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Macina D, Evans KE. Pertussis in Individuals with Co-morbidities: A Systematic Review. Infect Dis Ther 2021; 10:1141-1170. [PMID: 34117998 PMCID: PMC8322178 DOI: 10.1007/s40121-021-00465-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022] Open
Abstract
Pertussis is a highly contagious disease of the respiratory tract caused by Bordetella pertussis. Although the burden of pertussis is highest in children, available data suggests that pertussis in the elderly and those with underlying chronic conditions or illnesses can result in significant morbidity, mortality and costs. We undertook a comprehensive review to assess the association between pertussis and chronic conditions/illnesses. A search was undertaken on 17 June 2019 across EMBASE, Medline and BIOSIS. Citations were limited to those in English, in humans and published since 1 January 1990. There were 1179 papers identified with an additional 70 identified through a review of the reference lists. Of these, 34 met the inclusion criteria. Papers included were categorised in groups, those which reported: associations between prior pertussis and subsequent chronic conditions or illnesses; a link between chronic conditions/illnesses and subsequent risk of pertussis; and those which reported on the effect of the chronic conditions/illnesses on pertussis complications or exacerbations. Pertussis appears to increase the likelihood of developing some chronic conditions/illnesses, but also appears to decrease the likelihood of developing some haematological cancers. There were several chronic conditions/illnesses where the study results were mixed, and several studies that found no association with previous pertussis. There were also studies which showed that having some comorbid health condition(s) might increase the risk of developing pertussis. Three studies showed pertussis can lead to increased exacerbations of chronic conditions/illnesses and associated hospitalisations, although one study showed it reduced the effects of chronic bronchitis. Previous pertussis appears to contribute to the increased likelihood of developing some respiratory conditions like asthma, and conversely those with asthma or COPD are at increased risk of severe pertussis requiring further intervention. Further research is required to confirm or disprove these associations, and to characterise the pathophysiological mechanisms behind the potential associations with pertussis.
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Affiliation(s)
- Denis Macina
- Vaccines Epidemiology and Modelling, Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France.
| | - Keith E Evans
- inScience Communications, Chowley Oak Business Park, Chowley Oak Lane, Tattenhall, Cheshire, UK
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Pimenova AS, Borisova OY, Petrova MS, Voronina IS, Borisova AB, Shamsheva OV, Afanasiev SS, Vlasov EV, Aleshkin VA. EFFICIENCY OF APPLICATION OF ISOTHERMAL AMPLIFICATION AT INSPECTION OF PATIENTS WITH WHOOPING COUGH. ACTA ACUST UNITED AC 2018. [DOI: 10.15789/2220-7619-2018-3-361-368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Purpose: efficiency isothermal amplification (LAMP) at inspection of patients with whooping cough in clinical conditions. Materials and methods. Examination of 262 patients aged from 0 months up to 30 years hospitalized in Infectious diseases clinical hospital No. 1 of the Moscow Department of Healthcare is conducted. Clinical specimens (pharyngeal swabs) were collected according to MR 3.1.2.0072-13. Extraction DNA of B. pertussiswas carried out by means of the АmplyPrime® DNA-sorb-AM. Identification of specific fragments of a genome of B. pertussiswas performed by PCR-real time by means of the АmplySens ® Bordetella Multi-FL set (a comparison method) and by the LAMP with a phoresis and intercalating dye. Results.When using of the optimized method LAMP the DNA of B. pertussisis found at 252 (96.2%) patients. The method was effective at any forms of whooping cough —DNA of B. pertussisis found in all patients with a severe form, in 95.8% of cases — in patients with medium-weight and in 95.3% of cases — in patients with an easy form. The DNA of B. pertussisis found in clinical specimens received from patients on different terms from the beginning of a disease — from 92.3% on the 1st week up to 96% of cases — on the 5 th and more weeks of a disease. The DNA of B. pertussisis found in high percent of cases (96.7–95.9%) and did not depend on acceptance of antibacterial therapy. Children till 1 year are the main age group which is subject to hospitalization at suspicion of whooping cough and in which the highest risk of development of complications and severe forms of a clinical disease. At inspection of 169 children from 0 to 12 months by means of the optimized method LAMP, DNA of B. pertussisit is found in 98.6% of cases in children of patients with whooping cough aged from 0–3 months, in 98.4% of cases — children of 4–7 months and in 94.6% of cases — at children have 8–12 months. The efficiency of detection of DNA of B. pertussisat patients with whooping cough of children aged till 1 year by means of the optimized LAMP method was 97.6%.
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Affiliation(s)
- A. S. Pimenova
- G.N. Gabrichevsky Research Institute of Epidemiology and Microbiology
| | - O. Yu. Borisova
- G.N. Gabrichevsky Research Institute of Epidemiology and Microbiology; Russian National Research Medical University named after N.I. Pirogov
| | - M. S. Petrova
- G.N. Gabrichevsky Research Institute of Epidemiology and Microbiology
| | - I. S. Voronina
- G.N. Gabrichevsky Research Institute of Epidemiology and Microbiology
| | - A. B. Borisova
- G.N. Gabrichevsky Research Institute of Epidemiology and Microbiology
| | - O. V. Shamsheva
- Russian National Research Medical University named after N.I. Pirogov
| | - S. S. Afanasiev
- G.N. Gabrichevsky Research Institute of Epidemiology and Microbiology
| | - E. V. Vlasov
- Infectious Diseases Clinical Hospital No. 1 of the Moscow Department of Healthcare
| | - V. A. Aleshkin
- G.N. Gabrichevsky Research Institute of Epidemiology and Microbiology
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Tapiainen T, Aittoniemi J, Immonen J, Jylkkä H, Meinander T, Nuolivirta K, Peltola V, Salo E, Seuri R, Walle SM, Korppi M. Finnish guidelines for the treatment of community-acquired pneumonia and pertussis in children. Acta Paediatr 2016; 105:39-43. [PMID: 26341383 DOI: 10.1111/apa.13177] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/23/2015] [Accepted: 09/01/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED Evidence-based guidelines are needed to harmonise and improve the diagnostics and treatment of children's lower respiratory tract infections. Following a professional literature search, an interdisciplinary working group evaluated and graded the available evidence and constructed guidelines for the treatment of community-acquired pneumonia and pertussis. CONCLUSION The clinical guidelines state that chest radiography is not needed if the child is diagnosed with pneumonia and treated at home. Complications should be considered if there is no improvement after antimicrobial therapy and a paroxysmal cough can indicate pertussis, which is life-threatening in unvaccinated infants and can lead to respiratory failure.
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Affiliation(s)
- Terhi Tapiainen
- Department of Pediatrics and Adolescence; Oulu University Hospital; Oulu Finland
- PEDEGO Research Unit - Research Unit for Pediatrics; Dermatology; Clinical Genetics Obstetrics and Gynecology, and Medical Research Center; University of Oulu; Finland
| | | | | | - Heli Jylkkä
- Department of Pediatrics; University of Tampere; Tampere Finland
| | - Tuula Meinander
- Department of Internal Medicine; Tampere University Hospital and the Finnish Medical Society Duodecim; Tampere Finland
| | | | - Ville Peltola
- Department of Pediatrics; Turku University Hospital and University of Turku; Turku Finland
| | - Eeva Salo
- Department of Pediatrics; Helsinki University Hospital; Helsinki Finland
| | - Raija Seuri
- HUS Imaging; Children′s Hospital; Helsinki University Hospital; Helsinki Finland
| | | | - Matti Korppi
- Department of Pediatrics; Tampere University Hospital and University of Tampere; Tampere Finland
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Abstract
The introduction of vaccination in the 1950s significantly reduced the morbidity and mortality of pertussis. However, since the 1990s, a resurgence of pertussis has been observed in vaccinated populations, and a number of causes have been proposed for this phenomenon, including improved diagnostics, increased awareness, waning immunity, and pathogen adaptation. The resurgence of pertussis highlights the importance of standardized, sensitive, and specific laboratory diagnoses, the lack of which is responsible for the large differences in pertussis notifications between countries. Accurate laboratory diagnosis is also important for distinguishing between the several etiologic agents of pertussis-like diseases, which involve both viruses and bacteria. If pertussis is diagnosed in a timely manner, antibiotic treatment of the patient can mitigate the symptoms and prevent transmission. During an outbreak, timely diagnosis of pertussis allows prophylactic treatment of infants too young to be (fully) vaccinated, for whom pertussis is a severe, sometimes fatal disease. Finally, reliable diagnosis of pertussis is required to reveal trends in the (age-specific) disease incidence, which may point to changes in vaccine efficacy, waning immunity, and the emergence of vaccine-adapted strains. Here we review current approaches to the diagnosis of pertussis and discuss their limitations and strengths. In particular, we emphasize that the optimal diagnostic procedure depends on the stage of the disease, the age of the patient, and the vaccination status of the patient.
