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Journal of Clinical Microbiology, February 2002, p. 733-734, Vol. 40, No. 2
0095-1137/01/$04.00+0     DOI: 10.1128/JCM.40.2.733-734.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

LETTER TO THE EDITOR

Rapid Laboratory Diagnostics during the Winter Respiratory Virus Season

Top Letter References Letter  References

 
During the winter season, the testing of respiratory specimens (i.e., for the identification of influenza viruses, respiratory syncytial viruses, parainfluenza viruses, and/or adenoviruses) remains a major initiative in the clinical virology laboratory. Such testing is often critical to the care and management of immunocompromised patients, infants, and young children, as well as elderly (3, 5, 6).

Liolios et al. (8) confirm the recognized analytical superiority of nucleic acid testing compared to conventional cell cultures and direct specimen testing or immunofluorescence technology. As Liolios and colleagues suggested, respiratory virus testing utilizing their multiplex reverse transcriptase (RT)-PCR protocol, "is able to provide rapid" results with "turnaround times of 24 to 36 h." Many pediatric emergency room physicians, nursing home health care professionals, and infectious disease specialists would, however, take exception to the Australian workers’ definition of rapid respiratory virus diagnostics as appropriate to the clinical setting.

During the winter respiratory virus season, specifically in the hospital setting, virology laboratory personnel are under enormous pressure to meet specimen turnaround times; it is often requested that a verbal or computer report be delivered within 1 h or less for on-site patients or perhaps 2 to 3 h for those patients at off-site medical facilities (S. M. Lipson, personal observation). Rapid diagnostic testing, as defined in this commentary, is important for dividing patients into cohorts, for administration of antiviral drugs among the seriously ill, and for better antibiotic stewardship (2, 3, 4, 10, 13).

The study by Liolios and colleagues is of quality technical merit (8). In this laboratorian’s experience, however, the recommendation by Dr. Liolios et al. fails to meet specimen turnaround time demands made by the aforementioned physician groups during the winter respiratory virus season.

Regional and core medical center virology laboratories and commercial facilities are in continual competition for many of the same accounts. There is a continued effort, accordingly, to reduce specimen turnaround times in order to retain a competitive edge. To achieve this goal, many laboratory administrators direct their facilities to utilize rapid and simple-to-perform assays, rather than more-tedious but more-sensitive assays (2, 8, 9). The impetus to rapid respiratory viral diagnostics is reflected by the widespread use of the numerous enzyme immunoassay kits with detection times shorter than 15 min currently flooding the marketplace (1, 9).

The discipline of clinical virology is changing rapidly, and real-time testing is clearly the direction for the new millennium. Respiratory virus testing utilizing real-time nucleic acid amplification technologies is slowly being introduced to the clinical virology community (12). The technical study by Liolios et al., however, although capable of detecting seven respiratory virus types, fails to address the overwhelming practical issue of real-time (and simple-to-perform) laboratory viral diagnostics (8, 9). The described multiplex RT-PCR indeed serves as a valid epidemiological tool, but the assay’s 24- to 36-h turnaround time to the detection of respiratory viruses severely limits its routine application in the clinical setting. Until real-time multiplex nucleic acid testing becomes a reality, direct specimen testing along with immunofluorescence technology is likely to remain, in general, the most efficacious rapid (i.e., detection time of <1 h), sensitive, and specific methodology for the multiplex detection and identification of respiratory viruses in clinical specimens during the winter season (4, 7, 9, 11).

Top Letter References Letter  References

 

