. [PMID: 23417618 DOI: 10.1002/jmv.23484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2012] [Indexed: 11/10/2022]
Abstract
During the influenza pandemic of 2009-2010, rapid influenza diagnostic tests (RIDTs) were used to detect influenza viral infections because they are quick and simple to use. However, retrospective studies showed that RIDTs performed poorly when used to diagnose pandemic viral infections. Determining how amino acid sequence changes in pandemic or epidemic influenza viral antigens impact clinical value of RIDTs has not been possible, because the viral epitopes recognized by RIDTs have been not mapped. In this study, the effect of escape-variations or mutations in influenza viral antigens upon the sensitivity and specificity of an RIDT was investigated by characterizing the immunological properties of the antibodies used in the RIDT. Escape-mutants were generated by cultivating A/Korea/01/2009 in the presence of an excess of the same antibodies used in the RIDT. Escape-mutants not recognized by the RIDT were selected. Epitopes recognized by the RIDT were mapped by comparing the sequence and immunological analysis of the escape-variants and wild-type isolates. The RIDT antibodies recognized epitopes on the Sa antigenic site and in the F subdomain in hemagglutinin. Variants bearing mutations in these epitopes were not detected by the RIDT. The frequency of escape-variants emerging since the 2009-2010 pandemic was calculated as 1.27% using in silico surveillance of influenza sequence databases. These results suggest that mapping the relevant epitopes of RIDTs and making such information available to clinics would be helpful for determining whether RIDTs match newly emergent strains and subtypes prior to retrospective re-evaluation of the RIDTs using clinical specimens.
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Affiliation(s)
- Hwajung Yi
- Division of Influenza Virus, Center for Infectious Diseases, Korea National Institute of Health, Korea Centers for Disease Control and Prevention, Chungcheongbuk-do, South Korea
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23
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Moore C. Point-of-care tests for infection control: should rapid testing be in the laboratory or at the front line? J Hosp Infect 2013; 85:1-7. [PMID: 23916892 DOI: 10.1016/j.jhin.2013.06.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 06/08/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND A point-of-care test (POCT) offers a rapid result to manage a patient immediately. The presumed simplicity of such tests belies observed variation between personnel in performing and interpreting results when not appropriately trained. The number of point-of-care devices being developed for the diagnosis of infectious diseases is increasing; by understanding the limitations associated with their use, such tests for infection control purposes may be possible. AIM To review the expanding repertoire of POCTs for the diagnosis of infectious diseases and to assess their utility as tools to aid in the reduction of hospital-acquired infection and outbreak management. METHODS A systematic review using PubMed and Scopus of published literature on the subject of POCTs for the diagnosis of infectious diseases. FINDINGS Although the number of publications describing POCTs is increasing, there remains a paucity of literature describing their use in a clinical setting. Of the literature reviewed, POCTs for the diagnosis of respiratory syncytial virus and norovirus have the greatest utility in an infection control setting, although the data suggest that sensitivity and training issues might be a problem. The future generation of POCT devices is likely to be molecular-based, improving sensitivity but at a significant cost to the user. CONCLUSIONS POCTs have a role in infection control but currently the lack of good, consistent clinical data surrounding their use outside of the laboratory is a limiting factor in their implementation.
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Affiliation(s)
- C Moore
- Public Health Wales Microbiology Cardiff, University Hospital of Wales, Cardiff CF14 4XW, UK.
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24
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Peters TR, Suerken CK, Snively BM, Winslow JE, Nadkarni MD, Kribbs SB, Poehling KA. Influenza testing, diagnosis, and treatment in the emergency department in 2009-2010 and 2010-2011. Acad Emerg Med 2013; 20:786-94. [PMID: 24033621 DOI: 10.1111/acem.12175] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 02/12/2013] [Accepted: 03/20/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective was to describe patterns of rapid influenza test ordering, diagnosis of influenza, and antiviral prescribing by the treating physician for children and adults presenting to emergency departments (EDs) with fever and acute respiratory symptoms in Winston-Salem, North Carolina, over two influenza seasons. METHODS The authors prospectively enrolled patients presenting to the ED with fever and acute respiratory symptoms for two influenza seasons: H1N1 pandemic of September 2009 through mid-May 2010 and November 2010 through April 2011. Enrolled patients had nose or and throat swabs obtained and tested for influenza by viral culture and polymerase chain reaction (PCR) testing. Demographic information and medical history were obtained by patient or guardian report. Testing, treatment, and discharge diagnosis from the ED visit, as well as medical history and insurance status, were ascertained from chart review. RESULTS Among 2,293 eligible patients approached, 1,657 (72%) were enrolled, of whom 38% were younger than 18 years, 47% were 18 to 49 years, and 15% were 50 years of age and older. Overall, 14% had culture- or PCR-confirmed influenza. The odds of 1) rapid influenza test ordering, 2) a physician diagnosis of influenza, and 3) prescribing antiviral treatment during the ED visit were fourfold higher among patients with than without culture- or PCR-confirmed influenza. The odds of rapid influenza test ordering were threefold lower in 2009/2010 than 2010/2011, whereas the odds of physician diagnosis of influenza and antiviral prescriptions were 2- and 3.5-fold higher, respectively. CONCLUSIONS In 2009/2010 compared to 2010/2011, the odds of rapid influenza test ordering were lower, whereas the odds of influenza-specific discharge diagnoses and antiviral prescriptions were higher among patients presenting to the ED with culture/PCR-confirmed influenza. These results demonstrated a gap between clinical practice and recommendations for the diagnosis and treatment of influenza from the Centers for Disease Control and Prevention (CDC).
