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Rohana H, Marmur G, Azrad M, Peretz A. A new antigen test device for rapid influenza A and B detection. Heliyon 2024; 10:e33979. [PMID: 39055805 PMCID: PMC11269840 DOI: 10.1016/j.heliyon.2024.e33979] [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: 11/19/2023] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Introduction Tests for detection of influenza must demonstrate high sensitivity and specificity, affordability, and rapidness. Methods This study aimed to evaluate the performance of the LabOn-Time™ Influenza A + B Rapid test device (BMT Diagnostics, Ltd), as compared to Real-time polymerase chain reaction (RT-PCR), in identifying influenza A/B among 183 nasopharyngeal samples collected between February and April 2023 from patients with Influenza-like symptoms. Results Out of 70 participants with a positive RT-PCR result, 53 (75.7 %) had a positive LabOn-Time result. The LabOn-Time kit had a sensitivity of 75.7 % and specificity of 100 %. The odds ratio for showing a false negative LabOn-Time result for influenza B, compared to influenza A was 5.24 (95%CI: 1.35-20.31). All false negative LabOn-Time samples had a RT-PCT cycle threshold ≥20. Mean time from symptom onset was significantly lower in the false negative LabOn-Time cases compared to the positive cases (36 ± 15.3 vs. 42.6 ± 10.1, respectively). The mean number of symptoms reported per patient was significantly higher in positive compared to negative LabOn-Time cases (2.5 ± 0.5 vs. 1.9 ± 0.4, p < 0.001). Conclusions The LabOn-Time device, which is very simple and intuitive to operate, could significantly contribute to early detection of influenza A/B infection.
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Affiliation(s)
- Hanan Rohana
- Clinical Microbiology Laboratory, Tzafon Medical Center, Poriya, Israel
| | - Guy Marmur
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Maya Azrad
- Clinical Microbiology Laboratory, Tzafon Medical Center, Poriya, Israel
| | - Avi Peretz
- Clinical Microbiology Laboratory, Tzafon Medical Center, Poriya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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van der Kraan M, Hobbelink EL, Kalpoe J, Euser SM, Snijders D, Souverein D. Performance- and cost-benefit analysis of an influenza point-of-care test compared to laboratory-based multiplex RT-PCR in the emergency department. Am J Infect Control 2021; 49:1414-1418. [PMID: 33984418 DOI: 10.1016/j.ajic.2021.04.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Influenza poses a heavy burden on emergency departments (ED) and hospital wards. Fast and reliable bedside tests are invaluable in obtaining indications for (cohort) droplet isolation precautions and improving patient flow. We performed a cost-benefit analysis comparing influenza point-of-care testing (POCT) to laboratory-based multiplex ligation-dependent probe amplification. METHODS Data of 275 ED presentations between January-April 2019 were analyzed. Patients received both POCT and MLPA to calculate POCT sensitivity and specificity. Costs were calculated for both a POCT and MLPA scenario, including costs for testing, admission, droplet isolation precautions and cleaning. RESULTS In our study population, 34 patients (12%) were identified with influenza A. No cases of influenza B were identified. Mean age of the influenza positive patients was 75(18) years and 56% were male. The most common symptoms upon presentation were cough, malaise and fever, with 74%, 56% and 50%, respectively. Compared to MLPA, POCT yielded a sensitivity of 94%, a specificity of 98% and a negative predictive value of 99% for influenza A. Using POCT yielded a cost reduction of €93,26 per patient. CONCLUSIONS Influenza POCT is an accurate and cost-beneficial method to differentiate between admission with or without droplet isolation precautions. It can be useful in clinical decision making and reducing pressure on ED and hospital beds in an influenza peak season, by enabling fast patient flow and cohort isolation.
