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Puerari D, Camargo C, Gratura S, Watanabe ASA, Granato C, Bellei NCJ. [Application of molecular assay for adenovirus detection among different pediatric patients]. REVISTA PAULISTA DE PEDIATRIA 2015; 33:136-41. [PMID: 25890444 PMCID: PMC4516365 DOI: 10.1016/j.rpped.2014.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 09/22/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE: Adenoviruses play an important role in the etiology of severe acute lower
respiratory infection, especially in young children. The aim of the present study
was to evaluate the Human Adenovirus (HAdV) detection by different methods (Direct
Fluorescence Assay DFA and Nested Polymerase Chain Reaction nested PCR), among
samples collected from different groups of pediatric patients. METHODS: Collection of samples was made in children with congenital heart disease (CHD 123
nasal aspirates collected in the years of 2005, 2007 and 2008) and in community
children (CC 165 nasal aspirates collected in 2008). Children were eligible if
they presented acute respiratory infection (ARI) of probable viral etiology,
within up to 7 days of symptoms' onset. All studied samples were evaluated by DFA
and nested PCR assay. RESULTS: Of the 290 samples included during the study period, 43 (14.8%) were positive on
at least one test: 17/165 (10.3%) of the CC and 26/125 (20.8%) of the CHD
children. The nested PCR detection rates in the community children were 15/165
(9.1%), and for children with CHD, 24/125 (19.2%). Molecular method showed higher
detection rates when compared to the DFA test (p<0.001).
Univariate analysis showed that children with congenital heart disease presented a
significantly higher chance for acquiring the HAdV (Odds Ratio 2.3; 95% CI:
1.18-4.43). CONCLUSIONS: Based on data obtained in the present evaluation, we suggest that a routine
surveillance should be performed in high risk patients by molecular methods, thus
improving diagnostic flow and efficiency.
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Affiliation(s)
- Diane Puerari
- Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Clarice Camargo
- Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Sandra Gratura
- Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | | | - Celso Granato
- Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
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Watanabe A, Carraro E, Camargo C, Puerari D, Guatura S, Granato C, Bellei N. Human adenovirus detection among immunocompetent and immunocompromised patients presenting acute respiratory infection. Rev Soc Bras Med Trop 2013; 46:161-5. [DOI: 10.1590/0037-8682-1699-2013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 03/14/2013] [Indexed: 11/21/2022] Open
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Abstract
In most hospitals, clinics, and doctor's offices, immunologic assays are the only tests performed on site for the diagnosis of respiratory viruses. More than other methods, immunoassays have been shown to affect patient management and save costs, aiding early administration of antiviral therapy, reduction in unnecessary tests and antibiotics, and earlier discharges. This article discusses the major immunologic methods employed for respiratory virus diagnosis, recent developments in immunoassays and sample collection, and current test algorithms.
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Affiliation(s)
- Marie Louise Landry
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520-8035, USA.
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Peduru Hewa TM, Tannock GA, Mainwaring DE, Harrison S, Fecondo JV. The detection of influenza A and B viruses in clinical specimens using a quartz crystal microbalance. J Virol Methods 2009; 162:14-21. [PMID: 19628008 PMCID: PMC7112868 DOI: 10.1016/j.jviromet.2009.07.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 07/07/2009] [Accepted: 07/13/2009] [Indexed: 12/03/2022]
Abstract
Current methods for the accurate diagnosis of influenza based on culture of the virus or PCR are highly sensitive and specific but require specialised laboratory facilities and highly trained personnel and, in the case of viral culture, can take up to 14 days to obtain a definitive result. In this study, a quartz crystal microbalance-based immunosensor (QCM) has been developed and its potential evaluated for the rapid and sensitive detection of both influenza A and B viruses in laboratory-cultured preparations and clinical samples. The effective limit for detection by QCM for stock preparations of both A/PR/8/34 and B/Lee/40 viruses was 1 × 104 pfu/mL, associated with observed frequency shifts of 30 (±5) and 37 (±6.5) Hz, respectively. Conjugation of 13 nm gold nanoparticles to the detecting antibody improved the mass sensitivity of the immunosensor, resulting in a 10-fold increase in sensitivity and a detection limit of 1 × 103 pfu/mL for both preparations, with resulting frequency shifts of 102 (±11) and 115 (±5) Hz, respectively. Detection of virus in nasal washes with this technique was achieved by overnight passage in MDCK cultures prior to analysis. A comparison of results obtained from 67 clinical samples using existing RT-PCR, shell vial, cell culture and ELISA methods showed that QCM techniques were comparable in sensitivity and specificity to cell culture methods.
