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Chartrand C, Tremblay N, Renaud C, Papenburg J. Diagnostic Accuracy of Rapid Antigen Detection Tests for Respiratory Syncytial Virus Infection: Systematic Review and Meta-analysis. J Clin Microbiol 2015; 53:3738-49. [PMID: 26354816 DOI: 10.1128/JCM.01816-15] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/01/2015] [Indexed: 11/20/2022] Open
Abstract
Respiratory syncytial virus (RSV) rapid antigen detection tests (RADT) are extensively used in clinical laboratories. We performed a systematic review and meta-analysis to evaluate the accuracy of RADTs for diagnosis of RSV infection and to determine factors associated with accuracy estimates. We searched EMBASE and PubMed for diagnostic-accuracy studies of commercialized RSV RADTs. Studies reporting sensitivity and specificity data compared to a reference standard (reverse transcriptase PCR [RT-PCR], immunofluorescence, or viral culture) were considered. Two reviewers independently extracted data on study characteristics, diagnostic-accuracy estimates, and study quality. Accuracy estimates were pooled using bivariate random-effects regression models. Heterogeneity was investigated with prespecified subgroup analyses. Seventy-one articles met inclusion criteria. Overall, RSV RADT pooled sensitivity and specificity were 80% (95% confidence interval [CI], 76% to 83%) and 97% (95% CI, 96% to 98%), respectively. Positive- and negative-likelihood ratios were 25.5 (95% CI, 18.3 to 35.5) and 0.21 (95% CI, 0.18 to 0.24), respectively. Sensitivity was higher in children (81% [95% CI, 78%, 84%]) than in adults (29% [95% CI, 11% to 48%]). Because of this disparity, further subgroup analyses were restricted to pediatric data (63 studies). Test sensitivity was poorest using RT-PCR as a reference standard and highest using immunofluorescence (74% versus 88%; P < 0.001). Industry-sponsored studies reported significantly higher sensitivity (87% versus 78%; P = 0.01). Our results suggest that the poor sensitivity of RSV RADTs in adults may preclude their use in this population. Furthermore, industry-sponsored studies and those that did not use RT-PCR as a reference standard likely overestimated test sensitivity.
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Ochoa Sangrador C, González de Dios J. Conferencia de Consenso sobre Bronquiolitis Aguda (III): diagnóstico en la bronquiolitis aguda. Revisión de la evidencia científica. An Pediatr (Barc) 2010; 72:284.e1-284.e23. [DOI: 10.1016/j.anpedi.2009.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 12/14/2009] [Indexed: 11/22/2022] Open
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3
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Myers C, Wagner N, Kaiser L, Posfay-Barbe K, Gervaix A. Use of the rapid antigenic test to determine the duration of isolation in infants hospitalized for respiratory syncytial virus infections. Clin Pediatr (Phila) 2008; 47:493-5. [PMID: 18509148 DOI: 10.1177/0009922807310936] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infants hospitalized for bronchiolitis associated with respiratory syncytial virus are isolated for the duration of their hospitalization. This article reviews whether a negative rapid antigenic test could be used to shorten the duration of isolation measures. Rapid respiratory syncytial virus tests were performed from day 3 on alternate days in all patients hospitalized for bronchiolitis. Isolation measures were removed when the test result was negative. The result of the antigenic test was confirmed by viral culture and polymerase chain reaction. Surveillance of nosocomial cases was performed daily. Forty-one patients were analyzed. On day 3, 51.2% of patients were negative by viral culture and 56.1% were negative by rapid testing. On day 5, a further 26.8% were negative by viral culture and 31.7% by rapid testing. The rapid antigen test had a low sensitivity at 60% and a specificity of 76% compared with viral cultures; therefore this test alone cannot be used to lift isolation measures.
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Affiliation(s)
- Catherine Myers
- Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland.
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Affiliation(s)
- Hyung Su Kim
- Department of Pediatrics, Busan Medical Center, Busan, Korea
| | - Hee La Kim
- Department of Pediatrics, Busan Medical Center, Busan, Korea
| | - Ki Hyung Park
- Department of Clinical Pathology, Busan Medical Center, Busan, Korea
| | - Kyung Soon Cho
- Bacteriology Division Busan Metropolitan City Institute of Health & Environment, Busan, Korea
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Quinting B, Robert B, Letellier C, Boxus M, Kerkhofs P, Schynts F, Collard A. Development of a 1-step enzyme-linked immunosorbent assay for the rapid diagnosis of bovine respiratory syncytial virus in postmortem specimens. J Vet Diagn Invest 2007; 19:238-43. [PMID: 17459851 DOI: 10.1177/104063870701900302] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bovine respiratory syncytial virus (BRSV) is associated with severe respiratory disease in cattle. BRSV infection frequently leads to the death of young infected animals. The presence of BRSV in postmortem specimens is routinely detected using indirect immunofluorescence (IIF). However, this technique requires special equipment and considerable expertise. The present paper describes the development of a 1-step ELISA for rapid (1.5 hours) detection of BRSV antigen in organ homogenates. The performance of the new 1-step ELISA was evaluated using bovine postmortem specimens (n = 108) in comparison with 3 other BRSV diagnostic techniques: indirect immunofluorescence, the Clearview respiratory syncytial virus (RSV) test, and real-time reverse transcriptase polymerase chain reaction (RT-PCR). The relative sensitivity, specificity, and the kappa coefficient of 1-step ELISA, the Clearview RSV electroimmunoassay (EIA), and IIF were calculated, using real-time RT-PCR as the reference test. The new 1-step ELISA was the most sensitive and specific of the 3 tests. Thus, the new 1-step ELISA is a reliable test for detecting BRSV antigen in organ homogenates.
