Neonatal herpes simplex virus (HSV) can be a devastating illness and may be difficult to diagnose in those cases without a typical skin rash. As a result, physicians often rely on HSV polymerase chain reaction of cerebrospinal fluid to rule out HSV encephalitis. We developed a real-time polymerase chain reaction assay for HSV using the SmartCycler II (Cepheid, Sunnyvale, CA). End point dilution studies showed sensitivity comparable to that of two national reference laboratories that use LightCycler. In-house turnaround time was Ϸ1.5 days versus Ϸ5.2 days for sending the test to a reference laboratory. We hypothesized that the rapid availability of a negative test result would allow physicians to discharge appropriate patients earlier. Six months after implementation, clinical case analysis identified 12 pediatric patients who were discharged earlier based on more rapid test results, with a projected savings of Ϸ55.2 hospital days throughout the first year. Actual length of stay for patients tested in-house was significantly less than that of historical controls and was projected to save Ϸ70.2 hospital days in the first year. Including projected annual laboratory cost/test savings of Ϸ$11,000, a total savings of $38,000 to $43,000 was estimated for the first year of implementation, more than offsetting startup instrument and development cost. (J Mol Diagn 2005, 7:511-516) Neonatal herpes simplex virus (HSV) infection is a life threatening infection occurring within the first several weeks after birth. Classically, ϳ60 to 70% of patients have a typical herpetic skin rash, with or without disseminated infection involving brain, liver, lung, and other organs.1 Because central nervous system HSV can present with seizures, low-grade fever, and other nonspecific symptoms in the absence of the vesicular skin rash, physicians often rely on a negative cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) to rule out HSV encephalitis.2-4 In our hospital HSV CSF PCR was sent to a reference laboratory with an average 5.2-day turnaround time. We attempted to show that performing HSV CSF PCR in the hospital laboratory would shorten this turnaround time and lead to an earlier discharge for a subset of neonates without other complications who were kept in the hospital for observation pending this test result.
Background
Serological surveys are used to ascertain influenza infection and immunity, but evidence for the utility of mucosal immunoglobulin A (IgA) as a correlate of infection or protection is limited.
Methods
We performed influenza-like illness (ILI) surveillance on 220 individuals living or working in a retirement community in Gainesville, Florida, USA from January to May, 2018, and took pre- and post-season nasal samples of 11 individuals with PCR-confirmed influenza infection and 60 randomly selected controls. Mucosal IgA against 10 strains of influenza was measured from nasal samples.
Results
Overall, 28.2% and 11.3% of individuals experienced a 2-fold and 4-fold rise, respectively, in mucosal IgA to at least one influenza strain. Individuals with PCR-confirmed influenza A had significantly lower levels of pre-season IgA to influenza A. Influenza-associated respiratory illness was associated with a higher rise in mucosal IgA to influenza strains of the same subtype, and H3N2-associated respiratory illness was associated with a higher rise in mucosal IgA to other influenza A strains.
Conclusions
By comparing individuals with and without influenza illness, we demonstrated that mucosal IgA is a correlate of influenza infection. There was evidence for cross-reactivity in mucosal IgA across influenza A subtypes.
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