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MESH Headings
- Animals
- Antibodies, Viral
- Biosensing Techniques/instrumentation
- Cell Line
- Crystallization
- DNA, Viral/analysis
- DNA, Viral/genetics
- Gold/chemistry
- Humans
- Immunoassay/methods
- Influenza A Virus, H1N1 Subtype/genetics
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H1N1 Subtype/isolation & purification
- Influenza A Virus, H1N1 Subtype/physiology
- Influenza A Virus, H3N2 Subtype/genetics
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/isolation & purification
- Influenza A Virus, H3N2 Subtype/physiology
- Influenza B virus/genetics
- Influenza B virus/immunology
- Influenza B virus/isolation & purification
- Influenza B virus/physiology
- Influenza, Human/diagnosis
- Influenza, Human/virology
- Micro-Electrical-Mechanical Systems
- Quartz
- Reagent Kits, Diagnostic
- Sensitivity and Specificity
- Virus Cultivation
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Affiliation(s)
- Thamara M. Peduru Hewa
- School of Applied Sciences, Royal Melbourne Institute of Technology, Melbourne 3001, Australia
| | - Gregory A. Tannock
- School of Applied Sciences, Royal Melbourne Institute of Technology, Melbourne 3001, Australia
- Burnet Institute, Melbourne 3004, Australia
| | - David E. Mainwaring
- School of Applied Sciences, Royal Melbourne Institute of Technology, Melbourne 3001, Australia
| | - Sally Harrison
- School of Applied Sciences, Royal Melbourne Institute of Technology, Melbourne 3001, Australia
| | - John V. Fecondo
- School of Applied Sciences, Royal Melbourne Institute of Technology, Melbourne 3001, Australia
- Faculty of Life & Social Sciences, Swinburne University of Technology, Hawthorn 3122 Australia
- Corresponding author at: Faculty of Life & Social Sciences, Swinburne University of Technology, P.O. Box 218, Hawthorn, Victoria 3122, Australia. Tel.: +61 3 9214 8161; fax: +61 3 9819 0834.
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Rahman M, Kieke BA, Vandermause MF, Mitchell PD, Greenlee RT, Belongia EA. Performance of Directigen flu A+B enzyme immunoassay and direct fluorescent assay for detection of influenza infection during the 2004-2005 season. Diagn Microbiol Infect Dis 2007; 58:413-8. [PMID: 17509800 DOI: 10.1016/j.diagmicrobio.2007.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 03/12/2007] [Accepted: 03/15/2007] [Indexed: 11/28/2022]
Abstract
Early diagnosis of influenza infection is needed to optimize the benefit of prescribing antiviral drugs. However, the accuracy of rapid tests is highly variable. This study evaluated the performance of Directigen flu A+B enzyme immunoassay (EIA) and direct fluorescent assay (DFA) during the 2004-2005 influenza season. Participants with medically attended acute respiratory illness were identified through an active surveillance. Consenting patients (n=818) were enrolled and cultured for influenza. Physicians ordered a rapid antigen test (EIA or DFA) according to their clinical judgment. Physicians ordered rapid tests with EIA (n=109), DFA (n=86), or both (n=9) in 204 patients with acute respiratory illness who were also cultured for influenza. The EIA detected 18 of 43 influenza infections (sensitivity, 42%; 95% confidence interval [CI], 28-57%), whereas DFA detected 26 of 38 influenza infections (sensitivity, 68%; 95% CI, 53-81%). Compared with culture, specificity of both EIA and DFA was 96%. During the 2004-2005 influenza season, both the EIA and DFA had low sensitivity and failed to detect influenza in many patients.
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Affiliation(s)
- Mahbubur Rahman
- Marshfield Clinic Research Foundation, Marshfield, WI 54449, USA.