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Affiliation(s)
- Birgit Quinting
- Centre d'Economie Rurale, Division Immunologie Animale, rue du Carmel, 1, 6900 Marloie, Belgium.
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Nunes IFS, Moura FEA. Isolation of respiratory syncytial virus from nasopharyngeal aspirates stored at 20 degrees C from one to fifteen months after collection. Mem Inst Oswaldo Cruz 2006; 101:451-3. [PMID: 16951818 DOI: 10.1590/s0074-02762006000400017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Accepted: 05/04/2006] [Indexed: 11/22/2022] Open
Abstract
Cell culture isolation is used for recovering respiratory syncytial virus (RSV) from respiratory specimens. As RSV is a thermolabile virus, specimens destined for inoculation into cell culture require special transport, handling, and storage. The isolation rate of RSV from nasopharyngeal aspirates (NPA) stored at 20 20 degrees C for one to 15 months after collection was investigated. A total of 126 samples considered positive for RSV by indirect fluorescence-antibody were tested by virus isolation in HEp-2 cell culture. RSV was isolated from 47/126 specimens (37.3%). These results show that RSV may be recovered from NPA stored at 20 20 degrees C by cell culture.
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Affiliation(s)
- I F S Nunes
- Laboratório de Virologia, Departamento de Patologia e Medicina Legal, Universidade Federal do Ceará, Fortaleza, CE, 60441-750, Brasil
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Abstract
Viral pneumonia causes a heavy burden on our society. In the United States, more than one million cases of pneumonias afflict children under the age of 5 years, costing hundreds of millions of dollars annually. The majority of these infections are caused by a handful of common viruses. Knowledge of the epidemiology of these viruses combined with new rapid diagnostic techniques will provide faster and more, reliable diagnoses in the future. Although the basic clinical epidemiology of these viruses has been carefully investigated over the last 30 years, new molecular techniques are greatly expanding our understanding of these agents and the diseases they cause. Antigenic and genetic variations are being discovered in many viruses previously thought to be homogeneous. The exact roles and the biological significance of these variations are just beginning to be explored, but already evidence of differences in pathogenicity and immunogenicity has been found in many of these substrains. All of this information clearly will impact the development of future vaccines and antiviral drugs. Effective drugs exist for prophylaxis against influenza A and respiratory syncytial virus, and specific therapy exists for influenza A. Ribarivin is approved for use in respiratory synctial virus infections, and it alone or in combination with other agents (eg, IGIV) may be effective in immunocompromised patients, either in preventing the development of pneumonia or in decreasing morbidity and mortality. Many new antiviral agents are being tested and developed, and several are in clinical trials.
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Affiliation(s)
- Kelly J Henrickson
- Medical College of Wisconsin, MACC Fund Research Center, Milwaukee, WI, USA
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Reina J, Gutiérrez O, Munar M, Marí M. Evaluación preliminar de un método inmunocromatográfico (Directigen EZRSV) en la detección antigénica del virus respiratorio sincitial. Enferm Infecc Microbiol Clin 2005; 23:455-6. [PMID: 16159548 DOI: 10.1157/13078808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Reina J, Gonzalez Gárdenas M, Ruiz de Gopegui E, Padilla E, Ballesteros F, Mari M, Munar M. Prospective evaluation of a dot-blot enzyme immunoassay (Directigen RSV) for the antigenic detection of respiratory syncytial virus from nasopharyngeal aspirates of paediatric patients. Clin Microbiol Infect 2005; 10:967-71. [PMID: 15521998 DOI: 10.1111/j.1469-0691.2004.00986.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study investigated the efficacy of a commercial enzyme immunoassay (Directigen RSV, ColorPAC) in comparison with the shell vial culture method (using Hep-2 cells) for the detection of respiratory syncytial virus (RSV) in nasopharyngeal aspirates from children with bronchiolitis. During the period 1995-2002, 4950 samples were examined. RSV was detected in 1660 (33.5%) samples, with a sensitivity of 80.9%, a specificity of 97.5%, a positive predictive value of 93.8%, a negative predictive value of 91.6%, and a testing efficiency value of 92.2% compared with shell vial culture. In 83 (5%) samples, the ColorPAC was positive and the shell vial assay was negative. Of these, 71 (85.6%) were false-negative by cell culture. The true false-positive results obtained by ColorPAC represented only 0.7% of all RSV-positive samples. In general, no statistically significant differences were detected between the different months and epidemic periods studied. Compared with ColorPAC, the shell vial culture method displayed a sensitivity of 95.8% and a specificity of 100%. Overall, the ColorPAC assay was an acceptable, simple and rapid method for the antigenic detection of RSV in paediatric respiratory samples.