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Lisby JG, Schneider UV. Point of care testing for infectious disease: ownership and quality. J Antimicrob Chemother 2021; 76:iii28-iii32. [PMID: 34555156 PMCID: PMC8460106 DOI: 10.1093/jac/dkab247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Traditionally, diagnosis of acute infections has been organism-growth based, which makes timely and actionable infection diagnosis a major challenge. In addition, traditional microbial detection methods, including direct microscopy, are not suited for outsourcing to clinical, non-laboratory-educated personnel. Optimal management of patients with known or suspected clinical infections, such as targeted (or no) antimicrobial treatment and correct use of single room contact isolation facilities, requires rapid identification of the causative infectious microorganism. We are now facing a new disruptive paradigm shift in diagnostic microbiology. The availability of small-footprint robust instruments with easy-to-use assay kits allows non-laboratory-trained nurses and physicians to perform high-quality molecular diagnostics in a near-patient setting with results available in <30 minutes. This technology is currently breaking the centralized laboratory monopoly on the delivery of gold-standard clinical microbiology diagnostics. There is clear potential for huge positive impacts on clinical patient management and antibiotic stewardship, especially in settings where access to timely laboratory test results is not possible, but there are also potentially huge risks. Moving diagnostic testing away from the controlled diagnostic laboratory environment will lead to risks such as increased risk of inappropriate use of the diagnostic tests, insufficient training of staff performing the tests, incorrect interpretation of the test results, lack of quality control procedures, failure to capture test results in electronic patient records and compromised local as well as national surveillance. To reap the upside and avoid the downside of point-of-care infectious disease testing, the diagnostic laboratory needs to maintain oversight, and each institution must have a clear strategy for implementation and execution. If we fail, the risks could outweigh the benefits.
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Affiliation(s)
- Jan Gorm Lisby
- University of Copenhagen, Hvidovre Hospital, Department of Clinical Microbiology, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark
| | - Uffe Vest Schneider
- University of Copenhagen, Hvidovre Hospital, Department of Clinical Microbiology, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark
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Newman KL, Rogers JH, McCulloch D, Wilcox N, Englund JA, Boeckh M, Uyeki TM, Jackson ML, Starita L, Hughes JP, Chu HY. Point-of-care molecular testing and antiviral treatment of influenza in residents of homeless shelters in Seattle, WA: study protocol for a stepped-wedge cluster-randomized controlled trial. Trials 2020; 21:956. [PMID: 33228787 PMCID: PMC7682130 DOI: 10.1186/s13063-020-04871-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction Influenza is an important public health problem, but data on the impact of influenza among homeless shelter residents are limited. The primary aim of this study is to evaluate whether on-site testing and antiviral treatment of influenza in residents of homeless shelters reduces influenza spread in these settings. Methods and analysis This study is a stepped-wedge cluster-randomized trial of on-site testing and antiviral treatment for influenza in nine homeless shelter sites within the Seattle metropolitan area. Participants with acute respiratory illness (ARI), defined as two or more respiratory symptoms or new or worsening cough with onset in the prior 7 days, are eligible to enroll. Approximately 3200 individuals are estimated to participate from October to May across two influenza seasons. All sites will start enrollment in the control arm at the beginning of each season, with routine surveillance for ARI. Sites will be randomized at different timepoints to enter the intervention arm, with implementation of a test-and-treat strategy for individuals with two or fewer days of symptoms. Eligible individuals will be tested on-site with a point-of-care influenza test. If the influenza test is positive and symptom onset is within 48 h, participants will be administered antiviral treatment with baloxavir or oseltamivir depending upon age and comorbidities. Participants will complete a questionnaire on demographics and symptom duration and severity. The primary endpoint is the incidence of influenza in the intervention period compared to the control period, after adjusting for time trends. Trial registration ClinicalTrials.gov NCT04141917. Registered 28 October 2019. Trial sponsor: University of Washington. Supplementary information The online version contains supplementary material available at 10.1186/s13063-020-04871-5.
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Affiliation(s)
- Kira L Newman
- Division of Allergy and Infectious Diseases, University of Washington, UW Medicine at South Lake Union, Chu Lab Room E630, 750 Republican St., Seattle, WA, 98109, USA
| | - Julia H Rogers
- Division of Allergy and Infectious Diseases, University of Washington, UW Medicine at South Lake Union, Chu Lab Room E630, 750 Republican St., Seattle, WA, 98109, USA
| | - Denise McCulloch
- Division of Allergy and Infectious Diseases, University of Washington, UW Medicine at South Lake Union, Chu Lab Room E630, 750 Republican St., Seattle, WA, 98109, USA
| | - Naomi Wilcox
- Division of Allergy and Infectious Diseases, University of Washington, UW Medicine at South Lake Union, Chu Lab Room E630, 750 Republican St., Seattle, WA, 98109, USA
| | - Janet A Englund
- Division of Allergy and Infectious Diseases, University of Washington, UW Medicine at South Lake Union, Chu Lab Room E630, 750 Republican St., Seattle, WA, 98109, USA.,Seattle Children's Research Institute, Seattle, WA, USA
| | - Michael Boeckh
- Division of Allergy and Infectious Diseases, University of Washington, UW Medicine at South Lake Union, Chu Lab Room E630, 750 Republican St., Seattle, WA, 98109, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Timothy M Uyeki
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Lea Starita
- Division of Allergy and Infectious Diseases, University of Washington, UW Medicine at South Lake Union, Chu Lab Room E630, 750 Republican St., Seattle, WA, 98109, USA
| | - James P Hughes
- Division of Allergy and Infectious Diseases, University of Washington, UW Medicine at South Lake Union, Chu Lab Room E630, 750 Republican St., Seattle, WA, 98109, USA
| | - Helen Y Chu
- Division of Allergy and Infectious Diseases, University of Washington, UW Medicine at South Lake Union, Chu Lab Room E630, 750 Republican St., Seattle, WA, 98109, USA.