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Mehlmann M, Bonner AB, Williams JV, Dankbar DM, Moore CL, Kuchta RD, Podsiad AB, Tamerius JD, Dawson ED, Rowlen KL. Comparison of the MChip to viral culture, reverse transcription-PCR, and the QuickVue influenza A+B test for rapid diagnosis of influenza. J Clin Microbiol 2007; 45:1234-7. [PMID: 17301287 PMCID: PMC1865827 DOI: 10.1128/jcm.02202-06] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The performance of a diagnostic microarray (the MChip assay) for influenza was compared in a blind study to that of viral culture, reverse transcription (RT)-PCR, and the QuickVue Influenza A+B test. The patient sample data set was composed of 102 respiratory secretion specimens collected between 29 December 2005 and 2 February 2006 at Scott & White Hospital and Clinic in Temple, Texas. Samples were collected from a wide range of age groups by using direct collection, nasal/nasopharyngeal swabs, or nasopharyngeal aspiration. Viral culture and the QuickVue assay were performed at the Texas site at the time of collection. Aliquots for each sample, identified only by study numbers, were provided to the University of Colorado and Vanderbilt University teams for blinded analysis. When referenced to viral culture, the MChip exhibited a clinical sensitivity of 98% and a clinical specificity of 98%. When referenced to RT-PCR, the MChip assay exhibited a clinical sensitivity of 92% and a clinical specificity of 98%. While the MChip assay currently requires 7 to 8 h to complete the analysis, a significant advantage of the test for influenza virus-positive samples is simultaneous detection and full subtype identification for the two subtypes currently circulating in humans (A/H3N2 and A/H1N1) and avian (A/H5N1) viruses.
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Affiliation(s)
- Martin Mehlmann
- Department of Chemistry and Biochemistry, UCB 215, University of Colorado at Boulder, Boulder, CO 80309, USA
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Leroy O. [Contribution of microbiological investigations to the diagnosis of lower respiratory tract infections]. Med Mal Infect 2006; 36:570-98. [PMID: 17095176 PMCID: PMC7119138 DOI: 10.1016/j.medmal.2006.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 07/21/2006] [Indexed: 12/31/2022]
Abstract
The diagnosis of community-acquired pneumonia is usually based on clinical and radiological criteria. The identification of a causative organism is not required for the diagnosis. Although numerous microbiological techniques are available, their sensitivity and specificity are not high enough to guide first-line antimicrobial therapy. Consequently, this treatment remains most often empiric. If the causative organism is identified, the antimicrobial treatment is adapted. Sputum analysis may be proposed as a diagnostic tool for patients with an acute exacerbation of chronic obstructive pulmonary disease, in specific cases (prior antibiotherapy, hospitalization, failure of the empiric antimicrobial treatment).
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Affiliation(s)
- O Leroy
- Service de réanimation médicale et maladies infectieuses, hôpital G.-Chatiliez, 135, rue du Président-Coty, 59208 Tourcoing, France.
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Reina J, Ferres F, Gutiérrez O, Ruiz de Gopegui E, González-Cárdenas M. [Study of the clinical and epidemiological characteristics of respiratory infections caused by adenovirus in a pediatric population (1997-2003)]. An Pediatr (Barc) 2004; 61:137-42. [PMID: 15274878 DOI: 10.1016/s1695-4033(04)78371-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Infections due to adenoviruses are highly prevalent in pediatric patients. Because the clinical manifestations of the respiratory infections caused by adenoviruses are indistinguishable from those caused by other respiratory viruses, virological methods are required to establish their etiology. We present a retrospective study of the clinical and virological characteristics of patients with isolation of adenovirus in respiratory samples. MATERIAL AND METHODS From 1997 to 2003 we analyzed 5,746 respiratory samples from pediatric patients (< 15 years old), of which 2,122 (36.9 %) were considered positive. The adenoviruses were isolated in the Hep-2 cell line culture by the shell vial method. RESULTS Adenovirus was isolated in 100 clinical samples (4.7 % of all positive samples and 1.7 % of all samples studied) in a group of pediatric patients with a mean age of 14 months. The clinical diagnoses of patients were bronchiolitis (61 %), pneumonia (10 %), pertussis-like syndrome (16 %) and asthmatic crisis (11 %). Adenovirus infections mainly presented between December and March. Seventy-two percent of patients had a history of other viral respiratory tract infections and/or bronchial asthma. None of the patients had clinical conjunctivitis and only five patients had diarrhea due to adenoviruses. Seventy percent of the patients received artificial feeding and 30 % were breast-fed. Ninety percent of the patients were hospitalized and treatment mainly consisted of bronchodilator agents and antibiotics. CONCLUSIONS Respiratory tract infections caused by adenoviruses mainly affected patients aged less than 14 months, in the first four months of the year, and with clinical manifestations of bronchiolitis or pneumonia without conjunctivitis. Clinically, these infections are difficult to differentiate from other viral respiratory infections.
