Jewel M Greer

Baylor College of Medicine, Houston, TX, United States

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Publications (11)36.75 Total impact

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    ABSTRACT: Direct immunofluorescence assay (DFA) is commonly used for the rapid identification of herpes simplex virus (HSV) infection in mucocutaneous lesions, yet little is known about its diagnostic accuracy. To determine the diagnostic yield and accuracy of HSV DFA for the diagnosis of mucocutaneous HSV infection in pediatric patients. Retrospective cross-sectional study of all patients who underwent HSV DFA testing by the Texas Children's Hospital Diagnostic Virology between January 1, 1995 and December 31, 2005. HSV DFA sensitivity, specificity, positive likelihood ratio (LRs), and negative LRs were estimated using viral culture as the reference standard. 659 specimens were submitted for HSV DFA with concurrent viral cultures. Viral cultures were positive for HSV type 1 in 158 (24%) and HSV type 2 in 2 (0.3%). There were 433 different patients with a median age of 8.6 years. Types of lesions were as follows: 50% ulcerative, 26% vesicular, 8% erythema or purpura, 5% pustular, and 11% missing. Of the 659 specimens submitted for HSV DFA, 160 (24%) were inconclusive due to inadequate cells. Of the 499 adequate specimens, overall HSV DFA test accuracy was: sensitivity 61%, specificity 99%, LR positive 40, and LR negative 0.39. A quarter of specimens submitted for HSV DFA testing are not adequate for DFA testing. When HSV DFA can be performed, it is specific, but not sensitive, for the identification of mucocutaneous HSV infection in children.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 09/2010; 49(1):58-60. · 3.12 Impact Factor
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    ABSTRACT: Adenoviruses are a prominent cause of respiratory, ocular, gastrointestinal, and disseminated diseases in healthy and immunocompromised children. An accurate rapid diagnostic assay may impact clinical decision-making. Evaluate the performance of a new rapid assay for detection of adenoviruses directly in pediatric clinical specimens. The rapid assay was performed on adenovirus culture-positive original samples and on an equal number of culture-negative samples matched by patient age and specimen type. Discrepant results were resolved using a polymerase chain reaction (PCR) assay. 200 adenovirus culture-positive and 200 adenovirus culture-negative samples were evaluated from 315 different patients. Overall sensitivity was 55% and specificity was 98.9%. The assay was most sensitive in children 5 years old and younger and most specific in respiratory samples. The rapid assay was highly specific for detecting adenovirus infections in children. However, since this rapid assay had only moderate to low sensitivity, samples with negative rapid assay results should have additional testing for adenovirus performed by either viral culture or PCR.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 02/2009; 44(2):173-5. · 3.12 Impact Factor
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    ABSTRACT: The rapid and accurate diagnosis of influenza facilitates antiviral therapy, judicious antibiotic usage, and cohorting patients to decrease nosocomial infection. To determine the utility of rapid influenza tests in a children's hospital. Two in vitro rapid immunochromatographic assays that detect and distinguish influenza A and B viruses were compared to the reference standard of viral culture. In 9186 patients tested, overall sensitivity of the rapid assays for influenza A was 64.4% and specificity was 98.3%. Sensitivity and specificity were 28% and 99.9%, respectively, for influenza B. Overall sensitivity and specificity for Remel Xpect (2004/2005) were 47.7% and 98.7% for influenza A, and 20.3% and 99.8% for influenza B, respectively. Overall sensitivity and specificity of Binax NOW Flu A&B (2005/2006) were 78.3% and 98% for influenza A, and 35.9% and 99.9% for influenza B, respectively. The results for influenza B with both assays were significantly lower than previously reported and lower than stated in the manufacturer's package insert. In a contemporary clinical setting, rapid assays for influenza displayed significantly lower sensitivities, especially for influenza B, than prior reports. Differences in pre- and post-licensure performance demonstrate the importance of continuous evaluation of rapid diagnostic tests for influenza.
    Journal of Clinical Virology 02/2008; 41(2):143-7. · 3.47 Impact Factor
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    ABSTRACT: A rapid assay, Binax NOW RSV, was compared to viral culture for 14,756 pediatric respiratory specimens obtained from 2003 to 2006. There were 794 viral culture-confirmed respiratory syncytial virus infections. Sensitivity was 81%, and specificity was 93.2%. Sensitivity was greatest for neonates (91.1% versus 80.7% [P < 0.01]).