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Affiliation(s)
- Anneke van der Zee
- Molecular Diagnostics Unit, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Frits R Mooi
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands
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Epidemiological features of pertussis resurgence based on community populations with high vaccination coverage in China. Epidemiol Infect 2014; 143:1950-6. [DOI: 10.1017/s095026881400260x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYActive symptom surveillance was applied to three selected communities ( 160 147 persons) in Tianjin from 2010 to 2012. We examined 1089 individuals showing pertussis-like symptoms, of which 1022 nasopharyngeal specimens were tested for pertussis by polymerase chain reaction and 802 sera for anti-pertussis toxin antibodies. Of the total cases tested, 113 were confirmed, and their demographic, clinical, and vaccination-related data were collected. The annual incidence was 23·52 cases/100 000 persons among communities, which was 16·22 times that obtained via hospital reports for the same period (P< 0·001). The actual incidence in the 15–69 years age group was most significantly underestimated by hospitals, given that it was 43·08 times that of the reported hospital rate. Among the cases aged <15 years, 84·5% were individuals who had been fully vaccinated. The misdiagnosis rate was as high as 94·69%, and only 5·31% of the confirmed pertussis cases were properly diagnosed as pertussis at their first medical visit. Pertussis incidence in China has been severely underestimated and this was in part due to a high misdiagnosis rate. Adolescents and adults have become new high-risk populations. Future work should focus on reinforcing immunization programmes, especially among adolescents and adults.
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Hilton JP, Nguyen T, Barbu M, Pei R, Stojanovic M, Lin Q. Bead-based polymerase chain reaction on a microchip. MICROFLUIDICS AND NANOFLUIDICS 2012; 13:749-760. [PMID: 33664642 PMCID: PMC7929480 DOI: 10.1007/s10404-012-0993-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
We present a bead-based approach to microfluidic polymerase chain reaction (PCR), enabling fluorescent detection and sample conditioning in a single microchamber. Bead-based PCR, while not extensively investigated in microchip format, has been used in a variety of bioanalytical applications in recent years. We leverage the ability of bead-based PCR to accumulate fluorescent labels following DNA amplification to explore a novel DNA detection scheme on a microchip. The microchip uses an integrated microheater and temperature sensor for rapid control of thermal cycling temperatures, while the sample is held in a microchamber fabricated from (poly)dimethylsiloxane and coated with Parylene. The effects of key bead-based PCR parameters, including annealing temperature and concentration of microbeads in the reaction mixture, are studied to achieve optimized device sensitivity and detection time. The device is capable of detecting a synthetically prepared section of the Bordetella pertussis genome in as few as 10 temperature cycles with times as short as 15 min. We then demonstrate the use of the procedure in an integrated device; capturing, amplifying, detecting, and purifying template DNA in a single microfluidic chamber. These results show that this method is an effective method of DNA detection which is easily integrated in a microfluidic device to perform additional steps such as sample pre-conditioning.
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Affiliation(s)
- John P Hilton
- Department of Mechanical Engineering, Columbia University, New York, NY 10027, USA
| | - ThaiHuu Nguyen
- Department of Mechanical Engineering, Columbia University, New York, NY 10027, USA
| | - Mihaela Barbu
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, Columbia University, New York, NY 10032, USA
| | - Renjun Pei
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, Columbia University, New York, NY 10032, USA
| | - Milan Stojanovic
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, Columbia University, New York, NY 10032, USA
| | - Qiao Lin
- Department of Mechanical Engineering, Columbia University, New York, NY 10027, USA
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Zouari A, Smaoui H, Kechrid A. The diagnosis of pertussis: which method to choose? Crit Rev Microbiol 2011; 38:111-21. [PMID: 22103249 DOI: 10.3109/1040841x.2011.622715] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Despite the introduction of routine vaccination against pertussis for more than a half century, leading to a drastic decline in the number of reported cases, pertussis continues to be an important respiratory disease afflicting unvaccinated infants and previously vaccinated children as well as adults in whom immunity has waned. The diagnosis of pertussis is challenging and accurate laboratory identification of Bordetella infections remains problematic. Common laboratory diagnostic methods used for pertussis diagnosis include culture, direct-fluorescent-antibody testing (DFA), serology and polymerase chain reaction (PCR). Culture of Bordetella pertussis is highly specific but fastidious and has limited sensitivity. DFA provides a much more rapid result, but has the disadvantage of poor sensitivity and specificity. Serology is not useful in infants. In older persons, it is hampered by the limitations of paired sera and it provides mainly a retrospective diagnosis. Such limitations of conventional diagnosis testing have led to the development of PCR assays. Notwithstanding its lack of standardization, PCR has been found to be more sensitive and more specific than other methods. In this report, we aimed to review current knowledge about the available diagnostic methods and tests that accurately diagnose pertussis.
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Affiliation(s)
- Asma Zouari
- Microbiology Laboratory, Children's Hospital of Tunis, Tunis, Tunisia.
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Sole pathogen in acute bronchiolitis: is there a role for other organisms apart from respiratory syncytial virus? Pediatr Infect Dis J 2010; 29:e7-e10. [PMID: 19935450 DOI: 10.1097/inf.0b013e3181c2a212] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute bronchiolitis (AB) is a common disease of young children with peak incidence during the winter season. Respiratory syncytial virus (RSV) is a major causative organism, yet recent relatively small sized studies have suggested an increased role of other organisms as sole or codetected organisms. The aim of this study was to assess the prevalence of sole- and mixed-organisms infections in hospitalized children with AB, using combined antigen-based and polymerase chain reaction assays (PCR). METHODS Sputum or nasal wash specimens obtained from 490 previously healthy children < or =2 years of age hospitalized with AB between December 1, 2005 and March 31, 2006 were tested: (1) For RSV, by rapid antigen detection test; (2) For RSV, influenza A, B, Parainfluenza 1 to 3, and adenovirus antigens by direct fluorescent assay; (3) For influenza A and B, RSV, Parainfluenza 1 to 3 viruses RNA by reverse transcription (RT) PCR assay; (4) For human metapneumovirus and rhinovirus RNA by RT real-time PCR assay; (5) For adenovirus, and Bordetella pertussis DNA by conventional PCR assays; (6) For human bocavirus DNA by real-tine PCR assays. RESULTS At least 1 organism was detected in 465 (91%) children. In 283 (61%), 117 (25%), and 23 (5%) children, 1, 2, and 3/4 organisms were detected, respectively. The most commonly detected organism was RSV, detected in 76%, and as a sole organism in 49%. Rhinovirus, human metapneumovirus, influenza virus A, bocavirus, Bordetella pertussis, and adenovirus were detected as a sole organism in 7%, 2.1%, 1%, 0.6%, 0.6%, and 0.2% of the children, respectively. CONCLUSIONS Respiratory organisms were detected in the majority of the children, of whom about one third suffered from mixed organism infection. RSV was the most prevalent sole detected organism. The relevance of all other organisms may be much less than previously suggested.
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Fry NK, Duncan J, Wagner K, Tzivra O, Doshi N, Litt DJ, Crowcroft N, Miller E, George RC, Harrison TG. Role of PCR in the diagnosis of pertussis infection in infants: 5 years' experience of provision of a same-day real-time PCR service in England and Wales from 2002 to 2007. J Med Microbiol 2009; 58:1023-1029. [DOI: 10.1099/jmm.0.009878-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
As part of an enhanced surveillance programme for pertussis in England and Wales, a real-time PCR service for the detection of Bordetella pertussis was introduced for infants aged ≤6 months admitted to a paediatric intensive care unit or paediatric ward with a respiratory illness compatible with pertussis. Two real-time fluorescent resonance energy transfer hybridization probe LightCycler (Roche Diagnostics) PCR assays were used. One (designed in-house) targeted the pertussis toxin S1 promoter (ptxA-pr), and included an internal process control to test for sample inhibition and reagent performance. The other (already published) targeted the insertion element IS481. The analytical sensitivities of the assays were 100 and 10 fg per reaction for the ptxA-pr and IS481 PCRs, respectively. The ptxA-pr assay was specific for B. pertussis, whilst the IS481 PCR also showed some cross-reactivity with Bordetella holmesii and the type strain of Bordetella parapertussis. From April 2002 to March 2007, 848 samples were received from 774 patients and DNA was extracted. Of 824 samples that were suitable for testing, 183 (22.2 %) had evidence of Bordetella infection (18.9 % ptxA-pr and IS481; 3.3 % IS481 only), 621 (75.4 %) were negative and 20 (2.4 %) were inhibitory for the PCR. Within the targeted age group of ≤6 months, most patients (130/138) with evidence of Bordetella spp. by PCR were ≤3 months old. The overall percentage increase in laboratory-confirmed cases due to PCR compared with culture for the 5 year period described ranged from 9 to 26 % per year (mean 19 %). Real-time PCR is an invaluable tool both for enhanced epidemiological surveillance and for the provision of a rapid diagnosis of pertussis where results can affect patient and contact management.