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Affiliation(s)
- J Reina
- Unidad de Virología, Servicio de Microbiología Clínica, Hospital Universitario Son Dureta, Palma de Mallorca, Spain.
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Shetty AK, Treynor E, Hill DW, Gutierrez KM, Warford A, Baron EJ. Comparison of conventional viral cultures with direct fluorescent antibody stains for diagnosis of community-acquired respiratory virus infections in hospitalized children. Pediatr Infect Dis J 2003; 22:789-94. [PMID: 14506369 DOI: 10.1097/01.inf.0000083823.43526.97] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Because of the widespread availability of rapid viral antigen testing, many institutions never adopted a routine practice of ordering viral cultures to detect community-acquired respiratory viruses (CRVs). The ease of performing complete viral studies in our on site laboratory allowed us to assess the clinical implications of the absence of conventional culture results in previously healthy hospitalized children with CRV infections. METHODS From June 1997 through May 2000, the results of direct immunofluorescence assay (DFA) of 1069 nasopharyngeal swab (NP) specimens were compared with simultaneously inoculated conventional tube cell cultures for detection of CRVs. In addition the medical records of 140 previously healthy infants and children hospitalized for management of lower respiratory tract infections caused by culture-proved CRVs were reviewed. RESULTS Viruses were isolated or detected by DFA or viral culture or both in 468 (30%) of the 1557 NP samples evaluated. The most common CRV isolated was respiratory syncytial virus (49%), followed by parainfluenza viruses (15%), influenza A viruses (14%), rhinoviruses (8%), adenoviruses (4%), enteroviruses (4%) and influenza B viruses (1%). Of the 1069 NP specimens for which both viral culture and rapid antigen testing were performed, 190 specimens were DFA-positive and culture-positive, 7 specimens were DFA-positive and culture-negative, 35 specimens were DFA-negative and culture-positive and 837 specimens were DFA-negative and culture-negative. The overall sensitivity, specificity, positive predictive value and negative predictive value of DFA were 84, 99, 96 and 96%, respectively. Of the 140 hospitalized patients with culture-proved viral cultures (89 respiratory syncytial virus, 22 influenza A, 20 parainfluenza virus and 9 adenovirus), the mean duration of hospital stay was 3.6 days, and the mean time for viral cultures to become positive was 7.7 days (P < 0.001, signed rank test). One hundred twenty (86%) viral cultures did not become positive until after the patient had been discharged from the hospital. In no case was the clinical decision regarding the patient's treatment or discharge from the hospital based on the results of viral culture. CONCLUSIONS We conclude that positive viral cultures have no impact on clinical decision making and management of healthy children during hospitalization for illness attributable to community-acquired respiratory viruses.
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Affiliation(s)
- Avinash K Shetty
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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12
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Landry ML, Ferguson D. Suboptimal detection of influenza virus in adults by the Directigen Flu A+B enzyme immunoassay and correlation of results with the number of antigen-positive cells detected by cytospin immunofluorescence. J Clin Microbiol 2003; 41:3407-9. [PMID: 12843105 PMCID: PMC165325 DOI: 10.1128/jcm.41.7.3407-3409.2003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To provide 24-h influenza diagnosis for adults presenting to the emergency department, the Directigen Flu A+B enzyme immunoassay (EIA) was performed in the chemistry laboratory during the night shift. Nasopharyngeal swabs were retested by cytospin-enhanced direct immunofluorescence (DFA; SimulFluor respiratory screen) when the virology laboratory opened. The influenza EIA detected 16 influenza A virus infections, whereas cytospin-enhanced DFA detected 31 influenza A virus infections as well as 3 respiratory syncytial virus, 2 adenovirus, and 1 parainfluenza virus infections. A positive EIA result usually correlated with 50 or more influenza virus cells positive by DFA.
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Affiliation(s)
- Marie L Landry
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut 06520, and Clinical Virology Laboratory, Yale New Haven Hospital, New Haven, Connecticut 06504, USA.