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Affiliation(s)
- J Reina
- Virology Unit, Clinical Microbiology Service, University Hospital Son Dureta (Universitat Illes Balears), Palma de Mallorca, Spain.
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Slinger R, Milk R, Gaboury I, Diaz-Mitoma F. Evaluation of the QuickLab RSV test, a new rapid lateral-flow immunoassay for detection of respiratory syncytial virus antigen. J Clin Microbiol 2004; 42:3731-3. [PMID: 15297522 PMCID: PMC497566 DOI: 10.1128/jcm.42.8.3731-3733.2004] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rapid respiratory syncytial virus (RSV) diagnosis is vital to the prevention of nosocomial RSV infections. We evaluated a new rapid lateral-flow RSV immunoassay, the QuickLab RSV test, that requires use of only one reagent. We compared QuickLab to the Directigen RSV (DIR) assay, which requires six reagents, and direct fluorescent antibody (DFA) testing. DFA results were considered the "gold standard." For 133 nasopharyngeal aspirates tested, DFA results were 77 (57.8%) positive, 47 (35.3%) negative, and 9 (6.8%) indeterminate. The sensitivities, specificities, positive predictive values, and negative predictive values of QuickLab and DIR tests were 93.3% (70 of 75) and 80.8% (59 of 73), 95.6% (43 of 45) and 100.0% (46 of 46), 97.2% (70 of 72) and 100.0% (59 of 59), and 89.6% (43 of 48) and 76.7% (46 of 60), respectively. QuickLab was significantly (P = 0.02) more sensitive than DIR; the difference in specificities was not significant. DFA was more sensitive than DIR (P < 0.001) but not more sensitive than QuickLab (P = 0.45). The results of DIR testing were initially uninterpretable and required retesting with 15% of the specimens compared to 3% of QL results (P < 0.001). We conclude that the QuickLab RSV test has sensitivity similar to that of the DFA assay and better than that of the DIR assay. QuickLab testing is also simpler to perform and interpret than both DFA and DIR testing.
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Affiliation(s)
- Robert Slinger
- Division of Infectious Disease, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa, Ontario K1H 8L1, Canada.
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Ohm-Smith MJ, Nassos PS, Haller BL. Evaluation of the Binax NOW, BD Directigen, and BD Directigen EZ assays for detection of respiratory syncytial virus. J Clin Microbiol 2004; 42:2996-9. [PMID: 15243050 PMCID: PMC446264 DOI: 10.1128/jcm.42.7.2996-2999.2004] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Binax NOW assay (Binax, Inc., Portland, Maine) and the BD Directigen EZ assay (Becton Dickinson and Company, Sparks, Md.), two new rapid immunoassays for detection of respiratory syncytial virus (RSV), as well as the BD Directigen RSV assay (DRSV) (Becton Dickinson and Company) and direct immunofluorescence staining (DFA) were compared with culture for detection of RSV in fresh specimens from both children and adults during the 2002-2003 respiratory virus season. The majority (95%) of specimens were nasal or nasopharyngeal washes or aspirates. A total of 47 (26%) were culture positive for RSV. The overall sensitivities of DFA (n = 149), NOW (n = 118), EZ (n = 88), and DRSV (n = 180) compared with culture (n = 180) were 93, 89, 59, and 77%, respectively. The specificities of DFA, NOW, EZ, and DRSV were 97, 100, 98, and 96%, respectively. However, when results were separated into those from children and those from adults, DFA was the only rapid test adequate for detection of RSV (sensitivity of 100% compared to 0, 0, and 25% for NOW, EZ, and DRSV, respectively) in adults. For children the sensitivities of DFA, NOW, EZ, and DRSV were 93, 94, 72, and 81%. The NOW assay was the most sensitive and specific and the easiest to perform of the kit tests for detecting RSV in children. None of these three rapid kit tests was sensitive for detecting RSV in specimens from adults. DFA remains the rapid method of choice for detecting RSV in the adult population.