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Kuypers J. Impact of Rapid Molecular Detection of Respiratory Viruses on Clinical Outcomes and Patient Management. J Clin Microbiol 2019; 57:e01890-18. [PMID: 30651392 PMCID: PMC6440761 DOI: 10.1128/jcm.01890-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To determine if rapid molecular testing for respiratory viruses in patients with respiratory illnesses can provide advantages to patients and hospitals, rigorous investigations on the impacts of using these assays are required. Well-conducted studies are needed to inform decisions about implementation of new rapid assays to replace standard molecular testing or to initiate testing in laboratories that are currently not doing molecular tests for respiratory viruses due to the complex nature of standard panels. In this issue of the Journal of Clinical Microbiology, N. Wabe et al. (J Clin Microbiol 57:e01727-18, 2019, https://doi.org/10.1128/JCM.01727-18) report the results of their evaluation of the impact of using a rapid molecular test for influenza A/influenza B and RSV on outcomes for adults hospitalized with respiratory illness. The median time from admission to test result of the rapid test was 7.5 h compared to 40.3 h for the standard PCR assay. Compared to the use of the standard molecular assay, use of a rapid test significantly shortened time in the hospital and reduced the number of other microbiology tests performed. The authors concluded that rapid PCR testing of adults hospitalized with respiratory illnesses could provide benefits to both the patients and the hospital. Patients were able to leave the hospital earlier and a greater proportion of them had received their test results before discharge, which would allow appropriate treatment to be provided more quickly.
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Affiliation(s)
- Jane Kuypers
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
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Abstract
Acute upper and lower respiratory infections are a major public health problem and a leading cause of morbidity and mortality worldwide. At greatest risk are young children, the elderly, the chronically ill, and those with suppressed or compromised immune systems. Viruses are the predominant cause of respiratory tract illnesses and include RNA viruses such as respiratory syncytial virus, influenza virus, parainfluenza virus, metapneumovirus, rhinovirus, and coronavirus. Laboratory testing is required for a reliable diagnosis of viral respiratory infections, as a clinical diagnosis can be difficult since signs and symptoms are often overlapping and not specific for any one virus. Recent advances in technology have resulted in the development of newer diagnostic assays that offer great promise for rapid and accurate detection of respiratory viral infections. This chapter emphasizes the fundamental characteristics and clinical importance of the various RNA viruses that cause upper and lower respiratory tract diseases in the immunocompromised host. It highlights the laboratory methods that can be used to make a rapid and definitive diagnosis for the greatest impact on the care and management of ill patients, and the prevention and control of hospital-acquired infections and community outbreaks.
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Steensels D, Reynders M, Descheemaeker P, Curran MD, Jacobs F, Denis O, Delforge ML, Montesinos I. Performance evaluation of direct fluorescent antibody, Focus Diagnostics Simplexa™ Flu A/B & RSV and multi-parameter customized respiratory Taqman® array card in immunocompromised patients. J Virol Methods 2017; 245:61-65. [PMID: 28365410 PMCID: PMC7119654 DOI: 10.1016/j.jviromet.2017.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/25/2017] [Accepted: 03/26/2017] [Indexed: 11/29/2022]
Abstract
Limited sensitivity of direct fluorescent antibody testing in comparison to molecular methods. Simplexa™ direct assay is sensitive and specific for the detection of Flu A, B and RSV. Performing the TAC would increase the diagnostic yield and detection of co-infections significantly. Immunocompromised patient population with overall positivity rate of 62%. Co-infection rate of 15.3% found by TAC.