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Uyeki TM. Influenza diagnosis and treatment in children: a review of studies on clinically useful tests and antiviral treatment for influenza. Pediatr Infect Dis J 2003; 22:164-77. [PMID: 12586981 DOI: 10.1097/01.inf.0000050458.35010.b6] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prompt testing for influenza can help guide clinical management of patients with suspected influenza. Three antiviral medications, amantadine, oseltamivir and zanamivir, are approved for treatment of influenza in children. Rimantadine and ribavirin have also been used. OBJECTIVES To review the published evidence on clinically useful diagnostic tests and antiviral treatment for influenza virus infections in children. METHODS Studies published from 1966 through September 2002 were reviewed on clinical diagnosis, immunofluorescence and rapid influenza tests and on antiviral treatment of influenza virus infections among pediatric populations. RESULTS No studies assessed the accuracy of clinical diagnosis of influenza in children compared with viral culture. Compared with viral culture, direct immunofluorescence antibody and indirect immunofluorescence antibody tests for influenza had fair to moderate median sensitivities and high median specificities, whereas rapid influenza diagnostic tests had moderate median sensitivities and moderately high median specificities. No randomized, placebo-controlled studies were found of amantadine or rimantadine for treatment of influenza A. In a few separate controlled studies, oseltamivir, zanamivir and ribavirin each reduced symptom duration of influenza compared with placebo. CONCLUSIONS Additional data are needed about the accuracy of clinical diagnosis of influenza in children. Although direct immunofluorescence antibody staining, indirect immunofluorescence antibody staining and rapid tests are moderately to reasonably accurate in detecting influenza virus infections in children, physicians should use clinical judgment and local surveillance data about circulating influenza viruses when interpreting test results. Further controlled studies of the efficacy, adverse effects and emergence of antiviral resistance during treatment of influenza are needed for all of the antiviral drugs.
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Affiliation(s)
- Timothy M Uyeki
- Influenza Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Danés C, González-Martín J, Pumarola T, Rañó A, Benito N, Torres A, Moreno A, Rovira M, Puig de la Bellacasa J. Pulmonary infiltrates in immunosuppressed patients: analysis of a diagnostic protocol. J Clin Microbiol 2002; 40:2134-40. [PMID: 12037077 PMCID: PMC130687 DOI: 10.1128/jcm.40.6.2134-2140.2002] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2001] [Revised: 09/20/2001] [Accepted: 03/06/2002] [Indexed: 02/08/2023] Open
Abstract
A diagnostic protocol was started to study the etiology of pulmonary infiltrates in immunosuppressed patients. The diagnostic yields of the different techniques were analyzed, with special emphasis on the importance of the sample quality and the role of rapid techniques in the diagnostic strategy. In total, 241 patients with newly developed pulmonary infiltrates within a period of 19 months were included. Noninvasive or invasive evaluation was performed according to the characteristics of the infiltrates. Diagnosis was achieved in 202 patients (84%); 173 patients (72%) had pneumonia, and specific etiologic agents were found in 114 (66%). Bronchoaspirate and bronchoalveolar lavage showed the highest yields, either on global analysis (23 of 35 specimens [66%] and 70 of 134 specimens [52%], respectively) or on analysis of each type of pneumonia. A tendency toward better results with optimal-quality samples was observed, and a statistically significant difference was found in sputum bacterial culture. Rapid diagnostic tests yielded results in 71 of 114 (62.2%) diagnoses of etiological pneumonia.
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Affiliation(s)
- Cristina Danés
- Servei de Microbiologia, Institut Clínic d'Infeccions i Immunologia, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic de Barcelona, Barcelona, Spain
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Affiliation(s)
- E Geoffrey Playford
- Centre for Infectious Disease and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, NSW, Australia.
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Fong CK, Lee MK, Griffith BP. Evaluation of R-Mix FreshCells in shell vials for detection of respiratory viruses. J Clin Microbiol 2000; 38:4660-2. [PMID: 11101618 PMCID: PMC87659 DOI: 10.1128/jcm.38.12.4660-4662.2000] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The performance of a mixture of mink lung and A549 cell lines in shell vials (MSVs) for the detection of respiratory viruses in 159 specimens was evaluated. MSVs, conventional culture, and direct immunofluorescence assay identified 96, 85, and 67% of the influenza A virus-positive specimens, respectively. MSVs provided both a high degree of sensitivity and rapid turnaround times for the detection of influenza A virus.