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Affiliation(s)
- Timothy R. Peters
- Department of Pediatrics; Wake Forest School of Medicine; Winston-Salem; NC
| | - Cynthia K. Suerken
- Department of Biostatistical Sciences; Wake Forest School of Medicine; Winston-Salem; NC
| | - Beverly M. Snively
- Department of Biostatistical Sciences; Wake Forest School of Medicine; Winston-Salem; NC
| | - James E. Winslow
- Department of Emergency Medicine; Wake Forest School of Medicine; Winston-Salem; NC
| | - Milan D. Nadkarni
- Department of Emergency Medicine; Wake Forest School of Medicine; Winston-Salem; NC
| | - Scott B. Kribbs
- Department of Forsyth Emergency Services; Forsyth Medical Center; Winston-Salem; NC
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25
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Abstract
Collective knowledge regarding the occurrence of influenza among swine is incomplete due to inconsistent surveillance of swine populations. In this chapter, we review what surveillance activities exist and some of the practical challenges encountered. Furthermore, to support robust surveillance activities, accurate laboratory assays are needed for the detection of the virus and viral nucleic acids within clinical samples, or for antiviral antibodies in serum samples. The most common influenza diagnostic assays used for swine are explained and their use as surveillance tools evaluated.
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26
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Goodell CK, Prickett J, Kittawornrat A, Zhou F, Rauh R, Nelson W, O'Connell C, Burrell A, Wang C, Yoon KJ, Zimmerman JJ. Probability of detecting influenza A virus subtypes H1N1 and H3N2 in individual pig nasal swabs and pen-based oral fluid specimens over time. Vet Microbiol 2013; 166:450-60. [PMID: 23910522 DOI: 10.1016/j.vetmic.2013.06.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 06/16/2013] [Accepted: 06/24/2013] [Indexed: 11/30/2022]
Abstract
The probability of detecting influenza A virus (IAV) by virus isolation (VI), point-of-care (POC) antigen detection, and real-time reverse-transcription polymerase chain reaction (rRT-PCR) was estimated for pen-based oral fluid (OF) and individual pig nasal swab (NS) specimens. Piglets (n=82) were isolated for 30 days and confirmed negative for porcine reproductive and respiratory syndrome virus, Mycoplasma hyopneumoniae, and IAV infections. A subset (n=28) was vaccinated on day post inoculation (DPI) -42 and -21 with a commercial multivalent vaccine. On DPI 0, pigs were intratracheally inoculated with contemporary isolates of H1N1 (n=35) or H3N2 (n=35) or served as negative controls (n=12). OF (n=370) was collected DPI 0-16 and NS (n=924) DPI 0-6, 8, 10, 12, 14, 16. The association between IAV detection and variables of interest (specimen, virus subtype, assay, vaccination status, and DPI) was analyzed by mixed-effect repeated measures logistic regression and the results used to calculate the probability (pˆ) of detecting IAV in OF and NS over DPI by assay. Vaccination (p-value<0.0001), DPI (p-value<0.0001), and specimen-assay interaction (p-value<0.0001) were significant to IAV detection, but virus subtype was not (p-value=0.89). Vaccination and/or increasing DPI reduced pˆ for all assays. VI was more successful using NS than OF, but both VI and POC were generally unsuccessful after DPI 6. Overall, rRT-PCR on OF specimens provided the highest pˆ for the most DPIs, yet significantly different results were observed between the two laboratories independently performing rRT-PCR testing.
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Affiliation(s)
- Christa K Goodell
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50010, USA.
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27
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Cho JH, Song HY, Lee JH. Sensitivities of seasonal and pandemic rapid antigen tests differentiated by the level of immunofluorescence for the detection of pandemic influenza A/H1N1 2009 virus. Korean J Intern Med 2013; 28:507-9. [PMID: 23864813 PMCID: PMC3712163 DOI: 10.3904/kjim.2013.28.4.507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 05/13/2013] [Accepted: 05/16/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ji Hyun Cho
- Department of Laboratory Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Hyo Yeop Song
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae Hoon Lee
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
- Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
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28
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Evaluation of a proximity extension assay for the detection of H1 2009 pandemic influenza viruses. J Virol Methods 2013; 193:77-84. [PMID: 23707923 DOI: 10.1016/j.jviromet.2013.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 04/26/2013] [Accepted: 05/08/2013] [Indexed: 11/23/2022]
Abstract
The rapid influenza diagnostic tests (RIDTs) are widely distributed, simple to use, but often lack sensitivity as compared to gold standard methods (viral culture and nucleic acid detection technologies). Applying RIDTs outside of epidemic or pandemic infections results in large numbers of false negatives. Hence, a sensitive RIDT that would reduce the number of false negatives would result in an increased clinical value. We evaluated the potential of a proximity extension assay (PEA) for the detection of influenza A H1 viruses. This technology makes use of antibodies to capture the pathogen, followed by molecular detection. Forty-seven nasopharyngeal swab samples, all confirmed infections of the H1 2009 pandemic influenza virus, were evaluated. The performance of PEA was compared to the RIDT Quickvue Influenza A+B assay. The success rate of the comparative assays was modeled by means of a binary logistic response model. Both assays performed equally well within the current range of viral particles, expressed as log10 copies/ml. When the actual input of viral particles was taken into account, the 95% hitrate of PEA lies within the range of 4.60-7.02 log10 copies/reaction, which is an almost 2 log10 sensitivity improvement over the 95% hitrate of the Quickvue RIDT, ranging from 6.86 to 9.37 log10 copies/reaction. The PEA method holds promise to improve sensitive detection of influenza viruses in clinical samples.