    Journal of Clinical Microbiology 07/2007; 45(6):1993-5. · 4.23 Impact Factor
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    ABSTRACT: We evaluate the performance of a rapid assay (Binax NOW) for the detection of influenza A virus in children. The performance of an in vitro rapid immunochromatographic assay for detection of influenza A virus was compared to viral culture in 4,383 consecutive respiratory specimens received during the 2003 to 2004 season, which included an influenza A epidemic in October and November of 2003. The overall test sensitivity was 61.6% (95% confidence interval [CI] 60.3% to 63.2%) and specificity was 95.8% (95% CI 95.1% to 96.3%). In preplanned subset analyses, we found the test more sensitive in infants aged 90 days or younger (sensitivity 70.3%; specificity 96.6%) and less specific during the epidemic (sensitivity 61.7%; specificity 90.4%). This rapid assay was highly specific for detecting influenza A in children and thus appears useful for confirming this infection. Because of its limited sensitivity, however, a negative test cannot rule out influenza A.
    Annals of emergency medicine 04/2006; 47(3):250-4. · 4.33 Impact Factor
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    ABSTRACT: BACKGROUND: Infection with BK virus (BKV) generally occurs early during life, but its mode of transmission has not been clearly defined. We tested the hypothesis that polyomavirus shedding in stool may be a source of BKV exposure.METHODS. Pediatric stool and rectal swab samples were tested for the presence of polyomavirus DNA by a polymerase chain reaction (PCR) assay that could detect a conserved region in the large T antigen gene of BKV, JC virus (JCV), and simian virus 40 (SV40). The specific viruses detected by this assay were confirmed by DNA sequence analysis of the PCR amplicons.Results. Of 120 samples collected from 99 patients, 54 (45.0%) were positive for polyomavirus DNA. Of the 99 patients, 46 (46.5%) had at least 1 positive sample, with 38 (38.4%) positive for BKV and 8 (8.1%) positive for SV40. JCV was not detected. There was no association between polyomavirus fecal shedding and age, sex, race/ethnicity, immune status, or symptoms of gastrointestinal disease in the children studied. The BKV strains detected displayed polymorphisms in the T antigen sequence.Conclusions. Polyomaviruses are frequently present in stool samples from hospitalized children. These findings suggest that fecal-oral transmission of BKV may play a role in the ubiquity of infection.
    The Journal of Infectious Diseases 09/2005; 192(4):658-64. · 5.78 Impact Factor
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    ABSTRACT: Background: Human rhinoviruses (HRVs) commonly cause upper respiratory infections (URI) in children and adults and are associated with an enormous economic burden. However, the role of HRV in lower respiratory infections (LRI) or pneumonia is not well characterized, especially in pediatric populations. Methods: A retrospective chart review of patients with HRV isolated from tracheal aspirate (TA) or bronchoalveolar lavage (BAL) specimens obtained between January 1, 1997 and December 31, 2001 was performed. Demographic and clinical data were collected. Cases were classified as having URI or LRI based on symptoms and pneumonia based on final chest radiograph (CXR) report. Cases were defined as community-acquired (CA-HRV) if culture collected within 2 days of admission. Results: HRV was isolated from 1,560(5.5%) of 28,347 respiratory viral cultures. 82(5.2%) of HRVs were from TA (n=72) or BAL (n=10). 50/82 (61%) cases were available for review. 27(54%) were male, mean age 3.6 yrs (range 0.08-21 yrs) and 45(90%) had underlying medical conditions including asthma (n=6), cardiac defect (n=13) or tracheostomy (n=14). 30/50 (60%) were CA-HRV with 2 (6.7%) URI, 8(2.7%) LRI, and 19(63.3%) pneumonia. All CA-HRV cases were admitted (mean 11.2 ± 7.53 d, range 1-28 d); 16 (53.3%) to ICUs, 14 (46.7%) intubated and 27 (90%) received IV antibiotics (mean 7.2 ± 4.38 d, range 2-21 d) without clear evidence of bacterial infection. One patient died, a 1-month old with respiratory failure and histiocytosis. Although not significant, dual viral infection was associated with pneumonia (OR = 2.25, CI 0.18,61.63, p = 0.640). Conclusions: HRV was isolated from lower respiratory tract specimens and appeared to be associated with LRI and pneumonia complicated by respiratory failure or rarely, death. Cases tended to have underlying medical conditions and over half of cases with CA-HRV were admitted to ICU and received IV antibiotic therapy. Dual viral infections may play a role in pneumonia associated with HRV in children.