Background Molecular assays for diagnosis of Flu A, Flu B, and RSV with short turn-around-time (TAT) are of considerable clinical importance. In addition, rapid and accurate diagnosis of a large panel of viral and atypical pathogens can be crucial in immunocompromised patients. Objectives First, to evaluate the performance of the Simplexa™ Direct assay system in comparison with direct fluorescent antibody (DFA) and customized Taqman® Array Card (TAC) testing for RSV, Flu A, and Flu B in immunocompromised patients. Second, to evaluate different algorithms for the detection of respiratory pathogens in terms of cost, turn-around-time (TAT) and diagnostic yield. Study design We collected 125 nasopharyngeal swabs (NTS) and 25 BAL samples from symptomatic immunocompromised patients. Samples for which Simplexa™ and TAC results were discordant underwent verification testing. The TAC assay is based on singleplex RT-PCR, targeting 24 viruses, 8 bacteria and 2 fungi simultaneously. Results The overall sensitivity was significantly lower for DFA testing than for the two molecular methods (p < 0.05). Performance characteristics of Simplexa™ testing were not significantly different compared to TAC testing (p > 0.1). For BAL samples only, the sensitivity and specificity of the Simplexa™ assay was 100%. In total, 6.7, 16 and 18% of samples were positive for Flu A, Flu B or RSV by DFA, Simplexa™ and TAC testing, respectively. When considering not only these pathogens but also all results for TAC, the method identified 93 samples with one or more respiratory pathogens (62%). A co-infection rate of 15.3% was found by TAC. The estimated costs and TAT were 8.2€ and 2 h for DFA, 31.8€ and 1.5 h for Simplexa™ and 55€ and 3 h for TAC testing. Conclusions Performing the Simplexa™ test 24 h a day/7 days a week instead of DFA would considerably improve the overall sensitivity and time-to-result, albeit at a higher cost generated in the laboratory. Performing the TAC would increase the diagnostic yield and detection of co-infections significantly.
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Affiliation(s)
- Deborah Steensels
- Department of Clinical Microbiology, CUB-Erasme, Université Libre de Bruxelles, Brussels, Belgium.
| | - Marijke Reynders
- Department of Clinical Microbiology, AZ St-Jan Brugge-Oostende Hospital, Brugge, Belgium
| | - Patrick Descheemaeker
- Department of Clinical Microbiology, AZ St-Jan Brugge-Oostende Hospital, Brugge, Belgium
| | - Martin D Curran
- Public Health England, Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK
| | - Frédérique Jacobs
- Department of Infectious Diseases, CUB-Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Denis
- Department of Clinical Microbiology, CUB-Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie-Luce Delforge
- Department of Clinical Microbiology, CUB-Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabel Montesinos
- Department of Clinical Microbiology, CUB-Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Rapid diagnostic test for respiratory infections. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2017. [PMCID: PMC7148712 DOI: 10.1016/j.eimce.2017.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Acute respiratory infections are the second cause of morbidity and mortality in children and adults worldwide, being viruses, bacteria and fungi involved in their aetiology. The rapid diagnosis allows for a better clinical management of the patient, for adopting public health measures and for controlling possible outbreaks. The main etiologic agents can be diagnosed within the first hours after the onset of symptoms with antigen detection techniques, primarily immunochromatography. Results are obtained in 15–30 min, with 70–90% sensitivity and >95% specificity for the diagnosis of Streptococcus pneumoniae and Legionella pneumophila serogroup O1 infections from urine, Streptococcus pyogenes from throat swabs and respiratory syncytial virus from nasopharyngeal aspirates. Worse results are obtained for influenza viruses and Pneumocystis jirovecii with these techniques; however, other easy-to-perform molecular techniques are available for the rapid diagnosis of these microorganisms. In general, these techniques should not be used for monitoring the outcome or response to treatment.
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Marimón JM, Navarro-Marí JM. [Rapid diagnostic test for respiratory infections]. Enferm Infecc Microbiol Clin 2017; 35:108-115. [PMID: 28062161 PMCID: PMC7126338 DOI: 10.1016/j.eimc.2016.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/29/2016] [Indexed: 11/26/2022]
Abstract
Acute respiratory infections are the second cause of morbidity and mortality in children and adults worldwide, being viruses, bacteria and fungi involved in their etiology. The rapid diagnosis allows for a better clinical management of the patient, for adopting public health measures and for controlling possible outbreaks. The main etiologic agents can be diagnosed within the first hours after the onset of symptoms with antigen detection techniques, primarily immunochromatography. Results are obtained in 15-30minutes, with 70-90% sensitivity and >95% specificity for the diagnosis of Streptococcus pneumoniae and Legionella pneumophila serogroup O1 infections from urine, Streptococcus pyogenes from throat swabs and respiratory syncytial virus from nasopharyngeal aspirates. Worse results are obtained for influenza viruses and Pneumocystis jirovecii with these techniques; however, other easy-to-perform molecular techniques are available for the rapid diagnosis of these microorganisms. In general, these techniques should not be used for monitoring the outcome or response to treatment.