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Affiliation(s)
- Norman K. Fry
- Respiratory and Systemic Infection Laboratory, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, UK
| | - John Duncan
- Respiratory and Systemic Infection Laboratory, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, UK
| | - Karen Wagner
- Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, UK
| | - Oceanis Tzivra
- Respiratory and Systemic Infection Laboratory, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, UK
| | - Nita Doshi
- Respiratory and Systemic Infection Laboratory, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, UK
| | - David J. Litt
- Respiratory and Systemic Infection Laboratory, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, UK
| | - Natasha Crowcroft
- Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, UK
| | - Elizabeth Miller
- Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, UK
| | - Robert C. George
- Respiratory and Systemic Infection Laboratory, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, UK
| | - Timothy G. Harrison
- Respiratory and Systemic Infection Laboratory, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, UK
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Abstract
OBJECTIVES To describe children with pertussis who require intensive care. DESIGN, SETTING AND PATIENTS An audit in Auckland, New Zealand, of pertussis admissions to the national paediatric intensive care unit (PICU) from 1991 to 2003. RESULTS 72 children, 97% of whom were <12 months old. The annual number of cases increased with time (p = 0.04). Forty patients (56%) were coughing for less than 8 days before admission. Apnoea or paroxysmal cough was present in 33 (83%) of these children. Thirty five (49%) received assisted ventilation. Four died. 19% were readmitted to PICU. Those readmitted presented with more atypical disease and had a shorter first admission but longer total PICU admission (9 vs 5 days, p = 0.009). Of the 58 children from Auckland, nine either died (three) or had subsequent respiratory or neurodevelopmental problems (six). There was an increased risk (relative risk, 95% CI) of death or disability associated with having a co-morbidity (RR = 5.56, 1.50 to 8.15), an elevated lymphocyte count (RR = 5.75, 1.54 to 13.65), presenting with seizures/encephalopathy (4.87, 1.18 to 8.34) or shock (6.50, 1.89 to 8.94), having a PIM score of 1% or more (RR = 6.20, 1.22 to 21.72), any abnormal neurological signs (RR = 9.65, 3.32 to 15.23) or being readmitted to PICU (RR = 4.63, 1.44 to 8.82). CONCLUSIONS Apnoea and paroxysmal cough are key symptoms of pertussis in those with shorter cough duration. Death or disability are frequent. Clinical factors define children at increased risk of these poor outcomes. Early discharge from PICU is associated with an increased risk of readmission and poor outcome.
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Affiliation(s)
- Julia Surridge
- Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
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Mertens PLJM, Stals FS, Steyerberg EW, Richardus JH. Sensitivity and specificity of single IgA and IgG antibody concentrations for early diagnosis of pertussis in adults: an evaluation for outbreak management in public health practice. BMC Infect Dis 2007; 7:53. [PMID: 17553132 PMCID: PMC1924524 DOI: 10.1186/1471-2334-7-53] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Accepted: 06/06/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An accurate, practical laboratory test is needed to confirm clinical diagnosis of pertussis in adults during the first 3 symptomatic weeks, when treatment is effective and transmission can be interrupted. METHODS The sensitivity and specificity of single IgA and IgG levels were assessed in a cohort study of a pertussis epidemic in 99 adults in a closed community. Sensitivities were assessed in the sera of 46 laboratory confirmed clinical pertussis cases during the first 3 weeks. Specificities were calculated in sera of 35 asymptomatic controls without clinical symptoms or laboratory confirmed infections from the same community (internal controls). We compared these specificities with the specificities of single IgA and IgG levels in 4275 external controls from a cross-section of the general Dutch population aged 21-79 years who had not coughed for more than 2 weeks in the past year, and without pertussis diagnoses. The study was done in the Netherlands when whole-cell pertussis vaccine was used in the national vaccination programme. RESULTS Levels of 24 U/ml for IgA and 27 U/ml for IgG gave sensitivities of 100% and 75%, respectively, in the first 2 weeks, 100% in the third week, and 97% after the fourth week. The levels were reached within 2 days after onset of increase, and remained above these levels for roughly 7.2 and 5.1 months, respectively. Specificity was 82% for IgA and 89% for IgG in the internal controls and 90% in the external controls, respectively. CONCLUSION We suggest levels of 24 U/ml for IgA level and 27 U/ml (= 27 International Units (IU)/ml) for IgG as sensitive, specific, and practical for laboratory confirmation of clinical pertussis in adults in the first 3 weeks of outbreak management.
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Affiliation(s)
- Paul LJM Mertens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Municipal Health Service Rotterdam Rijnmond, Rotterdam, The Netherlands
| | | | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Jan H Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Municipal Health Service Rotterdam Rijnmond, Rotterdam, The Netherlands
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Korppi M, Hiltunen J. Pertussis is common in nonvaccinated infants hospitalized for respiratory syncytial virus infection. Pediatr Infect Dis J 2007; 26:316-8. [PMID: 17414394 DOI: 10.1097/01.inf.0000258690.06349.91] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is some evidence that Bordetella pertussis can cause co-infection with respiratory syncytial virus (RSV). SUBJECTS AND METHODS RSV etiology was studied by antigen detection in 117 infants <6 months of age, who were hospitalized for respiratory tract infection during an RSV epidemic. B. pertussis etiology was studied by polymerase chain reaction in those 88 in whom parents or nurses reported cough. RESULTS RSV was found in 91 (78%) infants and B. pertussis in 9 (8%) infants. In 7 cases, there was mixed RSV-pertussis infection. In retrospective analysis, RSV and mixed RSV-pertussis cases could not be separated by clinical characteristics. CONCLUSIONS Co-infection caused by B. pertussis was present in 8% of infants, aged <6 months, who were hospitalized for RSV infection. To avoid under-diagnosis, pertussis should be considered in all nonvaccinated infants with lower respiratory tract infection.
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Affiliation(s)
- Matti Korppi
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
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Mad'arová L, Klement C, Kohútová D, Tináková K, Krajcíková L, Obernauerová M. First Confirmation of Bordetella pertussis Occurence in Slovakia by Using Real-time PCR. Cent Eur J Public Health 2007; 15:38-43. [PMID: 17491558 DOI: 10.21101/cejph.a3401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
By application of the real-time PCR we manage to confirm the diagnosis and occurrence of a disease, which is caused by Bordetella pertussis-pertussis. Using this method we have proven the presence of DNA of Bordetella pertussis in the biological materials (nasopharyngeal swabs). The presence of IS481 genome sequence of Bordetella pertussis was confirmed. This method of detection of pathogens seems to be very rapid, simple, and specific. In the case of adequate technical laboratory equipment it may become very suitable and important supporter in explanation and confirmation of the occurrence of bacterial infections.
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Affiliation(s)
- Lucia Mad'arová
- Regional Authority of Public Health Banská Bystrica, Division of Medical Microbiology, Banská Bystrica, Slovak Republic
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Register KB, Sanden GN. Prevalence and sequence variants of IS481 in Bordetella bronchiseptica: implications for IS481-based detection of Bordetella pertussis. J Clin Microbiol 2006; 44:4577-83. [PMID: 17065269 PMCID: PMC1698417 DOI: 10.1128/jcm.01295-06] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report the prevalence in Bordetella bronchiseptica of IS481, a frequent target for diagnosis of Bordetella pertussis, as approximately 5%. However, PCR amplicons of the predicted size were detectable in 78% of IS481-negative strains. Our results suggest that PCR targeting IS481 may not be sufficiently specific for reliable identification of B. pertussis.
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Affiliation(s)
- Karen B Register
- Respiratory Diseases of Livestock Research Unit, USDA/ARS/National Animal Disease Center, P.O. Box 70, 2300 Dayton Road, Ames, IA 50010, USA.