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Affiliation(s)
- Marilyn J Ohm-Smith
- Department of Laboratory Medicine, University of California at San Francisco, San Francisco, CA 94110, USA
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van Elden LJR, van Loon AM, van der Beek A, Hendriksen KAW, Hoepelman AIM, van Kraaij MGJ, Schipper P, Nijhuis M. Applicability of a real-time quantitative PCR assay for diagnosis of respiratory syncytial virus infection in immunocompromised adults. J Clin Microbiol 2003; 41:4378-81. [PMID: 12958272 PMCID: PMC193825 DOI: 10.1128/jcm.41.9.4378-4381.2003] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Respiratory syncytial virus (RSV) accounts for the majority of respiratory virus infections, producing high mortality rates in immunocompromised patients with hematologic malignancies. The available methods for the rapid detection of RSV by antigen detection or PCR either lack sensitivity, require complex laboratory manipulation, or have not been evaluated in this patient population. To assess the applicability of a TaqMan-based real-time PCR technique for the detection of RSV A and B in immunocompromised adults, we developed a rapid, sensitive detection method that simultaneously detects RSV A and B and can be applied in routine diagnostics. The specificity of the assay was assessed using a panel of reference strains of other respiratory viruses and RSV. Electron microscopy-counted stocks of RSV A and B were used to develop a quantitative PCR format. Eleven copies of viral RNA could be detected for RSV A strain Long, and 14 copies could be detected for RSV B strain 9320, corresponding to 50% tissue culture infective doses of 0.86 and 0.34, respectively. The assay was evaluated on 411 combined nose and throat swabs derived from immunocompromised adults with or without signs of respiratory tract infection. The diagnostic efficacy of the TaqMan PCR determined on the clinical samples showed that this real-time PCR technique was substantially more sensitive than the combination of conventional viral culture and shell vial culture. None of the clinical specimens derived from patients without signs of respiratory illness were found to be positive for RSV by real-time TaqMan PCR.
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Affiliation(s)
- L J R van Elden
- Department of Virology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Affiliation(s)
| | - Daniel P Fedorko
- Clinical Pathology Department National Institutes of Health Bethesda, MD 20892, USA
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14
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Loeffelholz MJ. Rapid Diagnosis of Viral Infections. Lab Med 2002. [DOI: 10.1309/e505-ul0y-qx7a-jfmc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Doing KM, Jerkofsky MA, Dow EG, Jellison JA. Use of fluorescent-antibody staining of cytocentrifuge-prepared smears in combination with cell culture for direct detection of respiratory viruses. J Clin Microbiol 1998; 36:2112-4. [PMID: 9650977 PMCID: PMC104993 DOI: 10.1128/jcm.36.7.2112-2114.1998] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Over a 3-year period, 1,003 respiratory samples were collected and examined for selected respiratory viruses with cytocentrifuged prepared smears stained with fluorescently labeled antibodies (IFA) in conjunction with cell culture. IFA results were compared with results obtained by cell culture. Viruses were isolated or detected by direct means in 401 samples. Agreement between culture and IFA was 90%.
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Affiliation(s)
- K M Doing
- Department of Microbiology, Biochemistry and Molecular Biology, University of Maine, Orono 04469, USA.
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16
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Abstract
A microwave-accelerated direct immunofluorescence staining method which requires only 20 min from specimen receipt to interpretation is as effective as conventional methods for detecting respiratory syncytial virus and influenza A virus antigens in clinical specimens. The time required compares favorably with that for the less sensitive Abbott Test Pack RSV.
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Affiliation(s)
- S A Hite
- Department of Pathology, University Hospitals of Cleveland, Case Western Reserve University, Ohio 44106, USA
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Englund JA, Piedra PA, Jewell A, Patel K, Baxter BB, Whimbey E. Rapid diagnosis of respiratory syncytial virus infections in immunocompromised adults. J Clin Microbiol 1996; 34:1649-53. [PMID: 8784563 PMCID: PMC229088 DOI: 10.1128/jcm.34.7.1649-1653.1996] [Citation(s) in RCA: 126] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Although rapid antigen detection methods for the documentation of respiratory syncytial virus (RSV) infections are widely used with pediatric patients, these tests have not been prospectively evaluated in immunocompromised (IC) adults. For bone marrow transplant recipients and adult patients undergoing chemotherapy for leukemia who had recent onset of respiratory symptoms, respiratory samples (combined nasal wash [NW]-throat swab [TS], endotracheal tube [ET] aspirate, or bronchoalveolar lavage [BAL] samples) were collected for simultaneous culture and rapid antigen detection with the Directigen test kit (Becton Dickinson, Cockeysville, Md.). NW specimens from hospitalized pediatric patients with suspected RSV infection were also evaluated. Viral quantitation was performed on aliquots of the original specimens. A total of 539 samples from 372 adult patients were evaluated. RSV was isolated from 56 specimens (40 NW-TS, 7 ET aspirate, and 9 BAL specimens). By using culture as the "gold standard," rapid antigen detection had a sensitivity of 15% for adult NW-TS specimens, 71.4% for ET aspirate specimens, and 88.9% for BAL specimens; the specificity was > or = 97% for all specimen types. Significantly greater viral quantities were present in pediatric NW specimens than in adult NW specimens. In adults, more virus was present in BAL and ET aspirate specimens than in NW-TS specimens. Rapid detection of antigen respiratory samples obtained from the lower respiratory tracts of IC adults is sensitive and specific, but detection in upper respiratory tract samples is insensitive. The lower sensitivity of antigen detection in NW-TS specimens may be due to decreased viral load. A BAL specimen is more sensitive than an NW-TS specimen for the rapid diagnosis of RSV disease in IC adults.