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29
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Cao Q, Fan A, Klapperich C. Microfluidic chip fabrication and method to detect influenza. J Vis Exp 2013. [PMID: 23567317 DOI: 10.3791/50325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Fast and effective diagnostics play an important role in controlling infectious disease by enabling effective patient management and treatment. Here, we present an integrated microfluidic thermoplastic chip with the ability to amplify influenza A virus in patient nasopharyngeal (NP) swabs and aspirates. Upon loading the patient sample, the microfluidic device sequentially carries out on-chip cell lysis, RNA purification and concentration steps within the solid phase extraction (SPE), reverse transcription (RT) and polymerase chain reaction (PCR) in RT-PCR chambers, respectively. End-point detection is performed using an off-chip Bioanalyzer (Agilent Technologies, Santa Clara, CA). For peripherals, we used a single syringe pump to drive reagent and samples, while two thin film heaters were used as the heat sources for the RT and PCR chambers. The chip is designed to be single layer and suitable for high throughput manufacturing to reduce the fabrication time and cost. The microfluidic chip provides a platform to analyze a wide variety of virus and bacteria, limited only by changes in reagent design needed to detect new pathogens of interest.
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Affiliation(s)
- Qingqing Cao
- Department of Mechanical Engineering, Boston University, Boston, Massachusetts, USA
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30
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Sutter DE, Worthy SA, Hensley DM, Maranich AM, Dolan DM, Fischer GW, Daum LT. Performance of five FDA-approved rapid antigen tests in the detection of 2009 H1N1 influenza A virus. J Med Virol 2013; 84:1699-702. [PMID: 22997071 DOI: 10.1002/jmv.23374] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Rapid antigen tests are commonly used by clinicians for rapid, simple, point-of-care testing. Five rapid antigen tests were shown to have low sensitivity (40.3-58.8%) when compared to real-time RT-PCR using nasal wash specimens from patients with influenza-like-illness (N = 167) that were collected previously and confirmed as 2009 pandemic influenza A (H1N1)-positive by PCR. Rapid antigen test sensitivity correlated with virus levels in nasal secretions when comparisons were made to cycle threshold (C(T)) values obtained from real-time RT-PCR. When C(T) values are <25 (equating to viral concentrations of >10(4) TCID(50)/ml) sensitivity for all five rapid antigen kits was high (range: 83-94% positive); however, when C(T) values are >30 (10(2) TCID(50)/ml), sensitivities of only 16-18% were observed for four of five rapid antigen kits. The Directigen EZ Flu A + B test detected more positive samples (35%) at lower viral concentrations with C(T) values >30 when compared with other commercial kits (P = 0.05). Rapid antigen test results must be interpreted with caution, and negative specimens may need confirmation by sensitive molecular assays.
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Affiliation(s)
- Deena E Sutter
- Department of Pediatrics, San Antonio Military Medical Center, Ft Sam, Houston, Texas 78234, USA.
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31
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Vijayan V, Jing J, Zangwill KM. Evaluation of diagnostic and therapeutic approaches for suspected influenza A(H1N1)pdm09 infection, 2009-2010. Emerg Infect Dis 2013; 18:1414-21. [PMID: 22931909 PMCID: PMC3437695 DOI: 10.3201/eid1809.111564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Variations between practice and national recommendations could inform clinical education in future influenza seasons. Keywords: influenza; oseltamivir; H1N1, influenza A(H1N1)pdm09, viruses
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Affiliation(s)
- Vini Vijayan
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
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Woods CW, McClain MT, Chen M, Zaas AK, Nicholson BP, Varkey J, Veldman T, Kingsmore SF, Huang Y, Lambkin-Williams R, Gilbert AG, Hero AO, Ramsburg E, Glickman S, Lucas JE, Carin L, Ginsburg GS. A host transcriptional signature for presymptomatic detection of infection in humans exposed to influenza H1N1 or H3N2. PLoS One 2013; 8:e52198. [PMID: 23326326 PMCID: PMC3541408 DOI: 10.1371/journal.pone.0052198] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 11/15/2012] [Indexed: 11/18/2022] Open
Abstract
There is great potential for host-based gene expression analysis to impact the early diagnosis of infectious diseases. In particular, the influenza pandemic of 2009 highlighted the challenges and limitations of traditional pathogen-based testing for suspected upper respiratory viral infection. We inoculated human volunteers with either influenza A (A/Brisbane/59/2007 (H1N1) or A/Wisconsin/67/2005 (H3N2)), and assayed the peripheral blood transcriptome every 8 hours for 7 days. Of 41 inoculated volunteers, 18 (44%) developed symptomatic infection. Using unbiased sparse latent factor regression analysis, we generated a gene signature (or factor) for symptomatic influenza capable of detecting 94% of infected cases. This gene signature is detectable as early as 29 hours post-exposure and achieves maximal accuracy on average 43 hours (p = 0.003, H1N1) and 38 hours (p-value = 0.005, H3N2) before peak clinical symptoms. In order to test the relevance of these findings in naturally acquired disease, a composite influenza A signature built from these challenge studies was applied to Emergency Department patients where it discriminates between swine-origin influenza A/H1N1 (2009) infected and non-infected individuals with 92% accuracy. The host genomic response to Influenza infection is robust and may provide the means for detection before typical clinical symptoms are apparent.