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Antila M, He Q, de Jong C, Aarts I, Verbakel H, Bruisten S, Keller S, Haanperä M, Mäkinen J, Eerola E, Viljanen MK, Mertsola J, van der Zee A. Bordetella holmesii DNA is not detected in nasopharyngeal swabs from Finnish and Dutch patients with suspected pertussis. J Med Microbiol 2006; 55:1043-1051. [PMID: 16849724 DOI: 10.1099/jmm.0.46331-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Bordetella holmesii is a Gram-negative bacterium first identified in 1995. It can cause pertussis-like symptoms in humans. B. holmesii contains insertion sequences IS481 and IS1001, two frequently used targets in the PCR diagnosis of Bordetella pertussis and Bordetella parapertussis infections. To investigate the prevalence of B. holmesii in Finnish and Dutch patients with pertussis-like symptoms and whether B. holmesii has caused any false-positive results in diagnostic PCRs, B. holmesii-specific real-time PCRs were developed. The Finnish methods were conventional IS481 PCR and B. holmesii-specific real-time PCR (LightCycler, Roche) targeting the B. holmesii recA gene. The Dutch methods were IS481 and IS1001 PCRs with conventional or real-time formats and B. holmesii-specific real-time PCR targeting the homologue of IS1001. Of 11,319 nasopharyngeal swabs, 2804 were collected from Finnish patients from 2000 to 2003, and 8515 from Dutch patients from 1992 to 2003. B. holmesii DNA was not found in the samples analysed. The results suggest that B. holmesii is not among the causative agents of pertussis-like symptoms in Finnish and Dutch patients and thus does not in practice confound IS481 and IS1001 PCRs.
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Affiliation(s)
- Mia Antila
- Department of Pathology, Turku University Hospital, Turku, Finland
- Pertussis Reference Laboratory, National Public Health Institute, Kiinamyllynkatu 13, 20520 Turku, Finland
| | - Qiushui He
- Pertussis Reference Laboratory, National Public Health Institute, Kiinamyllynkatu 13, 20520 Turku, Finland
| | - Caroline de Jong
- Laboratory of Medical Microbiology, St Elisabeth Hospital, Tilburg, The Netherlands
| | - Ingrid Aarts
- Laboratory of Medical Microbiology, St Elisabeth Hospital, Tilburg, The Netherlands
| | - Harold Verbakel
- Laboratory of Medical Microbiology, St Elisabeth Hospital, Tilburg, The Netherlands
| | - Sylvia Bruisten
- The Area Health Authority (GGD), Municipal Health Laboratory, Amsterdam, The Netherlands
| | - Suzanne Keller
- The Area Health Authority (GGD), Municipal Health Laboratory, Amsterdam, The Netherlands
| | - Marjo Haanperä
- Pertussis Reference Laboratory, National Public Health Institute, Kiinamyllynkatu 13, 20520 Turku, Finland
| | - Johanna Mäkinen
- Mycobacterial Reference Laboratory, National Public Health Institute, Turku, Finland
| | - Erkki Eerola
- Department of Medical Microbiology, University of Turku, Turku, Finland
| | - Matti K Viljanen
- Department of Medical Microbiology, University of Turku, Turku, Finland
| | - Jussi Mertsola
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Anneke van der Zee
- Laboratory of Medical Microbiology, St Elisabeth Hospital, Tilburg, The Netherlands
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16
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Knorr L, Fox JD, Tilley PAG, Ahmed-Bentley J. Evaluation of real-time PCR for diagnosis of Bordetella pertussis infection. BMC Infect Dis 2006; 6:62. [PMID: 16556317 PMCID: PMC1435912 DOI: 10.1186/1471-2334-6-62] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Accepted: 03/23/2006] [Indexed: 11/28/2022] Open
Abstract
Background Nucleic acid amplification of the IS481 region by PCR is more sensitive than culture for detection and diagnosis of Bordetella pertussis but the assay has known cross-reactivity for Bordetella holmesii and its use as a routine diagnostic assay has not been widely evaluated. Methods The objectives of this study were: 1) to assess the diagnostic utility of real-time IS481 PCR by comparison of results with culture and direct fluorescent antigen (DFA) testing for B. pertussis, 2) to employ a PCR assay designed against a different insertion sequence (IS1001) to assess the incidence of B. holmesii in symptomatic individuals and 3) to design and evaluate a new PCR-based assay which could be used for B. pertussis confirmation. A total of 808 nasopharyngeal specimens were included in the study the majority of which were submitted in charcoal transport medium (88%) with the rest submitted in Regan-Lowe medium. Results Concordant results for PCR, DFA and culture were obtained for 21 B. pertussis positive and 729 B. pertussis negative specimens. DFA was prone to false positive and negative reactions when compared with both PCR and culture. The IS481 PCR identified 28 positive results for specimens that were DFA and culture negative. A novel real-time PCR targeting the B. pertussis toxin promoter was found to be specific and useful for confirming the majority of IS481 positive specimens as B. pertussis. B. holmesii was not detected in any of the submitted samples. Conclusion The potential pick up of B. holmesii by the IS481 PCR had minimal diagnostic relevance in the Alberta population during the time period of our study. The IS481 PCR assay is now used in our laboratory routinely for front-line screening of samples for B. pertussis with associated enhancement in diagnostic sensitivity compared with DFA and culture. Retrospectively, patients' samples are batched and tested by the IS1001 MB and TPR assays for research purposes and to ensure there is no change in B. holmesii incidence in the population.
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Affiliation(s)
- Laina Knorr
- Provincial Laboratory for Public Health, Calgary, Alberta, Canada
| | - Julie D Fox
- Provincial Laboratory for Public Health, Calgary, Alberta, Canada
- Department of Microbiology and Infectious Diseases, University of Calgary, Alberta, Canada
| | - Peter AG Tilley
- Provincial Laboratory for Public Health, Calgary, Alberta, Canada
- Department of Microbiology and Infectious Diseases, University of Calgary, Alberta, Canada
| | - Jasmine Ahmed-Bentley
- Department of Medical Microbiology, University of Alberta, Edmonton, Alberta, Canada
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17
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Speers DJ. Clinical applications of molecular biology for infectious diseases. Clin Biochem Rev 2006; 27:39-51. [PMID: 16886046 PMCID: PMC1390794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Molecular biological methods for the detection and characterisation of microorganisms have revolutionised diagnostic microbiology and are now part of routine specimen processing. Polymerase chain reaction (PCR) techniques have led the way into this new era by allowing rapid detection of microorganisms that were previously difficult or impossible to detect by traditional microbiological methods. In addition to detection of fastidious microorganisms, more rapid detection by molecular methods is now possible for pathogens of public health importance. Molecular methods have now progressed beyond identification to detect antimicrobial resistance genes and provide public health information such as strain characterisation by genotyping. Treatment of certain microorganisms has been improved by viral resistance detection and viral load testing for the monitoring of responses to antiviral therapies. With the advent of multiplex PCR, real-time PCR and improvements in efficiency through automation, the costs of molecular methods are decreasing such that the role of molecular methods will further increase. This review will focus on the clinical utility of molecular methods performed in the clinical microbiology laboratory, illustrated with the many examples of how they have changed laboratory diagnosis and therefore the management of infectious diseases.
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Affiliation(s)
- David J Speers
- Division of Clinical Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA, Nedlands, WA, Australia.
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18
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Abstract
Molecular diagnostic techniques, such as PCR, have become useful tools for the rapid etiological diagnosis of lower respiratory tract infections. Nucleic acid amplification tests (NAATs) have been evaluated for detecting most respiratory pathogens, and commercial assays are available for some pathogens. However, standardized protocols are needed before these assays are introduced into routine diagnostic use. For pneumonia, NAATs offer advantages over conventional tests for the detection of Mycoplasma pneumoniae, Legionella spp. and Chlamydia pneumoniae. For pneumococcal pneumonia in adults, PCR adds little to existing diagnostic tests, and is unable to distinguish pneumococcal colonization from infection when testing respiratory samples. Although less sensitive than culture-based methods, several commercial molecular diagnostic assays have been developed for tuberculosis and are useful rapid tests for selected patients. PCR can now be considered the rapid diagnostic test of choice for pertussis and some respiratory virus infections. Further work is required to better characterize the role of molecular diagnostic tests for diagnosing lower respiratory tract infections, and to develop standard assays that can be readily adopted by routine diagnostic laboratories.
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Affiliation(s)
- David R Murdoch
- Department of Pathology, Christchurch School of Medicine and Health Sciences, and Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand.
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19
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Dragsted DM, Dohn B, Madsen J, Jensen JS. Comparison of culture and PCR for detection of Bordetella pertussis and Bordetella parapertussis under routine laboratory conditions. J Med Microbiol 2004; 53:749-754. [PMID: 15272061 DOI: 10.1099/jmm.0.45585-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A PCR assay for the detection of Bordetella pertussis and Bordetella parapertussis was compared with the conventional culture method under routine laboratory conditions. Detection of B. pertussis was based on the amplification of a section of the IS481 insertion sequence and confirmation of positive results was based on a sequence of the pertussis toxin promoter region. Detection of B. parapertussis was based on the amplification of a section of the IS1001 insertion sequence. An internal control was included. Data were available for the period 28 November 2000 to 9 July 2003. In this period, 3096 patients were examined for infection with B. pertussis and B. parapertussis by culture and PCR on the same day. B. pertussis was found in 496 (16 %) patients; 208 (42 %) were diagnosed by PCR alone whereas 17 (3 %) were diagnosed by culture alone. B. parapertussis was found in 64 (2 %) patients. The sensitivity of the PCR was 97 % and of culture 58 %. The specificity of PCR was 93 % when regarding culture as 100 % sensitive. There was a significant relationship between laboratory method and age, as the superiority of PCR was most marked in the age group 0.5-3 years. The PCR assay proved highly sensitive for the diagnosis of pertussis. The specificity estimate of the PCR assay suffers from the influence of a gold-standard method with a low sensitivity. The PCR assay is considered highly specific due to the amplification of two different sequences in two separate assays.
