We compared the FilmArray RP (Idaho Technology, Inc., Salt Lake City, UT) and the xTAG RVP (Luminex Corporation, Toronto, Canada) multiplex respiratory virus PCR methods for the detection of respiratory viruses in a set of 200 patient specimens frozen at ؊70°C after standard viral culture and antigen detection methods were done. Both systems detected between 40 to 50% more viruses than traditional methods, primarily rhinoviruses and human metapneumovirus. The FilmArray RP detected significantly more total viruses either alone or as part of mixed infections than the xTAG RVP, as well as an additional 21.6% more respiratory syncytial viruses. The xTAG RVP requires 5 to 6 h with 2.5 to 3 h of hands-on time, while the FilmArray RP takes about an hour with 3 to 5 min of hands-on time, making it much easier to perform.Multiplex reverse transcriptase respiratory virus PCR has been shown to be more sensitive than standard respiratory virus culture, direct fluorescent-antigen, and direct enzymelinked immunosorbent assay (ELISA) antigen detection methods (1, 2, 7-9, 13-14, 16, 20). Viral culture is labor-intensive, detects some viruses (e.g., rhinovirus and coronavirus) poorly, and requires 3 to 5 days to detect most agents. Consequently, results are generally not available early in the clinical decisionmaking process. Direct fluorescent-antibody assay (DFA) and chromatographic immunoassays are rapid enough to support real-time clinical decisions, but DFA is highly labor-intensive and chromatographic immunoassays are relatively insensitive. The FilmArray RP multiplex respiratory virus panel uses a pouch system that contains all reagents for the identification of 18 respiratory viruses and 3 bacterial respiratory pathogens in about 1 h after inoculation of a patient sample, obviating both labor and turnaround time (TAT) issues. We compared the performance of the FilmArray RP with that of the FDAcleared Luminex xTAG RVP multiplex panel by using 200 retrospective clinical respiratory virus culture samples.
We report two CMV naïve children who received deceased donor renal transplants from a CMV IgG-negative single donor. CMV IgG in both recipients and the donor were negative immediately prior to transplant. Both recipients had early recurrences of their original disease in their transplants, requiring multiple sessions of plasmapheresis. All blood products used were leukoreduced or CMV seronegative. A few days post-transplant, both recipients developed significant positive CMV viremia. Both required initiation of oral valganciclovir. Case 1 responded to oral valganciclovir only while the case 2 had a delayed response to it and hence required intravenous ganciclovir with good response. When checked retrospectively, CMV IgM in the donor was positive along with positive CMV DNA PCR from the white cells. Here we describe a very unusual scenario of CMV transmission in two pediatric renal transplant recipients from a single donor during the CMV window period.
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