Article

Rapid-Test Sensitivity for Novel Swine-Origin Influenza A (H1N1) Virus in Humans

Westmead Hospital, Westmead, NSW, Australia, .
New England Journal of Medicine (Impact Factor: 55.87). 11/2009; 361(25):2493. DOI: 10.1056/NEJMc0909049
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Available from: Dominic E Dwyer, May 08, 2014
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    • "In spite of the poor sensitivity of these tests for detection of influenza virus, positive results in the emergency setting or from hospitalized patients can significantly impact patient management [27, 28]. Recent evaluations of rapid immunoassays for detection of the novel 2009 influenza A (H1N1) virus have demonstrated variable and generally poor sensitivity, in some cases 25% or lower compared to reverse transcriptase (RT)-PCR [29–31]. These data highlight the limitations of diagnostic tests that target infectious agents such as influenza A virus, that have the capability to evolve significantly and rapidly. "
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    ABSTRACT: The diagnosis of respiratory virus infections has evolved substantially in recent years, with the emergence of new pathogens and the development of novel detection methods. While recent advances have improved the sensitivity and turn-around time of diagnostic tests for respiratory viruses, they have also raised important issues such as cost, and the clinical significance of detecting multiple viruses in a single specimen by molecular methods. This article reviews recent advances in specimen collection and detection methods for diagnosis of respiratory virus infections, and discusses the performance characteristics and limitations of these methods.
    Full-text · Article · Oct 2010 · International Journal of Microbiology
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    • "Rapid detection of pandemic (H1N1) 2009 infection is performed using rRT-PCR testing due to the unreliability of rapid antigen tests [14], [15] and our laboratory used the technique extensively throughout the pandemic [10]. We have demonstrated suboptimal sensitivity (62.9%) of nasopharyngeal sampling in establishing the diagnosis of pandemic influenza (H1N1) 2009 pneumonia (fig. "
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    ABSTRACT: Background From the first case reports of pandemic influenza (H1N1) 2009 it was clear that a significant proportion of infected individuals suffered a primary viral pneumonia. The objective of this study was twofold; to assess the utility of the CURB-65 community acquired pneumonia (CAP) severity index in predicting pneumonia severity and ICU admission, and to assess the relative sensitivity of nasopharyngeal versus lower respiratory tract sampling for the detection of pandemic influenza (H1N1) CAP.MethodsA retrospective cohort study of 70 patients hospitalised for pandemic influenza (H1N1) 2009 in an adult tertiary referral hospital. Characteristics evaluated included age, pregnancy status, sex, respiratory signs and symptoms, smoking and alcohol history, CURB-65 score, co-morbidities, disabling sequelae, length of stay and in-hospital mortality outcomes. Laboratory features evaluated included lymphocyte count, C-reactive protein (CRP), nasopharyngeal and lower respiratory tract pandemic influenza (H1N1) 2009 PCR results.ResultsPatients with pandemic (H1N1) 2009 influenza CAP differed significantly from those without pneumonia regarding length of stay, need for ICU admission, CRP and the likelihood of disabling sequelae. The CURB-65 score did not predict CAP severity or the need for ICU admission (only 2/11 patients admitted to ICU had CURB-65 scores of 2 or 3). Nasopharyngeal specimens for PCR were only 62.9% sensitive in CAP patients compared to 97.8% sensitivity for lower respiratory tract specimens.Conclusions The CURB-65 score does not predict severe pandemic influenza (H1N1) 2009 CAP or need for ICU admission. Lower respiratory tract specimens should be collected when pandemic (H1N1) 2009 influenza CAP is suspected.
    Full-text · Article · Sep 2010 · PLoS ONE
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    • "In our study, 4 of the 9 patients with a negative NAT result and a positive serological test result had an NAT performed only on upper respiratory tract specimens (nasopharyngeal swab or nasopharyngeal aspirate specimens ). Blyth et al [5] reported that, for patients admitted to the ICU with severe respiratory failure secondary to influenza infection, an NAT on upper respiratory tract samples was 19% less sensitive than concurrently collected lower respiratory tract samples. However, the other 5 patients had at least 1 negative NAT result from a lower respiratory tract specimen (bronchoalveolar lavage or washing specimen). "
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    ABSTRACT: During the 2009 outbreak of pandemic (H1N1) 2009 influenza (pH1N1) in Australia, acute and convalescent serum specimens were collected from 33 patients with severe respiratory disease admitted to intensive care units. Using hemagglutination inhibition of pH1N1, 29 paired serum samples showed significant increases in specific antibody titers. Of these 29 patients, 18 had pH1N1 RNA detected by routine nucleic acid testing. These results indicate that up to onethird of pH1N1 cases may not have laboratory confirmation of infection unless serological testing is included for suspected cases.
    Preview · Article · Jul 2010 · Clinical Infectious Diseases
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