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Affiliation(s)
- Ditte M Dragsted
- Departments of Bacteriology, Mycology and Parasitology1 and Biostatistics2, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
| | - Birthe Dohn
- Departments of Bacteriology, Mycology and Parasitology1 and Biostatistics2, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
| | - Jesper Madsen
- Departments of Bacteriology, Mycology and Parasitology1 and Biostatistics2, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
| | - Jørgen S Jensen
- Departments of Bacteriology, Mycology and Parasitology1 and Biostatistics2, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
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20
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Anderson TP, Beynon KA, Murdoch DR. Comparison of real-time PCR and conventional hemi-nested PCR for the detection of Bordetella pertussis in nasopharyngeal samples. Clin Microbiol Infect 2003; 9:746-9. [PMID: 12925123 DOI: 10.1046/j.1469-0691.2003.00601.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We directly compared a conventional hemi-nested PCR assay with a real-time (LightCycler) PCR assay for the detection of Bordetella pertussis in nasopharyngeal samples. Of the 152 samples tested, 49 (32%) were positive by first-round conventional PCR, 56 (37%) were positive by the hemi-nested PCR assay, and 39 (26%) were positive by the real-time assay. All samples testing positive with the real-time assay were also positive by the hemi-nested assay (both first- and second-round PCR), and all culture-positive samples tested positive by both PCR assays. These results suggest that the hemi-nested assay is more sensitive than the real-time assay for detecting B. pertussis.
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Affiliation(s)
- T P Anderson
- Microbiology Unit, Canterbury Health Laboratories, PO Box 151, Christchurch, New Zealand
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21
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Cloud JL, Hymas W, Carroll KC. Impact of nasopharyngeal swab types on detection of Bordetella pertussis by PCR and culture. J Clin Microbiol 2002; 40:3838-40. [PMID: 12354894 PMCID: PMC130882 DOI: 10.1128/jcm.40.10.3838-3840.2002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A study was designed to assess the performance of various swabs and transport media routinely used to collect specimens submitted for Bordetella culture and PCR. Calcium-alginate swabs inhibited the PCR. No inhibition was detected in any PCRs with dacron or rayon swabs. All swab materials performed similarly for recovery of Bordetella pertussis in culture. The Amies with charcoal transport system performed poorly for culture. Calcium-alginate swabs are not recommended for PCR-based detection of B. pertussis. Dacron and rayon swabs are an excellent choice for both PCR and culture.
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Affiliation(s)
- Joann L Cloud
- Associated Regional and University Pathologists (ARUP) Institute for Clinical and Experimental Pathology, 500 Chipeta Way, Salt Lake City, UT 84108, USA.
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22
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Lievano FA, Reynolds MA, Waring AL, Ackelsberg J, Bisgard KM, Sanden GN, Guris D, Golaz A, Bopp DJ, Limberger RJ, Smith PF. Issues associated with and recommendations for using PCR to detect outbreaks of pertussis. J Clin Microbiol 2002; 40:2801-5. [PMID: 12149333 PMCID: PMC120629 DOI: 10.1128/jcm.40.8.2801-2805.2002] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2002] [Revised: 03/22/2002] [Accepted: 05/29/2002] [Indexed: 11/20/2022] Open
Abstract
Two outbreaks of respiratory tract illness associated with prolonged cough occurring in 1998 and 1999 in New York State were investigated. A PCR test for Bordetella pertussis was primarily used by a private laboratory to confirm 680 pertussis cases. Several clinical specimens had positive culture results for B. pertussis during both outbreaks, which confirmed that B. pertussis was circulating during the outbreaks. However, testing by the New York State Department of Health reference laboratory suggested that some of the PCR results may have been falsely positive. In addition, features of the outbreak that suggested that B. pertussis may not have been the primary agent of infection included a low attack rate among incompletely vaccinated children and a significant amount of illness among patients testing PCR negative for B. pertussis. These investigations highlight the importance of appropriate clinical laboratory quality assurance programs, of the limitations of the PCR test, and of interpreting laboratory results in context of clinical disease.
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Affiliation(s)
- Fabio A Lievano
- Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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23
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Wang J, Yang Y, Li J, Mertsola J, Arvilommi H, Yuan L, Shen X, He Q. Infantile pertussis rediscovered in China. Emerg Infect Dis 2002; 8:859-61. [PMID: 12141975 PMCID: PMC2732523 DOI: 10.3201/eid0808.010442] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Immunization against pertussis was introduced in China in the 1960s. Since the 1970s, no culture-confirmed pertussis cases have been reported in the country. We report six infants with culture-confirmed pertussis, who were initially diagnosed as having other respiratory diseases at Beijing Children's Hospital, Beijing.
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Affiliation(s)
- Jingmin Wang
- Beijing Children’s Hospital, Capital University of Medical Sciences, Beijing, China
| | - Yonghong Yang
- Beijing Children’s Hospital, Capital University of Medical Sciences, Beijing, China
| | - Jie Li
- Beijing Children’s Hospital, Capital University of Medical Sciences, Beijing, China
| | | | | | - Lin Yuan
- Beijing Children’s Hospital, Capital University of Medical Sciences, Beijing, China
| | - Xuzhuang Shen
- Beijing Children’s Hospital, Capital University of Medical Sciences, Beijing, China
| | - Qiushui He
- National Public Health Institute, Turku, Finland
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24
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Mäkinen J, Mertsola J, Viljanen MK, Arvilommi H, He Q. Rapid typing of Bordetella pertussis pertussis toxin gene variants by LightCycler real-time PCR and fluorescence resonance energy transfer hybridization probe melting curve analysis. J Clin Microbiol 2002; 40:2213-6. [PMID: 12037089 PMCID: PMC130802 DOI: 10.1128/jcm.40.6.2213-2216.2002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A LightCycler real-time PCR hybridization probe assay was developed for rapid typing of gene variants of the Bordetella pertussis virulence factor pertussis toxin. The assay correctly identified the ptxS1 alleles of all strains tested, comprising 57 Finnish clinical isolates and 2 vaccine strains. The method is simple, reliable, and suitable for large-scale screening of B. pertussis strains.
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Affiliation(s)
- Johanna Mäkinen
- National Public Health Institute, Department in Turku, Finland.
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25
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26
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Mäkinen J, Viljanen MK, Mertsola J, Arvilommi H, He Q. Rapid identification of Bordetella pertussis pertactin gene variants using LightCycler real-time polymerase chain reaction combined with melting curve analysis and gel electrophoresis. Emerg Infect Dis 2001; 7:952-8. [PMID: 11747721 PMCID: PMC2631898 DOI: 10.3201/eid0706.010606] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Recently, eight allelic variants of the pertactin gene (prn1-8) have been characterized in Bordetella pertussis strains isolated in Europe and the United States. It has been suggested that the divergence of the pertactin types of clinical isolates from those of the B. pertussis vaccine strains is a result of vaccine-driven evolution. Sequencing of the prn, which is relatively time-consuming, has so far been the only method for the differentiation of prn types. We have developed a rapid real-time polymerase chain reaction assay suitable for large-scale screening of the prn type of the circulating strains. This method correctly identified the prn type of all tested 41 clinical isolates and two Finnish vaccine strains. The method is simple and reliable and provides an alternative for sequencing in pertussis research.
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Affiliation(s)
- J Mäkinen
- Finnish Pertussis Reference Laboratory, National Public Health Institute, Department in Turku, Finland.
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27
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de Melker HE, Versteegh FG, Conyn-Van Spaendonck MA, Elvers LH, Berbers GA, van Der Zee A, Schellekens JF. Specificity and sensitivity of high levels of immunoglobulin G antibodies against pertussis toxin in a single serum sample for diagnosis of infection with Bordetella pertussis. J Clin Microbiol 2000; 38:800-6. [PMID: 10655388 PMCID: PMC86208 DOI: 10.1128/jcm.38.2.800-806.2000] [Citation(s) in RCA: 179] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Laboratory confirmation of pertussis by culture, PCR, or detection of antibody increase in paired sera is hampered by low sensitivity in the later stages of the disease. Therefore, we investigated whether, and at which level, concentrations of immunoglobulin G (IgG) antibodies against pertussis toxin (PT), IgG-PT, in a single serum sample are indicative of active or recent pertussis. IgG-PT, measured by enzyme-linked immunosorbent assay in units per milliliter, was analyzed in 7,756 sera collected in a population-based study in The Netherlands, in the sera of 3,491 patients with at least a fourfold increase of IgG-PT, in paired sera of 89 patients with positive cultures and/or PCR results, and in the sera of 57 patients with clinically documented pertussis with a median follow-up of 1.4 years. We conclude that, independently of age, IgG-PT levels of at least 100 U/ml are diagnostic of recent or active infection with Bordetella pertussis. Such levels are present in less than 1% of the population and are reached in most pertussis patients within 4 weeks after disease onset and persist only temporarily.