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Affiliation(s)
- Christopher W. Woods
- Institute for Genome Sciences and Policy, Duke University Medical Center, Durham, North Carolina, United States of America
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
- Durham Veteran’s Affairs Medical Center, Durham, North Carolina, United States of America
- * E-mail: (CW); (GG)
| | - Micah T. McClain
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
- Durham Veteran’s Affairs Medical Center, Durham, North Carolina, United States of America
| | - Minhua Chen
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, United States of America
| | - Aimee K. Zaas
- Institute for Genome Sciences and Policy, Duke University Medical Center, Durham, North Carolina, United States of America
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Bradly P. Nicholson
- Durham Veteran’s Affairs Medical Center, Durham, North Carolina, United States of America
| | - Jay Varkey
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Timothy Veldman
- Institute for Genome Sciences and Policy, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Stephen F. Kingsmore
- National Center for Genome Resources, Santa Fe, New Mexico, United States of America
| | - Yongsheng Huang
- Center for Computational Biology and Bioinformatics, University of Michigan, Ann Arobor, Michigan, United States of America
| | | | | | - Alfred O. Hero
- Center for Computational Biology and Bioinformatics, University of Michigan, Ann Arobor, Michigan, United States of America
| | - Elizabeth Ramsburg
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Seth Glickman
- Department of Emergency Medicine, University of North Carolina-Chapel-Hill, Chapel Hill, North Carolina, United States of America
| | - Joseph E. Lucas
- Institute for Genome Sciences and Policy, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Lawrence Carin
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, United States of America
| | - Geoffrey S. Ginsburg
- Institute for Genome Sciences and Policy, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail: (CW); (GG)
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Xu M, Qin X, Astion ML, Rutledge JC, Simpson J, Jerome KR, Englund JA, Zerr DM, Migita RT, Rich S, Childs JC, Cent A, Del Beccaro MA. Implementation of filmarray respiratory viral panel in a core laboratory improves testing turnaround time and patient care. Am J Clin Pathol 2013; 139:118-23. [PMID: 23270907 PMCID: PMC7110182 DOI: 10.1309/ajcph7x3nlyzphbw] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The FilmArray respiratory virus panel detects 15 viral agents in respiratory specimens using polymerase chain reaction. We performed FilmArray respiratory viral testing in a core laboratory at a regional children’s hospital that provides service 24 hours a day 7 days a week. The average and median turnaround time were 1.6 and 1.4 hours, respectively, in contrast to 7 and 6.5 hours documented 1 year previously at an on-site reference laboratory using a direct fluorescence assay (DFA) that detected 8 viral agents. During the study period, rhinovirus was detected in 20% and coronavirus in 6% of samples using FilmArray; these viruses would not have been detected with DFA. We followed 97 patients with influenza A or influenza B who received care at the emergency department (ED). Overall, 79 patients (81%) were given oseltamivir in a timely manner defined as receiving the drug in the ED, a prescription in the ED, or a prescription within 3 hours of ED discharge. Our results demonstrate that molecular technology can be successfully deployed in a nonspecialty, high-volume, multidisciplinary core laboratory.
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Affiliation(s)
- Min Xu
- Department of Laboratories, Seattle Children’s Hospital, Seattle, WA
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Xuan Qin
- Department of Laboratories, Seattle Children’s Hospital, Seattle, WA
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Michael L. Astion
- Department of Laboratories, Seattle Children’s Hospital, Seattle, WA
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Joe C. Rutledge
- Department of Laboratories, Seattle Children’s Hospital, Seattle, WA
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Joanne Simpson
- Department of Laboratories, Seattle Children’s Hospital, Seattle, WA
| | - Keith R. Jerome
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Janet A. Englund
- Department of Pediatrics, Seattle Children’s Hospital, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle
| | - Danielle M. Zerr
- Department of Pediatrics, Seattle Children’s Hospital, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle
| | - Russell T. Migita
- Department of Pediatrics, Seattle Children’s Hospital, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle
| | - Shannon Rich
- Department of Laboratories, Seattle Children’s Hospital, Seattle, WA
| | - John C. Childs
- Department of Laboratories, Seattle Children’s Hospital, Seattle, WA
| | - Anne Cent
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Mark A. Del Beccaro
- Department of Pediatrics, Seattle Children’s Hospital, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle
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Sun G, Hakozaki Y, Abe S, Takei O, Matsui T. A neural network-based infection screening system that uses vital signs and percutaneous oxygen saturation for rapid screening of patients with influenza. Health (London) 2013. [DOI: 10.4236/health.2013.58a5002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Song HO, Kim JH, Ryu HS, Lee DH, Kim SJ, Kim DJ, Suh IB, Choi DY, In KH, Kim SW, Park H. Polymeric LabChip real-time PCR as a point-of-care-potential diagnostic tool for rapid detection of influenza A/H1N1 virus in human clinical specimens. PLoS One 2012; 7:e53325. [PMID: 23285281 PMCID: PMC3532060 DOI: 10.1371/journal.pone.0053325] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 11/30/2012] [Indexed: 12/23/2022] Open
Abstract
It is clinically important to be able to detect influenza A/H1N1 virus using a fast, portable, and accurate system that has high specificity and sensitivity. To achieve this goal, it is necessary to develop a highly specific primer set that recognizes only influenza A viral genes and a rapid real-time PCR system that can detect even a single copy of the viral gene. In this study, we developed and validated a novel fluidic chip-type real-time PCR (LabChip real-time PCR) system that is sensitive and specific for the detection of influenza A/H1N1, including the pandemic influenza strain A/H1N1 of 2009. This LabChip real-time PCR system has several remarkable features: (1) It allows rapid quantitative analysis, requiring only 15 min to perform 30 cycles of real-time PCR. (2) It is portable, with a weight of only 5.5 kg. (3) The reaction cost is low, since it uses disposable plastic chips. (4) Its high efficiency is equivalent to that of commercially available tube-type real-time PCR systems. The developed disposable LabChip is an economic, heat-transferable, light-transparent, and easy-to-fabricate polymeric chip compared to conventional silicon- or glass-based labchip. In addition, our LabChip has large surface-to-volume ratios in micro channels that are required for overcoming time consumed for temperature control during real-time PCR. The efficiency of the LabChip real-time PCR system was confirmed using novel primer sets specifically targeted to the hemagglutinin (HA) gene of influenza A/H1N1 and clinical specimens. Eighty-five human clinical swab samples were tested using the LabChip real-time PCR. The results demonstrated 100% sensitivity and specificity, showing 72 positive and 13 negative cases. These results were identical to those from a tube-type real-time PCR system. This indicates that the novel LabChip real-time PCR may be an ultra-fast, quantitative, point-of-care-potential diagnostic tool for influenza A/H1N1 with a high sensitivity and specificity.
