Cost-effective Use of Rapid Diagnostic Techniques in the Treatment and Prevention of Viral Respiratory Infections

ArticleinPediatric Annals 34(1):24-31 · February 2005with24 Reads
Impact Factor: 0.61 · 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."

    • "It is also postulated that bacteria may be secondary invaders following a primary viral infection [14]. 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. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Jul 2015
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    • "Genital ulceration due to HSV, usually due to HSV type 2 infections, is now routinely detected by PCR in many clinical microbiology laboratories due to its increased sensitivity over viral culture. Molecular detection of respiratory viral pathogens from both upper respiratory specimens such as nasopharyngeal aspirates or throat swabs and lower respiratory specimens such as sputum or bronchoalveolar lavage fluid is cost-effective due to the prevention of hospitalisation, decreasing unnecessary testing and procedures, directing specific therapy, and reducing unnecessary antibiotic use (Henrickson, 2005). Large multiplex or tandem PCR assays testing for all the common respiratory viruses along with fastidious bacterial causes of pneumonia are now feasible providing a thorough yet cost-effective alternative to conventional detection methods. "
    [Show abstract] [Hide abstract] ABSTRACT: Diagnostic virology is of great importance particularly in disease management and for epidemiological purposes, but is slow and results are obtained when the patient has recovered or succumbed to the infection. In addition, consideration of antiviral chemotherapy is in short supply even where preliminary investigation results are available. Some viruses are highly unculturable, fastidious or hazardous to the laboratory personnel and diagnosis depends on serological methods or culture in an expensive bio-safety level. Molecular diagnostic techniques do not depend on pathogen isolation or growth or on the detection of an immune response to the pathogen, rather uses genotypic characteristics to identify specific pathogen. Nucleic acid of a given pathogen is unique, and therefore nucleic acid analysis can be used for unequivocal identification via amplification to increase the amount of material available for analysis. Nucleic acid-based diagnostic methods are extremely sensitive, reliable and to some extent affordable, and are widely used for clinical microbiology to detect pathogen.Keywords: Amplification, Diagnosis, Nucleic acid, Viral Diseases
    Full-text · Article · Aug 2014
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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 morbidity234. 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] . "
    [Show abstract] [Hide abstract] ABSTRACT: Human respiratory syncytial virus (RSV) is a common cause of respiratory infection in infants and the elderly, leading to significant morbidity and mortality. The interdisciplinary fields, especially biotechnology and nanotechnology, have facilitated the development of modern detection systems for RSV. Many anti-RSV compounds like fusion inhibitors and RNAi molecules have been successful in laboratory and clinical trials. But, currently, there are no effective drugs for RSV infection even after decades of research. Effective diagnosis can result in effective treatment, but the progress in both of these facets must be concurrent. The development in prevention and treatment measures for RSV is at appreciable pace, but the implementation into clinical practice still seems a challenge. This review attempts to present the promising diverse research approaches and advancements in the area of diagnosis, prevention, and treatment that contribute to RSV management.
    Full-text · Article · Dec 2013 · Advances in Virology
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