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Affiliation(s)
- J A Englund
- Department of Microbiology and Immunology, Baylor College of Medicine, Houston, Texas 77030, USA.
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Murphy P, Roberts ZM, Waner JL. Differential diagnoses of influenza A virus, influenza B virus, and respiratory syncytial virus infections by direct immunofluorescence using mixtures of monoclonal antibodies of different isotypes. J Clin Microbiol 1996; 34:1798-800. [PMID: 8784593 PMCID: PMC229118 DOI: 10.1128/jcm.34.7.1798-1800.1996] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Differences between isotypes of monoclonal antibodies were employed to detect influenza A and B viruses and respiratory syncytial virus by direct immunofluorescence using fluorescein isothiocyanate or Texas Red conjugates. Examination of 56 specimens for influenza A and B viruses and 112 specimens for influenza A virus and respiratory syncytial virus showed the mixed-isotype test to be comparable to the conventional procedure.
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Affiliation(s)
- P Murphy
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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Leonardi GP, Balbi H, Costello P, Harris P. Use of continuous human lung cells in the laboratory diagnosis of respiratory syncytial virus. ACTA ACUST UNITED AC 1995; 4:269-72. [PMID: 15566847 DOI: 10.1016/0928-0197(95)00019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/1995] [Revised: 05/01/1995] [Accepted: 05/08/1995] [Indexed: 10/17/2022]
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Todd SJ, Minnich L, Waner JL. Comparison of rapid immunofluorescence procedure with TestPack RSV and Directigen FLU-A for diagnosis of respiratory syncytial virus and influenza A virus. J Clin Microbiol 1995; 33:1650-1. [PMID: 7650206 PMCID: PMC228236 DOI: 10.1128/jcm.33.6.1650-1651.1995] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A rapid immunofluorescence format requiring 20 min for completion was as effective as conventional indirect and direct immunofluorescence procedures for detecting respiratory syncytial virus and influenza A virus antigens in clinical specimens. Rapid immunofluorescence was more sensitive than TestPack RSV and comparable to Directigen FLU-A immunosorbent assays, which require 20 min for completion.
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Affiliation(s)
- S J Todd
- Children's Hospital of Oklahoma, Oklahoma City 73190-3030, USA
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Tablan OC, Anderson LJ, Arden NH, Breiman RF, Butler JC, McNeil MM. Guideline for Prevention of Nosocomial Pneumonia. Infect Control Hosp Epidemiol 1994. [DOI: 10.2307/30147436] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
An analysis was done of the incidence and nature of mixed virus infections diagnosed in the same clinical specimen from immunocompetent patients; respiratory viruses were emphasized. Few studies have addressed mixed viral infections in any systematic fashion. The relevant studies reviewed focused on clinical relationships or diagnostic methods. Data relating to multiple infections were usually derived incidentally to the purpose of the investigations. Sixty-three percent of the reports with data on mixed infections identified them in < 5% of the total number of viral infections. Respiratory syncytial virus was the most common coinfecting virus, and respiratory syncytial virus and influenza virus were the most common virus pair identified. In considering rapid diagnostic techniques, in 87% of the reports with available data a virus was diagnosed in > 10% of specimens that were negative for the virus targeted by one method. There was no indication that mixed infections were associated with increased disease in immunocompetent patients or in certain immunocompromised patients. Immunocompromised patients, however, appeared to have a greater incidence of multiple infections. Mixed infections of single cells also occur and may have important clinical implications relative to reactivation of latent viruses and enhanced disease. The requirement for a comprehensive strategy for viral diagnosis involving multiple techniques was indicated by these findings.