    Infectious Diseases Society of America 2004 Annual Meeting; 10/2004
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    ABSTRACT: Background:Respiratory syncytial virus (RSV) is a common cause of hospitalization in young children and immunocompromised patients. Rapid and accurate detection of RSV allows for cohorting of patients to decrease nosocomial infection, judicious stewardship of antibiotics, timely initiation of antiviral therapy in high-risk patient populations, and admission of select patients for admission based on risk of apnea. Rapid RSV test methods vary and test performance in clinical settings may differ from package inserts. Methods: Between October 1, 2002 and May 31, 2003, all patients evaluated at a large children’s hospital for RSV respiratory illness by both rapid RSV membrane enzyme immunoassay (Directigen™ RSV; Becton Dickinson, Sparks, MD) and viral culture were included in this study. Fresh respiratory secretions (3920 nasal washes, 83 other sources) were processed within 1 hour. Performance characteristics of the assay compared to viral culture results were calculated using 2x2 contingency tables. Confidence intervals were calculated based on a population of 1,000,000. Results: 420/4003 (10.5%) were positive by rapid RSV assay; 3 were excluded for inconclusive results. 1136/4003 grew at least one virus: RSV 346, picornaviruses 252, influenza viruses 188, parainfluenza viruses 140, adenovirus 85, cytomegalovirus 61, herpes simplex 13. 51 grew multiple viruses, including 17 with RSV and at least one other virus. Overall performance was sensitivity 56%, specificity 94%, positive predictive value 47%, negative predictive value 96%. Performance did not vary by specimen source. However, sensitivity was greater (57% [CI: 54.7-59.3] vs. 42% [CI: 39.5-44.5], p < 0.001) in patients less than 1 year-old compared to older patients. Conclusion: The rapid assay evaluated displayed excellent specificity but only fair sensitivity for detecting RSV in respiratory samples from children, suggesting it is a good confirmatory test, but less accurate if used as a screening tool.
    Infectious Diseases Society of America 2004 Annual Meeting; 10/2004
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    ABSTRACT: The performance of a commercially available, rapid membrane enzyme immunoassay for influenza A and B virus detection was compared to that of viral culture in 4,092 respiratory specimens collected from patients presenting with respiratory symptoms during the 2002-2003 influenza season. The test's overall sensitivity was 43.83%, lower than previously reported but similar for detection of both influenza A and B viruses (42.98 versus 44.76%). However, specificity, 99.74%, was excellent for both influenza A and B viruses (99.82 versus 99.92%). These values make this test a very good confirmatory test when clinical suspicion is high, but a less accurate screening test for large populations.
    Journal of Clinical Microbiology 09/2004; 42(8):3707-10. · 4.23 Impact Factor
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    ABSTRACT: The performance of a new rapid lateral-flow chromatographic membrane immunoassay test kit for detection of influenza virus was evaluated and compared to that of viral culture in respiratory secretions collected from 400 adults and children seen at three large university hospitals during the recent 2003 influenza season. The rapid test provided results in 15 min, with excellent overall performance statistics (sensitivity, 94.4%; specificity, 100%; positive predictive value, 100%; negative predictive value, 97.5%). Both influenza A and B type viruses were reliably detected, with no significant difference in performance statistics noted by influenza virus type or by the center performing the test.
    Journal of Clinical Microbiology 09/2004; 42(8):3661-4. · 4.23 Impact Factor
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    ABSTRACT: The performance of two commercially available rapid test kits for influenza virus detection was compared to that of viral culture by using 356 nasal wash specimens collected during the 2001 to 2002 influenza season. Overall, the two rapid tests were easy to perform and showed comparable sensitivities (70.4 and 72.2%) and specificities (97.7 and 98.3%); for both test kit groups, most of the specimens that yielded false-negative results were found to be growing influenza B virus.
    Journal of Clinical Microbiology 06/2003; 41(5):2132-4. · 4.23 Impact Factor