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Affiliation(s)
- José María Marimón
- Microbiology Department, Hospital Universitario Donostia-Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España; Biomedical Research Center Network for Respiratory Diseases (CIBERES), San Sebastián, España.
| | - José María Navarro-Marí
- Servicio de Microbiología, Hospital Virgen de las Nieves, Complejo Hospitales Universitarios de Granada, Granada, España; Instituto Biosanitario Granada
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Navarro-Marí JM. Rapid diagnostic methods for acute viral respiratory infections. Enferm Infecc Microbiol Clin 2016; 34:329-30. [PMID: 27156247 PMCID: PMC7103359 DOI: 10.1016/j.eimc.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/04/2016] [Indexed: 12/11/2022]
Affiliation(s)
- José M Navarro-Marí
- Servicio de Microbiología, Complejo Hospitales Universitarios de Granada, Instituto Biosanitario Granada, Granada, Spain.
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Chu HY, Englund JA, Strelitz B, Lacombe K, Jones C, Follmer K, Martin EK, Bradford M, Qin X, Kuypers J, Klein EJ. Rhinovirus Disease in Children Seeking Care in a Tertiary Pediatric Emergency Department. J Pediatric Infect Dis Soc 2016; 5:29-38. [PMID: 26908489 PMCID: PMC4765491 DOI: 10.1093/jpids/piu099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 09/02/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Rhinovirus is the most common cause of viral respiratory tract infections in children. Virologic predictors of lower respiratory tract infection (LRTI), such as viral load and the presence of another respiratory virus (coinfection), are not well characterized in pediatric outpatients. METHODS Mid-nasal turbinate samples were collected from children presenting for care to the Seattle Children's Hospital emergency department (ED) or urgent care with a symptomatic respiratory infection between December 2011 and May 2013. A subset of samples was tested for rhinovirus viral load by real-time polymerase chain reaction. Clinical data were collected by chart reviews. Multivariate logistic regression was used to evaluate the relationship between viral load and coinfection and the risk for LRTI. RESULTS Rhinovirus was the most frequent respiratory virus detected in children younger than 3 years. Of 445 patients with rhinovirus infection, 262 (58.9%) had LRTIs, 231 (51.9%) required hospital admission and 52 (22.5%) were hospitalized for 3 days or longer. Children with no comorbidities accounted for 142 (54%) of 262 rhinovirus LRTIs. Higher viral load was significantly associated with LRTI among illness episodes with rhinovirus alone (OR, 2.11; 95% confidence interval [CI], 1.24-3.58). Coinfection increased the risk of LRTI (OR, 1.83; 95% CI, 1.01-3.32). CONCLUSIONS Rhinovirus was the most common pathogen detected among symptomatic young children in a pediatric ED who had respiratory viral testing performed, with the majority requiring hospitalization. Higher rhinovirus viral load and coinfection increased disease severity. Virologic data may assist clinical decision making for children with rhinovirus infections in the pediatric ED.
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Affiliation(s)
- Helen Y. Chu
- Department of Medicine, University of Washington
| | | | | | | | | | | | | | | | - Xuan Qin
- Department of Microbiology, Seattle Children's Hospital, Washington
| | - Jane Kuypers
- Department of Laboratory Medicine, University of Washington
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Beal SG, Assarzadegan N, Rand KH. Sample-to-result molecular infectious disease assays: clinical implications, limitations and potential. Expert Rev Mol Diagn 2016; 16:323-41. [PMID: 26689497 PMCID: PMC7103687 DOI: 10.1586/14737159.2016.1134325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/17/2015] [Indexed: 01/01/2023]
Abstract
Molecular infectious disease diagnostic tests have undergone major advances in the past decade and will continue to rapidly evolve. Assays have become extraordinarily simple to perform, eliminating the need for pre-analytic sample preparation and post-amplification analysis. This allows these tests to be performed in settings without sophisticated expertise in molecular biology, including locations with limited resources. Additionally, the sensitivity and specificity of these assays is superb and many offer extremely fast turn-around times. These tests have major impacts on patient care, but also have some limitations.