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Affiliation(s)
- C K Fong
- Virology Reference Laboratory, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut 06516, USA
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Barenfanger J, Drake C, Leon N, Mueller T, Troutt T. Clinical and financial benefits of rapid detection of respiratory viruses: an outcomes study. J Clin Microbiol 2000; 38:2824-8. [PMID: 10921934 PMCID: PMC87120 DOI: 10.1128/jcm.38.8.2824-2828.2000] [Citation(s) in RCA: 218] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To assess the expected benefits of rapid reporting of respiratory viruses, we compared patients whose samples were processed using standard techniques such as enzyme immunoassays, shell vial assays, and culture tube assays (year 1) to patients whose samples were processed with the same standard techniques in addition to immunofluorescent testing (FA) directly on cytocentrifuged samples (year 2). The cytospin FA screened for influenza A and B viruses, respiratory syncytial virus (RSV), parainfluenza viruses 1 to 3, and adenovirus (DAKO Diagnostics Ltd.). The specificity of the cytospin FA for all viruses was 100%. The sensitivities for influenza A virus and RSV were 90 and 98%, respectively, but the sensitivities for influenza B virus and adenovirus were unacceptable (14.3 and 0%, respectively). However, since the former viruses account for >85% of our isolates from clinical specimens, the cytospin FA is an excellent screening test since the positive result was available within hours. The mean turnaround time for all positive viruses was 4.5 days in year 1 and 0.9 day in year 2 (P = 0.001). This rapid reporting resulted in physicians having access to information sooner, enabling more appropriate treatment. The mean length of stay in the hospital for inpatients with respiratory viral isolates was 10.6 days for year 1 versus 5.3 days for year 2. Mean variable costs for these patients was $7,893 in year 1 and $2,177 in year 2. After subtracting reagent costs and technological time, the savings in variable costs was $144,332/year. Summarizing, the cytospin FA markedly decreased turnaround time and was associated with decreased mortality, length of stay, and costs and with better antibiotic stewardship.
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Affiliation(s)
- J Barenfanger
- Laboratory Medicine, Memorial Medical Center, Springfield, Illinois 62781, USA.
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Landry ML, Ferguson D. SimulFluor respiratory screen for rapid detection of multiple respiratory viruses in clinical specimens by immunofluorescence staining. J Clin Microbiol 2000; 38:708-11. [PMID: 10655371 PMCID: PMC86182 DOI: 10.1128/jcm.38.2.708-711.2000] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A new rapid direct immunofluorescence assay (DFA) respiratory screen reagent for detection of seven common respiratory viruses (respiratory syncytial virus [RSV], influenza A and B viruses, parainfluenza virus types 1 to 3, and adenovirus) was compared with standard single or dual DFA reagents and culture. In total, 1,531 respiratory samples were adequate for testing with both SimulFluor Respiratory Screen (RS) reagent (Chemicon International, Temecula, Calif.) and single or dual DFA reagents. The RS DFA reagent detected 367 (98.4%) and single or dual DFA reagents detected 368 (98.7%) of 373 DFA-positive samples. In addition, the RS DFA reagent was equivalent to or better than culture for detection of all viruses except adenovirus. Only 15 of 799 (1.9%) RS-negative samples inoculated into cell cultures yielded respiratory virus isolates (one RSV, five influenza A virus, two influenza B virus, one parainfluenza virus, and six adenovirus). Sixty-six other virus isolates (13 rhinovirus, 24 cytomegalovirus, 28 herpes simplex virus type 1, and 1 enterovirus) were also recovered in culture. With cytospin preparation of slides, only 7.5% of samples submitted were deemed inadequate for DFA. The availability of a rapid DFA screening reagent for detection of multiple common respiratory viruses within 1 to 2 h of sample collection should be of great benefit in terms of patient management and infection control.