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Affiliation(s)
- Hyun-Ok Song
- Zoonosis Research Center, Department of Infection Biology, Wonkwang University School of Medicine, Iksan, Jeonbuk, Republic of Korea
| | - Je-Hyoung Kim
- Zoonosis Research Center, Department of Infection Biology, Wonkwang University School of Medicine, Iksan, Jeonbuk, Republic of Korea
| | - Ho-Sun Ryu
- NanoBioSys Inc., Geumcheon-gu, Seoul, Republic of Korea
| | - Dong-Hoon Lee
- NanoBioSys Inc., Geumcheon-gu, Seoul, Republic of Korea
| | - Sun-Jin Kim
- NanoBioSys Inc., Geumcheon-gu, Seoul, Republic of Korea
| | | | - In Bum Suh
- Department of Laboratory Medicine, Kangwon National University School of Medicine, Chuncheon, Kangwon-do, Republic of Korea
| | - Du Young Choi
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Jeonbuk, Republic of Korea
| | - Kwang-Ho In
- Department of Medicine, Korea University School of Medicine, Seoul, Republic of Korea
| | - Sung-Woo Kim
- NanoBioSys Inc., Geumcheon-gu, Seoul, Republic of Korea
- * E-mail: (SK); (HP)
| | - Hyun Park
- Zoonosis Research Center, Department of Infection Biology, Wonkwang University School of Medicine, Iksan, Jeonbuk, Republic of Korea
- * E-mail: (SK); (HP)
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Zhang GJ, Ning Y. Silicon nanowire biosensor and its applications in disease diagnostics: A review. Anal Chim Acta 2012; 749:1-15. [DOI: 10.1016/j.aca.2012.08.035] [Citation(s) in RCA: 201] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/30/2012] [Accepted: 08/20/2012] [Indexed: 01/24/2023]
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Rasmussen SA, Power ML, Jamieson DJ, Williams J, Schulkin J, Kahn EB, Zhang Y, MacFarlane K, Kissin DM. Practices of obstetrician-gynecologists regarding nonvaccine-related public health recommendations during the 2009 H1N1 influenza pandemic. Am J Obstet Gynecol 2012; 207:294.e1-7. [PMID: 22921096 PMCID: PMC5823252 DOI: 10.1016/j.ajog.2012.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/04/2012] [Accepted: 07/09/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We examined practices of obstetrician-gynecologists regarding nonvaccine-related public health recommendations during the 2009 H1N1 influenza pandemic. STUDY DESIGN From February to May 2010, a survey was sent to a random sample of members of the American College of Obstetricians and Gynecologists involved in obstetric care. RESULTS Obstetrician-gynecologists varied in their adherence to 2009 H1N1 influenza public health recommendations. Nearly all reported prescribing antiviral medications to pregnant women with suspected influenza. Most obstetrician-gynecologists reported using preventive practices in the outpatient setting to reduce exposure of well patients to ill ones. A wide range of responses was provided regarding postpartum infection control practices, suggesting lack of awareness of, disagreement with, or difficulty adhering to these recommendations. CONCLUSION Obstetrician-gynecologists reported that they adhered to some recommendations related to 2009 H1N1 influenza, but not to others. These data provide insight into strategies for development and dissemination of recommendations in a future pandemic.
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Quantitative analysis of four rapid antigen assays for detection of pandemic H1N1 2009 compared with seasonal H1N1 and H3N2 influenza A viruses on nasopharyngeal aspirates from patients with influenza. J Virol Methods 2012; 186:184-8. [PMID: 22989408 DOI: 10.1016/j.jviromet.2012.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 08/29/2012] [Accepted: 09/03/2012] [Indexed: 11/20/2022]
Abstract
Data on analytical sensitivity of rapid diagnostic assays are important for clinical management of influenza, especially during a pandemic. Four rapid antigen detection assays were compared for detection of pandemic influenza A H1N1 2009, seasonal H1N1 and H3N2 in 96 patients with influenza A infection confirmed by real-time RT-PCR. These rapid antigen tests appeared to have lower sensitivity (55.8%) for the diagnosis of pandemic influenza A H1N1 2009 as compared with seasonal H3N2 (71.0%) or H1N1 (69.4%) influenza infections, a difference that was related to a lower viral load in patients infected with the pandemic influenza A H1N1 2009 virus. The detection limit of these antigen detection tests in clinical specimens was an influenza A M gene copy number of average 1.0×10(7) copies/ml. Significant variations between tests in sensitivity for detection of pandemic influenza A H1N1 2009 (43.4-63.3%) were observed. The Directigen EZ Influenza A+B and the Espline Influenza A+B had comparable sensitivity (63%) and were the most sensitive among the four assays evaluated.
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Blanton L, Peacock G, Cox C, Jhung M, Finelli L, Moore C. Neurologic disorders among pediatric deaths associated with the 2009 pandemic influenza. Pediatrics 2012; 130:390-6. [PMID: 22931899 DOI: 10.1542/peds.2011-3343] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal of this study was to describe reported influenza A (H1N1)pdm09 virus (pH1N1)-associated deaths in children with underlying neurologic disorders. METHODS The study compared demographic characteristics, clinical course, and location of death of pH1N1-associated deaths among children with and without underlying neurologic disorders reported to the Centers for Disease Control and Prevention. RESULTS Of 336 pH1N1-associated pediatric deaths with information on underlying conditions, 227 (68%) children had at least 1 underlying condition that conferred an increased risk of complications of influenza. Neurologic disorders were most frequently reported (146 of 227 [64%]), and, of those disorders, neurodevelopmental disorders such as cerebral palsy and intellectual disability were most common. Children with neurologic disorders were older (P = .02), had a significantly longer duration of illness from onset to death (P < .01), and were more likely to die in the hospital versus at home or in the emergency department (P < .01) compared with children without underlying medical conditions. Many children with neurologic disorders had additional risk factors for influenza-related complications, especially pulmonary disorders (48%). Children without underlying conditions were significantly more likely to have a positive result from a sterile-site bacterial culture than were those with an underlying neurologic disorder (P < .01). CONCLUSIONS Neurologic disorders were reported in nearly two-thirds of pH1N1-associated pediatric deaths with an underlying medical condition. Because of the potential for severe outcomes, children with underlying neurologic disorders should receive influenza vaccine and be treated early and aggressively if they develop influenza-like illness.