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Affiliation(s)
- H E de Melker
- Department of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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28
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Srugo I, Benilevi D, Madeb R, Shapiro S, Shohat T, Somekh E, Rimmar Y, Gershtein V, Gershtein R, Marva E, Lahat N. Pertussis infection in fully vaccinated children in day-care centers, Israel. Emerg Infect Dis 2000; 6:526-9. [PMID: 10998384 PMCID: PMC2627963 DOI: 10.3201/eid0605.000512] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We tested 46 fully vaccinated children in two day-care centers in Israel who were exposed to a fatal case of pertussis infection. Only two of five children who tested positive for Bordetella pertussis met the World Health Organization's case definition for pertussis. Vaccinated children may be asymptomatic reservoirs for infection.
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Affiliation(s)
- I Srugo
- Department of Clinical Microbiology, Bnai Zion Medical Center, Haifa, Israel.
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29
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Loeffelholz MJ, Thompson CJ, Long KS, Gilchrist MJ. Detection of Bordetella holmesii using Bordetella pertussis IS481 PCR assay. J Clin Microbiol 2000; 38:467. [PMID: 10681208 PMCID: PMC88756 DOI: 10.1128/jcm.38.1.467-467.2000] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nygren M, Reizenstein E, Ronaghi M, Lundeberg J. Polymorphism in the pertussis toxin promoter region affecting the DNA-based diagnosis of Bordetella infection. J Clin Microbiol 2000; 38:55-60. [PMID: 10618063 PMCID: PMC86018 DOI: 10.1128/jcm.38.1.55-60.2000] [Citation(s) in RCA: 24] [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
The pertussis toxin (PT) promoter region is a frequently used target for DNA-based diagnosis of pertussis and parapertussis infections. The reported polymorphism in this region has also allowed discrimination of species in mixtures with several Bordetella species by their specific PCR amplicon restriction patterns. In the present study, we investigated the degree of polymorphism in order to confirm the reliability of the assay. Five different sequence types of the amplified 239- or 249-bp region were found among the 33 Bordetella pertussis, B. parapertussis, and B. bronchiseptica American Type Culture Collection reference strains and patient isolates analyzed. According to the sequences that were obtained and according to the PT promoter sequences already available in the databases, restriction enzyme analysis with TaqI, BglI, and HaeII, which gave four different patterns, can be performed to reliably identify B. pertussis, B. parapertussis, and B. bronchiseptica.
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Affiliation(s)
- M Nygren
- Department of Biotechnology, KTH, Royal Institute of Technology, Sweden
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31
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Loeffelholz MJ, Thompson CJ, Long KS, Gilchrist MJ. Comparison of PCR, culture, and direct fluorescent-antibody testing for detection of Bordetella pertussis. J Clin Microbiol 1999; 37:2872-6. [PMID: 10449467 PMCID: PMC85400 DOI: 10.1128/jcm.37.9.2872-2876.1999] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We prospectively compared the performance of culture, direct fluorescent-antibody testing (DFA), and an in-house-developed PCR test targeting the repeated insertion sequence IS481 for the detection of Bordetella pertussis in nasopharyngeal swab specimens. We tested 319 consecutive paired specimens on which all three tests were performed. A total of 59 specimens were positive by one or more tests. Of these, 5 were positive by all three tests, 2 were positive by culture and PCR, 16 were positive by PCR and DFA, 28 were positive by PCR only, and 8 were positive by DFA only. Any specimen positive by culture was considered to be a true positive, as were specimens positive by both PCR and DFA. Specimens positive only by PCR or DFA were considered discrepant, and their status was resolved by review of patient histories. Patients with symptoms meeting the Centers for Disease Control and Prevention clinical case definition for pertussis and who had a specimen positive by PCR or DFA were considered to have true B. pertussis infections. Of the 28 patients positive by PCR only, 20 met the clinical case definition for pertussis, while 3 of the 8 patients positive by DFA only met the clinical case definition. After resolution of the status of discrepant specimens, the sensitivity, specificity, positive predictive value, and negative predictive value were 15.2, 100, 100, and 87.5%, respectively, for culture; 93.5, 97.1, 84.3, and 98.9%, respectively, for PCR; and 52.2, 98.2, 82.8, and 92.4%, respectively, for DFA. The actual positive predictive value of PCR was probably greater, as several PCR-positive patients who did not meet the clinical case definition had symptoms consistent with typical or atypical pertussis. PCR is a sensitive and specific method for the detection of B. pertussis.
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Affiliation(s)
- M J Loeffelholz
- State Hygienic Laboratory, University of Iowa, Iowa City, Iowa 52242, USA.
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32
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Müller FM, Schnitzler N, Cloot O, Kockelkorn P, Haase G, Li Z. The rationale and method for constructing internal control DNA used in pertussis polymerase chain reaction. Diagn Microbiol Infect Dis 1998; 31:517-23. [PMID: 9764389 DOI: 10.1016/s0732-8893(98)00043-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The inclusion of an appropriate internal control DNA in polymerase chain reaction (PCR) is a rapid and simple method for the detection of PCR failure. Two PCR coamplification internal control DNAs (ICD I and ICD II) with the same primer-binding sequences as the target DNA for the detection of Bordetella pertussis and Bordetella parapertussis were produced using an overlap extension technique and a PCR MIMIC construction kit, respectively. The ICD II was further evaluated in a prospective clinical study in 360 patients with a clinical diagnosis of pertussis. From 360 nasopharyngeal swabs the internal control was positive in 318 (88%) samples, but was negative in 42 (12%). After phenol-chloroform extraction an additional 10 internal controls became positive. For the detection of PCR failure, the use of internal control DNA is highly recommended for PCR-based identification of B. pertussis and B. parapertussis organisms from nasopharyngeal swabs and aspirates.
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Affiliation(s)
- F M Müller
- Children's Hospital, Institute for Medical Microbiology, University of Aachen, Germany
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33
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ERLANDSSON ANN, BÄCKMAN ANDERS, NYGREN MALIN, LUNDEBERG JOAKIM, OLCÉN PER. Quantification ofBordetella pertussisin clinical samples by colorimetric detection of competitive PCR products. APMIS 1998. [DOI: 10.1111/j.1699-0463.1998.tb00256.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lind-Brandberg L, Welinder-Olsson C, Lagergård T, Taranger J, Trollfors B, Zackrisson G. Evaluation of PCR for diagnosis of Bordetella pertussis and Bordetella parapertussis infections. J Clin Microbiol 1998; 36:679-83. [PMID: 9508295 PMCID: PMC104608 DOI: 10.1128/jcm.36.3.679-683.1998] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PCR, using primers Plp1 and Plp2, was evaluated for the detection of DNA from Bordetella pertussis in bacterial strains and in nasopharyngeal samples from patients with a cough lasting at least 7 days. The assay could detect DNA from 6 CFU of B. pertussis/10 microl of sample. Results of the PCR assay were compared with those of cultures, a determination of serum antibodies against pertussis toxin and filamentous hemagglutinin, and a clinical evaluation of 2,442 coughing episodes. The overall sensitivity of PCR was 65% (623 of 956), which was higher than the sensitivity of cultures (58%) (P < 0.001). Factors influencing the sensitivity of PCR were the interval between the onset of symptoms and sampling and the vaccination status of the patient. The specificity of PCR was 98% (1,451 of 1,486). The positive and negative predictive values were 95 and 81%, respectively. Parapertussis PCR, using primers BPPA and BPPZ, was positive in 11 of 18 culture-positive cases and was confirmed by serology in another 4 cases. In conclusion, PCR is a valuable complement to cultures and can probably replace cultures for diagnosis of B. pertussis and Bordetella parapertussis infections.