1
1. Anonymous. 1999. Rapid diagnostic tests for influenza. Medi. Lett. Drugs Thera. 41:121-122.
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2. Barenfanger, J., C. Drake, N. Leon, T. Mueller, and T. Troutt. 2000. Clinical and financial benefits of rapid detection of respiratory viruses: an outcomes study. J. Clin. Microbiol. 38:2824-2828.[Abstract/Free Full Text]
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3. Drinka, P. J., S. Gravenstein, E. Langer, P. Krause, and P. Shult. 1999. Mortality following isolation of various respiratory viruses in nursing home residents. Infect. Control Hosp. Epidemiol. 20:812-815.[CrossRef][Medline]
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4. Elizaga, J., E. Olavarria, J. F., Apperley, J. M. Goldman, and K. N. Ward. 2001. Parainfluenza virus 3 infection after stem cell transplant: relevance to outcome of rapid diagnostics and ribavirin treatment. Clin. Infect. Dis. 32:413-418.[CrossRef][Medline]
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5. Hohenthal, J. Nikoskelainen, R. Vainionpaa, R. Peltonen, M. Routamaa, M. Itala, and P. Kotilainen. 2001. Parainfluenza virus type 3 infections in a hematology unit. Bone Marrow Transplant. 27:295-300.[CrossRef][Medline]
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6. Krilov, L. R. 2001. Respiratory syncytial virus: update on infection, treatment, and prevention. Curr. Infect. Dis. Rep. 3:242-246.[Medline]
7
7. Landry, M. L., and D. Ferguson. 2000. SimulFluor respiratory screen and rapid detection of multiple respiratory viruses in clinical specimens by immunofluorescence staining. J. Clin. Microbiol. 38:708-711.[Abstract/Free Full Text]
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8. Liolios, I., A. Jenney, D. Spelman, T. Kotsimbos, M. Catton, and S. Wesselingh. 2001. Comparison of multiplex reverse transcription-PCR-enzyme hybridization assay with conventional viral culture and immunofluorescence techniques for the detection of seven viral respiratory pathogens. J. Clin. Microbiol. 39:2779-2783.[Abstract/Free Full Text]
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9. Lipson, S. M., D. Popiolek, Q. Z. Hu, L. H. Falk, M. Bornfreund, and L. R. Krilov. 1999. Efficacy of Directigen RSV testing in patient management following admission from the pediatric emergency department. J. Hosp. Infect. 41:323-329.[CrossRef][Medline]
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10. Mackie, P. L., P. A. Joannidis, and J. Beattie. 2001. Evaluation of an acute point-of-care system screening for respiratory syncytial virus infection. J. Hosp. Infect. 48:66-71.[CrossRef][Medline]
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11. Ng, W., V. S. Rajadurai, V. K. Pradeepkumar, K. W. Tan, and K. P. Chan. 1999. Parainfluenza type 3 viral outbreak in a neonatal nursery. Ann. Acad. Med. Singapore 28:471-475.[Medline]
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12. van Elden, L. J., M. Nijhuis, P. Schipper, R. Schuurman, and A. M. van Loon. 2001. Simultaneous detection of influenza viruses A and B using real quantitative PCR. J. Clin. Microbiol. 39:196-200.[Abstract/Free Full Text]
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13. Zambon, M., T. Bull, C. T. Sadler, J. M. Goldman, and K. N. Ward. 1998. Molecular epidemiology of two consecutive outbreaks of parainfluenza 3 in a bone marrow transplant unit. J. Clin. Microbiol. 36:2289-2293.[Abstract/Free Full Text]

						Steven M. Lipson* State University of New York   at Stony Brook Stony Brook, New York 11794-7300 and Department of Veterans Affairs Medical Center Northport, New York 11768
						* *Phone: (631) 261-4400, ext. 2836 Fax: (631) 544-5317 E-mail: montmor{at}aol.com

Authors' Reply

Top Letter References Letter  References

 
The rapid identification of respiratory pathogens, such as parainfluenza virus, influenza virus, respiratory syncytial virus, and/or adenovirus, especially during a winter period, is of great importance for the prevention of nosocomial spread, for monitoring infected patients, and for improved clinical management. For good reason, then, there is added pressure for clinical laboratories to be able to provide rapid and sensitive applications for the testing of these respiratory pathogens, particularly for immunocompromised individuals, the young, and the elderly.

We agree with Dr. Lipson that a rapid diagnostic test should be able to provide the clinician with a result within a few hours, to allow for prompt and appropriate therapeutic action. However, rapid assays such as direct antigen detection by immunofluorescence (IF) and commercially available antigen tests lack the sensitivity for rapid diagnosis of these viral pathogens (1, 2). Although the Hexaplex assay is technically demanding, we demonstrated excellent sensitivity and specificity with this assay, detecting 50% more positive specimens than would have been detected by rapid IF and culture methods. These findings may be of little importance to the immunocompetent patient population, but they are certainly of greater importance for the critically ill. We treat a large number of severely ill patients with complicated conditions (immunocompromised human immunodeficiency virus patients, and bone marrow, heart, and lung transplant patients) and extensively utilize the multiplex reverse transcriptase-PCR assay for diagnosing viral infections in these patient groups. The accurate identification of viral infection in these patients is critically important for optimal management of their care.

We believe that rapid methods, such as IF, should be used to screen incoming clinical specimens to rapidly identify any positive test results and that further testing should be performed on negative specimens, using more sensitive diagnostic tests, such as multiplex RT-PCR assays.

Top Letter References Letter  References

 

1
1. Dominguez, E. A., L. H. Taber, and R. B. Couch. 1993. Comparison of rapid diagnostic techniques for respiratory syncytial and influenza A virus respiratory infection in young children. J. Clin. Microbiol. 31:2286-2290.[Abstract/Free Full Text]
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2. Kehl, S. C., K. J. Henrickson, W. Hua, and J. Fan. 2001. Evaluation of the Hexaplex assay for detection of respiratory viruses in children. J. Clin. Microbiol. 39:1696-1701.[Abstract/Free Full Text]

						Lisa Liolios Steve Wesselingh Infectious Diseases Unit Alfred Hospital Prahran, 3181 VIC, Australia

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Journal of Clinical Microbiology, February 2002, p. 733-734, Vol. 40, No. 2
0095-1137/01/$04.00+0     DOI: 10.1128/JCM.40.2.733-734.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

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