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.
Studies suggest that by age 5 years nearly all people have been exposed to metapneumovirus. To determine its prevalence in central Illinois, we tested respiratory secretions by direct immunofluorescence staining from December to March. Metapneumovirus was detected in 11/391 specimens. The distribution of metapneumovirus was bimodal, with the split being between children aged <4 years and adults.Human metapneumovirus was discovered in 2001 and is classified as an RNA virus of the paramyxovirus group (6). Seroepidemiologic studies suggest that by age 5 years, nearly all individuals have been exposed to metapneumovirus. It is worldwide in distribution, and several studies suggest that it may be responsible for ϳ10% of viral respiratory infections in which the common respiratory viruses are not found (5, 9).Metapneumovirus is thought to cause both upper and lower respiratory tract infections in children and adults and causes disease most closely mimicking the disease produced by respiratory syncytial virus (RSV), with symptoms of cough, dyspnea, wheeze, hypoxia, fever, and exacerbation of asthma. It may have a seasonal distribution, most likely peaking at the end of the winter respiratory season (January to April). The detection and investigation of metapneumovirus have been impaired partly because (i) it does not replicate in continuous or commonly used cell lines, (ii) it requires trypsin for in vitro growth, and (iii) it has very slow replication kinetics in vitro (1, 7).The purpose of this study was to determine the prevalence of metapneumovirus in specimens submitted to Memorial Medical Center in Springfield, IL, from patients suspected of having respiratory viral infection.This study was conducted from 2 December 2006 to 23 March 2007 with respiratory secretions from both inpatients and outpatients in central Illinois which were either (i) nasal washings with orders for RSV testing which screened negative by an immunochromatographic sandwich assay (X/pect RSV; Remel, Inc., Lenexa, KS) or (ii) respiratory specimens with requests for respiratory viral screening. (It should be noted that the samples were somewhat prescreened, because samples with requests only for RSV screening which tested positive by the RSV immunochromatographic sandwich assay were not included in this study.)For samples with requests for RSV screening (which were negative by the RSV immunochromatographic sandwich assay), immunofluorescent testing for RSV and metapneumovirus was performed with cytopsun samples with reagents from Diagnostic Hybrids Inc. (Athens, OH) (2). For specimens with requests for other respiratory virus testing, immunofluorescent screening with cytospun samples and/or culture with R-Mix
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