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Affiliation(s)
- L Lind-Brandberg
- Department of Clinical Bacteriology, Göteborg University, Sweden
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35
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36
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Erlandsson A, Bäckman A, Törnqvist E, Olcén P, Olsen P. PCR assay or culture for diagnosis of Bordetella pertussis in the routine diagnostic laboratory? J Infect 1997; 35:221-4. [PMID: 9459391 DOI: 10.1016/s0163-4453(97)92738-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A nested PCR method was compared with culture for the detection of Bordetella pertussis in a routine clinical diagnostic laboratory. A total of 241 clinical nasopharyngeal aspirates were examined in parallel in the laboratory. Both methods were positive for 75 samples (31%), eight samples were positive by nested PCR only (3.3%), and one sample was positive by culture only (0.4%). The mean time actually required in the clinical laboratory (not operating with pertussis diagnosis during weekends) from the day of arrival to the diagnosis of a positive or negative sample by the nested PCR assay was 1.8 +/- 1.3 days (mean +/- SD), for positive culture 4.5 +/- 1.4 days and for negative culture 10.5 +/- 1.0 days. The hands-on time in the laboratory to perform the nested PCR was 2 h, for a positive culture 25 min, and for a negative culture 15 min. The cost analysis of the methods, when running one sample at a time, showed that the laboratory cost for PCR was six times higher than culture. When running four samples together the cost for PCR was three times higher than culture. In conclusion, the nested PCR is the more rapid and sensitive method compared to culture. With the present design, the PCR-protocol involves higher material expenditure and claims more hands-on time.
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Affiliation(s)
- A Erlandsson
- Department of Clinical Microbiology and Immunology, Orebro Medical Centre Hospital, Sweden
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37
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Matlow AG, Nelson S, Wray R, Cox P. Nosocomial Acquisition of Pertussis Diagnosed by Polymerase Chain Reaction. Infect Control Hosp Epidemiol 1997. [DOI: 10.2307/30141514] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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38
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Müller FM, Hoppe JE, Wirsing von König CH. Laboratory diagnosis of pertussis: state of the art in 1997. J Clin Microbiol 1997; 35:2435-43. [PMID: 9316885 PMCID: PMC229988 DOI: 10.1128/jcm.35.10.2435-2443.1997] [Citation(s) in RCA: 128] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- F M Müller
- University Children's Hospital, Aachen, Germany.
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39
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Ieven M, Goossens H. Relevance of nucleic acid amplification techniques for diagnosis of respiratory tract infections in the clinical laboratory. Clin Microbiol Rev 1997; 10:242-56. [PMID: 9105753 PMCID: PMC172918 DOI: 10.1128/cmr.10.2.242] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Clinical laboratories are increasingly receiving requests to perform nucleic acid amplification tests for the detection of a wide variety of infectious agents. In this paper, the efficiency of nucleic acid amplification techniques for the diagnosis of respiratory tract infections is reviewed. In general, these techniques should be applied only for the detection of microorganisms for which available diagnostic techniques are markedly insensitive or nonexistent or when turnaround times for existing tests (e.g., viral culture) are much longer than those expected with amplification. This is the case for rhinoviruses, coronaviruses, and hantaviruses causing a pulmonary syndrome, Bordetella pertussis, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Coxiella burnetii. For Legionella spp. and fungi, contamination originating from the environment is a limiting factor in interpretation of results, as is the difficulty in differentiating colonization and infection. Detection of these agents in urine or blood by amplification techniques remains to be evaluated. In the clinical setting, there is no need for molecular diagnostic tests for the diagnosis of Pneumocystis carinii. At present, amplification methods for Mycobacterium tuberculosis cannot replace the classical diagnostic techniques, due to their lack of sensitivity and the absence of specific internal controls for the detection of inhibitors of the reaction. Also, the results of interlaboratory comparisons are unsatisfactory. Furthermore, isolates are needed for susceptibility studies. Additional work remains to be done on sample preparation methods, comparison between different amplification methods, and analysis of results. The techniques can be useful for the rapid identification of M. tuberculosis in particular circumstances, as well as the rapid detection of most rifampin-resistant isolates. The introduction of diagnostic amplification techniques into a clinical laboratory implies a level of proficiency for excluding false-positive and false-negative results.
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Affiliation(s)
- M Ieven
- Department of Microbiology, University Hospital, Antwerp, Belgium
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40
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Aoyama T, Tamura C, Takeuchi Y, Kamimura T, Imaizumi A. Rapid, sensitive and specific diagnosis of Bordetella pertussis using the polymerase chain reaction. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1997; 39:44-7. [PMID: 9124052 DOI: 10.1111/j.1442-200x.1997.tb03554.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Use of a repetitive DNA sequence of Bordetella pertussis allowed successful detection of the organism by the polymerase chain reaction (PCR). The method was highly sensitive, being able to detect B. pertussis in specimens containing only a few cells. It was also highly specific, with no amplification of specimens containing other organisms, for example Haemophilus influenzae or Neisseria, being observed. A diagnosis could be made within 1 day. The PCR assay was also evaluated in clinical specimens. Among 47 nasopharyngeal specimens obtained from 24 patients with laboratory-confirmed pertussis, 27 were positive by PCR and 19 by culture. In particular, all three bronchial aspirates from one patient with pertussis were positive by PCR, but only one showed positive on culture. Eleven specimens from parapertussis patients and 65 specimens from patients without pertussis tested negative. It was concluded that this newly developed PCR method for the diagnosis of pertussis was more rapid and sensitive than the usual culture method. Polymerase chain reaction could have a major impact on the treatment and control of this infection and would be a useful tool for studying the pathogenesis of B. pertussis infection.
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Affiliation(s)
- T Aoyama
- Department of Pediatrics, Kawasaki Municipal Hospital, Japan
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41
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Nelson S, Matlow A, McDowell C, Roscoe M, Karmali M, Penn L, Dyster L. Detection of Bordetella pertussis in clinical specimens by PCR and a microtiter plate-based DNA hybridization assay. J Clin Microbiol 1997; 35:117-20. [PMID: 8968891 PMCID: PMC229522 DOI: 10.1128/jcm.35.1.117-120.1997] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
In order to improve detection of Bordetella pertussis in nasopharyngeal aspirates (NPAs) in our laboratory, a PCR-based assay was optimized, and a study was designed (i) to compare results obtained by PCR to those obtained by culture and (ii) to evaluate a novel microtiter plate-based DNA hybridization assay (PCR-plate) by comparing it to agarose gel electrophoresis (PCR-gel) for detection of the PCR product. DNA for the PCR was extracted with a guanidine thiocyanate buffer and used in a PCR mixture containing primers directed against a reiterated gene sequence in B. pertussis (Q. He, J. Mertsola, H. Soini, M. Skurnik, O. Ruuskanen, and M. K. Viljanen, J. Clin, Microbiol. 31:642-645, 1993). Of 96 NPAs submitted from a targeted study group, 23 were positive by culture, 27 were positive by PCR-gel, and 31 were positive by PCR-plate. All culture-positive specimens were also positive by PCR. Of nine patients with culture-negative-PCR-positive results, six had discharge diagnoses of pertussis. Thus, PCR with plate-based product detection is a sensitive method for the laboratory detection of B. pertussis in NPAs. Additional advantages of the plate assay include rapidity, objectivity in reading results, specificity, and the capability of being adapted to a high-volume, automated system.
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Affiliation(s)
- S Nelson
- Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
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Lichtensteiger CA, Steenbergen SM, Lee RM, Polson DD, Vimr ER. Direct PCR analysis for toxigenic Pasteurella multocida. J Clin Microbiol 1996; 34:3035-9. [PMID: 8940444 PMCID: PMC229455 DOI: 10.1128/jcm.34.12.3035-3039.1996] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A more rapid, accurate method to detect toxigenic Pasteurella multocida is needed for improved clinical diagnosis, farm biosecurity, and epidemiological studies. Toxigenic and nontoxigenic P. multocida isolates cannot be differentiated by morphology or standard biochemical reactions. The feasibility of using PCR for accurate, rapid detection of toxigenic P. multocida from swabs was investigated. A PCR protocol which results in amplification of an 846-nucleotide segment of the toxA gene was developed. The PCR amplification protocol is specific for toxigenic P. multocida and can detect fewer than 100 bacteria. There was concordance of PCR results with (i) detection of toxA gene with colony blot hybridization, (ii) detection of ToxA protein with colony immunoblot analysis, and (iii) lethal toxicity of sonicate in mice in a test set of 40 swine diagnostic isolates. Results of an enzyme-linked immunosorbent assay for ToxA agreed with the other assays except for a negative reaction in one of the 19 isolates that the other assays identified as toxigenic. In addition to accuracy, as required for a rapid direct specimen assay, toxigenic P. multocida was recovered efficiently from inoculated swabs without inhibition of the PCR. The results show that PCR detection of toxigenic P. multocida directly from clinical swab specimens should be feasible.
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Affiliation(s)
- C A Lichtensteiger
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Illinois, Urbana 61801, USA.