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Affiliation(s)
- J L Waner
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City
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Marks M. Respiratory syncytial virus infections. An update. Med Mal Infect 1993; 23:870-3. [DOI: 10.1016/s0399-077x(05)80366-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Dominguez EA, Taber LH, Couch RB. Comparison of rapid diagnostic techniques for respiratory syncytial and influenza A virus respiratory infections in young children. J Clin Microbiol 1993; 31:2286-90. [PMID: 8408545 PMCID: PMC265748 DOI: 10.1128/jcm.31.9.2286-2290.1993] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We performed virus isolation tests for respiratory viruses on combined nasal wash-throat swab specimens collected from infants and children with acute respiratory illnesses presenting to a hospital clinic during a 3-month period of concurrent epidemics of respiratory syncytial virus (RSV) and influenza A virus (Flu A) infections. Virus isolation results were used to assess the utility of commercially available rapid diagnostic kits for these two viruses. The kits employed direct immunofluorescence (IF) of cells (Imagen for RSV and Flu A), indirect IF of cells (Baxter Bartels Microscan), and enzyme immunoassay (EIA) (Becton Dickinson Directigen for RSV and Flu A and Abbott TestPack for RSV). All testing was completed on 81 specimens from 80 subjects. Of the 81 specimens, 53 (65%) yielded a virus: RSV, 28%; Flu A, 25%; rhinovirus, 6%; and enterovirus, cytomegalovirus, herpes simplex virus, and adenovirus, 2 to 4% each. Among the tests, Bartels Microscan and Directigen Flu-A exhibited the highest sensitivities (87 and 75%) and efficiencies (94 and 94%) for RSV and Flu A, respectively. All the tests exhibited high specificity. Thus, optimal detection of RSV and Flu A among infants and children who presented to a hospital clinic required two different detection methods (IF and enzyme immunoassay) and kits from two different companies (Baxter [Bartels Microscan] and Becton Dickinson [Directigen]).
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Affiliation(s)
- E A Dominguez
- Department of Microbiology, Baylor College of Medicine, Houston, Texas 77030
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Abstract
Abbott TestPack RSV, a 20-minute enzyme immunoassay, is available for the rapid diagnosis of respiratory syncytial virus (RSV) infections. We have compared TestPack with a "gold standard" method of virus isolation in traditional tube cultures and shell vials to determine the sensitivity and specificity of this rapid method. Respiratory specimens were collected prospectively from 402 children and assayed by the rapid antigen detection method and isolation in culture. Virus was isolated by inoculation of specimen in a total of eight tubes and 2-3 shell vials. Isolation of RSV was confirmed by characteristic cytopathic effect and immunofluorescence using monoclonal antibodies to RSV. Of the 402 specimens tested, there were only 18 discrepant results (seven TestPack-positive, culture-negative, and 11 TestPack-negative, culture-positive specimens). The sensitivity of TestPack RSV versus culture was 93.6% (162 of 173) and the specificity was 97.0% (222 of 229). Using a very rigorous culture system, we have obtained high values for the sensitivity and specificity of TestPack RSV. This assay is an excellent method for the rapid diagnosis of RSV infections in young children.
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Affiliation(s)
- M A Olsen
- Department of Medical Microbiology, Creighton University School of Medicine, Omaha, Nebraska
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Döller G, Schuy W. Stability of respiratory syncytial virus antigen due to buffer treatment for direct detection in nasopharyngeal specimens with enzyme immunoassay. J Clin Lab Anal 1993; 7:5-10. [PMID: 8426273 DOI: 10.1002/jcla.1860070103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We developed an enzyme immunoassay (direct EIA; Enzygnost RSV[Ag]) for the direct detection of respiratory syncytial virus (RSV) antigen in nasopharyngeal specimens (NPS). The test procedure is the same as our recently described direct EIA for detection of influenza A and B virus antigens in NPS. For practical purposes it is of advantage to differentiate respiratory viruses on the same microtitration plate in the same run. The test shows no limitations by sample consistency, and results are obtained within 4 hr. In contrast to other test systems, sonification is not necessary. This is due to the sample buffer STD. We studied the influence of sample buffer STD on the stability of RSV (strain Long) antigen at different temperatures over a period of 7 days. PBS-BSA-buffer served as control. The treatment and storage of RSV (strain Long) with sample buffer STD at room temperature or at 4 degrees C showed no decrease of antigen detectability. The antigen is very stable in contrast to the storage of RSV (strain Long) in PBS-BSA buffer during the observation period of 7 days. Consequently, when NPS are stored in sample buffer STD, results of direct EIA are independent from the time of transport and temperature within 7 days. Thirty-eight NPS from infants with confirmed RSV infection were investigated. Confirmation was performed by virus isolation (n = 29) or with commercially available enzyme immunoassays or immunofluorescence test (n = 9). The direct EIA showed a specificity of 99.3% (n = 140) and a sensitivity of 95% (n = 38).