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Affiliation(s)
- Lenee Blanton
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Update on influenza diagnostics: lessons from the novel H1N1 influenza A pandemic. Clin Microbiol Rev 2012; 25:344-61. [PMID: 22491775 DOI: 10.1128/cmr.05016-11] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The menu of diagnostic tools that can be utilized to establish a diagnosis of influenza is extensive and includes classic virology techniques as well as new and emerging methods. This review of how the various existing diagnostic methods have been utilized, first in the context of a rapidly evolving outbreak of novel influenza virus and then during the different subsequent phases and waves of the pandemic, demonstrates the unique roles, advantages, and limitations of each of these methods. Rapid antigen tests were used extensively throughout the pandemic. Recognition of the low negative predictive values of these tests is important. Private laboratories with preexisting expertise, infrastructure, and resources for rapid development, validation, and implementation of laboratory-developed assays played an unprecedented role in helping to meet the diagnostic demands during the pandemic. FDA-cleared assays remain an important element of the diagnostic armamentarium during a pandemic, and a process must be developed with the FDA to allow manufacturers to modify these assays for detection of novel strains in a timely fashion. The need and role for subtyping of influenza viruses and antiviral susceptibility testing will likely depend on qualitative (circulating subtypes and their resistance patterns) and quantitative (relative prevalence) characterization of influenza viruses circulating during future epidemics and pandemics.
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Variations in positive predictive values for rapid influenza tests for 2009 pandemic influenza a (pH1N1)--Arizona, April-October 2009. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 18:268-71. [PMID: 22473120 DOI: 10.1097/phh.0b013e3182214730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Rapid influenza diagnostic tests (RIDTs) are used for influenza screening, clinical decision making, and influenza surveillance. In August 2009, a hospital reported increased false-positive RIDT results to the Arizona Department of Health Services. Because of reported RIDT low sensitivities (40%-62%) for 2009 pandemic influenza A (pH1N1), the hospital's report raised further concerns about the specificity and clinical utility of RIDTs. OBJECTIVE To determine the positive predictive value (PPV) of RIDTs compared with real-time reverse transcription-polymerase chain reaction assay (rRT-PCR) using Centers for Disease Control and Prevention (CDC) protocols and primers as a standard. DESIGN A standardized survey collected information including RIDT brand/lot number, training of personnel performing test, type of laboratory, swab and specimen type, time from collection to testing, sample storage, and viral transport medium. SETTING Arizona. PARTICIPANTS Seven Arizona laboratories submitted positive RIDT clinical samples to Arizona State Public Health Laboratory (ASPHL) for confirmatory rRT-PCR testing. MAIN OUTCOME MEASURE The PPV was calculated on the basis of rRT-PCR-positive results for April through October. RESULTS Results from 600 specimens using 1 of 4 RIDTs were available. Median pH1N1 PPV was 80% (range: 62%-91%) when calculated by RIDT brand. A significant difference in PPV was identified between the 2 largest facilities, which used the same RIDT brand, BinaxNOW Influenza A&B, (Laboratories A, 33% and B, 92%, [P < .01]). The facilities reported similar testing practices except lot numbers used and timing of testing. Laboratory A used lot 003684 and performed testing within 1 hour of collection; Laboratory B used multiple lots, excluding lot 003684, and performed testing within 24 hours. Laboratory A switched RIDT brands and noted a significant PPV increase from 33% to 91% (P < .01). CONCLUSIONS Wide PPV variability combined with documented low sensitivity among RIDTs for pH1N1 diagnosis increases concerns about their specificity and clinical and epidemiologic utility for influenza.
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Nelson GE, Gershman KA, Swerdlow DL, Beall BW, Moore MR. Invasive pneumococcal disease and pandemic (H1N1) 2009, Denver, Colorado, USA. Emerg Infect Dis 2012; 18:208-16. [PMID: 22306234 PMCID: PMC3310448 DOI: 10.3201/eid1802.110714] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Pneumococcal pneumonia was a complication during previous influenza pandemics but was not evident initially during pandemic (H1N1) 2009. During October 2009 in Denver, Colorado, USA, invasive pneumococcal disease (IPD) and pandemic (H1N1) 2009 peaked simultaneously, which suggests a link. We compared cases of IPD in October 2009 with cases in February 2009, the most recent peak month of seasonal influenza. During October 2009, we observed 58 IPD cases, which was 3× the average number of IPD cases that usually occur in October in Denver. Patients with IPD in October 2009 were younger and more likely to have chronic lung disease than patients who had IPD in February 2009; a total of 10/47 patients had influenza, and 33/53 patients had influenza-like illness. Thus, ≈17%-62% cases of IPD may have been associated with pandemic (H1N1) 2009. Pneumococcal disease prevention strategies should be emphasized during future influenza pandemics.