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43
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Buck GE. Detection of Bordetella pertussis by rapid-cycle PCR and colorimetric microwell hybridization. J Clin Microbiol 1996; 34:1355-8. [PMID: 8735080 PMCID: PMC229024 DOI: 10.1128/jcm.34.6.1355-1358.1996] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The use of rapid-cycle PCR combined with colorimetric microwell hybridization for detecting Bordetella pertussis was investigated. Rapid cycling was performed with an air thermocycler (model 1605; Idaho Technology, Idaho Falls, Idaho). Although the instrument was originally designed to be used with capillary tubes, an adapter that allows this instrument to be used with PCR tubes has recently been introduced. Because of the low heat capacity of air, the thermocycler has rapid transition rates between temperatures. The combination of a rapid temperature transition rate, small sample volume (10 microliters), and overshooting or undershooting of the temperature set points allowed the cycles to be reduced to 5 s for denaturation and 10 s for extension and annealing. Thus, the amplification could be completed in a total of approximately 35 min. Amplified DNA was detected with biotin-labeled primers and by hybridization to a capture probe immobilized in microwell plates. When simulated clinical specimens consisting of pooled nasopharyngeal washes with known numbers of B. pertussis organisms were examined by this procedure, as little as one organism per 5 microliters of sample could be detected. Six nasopharyngeal aspirates or washes from culture-positive patients were positive by PCR, as were two of seven specimens obtained from patients that were negative by culture and direct fluorescent-antibody assay. The two patients who were PCR positive but culture and direct fluorescent-antibody assay negative had clinical disease compatible with pertussis. This method appears to be a sensitive, convenient means of detecting B. pertussis in clinical specimens. The total time required for specimen processing, amplification, and detection is about 2.5 h.
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Affiliation(s)
- G E Buck
- Laboratory Services, Alliant Health System, Louisville, Kentucky 40232, USA
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Reizenstein E, Lindberg L, Möllby R, Hallander HO. Validation of nested Bordetella PCR in pertussis vaccine trial. J Clin Microbiol 1996; 34:810-5. [PMID: 8815088 PMCID: PMC228897 DOI: 10.1128/jcm.34.4.810-815.1996] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A nested PCR, using a 239-bp sequence in the pertussis toxin promoter region, was developed and evaluated. The assay differentiates Bordetella pertussis, Bordetella parapertussis, and Bordetella bronchiseptica by restriction enzyme analysis of the amplified fragments. The diagnostic performance of the PCR was evaluated in a Swedish pertussis vaccine efficacy trial which took place from 1992 to 1995, including study children and household members and using culture and serology for laboratory confirmation of suspected cases. In total 2,421 nasopharyngeal aspirates were analyzed. The total diagnostic sensitivity for B. pertussis was 90.2% (194 of 215). During the study period samples were processed with and without the cation-exchange resin Chelex. The PCR diagnostic sensitivity for B. pertussis among the Chelex-treated aspirates was 94.9% (75 of 79), and that for B. pertussis among 124 aspirates in a consecutive non-Chelex-treated material was 89.5% (111 of 124). After Chelex treatment of the 13 PCR-negative samples, an additional six became PCR positive, giving a final sensitivity of 94.3%. In addition, PCR was positive for B. pertussis with 57 of 1,744 samples negative by culture but with available serological data. The specificity of PCR with these samples was supported by a significant increase in antibody levels between acute and convalescent sera in 45 cases and by epidemiological or clinical data in all but two of the remaining cases. PCR was also positive for B. pertussis with 26 of 415 aspirates from episodes lacking serology. The diagnostic sensitivity of PCR for B. parapertussis was 74.0% (37 of 50). There were an additional seven culture-negative B. parapertussis PCR findings, six from cases with significant antibody increases against filamentous hemagglutinin only and one from a case lacking serology. There were no samples positive for B. bronchiseptica. In conclusion, PCR detection of B. pertussis and/or B. parapertussis enabled us to identify 90 positive nasopharyngeal aspirates, in addition to the 262 culture-positive samples (an increase of 34%). Relating these cases to serology and clinical data indicated a PCR specificity approaching 100%.
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Affiliation(s)
- E Reizenstein
- Swedish Institute for Infectious Disease Control, Stockholm, Sweden
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Jero J, Virolainen A, Salo P, Leinonen M, Eskola J, Karma P. PCR assay for detecting Streptococcus pneumoniae in the middle ear of children with otitis media with effusion. Acta Otolaryngol 1996; 116:288-92. [PMID: 8725534 DOI: 10.3109/00016489609137843] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We compared a newly developed pneumococcal polymerase chain reaction (PCR) for Streptococcus pneumoniae (Pnc) to bacterial culture in 123 middle ear effusion (MEE) samples of 123 children with otitis media with effusion (OME). For the pneumococcal PCR assay, DNA of MEE samples was purified by a QIAamp blood kit. The outer primers used amplified a 348 basepair region of the pneumolysin gene, and the inner a 208. Pnc was cultured in 14 (11%) and pneumolysin PCR was positive in 57 (46%) of the 123 MEE samples. All the culture positive samples were also PCR-positive. Both the samples with culturable Pnc and with positive pneumolysin PCR increased with shorter duration of OME and a greater number of acute otitis media during the preceding 6 months. In conclusion, pneumolysin PCR suggests pneumococcal involvement in MEE even in OMEs with no evidence of Pnc in culture, and thus offers a good diagnostic tool when a more accurate and sensitive pneumococcal diagnosis is needed.
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Affiliation(s)
- J Jero
- Department of Otolaryngology, Helsinki University Central Hospital, Finland
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46
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Edelman K, Nikkari S, Ruuskanen O, He Q, Viljanen M, Mertsola J. Detection of Bordetella pertussis by polymerase chain reaction and culture in the nasopharynx of erythromycin-treated infants with pertussis. Pediatr Infect Dis J 1996; 15:54-7. [PMID: 8684877 DOI: 10.1097/00006454-199601000-00012] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pertussis is a highly contagious respiratory disease and the most serious effects occur in young infants. Recently it has been shown that rapid and highly specific PCR can be a useful diagnostic tool for detection of pertussis infection. To our knowledge there are no previous studies concerning the disappearance of Bordetella pertussis DNA from the nasopharynx during antimicrobial treatment. METHODS We studied prospectively how rapidly live B. pertussis organisms and DNA of these bacteria disappear from the nasopharynx during erythromycin therapy in unvaccinated infants. Eighty-five nasopharyngeal swabs obtained from nine erythromycin-treated infants with pertussis on consecutive days during hospitalization were tested by PCR and culture. The PCR products were further analyzed by Southern hybridization. RESULTS On the fourth day of treatment 56% of the samples were positive by culture and 89% by PCR, whereas after 7 days the rates were 0 and 56%, respectively. In seven of nine patients PCR remained positive for 1 to 7 days longer than culture. The follow-up study also showed the semiquantitative nature of the PCR assay. The intensity of the PCR products in agarose gel usually weakened with time during erythromycin therapy. CONCLUSIONS The results of this study show that PCR assay can achieve the specific diagnosis of pertussis infection in a large proportion of infants even when antimicrobial treatment has killed the organisms and culture is no longer positive.
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Affiliation(s)
- K Edelman
- Department of Pediatrics, Turku University, Finland
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47
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Buck GE, Eid NS. Applications of the polymerase chain reaction (PCR) to the diagnosis of pediatric pulmonary disease. Pediatr Pulmonol 1995; 20:309-22. [PMID: 8903904 DOI: 10.1002/ppul.1950200510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- G E Buck
- Clinical Laboratory, Alliant Health System, Department of Pediatrics, University of Louisville, Kentucky, USA
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48
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Lichtinghagen R, Glaubitz R. A competitive polymerase chain reaction assay for reliable identification of Bordetella pertussis in nasopharyngeal swabs. EUROPEAN JOURNAL OF CLINICAL CHEMISTRY AND CLINICAL BIOCHEMISTRY : JOURNAL OF THE FORUM OF EUROPEAN CLINICAL CHEMISTRY SOCIETIES 1995; 33:87-93. [PMID: 7632825 DOI: 10.1515/cclm.1995.33.2.87] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In order to optimize the identification of clinically relevant quantities of Bordetella pertussis in nasopharyngeal swabs, an automated assay introducing competitive polymerase chain reaction was established. A 183 base pair DNA fragment from a repetitive region of the Bordetella pertussis genome was amplified in a polymerase chain reaction. An internal control DNA with nine base substitutions was coamplified in the same reaction. The differentiation between the amplified B. pertussis DNA and the internal control was based on hybridisation against two different probes using Enzymun Test DNA Detection (Boehringer Mannheim). Nasopharyngeal swabs from serologically positive patients, clinically diagnosed with whooping cough, serologically negative patients after contact with B. pertussis and a negative group were compared. The advantages of competitive PCR are a reduced risk of false-positive and false-negative results and the possibility to differentiate between the different PCR positive groups.
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Affiliation(s)
- R Lichtinghagen
- Institut für Klinische Chemie I, Medizinischen Hochschule Hannover, Germany
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50
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