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Affiliation(s)
- G Döller
- Department of Medical Virology and Epidemiology for Virus Diseases, Hygiene Institute, Tübingen, Germany
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Schirm J, Luijt DS, Pastoor GW, Mandema JM, Schröder FP. Rapid detection of respiratory viruses using mixtures of monoclonal antibodies on shell vial cultures. J Med Virol 1992; 38:147-51. [PMID: 1334129 DOI: 10.1002/jmv.1890380214] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Eleven hundred and thirty-three clinical specimens submitted to the laboratory for diagnosis of respiratory virus infections were tested by direct immunofluorescence (DIF) for respiratory syncytial virus (RSV), by shell vial culture, and by conventional cell culture. The shell vial cultures were stained with 8 different monoclonal antibodies both 1 day and 3-7 days after inoculation. In order to limit the cost and the workload, mixtures of monoclonal antibodies were used. Coverslips with HEp-2 cells were incubated with a mixture of FITC-labeled monoclonal antibody to RSV and nonlabeled monoclonal antibody to adenovirus. When no RSV positive IF staining was observed after the first incubation step, the same coverslip was incubated once more with FITC-labeled anti-mouse antibody. A positive reaction at this stage indicated the presence of adenovirus. Similarly, cultures of tertiary monkey kidney cells were investigated with a mixture of two FITC-labeled monoclonals to the influenza viruses A and B and three nonlabeled monoclonals to the parainfluenza viruses 1, 2 and 3. If influenza virus or parainfluenza virus was detected, the exact type was determined by staining different parts of a duplicate coverslip. Shell vial cultures for cytomegalovirus (CMV) were always performed separately on human embryonic lung fibroblasts. Using this approach, we detected RSV (n = 248), CMV (n = 42), parainfluenza virus (n = 31), influenza virus (n = 28), and adenovirus (n = 6), in most cases after only one day of culture. For RSV, the sensitivity of the shell vial method was too low (74%) to allow omission of DIF (sensitivity 95%).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Schirm
- Regional Public Health Laboratory, University Hospital, Groningen, The Netherlands
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Ryan-Poirier KA, Katz JM, Webster RG, Kawaoka Y. Application of Directigen FLU-A for the detection of influenza A virus in human and nonhuman specimens. J Clin Microbiol 1992; 30:1072-5. [PMID: 1583103 PMCID: PMC265226 DOI: 10.1128/jcm.30.5.1072-1075.1992] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Directigen FLU-A, a new enzyme immunoassay membrane test, rapidly detects influenza A virus antigen in specimens from patients. Nasopharyngeal washes and pharyngeal gargles were used to determine the effectiveness of the assay as applied to different types of routinely collected clinical samples. All specimens had been previously shown to contain influenza A virus by virus isolation in tissue culture. Directigen FLU-A was 90% sensitive (95% confidence interval, 56 to 99.7%) with nasopharyngeal washes but only 39% sensitive (95% confidence interval, 17 to 64%) with pharyngeal gargles (P = 0.018) when used with samples containing similar amounts of infectious virus (50% tissue culture infective dose, 1.0 to 4.5). The intensity of the positive reaction with Directigen FLU-A did not correlate with the amount of virus in the specimens. Directigen FLU-A was found to detect cell-associated antigen more readily than free virus; only 20 infected cells were required to identify cell-associated influenza A virus antigen, whereas the limit of detection for free virus was 1.63 x 10(3) infectious virus particles. These findings suggest that Directigen FLU-A detects the cell-associated antigen present in clinical specimens rather than free virus. In addition, Directigen FLU-A detected avian and swine influenza A viruses in both cloacal swabs (75% sensitivity) and swine lung homogenates (86% sensitivity), indicating its potential usefulness in the surveillance of nonhuman influenza A viruses.
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Affiliation(s)
- K A Ryan-Poirier
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38101
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Mendoza J, Rojas A, Navarro JM, Plata C, de la Rosa M. Evaluation of three rapid enzyme immunoassays and cell culture for detection of respiratory syncytial virus. Eur J Clin Microbiol Infect Dis 1992; 11:452-4. [PMID: 1425717 DOI: 10.1007/bf01961862] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Three rapid enzyme immunoassay techniques for the detection of respiratory syncytial virus antigen (Becton Dickinson Directigen RSV, Abbott RSV Testpack and Abbott RSV EIA) and cell culture were evaluated in a total of 250 nasal washings. The sensitivity and specificity were 62% and 76% respectively for Directigen, 64% and 86% for RSV Testpack, and 76% and 81% for RSV EIA, taking cell culture as the reference method. Agreement between cell culture and EIA techniques was 79% (70 positive and 128 negative results). All three EIA techniques gave positive results in 69 samples (52 positive and 17 negative in the cell culture). In 121 samples all three EIA techniques gave negative results (103 negative and 18 positive in the cell culture). Using the cell culture technique 46 strains other than respiratory syncytial virus were isolated.
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Affiliation(s)
- J Mendoza
- Servicio de Microbiologia, Hospital Regional de Especialidades Virgen de las Nieves, Granada, Spain
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Garea MT, Lopez JM, Perez del Molino ML, Coira A, Pardo F. Comparison of a new commercial enzyme immunoassay for rapid detection of respiratory syncytial virus. Eur J Clin Microbiol Infect Dis 1992; 11:175-7. [PMID: 1396733 DOI: 10.1007/bf01967073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Two rapid methods for detection of respiratory syncytial virus in respiratory specimens were compared: direct immunofluorescence assay (DFA) with monoclonal antibody and an enzyme immunoassay (EIA) (Test-Pack RSV). Ninety-five nasopharyngeal washings and aspirates from 51 children were examined; the patients were hospitalized during a winter outbreak of RSV infection in the first trimester of 1990. A total of 41.0% and 56.8% of these samples were positive by EIA and DFA respectively. Considering only the 51 specimens collected at the onset of illness, EIA detected 72.5% positive samples and DFA detected 78.4%. In comparison with DFA, EIA was 92.5% sensitive and 100% specific for the acute phase of illness. When all the samples were taken into account, specificity was maintained but sensitivity fell to 72.2%. The results show that both methods are useful during the acute phase of the illness, when the viral load is important. However, later on in the course of the infection DFA appears to be more sensitive than EIA.