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Affiliation(s)
- George E Nelson
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Cao Q, Mahalanabis M, Chang J, Carey B, Hsieh C, Stanley A, Odell CA, Mitchell P, Feldman J, Pollock NR, Klapperich CM. Microfluidic chip for molecular amplification of influenza A RNA in human respiratory specimens. PLoS One 2012; 7:e33176. [PMID: 22457740 PMCID: PMC3310856 DOI: 10.1371/journal.pone.0033176] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 02/05/2012] [Indexed: 11/18/2022] Open
Abstract
A rapid, low cost, accurate point-of-care (POC) device to detect influenza virus is needed for effective treatment and control of both seasonal and pandemic strains. We developed a single-use microfluidic chip that integrates solid phase extraction (SPE) and molecular amplification via a reverse transcription polymerase chain reaction (RT-PCR) to amplify influenza virus type A RNA. We demonstrated the ability of the chip to amplify influenza A RNA in human nasopharyngeal aspirate (NPA) and nasopharyngeal swab (NPS) specimens collected at two clinical sites from 2008-2010. The microfluidic test was dramatically more sensitive than two currently used rapid immunoassays and had high specificity that was essentially equivalent to the rapid assays and direct fluorescent antigen (DFA) testing. We report 96% (CI 89%,99%) sensitivity and 100% (CI 95%,100%) specificity compared to conventional (bench top) RT-PCR based on the testing of n = 146 specimens (positive predictive value = 100%(CI 94%,100%) and negative predictive value = 96%(CI 88%,98%)). These results compare well with DFA performed on samples taken during the same time period (98% (CI 91%,100%) sensitivity and 96%(CI 86%,99%) specificity compared to our gold standard testing). Rapid immunoassay tests on samples taken during the enrollment period were less reliable (49%(CI 38%,61%) sensitivity and 98%(CI 98%,100%) specificity). The microfluidic test extracted and amplified influenza A RNA directly from clinical specimens with viral loads down to 10³ copies/ml in 3 h or less. The new test represents a major improvement over viral culture in terms of turn around time, over rapid immunoassay tests in terms of sensitivity, and over bench top RT-PCR and DFA in terms of ease of use and portability.
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Affiliation(s)
- Qingqing Cao
- Department of Mechanical Engineering, Boston University, Boston, Massachusetts, United States of America
| | - Madhumita Mahalanabis
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, United States of America
| | - Jessie Chang
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, United States of America
| | - Brendan Carey
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, United States of America
| | - Christopher Hsieh
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, United States of America
| | - Ahjegannie Stanley
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, United States of America
| | - Christine A. Odell
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Patricia Mitchell
- Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - James Feldman
- Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Nira R. Pollock
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Catherine M. Klapperich
- Department of Mechanical Engineering, Boston University, Boston, Massachusetts, United States of America
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, United States of America
- * E-mail:
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Gubala V, Harris LF, Ricco AJ, Tan MX, Williams DE. Point of Care Diagnostics: Status and Future. Anal Chem 2011; 84:487-515. [DOI: 10.1021/ac2030199] [Citation(s) in RCA: 832] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Vladimir Gubala
- Biomedical Diagnostics Institute, Dublin City University, Dublin 9, Ireland
| | - Leanne F. Harris
- Biomedical Diagnostics Institute, Dublin City University, Dublin 9, Ireland
| | - Antonio J. Ricco
- Biomedical Diagnostics Institute, Dublin City University, Dublin 9, Ireland
| | - Ming X. Tan
- Biomedical Diagnostics Institute, Dublin City University, Dublin 9, Ireland
| | - David E. Williams
- Biomedical Diagnostics Institute, Dublin City University, Dublin 9, Ireland
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Abstract
The 2009 H1N1 influenza A virus that has targeted not only those with chronic medical illness, the very young and old, but also a large segment of the patient population that has previously been afforded relative protection - those who are young, generally healthy, and immune naive. The illness is mild in most, but results in hospitalization and severe ARDS in an important minority. Among those who become critically ill, 20-40% will die, predominantly of severe hypoxic respiratory failure. However, and potentially in part due to the young age of those affected, intensive care with aggressive oxygenation support will allow most people to recover. The volume of patients infected and with critical illness placed substantial strain on the capacity of the health care system and critical care most specifically. Despite this, the 2009 pandemic has engaged our specialty and highlighted its importance like no other. Thus far, the national and global critical care response has been brisk, collaborative and helpful - not only for this pandemic, but for subsequent challenges in years ahead.
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Affiliation(s)
- Anand Kumar
- Department of Critical Care Medicine, Infectious Diseases, University of Manitoba, Manitoba, Canada
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Gao F, Loring C, Laviolette M, Bolton D, Daly ER, Bean C. Detection of 2009 pandemic influenza A(H1N1) virus Infection in different age groups by using rapid influenza diagnostic tests. Influenza Other Respir Viruses 2011; 6:e30-4. [PMID: 22114876 PMCID: PMC4941676 DOI: 10.1111/j.1750-2659.2011.00313.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The performance of rapid influenza diagnostic tests (RIDTs) in detecting influenza A(H1N1) 2009 has varied widely. Evaluations of RIDTs among infected individuals across all age groups have not been described in depth. OBJECTIVES Determine RIDT clinical sensitivity in comparison with influenza detection using real-time RT-PCR among patients infected with influenza A(H1N1) 2009 across all age groups. STUDY DESIGN This study analyzed respiratory specimens received by the New Hampshire Public Health Laboratories (NHPHL) from September 1, 2009, through December 31, 2009. RIDT performance was evaluated among different age groups of patients determined to be infected with influenza A (H1N1) 2009, and the association between age and RIDT sensitivity was determined. RESULTS Of 1373 specimens examined, 269 tested positive for influenza A(H1N1) 2009 by real-time RT-PCR (rRT-PCR) and had RIDT results available. Overall clinical sensitivity and specificity of RIDTs were 53·9 and 98·5%, respectively. By age group, clinical sensitivity was 85·7% in patients <2 years old, 60·3% in patients between 2- and 39 years old, and 33·3% in patients aged 40 and older. Logistic regression analysis indicated that increasing age was negatively associated with RIDT performance. CONCLUSION Rapid influenza diagnostic test sensitivity decreased significantly with increasing age. Findings from this study may impact a clinician's interpretation of RIDT test results and ultimately have implications in clinical decision-making.