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Affiliation(s)
- M L Landry
- Clinical Virology Laboratory, Yale New Haven Hospital, and Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
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Covalciuc KA, Webb KH, Carlson CA. Comparison of four clinical specimen types for detection of influenza A and B viruses by optical immunoassay (FLU OIA test) and cell culture methods. J Clin Microbiol 2000; 37:3971-4. [PMID: 10565916 PMCID: PMC85858 DOI: 10.1128/jcm.37.12.3971-3974.1999] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although laboratory diagnosis of respiratory viruses has been widely studied, there is a relative insufficiency of literature examining the impact of specimen type on the laboratory diagnosis of influenza A and B. In a clinical study comparing the FLU OIA test with 14-day cell culture, clinical specimens from nasopharyngeal swabs, throat swabs, nasal aspirates, and sputum were obtained from patients experiencing influenza-like symptoms. A total of 404 clinical specimens were collected from 184 patients. Patients were defined as influenza positive if the viral culture of a specimen from any sample site was positive. Patients were defined as influenza negative if the viral cultures of specimens from all sample sites were negative. By this gold standard, culture and FLU OIA test results for each sample type were compared. For each of the four specimen types, the viral culture and FLU OIA test demonstrated equal abilities to detect the presence of influenza A or B virus or viral antigen. Sputum and nasal aspirate samples were the most predictive of influenza virus infection. Throat swabs were the least predictive of influenza virus infection, with both tests failing to detect influenza virus in nearly 50% of the throat samples studied.
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Landry ML, Cohen S, Ferguson D. Impact of sample type on rapid detection of influenza virus A by cytospin-enhanced immunofluorescence and membrane enzyme-linked immunosorbent assay. J Clin Microbiol 2000; 38:429-30. [PMID: 10618134 PMCID: PMC88742 DOI: 10.1128/jcm.38.1.429-430.2000] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cytospin-enhanced direct fluorescent-antibody assay (DFA) detected 49 (92.5%) and rapid membrane enzyme-linked immunosorbent assay (ELISA) detected 40 (75.5%) of 53 influenza virus A-positive samples. All 15 positive nasopharyngeal aspirates from children were detected by both tests. In contrast, 34 of 38 (89.5%) positive swabs from adults were detected by DFA, but only 25 (66%) were detected by ELISA.
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Affiliation(s)
- M L Landry
- Clinical Virology Laboratory, Yale New Haven Hospital, New Haven, Connecticut 06520, USA.
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Shih SR, Tsao KC, Ning HC, Huang YC, Lin TY. Diagnosis of respiratory tract viruses in 24 h by immunofluorescent staining of shell vial cultures containing Madin-Darby Canine Kidney (MDCK) cells. J Virol Methods 1999; 81:77-81. [PMID: 10488764 DOI: 10.1016/s0166-0934(99)00065-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nine hundred and seventy-eight clinical specimens were examined taken from patients with respiratory tract viruses (RV)-like syndrome between November 1996 and July 1998. The study was undertaken to evaluate the effectiveness of centrifuge-enhanced shell vial cultures (SVC) containing Madin-Darby Canine Kidney (MDCK) cells, combined with immunofluorescent (IF) staining in 24 h. This technique rapidly detects and identifies respiratory tract viruses. The conventional tube culture system with multiple cell lines would ordinarily detect RV within 3-30 days. The SVC/IF method using single cell line (MDCK cells) allowed detection of 81.5% of influenza A virus, 72% of parainfluenza virus, 82.6% of respiratory syncytial virus (RSV) and 79.6% of adenovirus in 24 h.
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Affiliation(s)
- S R Shih
- School of Medical Technology, Chang Gung University, Department of Clinical Pathology, Chang Gung Memorial Hospital, Taiwan, ROC.
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22
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Abstract
The laboratory diagnosis of infections of the respiratory tract is not an exact science, with many clinicians electing to empirically select antimicrobial therapy without the benefit of laboratory testing. With trained laboratory personnel and the proper selection of tests, accurate laboratory diagnosis is available. Progress is occurring most rapidly with molecular methods, such as polymerase chain reaction (PCR) testing. As molecular approaches are technically simplified and become less expensive, advances in the laboratory diagnosis of most respiratory tract infections caused by fastidious pathogens will occur. The diagnosis of non-fastidious bacteria, that require in-vitro antimicrobial testing, will continue to require conventional culture methods. New bronchoscopic methods, quantitative evaluation of cultures, and recognition of intracellular bacteria in stained smears do improve the usefulness of conventional culture and stain in the diagnosis of pneumonia.
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Affiliation(s)
- R B Thomson
- Microbiology and Virology, Evanston Northwestern Healthcare, Evanston, Illinois 60201, USA.
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