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Affiliation(s)
- Stacy G. Beal
- Department of Pathology, Immunology and Laboratory Medicine,
University of Florida College of Medicine, Gainesville, FL,
USA
| | - Naziheh Assarzadegan
- Department of Pathology, Immunology and Laboratory Medicine,
University of Florida College of Medicine, Gainesville, FL,
USA
| | - Kenneth H. Rand
- Department of Pathology, Immunology and Laboratory Medicine,
University of Florida College of Medicine, Gainesville, FL,
USA
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Using Nucleic Acid Amplification Techniques in a Syndrome-Oriented Approach: Detection of Respiratory Agents. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Leonard DG. Respiratory Infections. MOLECULAR PATHOLOGY IN CLINICAL PRACTICE 2016. [PMCID: PMC7123443 DOI: 10.1007/978-3-319-19674-9_52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The majority of respiratory tract infections (RTIs) are community acquired and are the single most common cause of physician office visits and among the most common causes of hospitalizations. The morbidity and mortality associated with RTIs are significant and the financial and social burden high due to lost time at work and school. The scope of clinical symptoms can significantly overlap among the respiratory pathogens, and the severity of disease can vary depending on patient age, underlying disease, and immune status, thereby leading to inaccurate presumptions about disease etiology. The rapid and accurate diagnosis of the causative agent of RTIs improves patient care, reduces morbidity and mortality, promotes effective hospital bed utilization and antibiotic stewardship, and reduces length of stay. This chapter focuses on the clinical utility, advantages, and disadvantages of viral and bacterial tests cleared by the Food and Drug Administration (FDA), and new promising technologies for the detection of bacterial agents of pneumonia currently in development or in US FDA clinical trials are briefly reviewed.
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Affiliation(s)
- Debra G.B. Leonard
- Pathology and Laboratory Medicine, University of Vermont College of Medicine and University of Vermont Medical Center, Burlington, Vermont USA
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Riazzo C, Pérez-Ruiz M, Sanbonmatsu-Gámez S, Pedrosa-Corral I, Gutiérrez-Fernández J, Navarro-Marí JM. Analytical performance of the Alere™ i Influenza A&B assay for the rapid detection of influenza viruses. Enferm Infecc Microbiol Clin 2015; 35:438-440. [PMID: 26620605 PMCID: PMC7103361 DOI: 10.1016/j.eimc.2015.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/06/2015] [Accepted: 10/10/2015] [Indexed: 11/17/2022]
Abstract
The analytical performance of the new Alere™ i Influenza A&B kit (AL-Flu) assay, based on isothermal nucleic acids amplification, was evaluated and compared with an antigen detection method, SD Bioline Influenza Virus Antigen Test (SDB), and an automated real-time RT-PCR, Simplexa™ Flu A/B & VRS Direct assay (SPX), for detection of influenza viruses. An “in-house” RT-PCR was used as the reference method. Sensitivity of AL-Flu, SDB, and SPX was 71.7%, 34.8%, and 100%, respectively. Specificity was 100% for all techniques. The turnaround time was 13 min for AL-Flu, 15 min for SDB, and 75 min for SPX. The Alere™ i Influenza A&B assay is an optimal point-of-care assay for influenza diagnosis in clinical emergency settings, and is more sensitive and specific than antigen detection methods.
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Affiliation(s)
- Cristina Riazzo
- Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Instituto Biosanitario de Granada, Granada, Spain
| | - Mercedes Pérez-Ruiz
- Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Instituto Biosanitario de Granada, Granada, Spain.
