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Role of real-time reverse transcription polymerase chain reaction for detection of respiratory viruses in critically ill children with respiratory disease: Is it time for a change in algorithm?
Pediatr Crit Care Med. 2011 Jul; 12(4):e160-5.PC

Abstract

OBJECTIVES

To identify the respiratory viral pathogens associated with acute lower respiratory tract infection in critically ill pediatric patients by using real-time reverse transcription-polymerase chain reaction, and compare results with those of direct fluorescence antibody assay testing.

DESIGN

Observational cohort study.

SETTING

Pediatric intensive care unit at a tertiary care academic hospital.

PATIENTS

Pediatric patients admitted to the pediatric intensive care unit with severe respiratory symptoms consistent with viral lower respiratory tract infection.

INTERVENTIONS

None.

MEASUREMENTS

Respiratory samples of pediatric patients admitted to the pediatric intensive care unit with severe respiratory symptoms between January 2008 and July 2009 were tested with direct fluorescence antibody assay and real-time reverse transcription-polymerase chain reaction.

MAIN RESULTS

At least one viral agent was detected in 70.5% of specimens by real-time reverse transcription-polymerase chain reaction and in 16.5% by direct fluorescence antibody assay (p < .001). Real-time reverse transcription-polymerase chain reaction increased the total viral yield five-fold compared to direct fluorescence antibody assay. Rhinovirus was the most commonly identified virus (41.6%). For viruses included in the direct fluorescence antibody assay panel, direct fluorescence antibody assay had a sensitivity of 0.42 (95% confidence interval 0.25-0.61) and a specificity of 1 (95% confidence interval 0.86-1.00) compared with real-time reverse transcription-polymerase chain reaction. Coinfections were not uncommon, in particular with rhinovirus, and these patients tended to have higher mortality.

CONCLUSIONS

Direct fluorescence antibody assay testing is a suboptimal method for the detection of respiratory viruses in critically ill children with lower respiratory tract infection. Given the importance of a prompt and accurate viral diagnosis for this group of patients, we suggest that real-time reverse transcription-polymerase chain reaction becomes part of the routine diagnostic algorithm in critically ill children when a viral etiology is suspected, even if conventional tests yield a negative result.

Authors+Show Affiliations

Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of California at San Francisco, San Francisco, CA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20711084

Citation

Aramburo, Angela, et al. "Role of Real-time Reverse Transcription Polymerase Chain Reaction for Detection of Respiratory Viruses in Critically Ill Children With Respiratory Disease: Is It Time for a Change in Algorithm?" Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 12, no. 4, 2011, pp. e160-5.
Aramburo A, van Schaik S, Louie J, et al. Role of real-time reverse transcription polymerase chain reaction for detection of respiratory viruses in critically ill children with respiratory disease: Is it time for a change in algorithm? Pediatr Crit Care Med. 2011;12(4):e160-5.
Aramburo, A., van Schaik, S., Louie, J., Boston, E., Messenger, S., Wright, C., & Lawrence Drew, W. (2011). Role of real-time reverse transcription polymerase chain reaction for detection of respiratory viruses in critically ill children with respiratory disease: Is it time for a change in algorithm? Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 12(4), e160-5. https://doi.org/10.1097/PCC.0b013e3181f36e86
Aramburo A, et al. Role of Real-time Reverse Transcription Polymerase Chain Reaction for Detection of Respiratory Viruses in Critically Ill Children With Respiratory Disease: Is It Time for a Change in Algorithm. Pediatr Crit Care Med. 2011;12(4):e160-5. PubMed PMID: 20711084.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of real-time reverse transcription polymerase chain reaction for detection of respiratory viruses in critically ill children with respiratory disease: Is it time for a change in algorithm? AU - Aramburo,Angela, AU - van Schaik,Sandrijn, AU - Louie,Janice, AU - Boston,Erica, AU - Messenger,Sharon, AU - Wright,Carolyn, AU - Lawrence Drew,W, PY - 2010/8/17/entrez PY - 2010/8/17/pubmed PY - 2012/5/12/medline SP - e160 EP - 5 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 12 IS - 4 N2 - OBJECTIVES: To identify the respiratory viral pathogens associated with acute lower respiratory tract infection in critically ill pediatric patients by using real-time reverse transcription-polymerase chain reaction, and compare results with those of direct fluorescence antibody assay testing. DESIGN: Observational cohort study. SETTING: Pediatric intensive care unit at a tertiary care academic hospital. PATIENTS: Pediatric patients admitted to the pediatric intensive care unit with severe respiratory symptoms consistent with viral lower respiratory tract infection. INTERVENTIONS: None. MEASUREMENTS: Respiratory samples of pediatric patients admitted to the pediatric intensive care unit with severe respiratory symptoms between January 2008 and July 2009 were tested with direct fluorescence antibody assay and real-time reverse transcription-polymerase chain reaction. MAIN RESULTS: At least one viral agent was detected in 70.5% of specimens by real-time reverse transcription-polymerase chain reaction and in 16.5% by direct fluorescence antibody assay (p < .001). Real-time reverse transcription-polymerase chain reaction increased the total viral yield five-fold compared to direct fluorescence antibody assay. Rhinovirus was the most commonly identified virus (41.6%). For viruses included in the direct fluorescence antibody assay panel, direct fluorescence antibody assay had a sensitivity of 0.42 (95% confidence interval 0.25-0.61) and a specificity of 1 (95% confidence interval 0.86-1.00) compared with real-time reverse transcription-polymerase chain reaction. Coinfections were not uncommon, in particular with rhinovirus, and these patients tended to have higher mortality. CONCLUSIONS: Direct fluorescence antibody assay testing is a suboptimal method for the detection of respiratory viruses in critically ill children with lower respiratory tract infection. Given the importance of a prompt and accurate viral diagnosis for this group of patients, we suggest that real-time reverse transcription-polymerase chain reaction becomes part of the routine diagnostic algorithm in critically ill children when a viral etiology is suspected, even if conventional tests yield a negative result. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/20711084/Role_of_real_time_reverse_transcription_polymerase_chain_reaction_for_detection_of_respiratory_viruses_in_critically_ill_children_with_respiratory_disease:_Is_it_time_for_a_change_in_algorithm L2 - https://doi.org/10.1097/PCC.0b013e3181f36e86 DB - PRIME DP - Unbound Medicine ER -