Article

Cost-effective use of rapid diagnostic techniques in the treatment and prevention of viral respiratory infections

Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Pediatric Annals (Impact Factor: 0.29). 02/2005; 34(1):24-31. DOI: 10.3928/0090-4481-20050101-08
Source: PubMed

ABSTRACT The most cost-effective current use of rapid respiratory virus diagnostics is through highly sensitive and specific molecular assays (mostly PCR-based) in the hospital setting or for chronically ill or immunocompromised outpatients. Specifically, this cost savings is the result of preventing hospitalization or decreasing length of hospitalization, decreasing unnecessary testing and procedures, directing specific therapy, and reducing unnecessary antibiotic use. Equally important is community surveillance by informing physicians rapidly what agents are in the community. Important ongoing issues regarding the cost-effective use of these assays include the cost of reagents or machinery, reimbursement for testing, the need for reliable commercial reagents, the need for open platforms that can respond to new "emerging" or "reemerging" agents, and the need for proficiency panels to share between laboratories. Rapid molecular diagnostic assays for the detection of respiratory viruses have moved into the mainstream of clinical testing. These assays already play important roles in select populations and clinical situations for critical patient management. In addition, there are numerous clinical scenarios where the use of these assays should have a positive cost/benefit ratio. Further work needs to be done to demonstrate this benefit to society. Further development of multiplex assays and decreasing the cost of testing will help improve the benefit of these assays to clinical care. Work is underway on large multiplex molecular assays with high sensitivity and specificity that will be able to be used in an outpatient setting both because of speed and low cost. The future holds great potential for physicians. who soon may be able to answer the age-old question, "Doc, what do I have?" with more than, "You probably have a virus."

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    • "Of all respiratory viruses, Human respiratory syncytial virus (HRSV) is the major cause of lower respiratory disease among infants and adults [15], [16] of the lungs and breathing passages causing bronchiolitis, pneumonia, and chronic obstructive pulmonary infections along with other viral infections leading to high mortality and morbidity [17], [18], [19]. However, there had been sparse studies reporting viral etiology in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients worldwide. "
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    ABSTRACT: Chronic obstructive pulmonary disease is the leading cause of fatality. The course of COPD is followed by episodes of acute deterioration in respiratory health, ref erred as ‘exacerbations’. Acute exacerbations of COPD contribute substantially to the morbidity and mortality due to number of infectious agents including bacteria, viruses, or both. Therefore, we planned a case control study to know the association of res piratory viruses especially HRSV genotype with acute exacerbation of COPD, if any. This is a prospective case -control study with two groups of patients (AECOPD and stable COPD). Nasopharyngeal aspirate were tested for the detection of Human Respiratory Syncytial Virus; Influenza Viruses; Human Metapneumovirus; Adeno Virus; Human Boca Virus and Parainfluenza Virus 1,2,3,4 by real time PCR. Respiratory viruses are more often found in case group (AECOPD patients) 45/ 234 patients (19.23%) than in control group (stable COPD), 8/100 patients (8%; P=0.0330). In case group HRSV was detected in 7.6% (18/234) and was most commonly detected virus followed by INFV-A (11/234; 4.7%), INFV- B (10/234; 4.2%), HMPV (2/234; 0.8%), and ADV (4/234; 1.7%). In control group INFV-A was most commonly detected (4/100, 4%), followed by ADV (2/100, 2%) and HRSV (1/100, 1%). No patient tested positive for more than one virus. Among respiratory viruses, HRSV- A is the most prominent group associated with AECOPD patients. Present study concluded that respiratory viruses play an important role in exacerbation.
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    • "Worldwide, there are reportedly about 12 million severe and 3 million very severe cases of lower respiratory tract infection (LRTI) in children [1]. Respiratory syncytial virus (RSV) is a common contributor of respiratory infections causing bronchiolitis, pneumonia, and chronic obstructive pulmonary infections in people of all ages but affects mainly children and elderly along with other viral infections leading to high mortality and morbidity [2] [3] [4]. A recent global survey suggests that RSV is not prevalent throughout the year in the tropical regions of the globe, but the incidence peaks in winter with a wide ranging persistence depending on the geographical topology [5]. "
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    Advances in Virology 12/2013; 2013:595768. DOI:10.1155/2013/595768
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    • "Diagnosis will become increasingly important to clinical management of individual children, and is urgently needed for global public health, including pathogen surveillance. In recent years significant progress has been made in applying advances in molecular biology to respiratory virus diagnosis, and some of the new strategies are already clinically useful [155] [156] [157]. For the practitioner, guidelines and clear data are needed regarding the situations in which specific kinds of assays may be appropriate. "
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    ABSTRACT: Respiratory syncytial virus (RSV), the recently identified human metapneumovirus (HMPV), and the human parainfluenza viruses (HPIVs), cause most cases of childhood croup, bronchiolitis, and pneumonia. Influenza virus also causes a significant burden of disease in young children, although its significance in children was not fully recognized until recently. This article discusses pathogens that have been studied for several decades, including RSV and HPIVs, and also explores the newly identified viral pathogens HMPV and human coronavirus NL63. The escalating rate of emergence of new infectious agents, fortunately meeting with equally rapid advancements in molecular methods of surveillance and pathogen discovery, means that new organisms will soon be added to the list. A section on therapies for bronchiolitis addresses the final common pathways that can result from infection with diverse pathogens, highlighting the mechanisms that may be amenable to therapeutic approaches. The article concludes with a discussion of the overarching impact of new diagnostic strategies.
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