| | - Sara Sanbonmatsu-Gámez
- Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Instituto Biosanitario de Granada, Granada, Spain
| | - Irene Pedrosa-Corral
- Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Instituto Biosanitario de Granada, Granada, Spain
| | - José Gutiérrez-Fernández
- Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Instituto Biosanitario de Granada, Granada, Spain
| | - José-María Navarro-Marí
- Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Instituto Biosanitario de Granada, Granada, Spain
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Chu HY, Englund JA, Huang D, Scott E, Chan JD, Jain R, Pottinger PS, Lynch JB, Dellit TH, Jerome KR, Kuypers J. Impact of rapid influenza PCR testing on hospitalization and antiviral use: A retrospective cohort study. J Med Virol 2015; 87:2021-6. [PMID: 26017150 DOI: 10.1002/jmv.24279] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 11/08/2022]
Abstract
Rapid PCR-based influenza tests are increasingly used as point-of-care diagnostics in hospitals and clinics. To our knowledge, no prior studies have described clinical outcomes with implementation of rapid PCR-based influenza tests in hospitalized adult inpatients. Electronic medical records were used to assess differences in laboratory testing time and antiviral use among a subset of 175 consecutive adult inpatients tested for influenza in two respiratory seasons before and after implementation of rapid PCR-based influenza testing at an academic medical center. Of the 350 hospitalized inpatients included in this analysis, 96 (27%) were over 65 years of age and 308 (88%) had a comorbid condition. The overall time to result decreased significantly from 25.2 to 1.7 hr (P < 0.001) after implementation of rapid PCR-based influenza testing. Among influenza-negative patients, the frequency of oseltamivir initiation remained unchanged (before: 43% vs. after: 45%; P = 0.60), though the median duration of oseltamivir was significantly decreased from 1.1 to 0.0 days (P < 0.001). By providing an earlier result to clinicians, rapid PCR-based influenza tests may decrease unnecessary antiviral use among adult inpatients who test negative for influenza.
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Affiliation(s)
- Helen Y Chu
- Department of Medicine, University of Washington, Seattle, Washington
| | - Janet A Englund
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Dandi Huang
- Department of Medicine, University of Washington, Seattle, Washington
| | - Emily Scott
- Department of Medicine, University of Washington, Seattle, Washington
| | - Jeanne D Chan
- Department of Pharmacy, University of Washington, Seattle, Washington
| | - Rupali Jain
- Department of Pharmacy, University of Washington, Seattle, Washington
| | - Paul S Pottinger
- Department of Medicine, University of Washington, Seattle, Washington
| | - John B Lynch
- Department of Medicine, University of Washington, Seattle, Washington
| | - Timothy H Dellit
- Department of Medicine, University of Washington, Seattle, Washington
| | - Keith R Jerome
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Jane Kuypers
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
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18
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Goldenberg SD, Edgeworth JD. The Enigma ML FluAB-RSV assay: a fully automated molecular test for the rapid detection of influenza A, B and respiratory syncytial viruses in respiratory specimens. Expert Rev Mol Diagn 2015; 15:23-32. [PMID: 25399865 DOI: 10.1586/14737159.2015.983477] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Enigma(®) ML FluAB-RSV assay (Enigma Diagnostics, Porton Down, Salisbury, UK) is a CE-IVD marked multiplex molecular panel for the detection of influenza A, B and respiratory syncytial viruses in nasopharyngeal swabs. The assay runs on the fully automated Enigma ML platform without further specimen manipulation and provides a sample-to-answer result within 95 min. The reported sensitivity and specificity for influenza A are 100% (95% CI: 98.2-100) and 98.3% (95% CI: 95.5-99.4), respectively, for influenza B are 100% (95% CI: 98.2-100) and 98.7% (95% CI: 96-99.6), respectively, and for respiratory syncytial virus are 100% (95% CI: 98.2-100) and 99.4% (95% CI: 97.2-99.9), respectively.
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Affiliation(s)
- Simon D Goldenberg
- Centre for Clinical Infection and Diagnostics Research, King's College London and Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
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19