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Affiliation(s)
- M T Garea
- Servicio de Microbiología, Hospital General de Galicia, Santiago de Compostela, Spain
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Abstract
Two new rapid enzyme immunoassays (EIAs) for detecting respiratory syncytial virus (RSV), Directigen (Becton Dickinson Microbiology Systems) and TestPack (Abbott Diagnostics) were compared with virus isolation and direct immunofluorescence by using fresh specimens. The sensitivities of both EIAs were low (72 to 73%), but when initial specimens were used, TestPack had a high sensitivity (92%) in contrast to that of Directigen (76%). Because of its high sensitivity and specificity, TestPack can be used for diagnosis of RSV in acute disease.
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Affiliation(s)
- P H Rothbarth
- Department of Virology, University Hospital Rotterdam, The Netherlands
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Waner JL, Todd SJ, Shalaby H, Murphy P, Wall LV. Comparison of Directigen FLU-A with viral isolation and direct immunofluorescence for the rapid detection and identification of influenza A virus. J Clin Microbiol 1991; 29:479-82. [PMID: 2037665 PMCID: PMC269804 DOI: 10.1128/jcm.29.3.479-482.1991] [Citation(s) in RCA: 91] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Directigen FLU-A, an enzyme immunoassay membrane test, was compared prospectively to isolation in cell culture and direct immunofluorescence (IF) for the detection of influenza A virus. One hundred ninety specimens were evaluated by Directigen FLU-A and cell culture; 184 of these specimens were also tested by direct IF. The sensitivity of Directigen FLU-A compared to isolation in cell culture and direct IF was 100%. The specificities of Directigen FLU-A compared to isolation and direct IF were identical, 91.6%. Fourteen specimens that were positive by Directigen FLU-A did not yield virus in culture; two of the specimens, however, were positive by direct IF, and four other specimens were not specimens of choice for the test. A positive Directigen result had positive predictive values of 62.6 and 75.0% compared to isolation and direct IF, respectively; a positive Directigen result with an intensity reading of 2+ or greater, however, had positive predictive values of 85 and 100% compared to isolation and direct IF, respectively. In all comparisons, the negative predictive value was 100%. There was no evidence that cross-reactivity occurred with non-influenza A antigens. Directigen FLU-A should serve as a convenient screening test for influenza A and as a rapid test supported by isolation in cell culture during an influenza outbreak.
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Affiliation(s)
- J L Waner
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City 73190-3030
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Mendoza J, Navarro JM, Rojas A, de la Rosa M. Evaluation of immunofluorescence, two enzyme immunoassays and the shell-vial assay for detection of respiratory syncytial virus. Eur J Clin Microbiol Infect Dis 1991; 10:40-2. [PMID: 2009879 DOI: 10.1007/bf01967097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J Mendoza
- Department of Microbiology, Virgen de las Nieves Hospital, Granada, Spain
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Johnston SL, Siegel CS. Evaluation of direct immunofluorescence, enzyme immunoassay, centrifugation culture, and conventional culture for the detection of respiratory syncytial virus. J Clin Microbiol 1990; 28:2394-7. [PMID: 2254415 PMCID: PMC268194 DOI: 10.1128/jcm.28.11.2394-2397.1990] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Four methods of detecting respiratory syncytial virus (RSV) from clinical specimens were evaluated. A total of 410 specimens consisting of nasopharyngeal washes, aspirates, and swabs were simultaneously tested for the presence of RSV by direct immunofluorescence assay (DFA), enzyme immunoassay (EIA) (Kallestad Pathfinder), shell vial centrifugation culture (SVC), and conventional culture. DFA identified 146 (83%) of the 175 positive cases, EIA detected 153 (87%), SVC detected 127 (73%), and conventional culture detected 70 (40%). Conventional culture isolated an additional 19 respiratory viruses other than RSV. DFA and EIA were able to detect nonviable virus not isolated by a culture method, and SVC isolated low-titer virus not detected by conventional culture. DFA and EIA gave similar results; however, the EIA system was less dependent on technical expertise. The use of SVC enhanced the conventional culture system with 63 RSV isolates not recovered from the tube culture. We recommend complementary use of both culture and nonculture methods in the detection of RSV.
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Affiliation(s)
- S L Johnston
- Department of Laboratory Medicine, Bellin Memorial Hospital, Green Bay, Wisconsin 54305
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