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Affiliation(s)
- Fengxiang Gao
- Division of Public Health Services, New Hampshire Department of Health and Human Services, Concord, NH 03301, USA.
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Inglis TJJ, Merritt AJ, Levy A, Vietheer P, Bradbury R, Scholler A, Chidlow G, Smith DW. Deployable laboratory response to influenza pandemic; PCR assay field trials and comparison with reference methods. PLoS One 2011; 6:e25526. [PMID: 22022407 PMCID: PMC3192042 DOI: 10.1371/journal.pone.0025526] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 09/05/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The influenza A/H1N1/09 pandemic spread quickly during the Southern Hemisphere winter in 2009 and reached epidemic proportions within weeks of the official WHO alert. Vulnerable population groups included indigenous Australians and remote northern population centres visited by international travellers. At the height of the Australian epidemic a large number of troops converged on a training area in northern Australia for an international exercise, raising concerns about their potential exposure to the emerging influenza threat before, during and immediately after their arrival in the area. Influenza A/H1N1/09 became the dominant seasonal variant and returned to Australia during the Southern winter the following year. METHODS A duplex nucleic acid amplification assay was developed within weeks of the first WHO influenza pandemic alert, demonstrated in northwestern Australia shortly afterwards and deployed as part of the pathology support for a field hospital during a military exercise during the initial epidemic surge in June 2009. RESULTS The nucleic acid amplification assay was twice as sensitive as a point of care influenza immunoassay, as specific but a little less sensitive than the reference laboratory nucleic acid amplification assay. Repetition of the field assay with blinded clinical samples obtained during the 2010 winter influenza season demonstrated a 91.7% congruence with the reference laboratory method. CONCLUSIONS Rapid in-house development of a deployable epidemic influenza assay allowed a flexible laboratory response, effective targeting of limited disease control resources in an austere military environment, and provided the public health laboratory service with a set of verification tools for resource-limited settings. The assay method was suitable for rapid deployment in time for the 2010 Northern winter.
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Affiliation(s)
- Timothy J J Inglis
- Division of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, Western Australia, Australia.
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Clinical Presentation of 2009 H1N1 Influenza A Disease in HIV-Infected Patients. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2011. [DOI: 10.1097/ipc.0b013e3182142fa6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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During the summer 2009 outbreak of "swine flu" in Scotland what respiratory pathogens were diagnosed as H1N1/2009? BMC Infect Dis 2011; 11:192. [PMID: 21752259 PMCID: PMC3146830 DOI: 10.1186/1471-2334-11-192] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 07/13/2011] [Indexed: 11/10/2022] Open
Abstract
Background During the April-July 2009 outbreak of H1N1/2009 in scotland the West of Scotland Specialist Virology Centre (WoSSVC) in Glasgow tested > 16 000 clinical samples for H1N1/2009. Most were from patients clinically diagnosed with H1N1/2009. Out of these, 9% were positive. This study sought to determine what respiratory pathogens were misdiagnosed as cases of H1N1/2009 during this time. Methods We examined the results from 3247 samples which were sent to the laboratory during April-July 2009. All were from patients clinically diagnosed as having H1N1/2009 (based on accepted criteria) and all were given a full respiratory screen using real time reverse transcriptase polymerase chain reaction (rtRT-PCR) assays. Results In total, respiratory pathogens were detected in 27.9% (95% confidence interval, 26.3-29.5%) of the samples submitted. Numerous pathogens were detected, the most common of which were rhinovirus (8.9% (95% confidence interval, 7.9-9.9%)), parainfluenza 1 (1.9% (95% confidence interval, 1.4-2.4%)) and 3 (4.1% (95% confidence interval, 3.3-4.9%)), and adenovirus ((3.5% (95% confidence interval, 2.9-4.2%)). Conclusions This study highlights the problems of using a clinical algorithm to detect H1N1/2009. Clinicians frequently misdiagnosed common respiratory pathogens as H1N1/2009 during the spring/summer outbreak in Scotland. Many undesirable consequences would have resulted, relating to treatment, infection control, and public health surveillance.
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Peters PJ, Skarbinski J, Louie JK, Jain S, Roland M, Jani SG, Finelli L, Brooks JT. HIV-infected hospitalized patients with 2009 pandemic influenza A (pH1N1)--United States, spring and summer 2009. Clin Infect Dis 2011; 52 Suppl 1:S183-8. [PMID: 21342893 DOI: 10.1093/cid/ciq036] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We describe the clinical findings of HIV-infected patients hospitalized with 2009 pandemic influenza A (pH1N1). Data were derived from 3 separate case series in the United States. Among 911 adults hospitalized with pH1N1 influenza, 31 (3.4%) were HIV infected compared with an HIV prevalence of 0.45% in the general US adult population. HIV-infected influenza patients experienced similar rates of intensive care unit admission (29% vs 34%) and death (13% vs 13%) compared with non-HIV-infected patients. Among HIV-infected patients with available data, 14 (50%) of 28 patients had a CD4 cell count <200 cells/μL, which was not associated with an increased risk of an intensive care unit admission or death. Overall, 25 (81%) HIV-infected patients received influenza antiviral therapy, but treatment was initiated within 48 h of illness onset in only 33% of cases. Clinicians should consider early empiric influenza antiviral treatment in HIV-infected patients presenting with suspected influenza.
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Affiliation(s)
- Philip J Peters
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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