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Volling C, Hassan K, Mazzulli T, Green K, Al-Den A, Hunter P, Mangat R, Ng J, McGeer A. Respiratory syncytial virus infection-associated hospitalization in adults: a retrospective cohort study. BMC Infect Dis 2014; 14:665. [PMID: 25494918 PMCID: PMC4269936 DOI: 10.1186/s12879-014-0665-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Once considered primarily a pediatric concern, respiratory syncytial virus (RSV) infection is gaining recognition as a cause of significant morbidity and mortality in adults. A better understanding of RSV epidemiology and disease in adults is needed to guide patient management and to assess the need for prophylaxis, vaccines, and treatments. METHODS We conducted a retrospective cohort study of adults admitted to four hospitals in Toronto, Canada, between September 2012 and June 2013 with RSV identified by a qualitative real-time reverse-transcriptase polymerase chain reaction assay in nasopharyngeal swab or bronchoscopy specimens. Main outcomes were hospital length of stay, need for intensive care unit (ICU) or mechanical ventilation, and all-cause mortality. RESULTS Eighty-six patients were identified as requiring hospitalization for RSV infection (56% female). Median age was 74 (range 19-102) years; 29 (34%) were < 65 years. Eighty-three (97%) had underlying chronic medical conditions; 27 (31%) were immunosuppressed, and 10 (12%) known smokers. The most common symptoms and signs were cough in 73 (85%), shortness of breath in 68 (79%), sputum production in 54 (63%), weakness in 43 (50%), fever in 41 (48%), and wheezing in 33 (38%). Lower respiratory tract complications occurred in 45 (52%), cardiovascular complications occurred in 19 (22%), and possible co-pathogens were identified in 11 (13%). Sixty-seven (78%) were treated with antibiotics and 31 (36%) with anti-influenza therapy. Thirteen (15%) required ICU care and 8 (9%) required mechanical ventilation. Five (6%) died during hospitalization. Need for ICU and mechanical ventilation were associated with mortality (P ≤ 0.02). Median hospital length of stay was 6 days (mean 10.8 days). CONCLUSIONS RSV infection is associated with the need for extended hospital stay, ICU care and mortality in adults of all ages with chronic underlying conditions. Presenting signs and symptoms are nonspecific, co-infections occur, and patients often receive antibiotics and anti-influenza therapy. There is need for ongoing research and development of RSV prophylaxis, vaccines and treatments for adults.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Allison McGeer
- Department of Microbiology, Mount Sinai Hospital, Room 210, 600 University Avenue, Toronto, M5G 1X5, ON, Canada.
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Svensson MJ, Lind I, Wirgart BZ, Östlund MR, Albert J. Performance of the Simplexa™ Flu A/B & RSV Direct Kit on respiratory samples collected in saline solution. ACTA ACUST UNITED AC 2014; 46:825-31. [PMID: 25195649 DOI: 10.3109/00365548.2014.946444] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Molecular assays for diagnosis of influenza A, influenza B, and respiratory syncytial virus (RSV) with short turnaround time are of considerable clinical importance. We have evaluated the diagnostic performance of the Simplexa(™) Flu A/B & RSV Direct Kit, which has a run time of 60 min, using different types of respiratory samples collected from patients with a suspected respiratory tract infection, including materials not previously evaluated on this kit. METHODS In total, 210 clinical respiratory samples were analyzed using both the Simplexa direct assay and a laboratory-developed assay (LDA). The 210 clinical samples included 99 nasopharyngeal aspirates collected in 0.9% saline, 91 nasopharyngeal swabs in Σ-Virocult transport medium, 9 tracheal secretions, 8 bronchoalveolar lavages (BAL), and 3 other respiratory sample materials. RESULTS The specificity of the Simplexa assay, using the LDA as gold standard and excluding secondary viral findings, was 100% for all three viruses, whereas the sensitivity was 94.0% for influenza A (47/50), 90.7% for influenza B (49/54), and 90.1% for RSV (46/51), respectively. Discordant results were only observed for samples with cycle threshold values (Ct) > 31 in the LDA. The Simplexa assay generated higher Ct values than the LDA for all three viruses and performed equally well on nasopharyngeal swabs and aspirates. CONCLUSIONS The short run time of the Simplexa direct assay, in combination with high specificity and good sensitivity regarding the sample materials used in this study, make it an interesting option for rapid detection of these three important viral respiratory pathogens in a variety of clinical sample materials.
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Affiliation(s)
- Malin J Svensson
- From the Department of Clinical Microbiology, Karolinska University Hospital , Stockholm , Sweden
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Comparison of Simplexa Flu A/B & RSV PCR with cytospin-immunofluorescence and laboratory-developed TaqMan PCR in predominantly adult hospitalized patients. J Clin Microbiol 2014; 52:3057-9. [PMID: 24850350 DOI: 10.1128/jcm.00738-14] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To compare Simplexa Flu A/B & RSV PCR with cytospin-immunofluorescence and laboratory-developed TaqMan PCR methods, 445 nasopharyngeal samples were tested. Of these, 199 were positive (46 for respiratory syncytial virus [RSV], 120 for influenza A, and 33 for influenza B) and 246 were negative. The direct fluorescent-antibody assay (DFA) detected 132 (66.3%) positive samples, Simplexa direct detected 162 (81.4%), Simplexa using extracts detected 177 (88.9%), and lab-developed TaqMan PCR reference methods detected 199 (100%). The specificities were 99.6%, 100%, 100%, and 100%, respectively. The two Simplexa methods were more sensitive than the DFA (P = 0.0001) but less sensitive than the TaqMan reverse transcriptase PCR (P = 0.0001).
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