Identification of respiratory virus in infants with congenital heart disease by comparison of different methods

Abstract

Respiratory virus infections are the main cause of infant hospitalization and are potentially severe in children with congenital heart disease (CHD). Rapid and sensitive diagnosis is very important to early introduction of antiviral treatment and implementation of precautions to control transmission, reducing the risk of nosocomial infections. In the present study we compare different techniques in the diagnosis of respiratory viruses in CHD infants. Thirty-nine samples of nasopharyngeal aspirate were obtained from CHD infants with symptoms of respiratory infection. The Multiplex PCR (Seeplex® RV 12 ACE Detection) driven to the detection of 12 respiratory viruses was compared with the direct immunofluorescence assay (DFA) and PCR, both targeting seven respiratory viruses. The positivity found by DFA, Multiplex and PCR was 33.3%, 51.3% and 48.7%, respectively. Kappa index comparing DFA and Multiplex, DFA and PCR and PCR and Multiplex PCR was 0.542, 0.483 and 0.539, respectively. The concordance between techniques was considered moderate. Both Multiplex PCR (p = 0.001) and PCR (p = 0.002) detected significantly more respiratory virus than DFA. As the performance of the tests may vary, the combination of two or more techniques may increase diagnostic sensitivity favoring the diagnosis of co-infections, early introduction of antiviral therapy and implementation of appropriate measures.

Clinical and economical impact of multiplex respiratory virus assays

“…Similarly, a commercial multiplex PCR (Seeplex RV12 ACE detection) was used to diagnose respiratory infections in infants with congenital heart disease, another major risk factor for severe disease. In comparison with DFA, the sensitivity of multiplex PCR was better, detecting respiratory viruses in 51.3% of samples vs. 33.3% (Kanashiro et al, 2011). The utility of multiplex PCR in neonates and infants with congenital heart disease seems obvious, but more data are necessary to explore the impact of population screening in the NICU.…”

Bacteriemia oculta en niños atendidos en el Complejo Asistencial Dr. Sótero del Río: Experiencia post vacuna neumocóccica conjugada

“…Si el paciente no tiene foco y está en buenas condiciones generales, Respecto al diagnóstico de infección respiratoria viral, es importante mencionar que el examen se realizó en pacientes sin sintomatología respiratoria evidente y eso explica, probablemente, el alto número de pacientes con IFD positiva para ADV, causante a veces, de cuadros úni-camente febriles. Existe bastante evidencia en la literatura médica, que demuestra la sensibilidad y especificidad de los métodos moleculares muy por sobre la IFD (88 y 98% vs 68 y 70%, respectivamente) [19][20][21][22][23][24][25] . Gharabaghi y cols., compararon el rendimiento de cuatro ensayos comerciales de reacción de polimerasa en cadena-RPC con IFD y aislamiento viral en 750 hisopados nasofarín-geos de pacientes pediátricos, obteniendo un porcentaje de positividad adicional de 28,5%, lo que se traduce en un incremento de la sensibilidad de detección de virus respiratorios en niños, de 74,3% sobre la IFD y el cultivo viral 20 .…”

“…El microorganismo recuperado con mayor frecuencia desde hemocultivos de niños con BO probable fue S. pneumoniae y como era de esperar, fue menos frecuente, aunque estadísticamente no significativo, en el grupo de niños protegidos. Estudios como el de Kaiser Permanente describe el gran impacto de la PCV7 en niños entre 3 y 36 meses ambulatorios con bacteriemia por S. pneumoniae, con marcado descenso de su incidencia en Carolina del Norte [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] . En nuestro estudio es destacable que los pacientes protegidos y parcialmente protegidos, presentaron ENI por serotipos no vaccinales, mientras que los no protegidos tuvieron infecciones tanto por serotipos vaccinales como no vaccinales.…”

Human Metapneumovirus Pediatric Respiratory Infections: Comparing Direct Immunofluorescence versus Polymerase Chain Reaction

“…Moreover, this technique has a lower sensitivity when compared with rRT-PCR (45). Also, the reader's subjectivity, the need for specimens with appropriate number of cells and the impossibility of automation are other impediments associated with DFA (46). Therefore, combining the two methods, with the DFA assay as the first line, followed by RT-PCR for DFA-negative samples, may be the best approach to achieve prompt and sensitive detection of hMPV (17).…”