RESUMO
BACKGROUND: The rapid and accurate diagnosis of influenza facilitates antiviral therapy, judicious antibiotic usage, and cohorting patients to decrease nosocomial infection. OBJECTIVE: To determine the utility of rapid influenza tests in a children's hospital. STUDY DESIGN: Two in vitro rapid immunochromatographic assays that detect and distinguish influenza A and B viruses were compared to the reference standard of viral culture. RESULTS: 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. CONCLUSIONS: 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.
Assuntos
Cromatografia/métodos , Hospitais Pediátricos , Vírus da Influenza A/isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Influenza Humana/diagnóstico , Kit de Reagentes para Diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Influenza Humana/virologia , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Texas , Fatores de Tempo , Cultura de VírusRESUMO
We present 53 pediatric cases of Pantoea agglomerans infections cultured from normally sterile sites in patients seen at a children's hospital over 6 years. Isolates included 23 from the bloodstream, 14 from abscesses, 10 from joints/bones, 4 from the urinary tract, and 1 each from the peritoneum and the thorax. P. agglomerans was most associated with penetrating trauma by vegetative material and catheter-related bacteremia.
Assuntos
Infecções por Bactérias Gram-Negativas/microbiologia , Pantoea/patogenicidade , Doenças das Plantas/microbiologia , Abscesso/microbiologia , Adolescente , Bacteriemia/microbiologia , Criança , Pré-Escolar , Feminino , Infecções por Bactérias Gram-Negativas/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Pantoea/isolamento & purificaçãoRESUMO
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]).
Assuntos
Antígenos Virais/análise , Hospitais Pediátricos , Kit de Reagentes para Diagnóstico , Infecções por Vírus Respiratório Sincicial/diagnóstico , Vírus Sincicial Respiratório Humano/isolamento & purificação , Adolescente , Adulto , Linhagem Celular , Criança , Pré-Escolar , Cromatografia/métodos , Humanos , Testes Imunológicos/métodos , Lactente , Recém-Nascido , Infecções por Vírus Respiratório Sincicial/virologia , Vírus Sincicial Respiratório Humano/imunologia , Sistema Respiratório/virologia , Sensibilidade e Especificidade , Fatores de Tempo , Cultura de VírusRESUMO
STUDY OBJECTIVE: We evaluate the performance of a rapid assay (Binax NOW) for the detection of influenza A virus in children. METHODS: 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. RESULTS: 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%). CONCLUSION: 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.
Assuntos
Vírus da Influenza A/isolamento & purificação , Influenza Humana/diagnóstico , Influenza Humana/virologia , Kit de Reagentes para Diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Cromatografia/instrumentação , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Imunoensaio/instrumentação , Lactente , Recém-Nascido , Sensibilidade e Especificidade , Cultura de VírusRESUMO
Little evidence exists on how to efficiently and effectively monitor HIV-disease progression in developing countries. Better understanding regarding cost-effective tests may help to resolve questions regarding treatment. A prospective cohort study was conducted with a 1-year follow-up period. Immune complex-dissociated (ICD) p24 antigen (ICD p24Ag), alone or in combination with HIV p24 antibody (p24Ab), was compared to HIV-RNA and CD4+ count in a cohort of 160 HIV-infected adolescents in Romania. The main outcome measure was disease progression, defined as >50,000 copies/ml of HIV-RNA or death. Among the 160 adolescents, a higher mean ICD p24Ag was significantly associated with clinical disease classification (CDC), plasma HIV-RNA concentration, and p24Ab. Multivariate logistic regression showed detectable ICD p24Ag had an odds ratio of 3.7 (95% CI 1.4-9.7) for disease progression in comparison to undetectable ICD p24Ag. ICD p24Ag is of value in determining the prognosis of disease in HIV-1-infected adolescents in developing countries. Additional studies for validation of this assay for HIV clades primarily affecting developing countries, are now needed.
Assuntos
Contagem de Linfócito CD4 , Proteína do Núcleo p24 do HIV/sangue , Infecções por HIV/imunologia , RNA Viral/sangue , Adolescente , Criança , Progressão da Doença , Feminino , Anticorpos Anti-HIV/sangue , Proteína do Núcleo p24 do HIV/imunologia , Infecções por HIV/sangue , Infecções por HIV/fisiopatologia , HIV-1 , Humanos , Masculino , Análise Multivariada , Estudos Prospectivos , Romênia , Sensibilidade e EspecificidadeAssuntos
Endocardite Bacteriana/diagnóstico , Febre de Causa Desconhecida/etiologia , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/crescimento & desenvolvimento , Antibacterianos/uso terapêutico , Pré-Escolar , Ecocardiografia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/cirurgia , Humanos , Masculino , Meticilina/uso terapêutico , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgiaRESUMO
OBJECTIVES: Our objectives were to (1) describe the clinical characteristics of and viruses isolated from patients who presented with neurologic symptoms associated with influenza A infection and were hospitalized at Texas Children's Hospital during October and November 2003 and (2) to raise awareness of the neurologic complications of influenza among US children. METHODS: We reviewed the medical and laboratory records of all children who were hospitalized with neurologic symptoms and who also had evidence of influenza virus infection by rapid antigen testing or viral isolation. RESULTS: Eight children aged 5 months to 9 years with neurologic complications associated with influenza A were identified. None of the children had received the influenza vaccine. Four presented with seizures, 3 with mental status changes, and 1 with mutism. All but 1 of the patients had influenza A viral antigen detected in nasal wash samples. Influenza A virus was isolated in culture from nasal wash specimens obtained from 6 of the patients; influenza A virus was also isolated from the cerebrospinal fluid of 1 of these patients. None of the patients had serum metabolic abnormalities or other cerebrospinal fluid abnormalities. Three of the patients had brain imaging abnormalities. Five of the patients were treated with antivirals. All 8 of the patients survived, 6 with complete recovery and 2 with sequelae (1 mild and 1 severe). CONCLUSIONS: Neurologic symptoms and sequelae were associated with influenza A virus infection in children during the 2003-2004 influenza season in Houston, Texas. Influenza should be considered in the differential diagnosis in patients with seizures and mental status changes, especially if they present with respiratory symptoms or during an influenza outbreak.
Assuntos
Transtornos da Consciência/etiologia , Vírus da Influenza A , Influenza Humana/complicações , Mutismo/etiologia , Doenças do Sistema Nervoso/etiologia , Convulsões/etiologia , Encéfalo/patologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Vírus da Influenza A/isolamento & purificação , Influenza Humana/patologia , Influenza Humana/virologia , Imageamento por Ressonância Magnética , Masculino , Líquido da Lavagem Nasal/virologia , TexasRESUMO
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.
Assuntos
Vírus da Influenza A/isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Influenza Humana/diagnóstico , Sistema Respiratório/virologia , Cromatografia/métodos , Humanos , Imunoensaio/métodos , Vírus da Influenza A/classificação , Vírus da Influenza B/classificação , Laboratórios/normas , Valor Preditivo dos Testes , Kit de Reagentes para Diagnóstico/normas , Sensibilidade e EspecificidadeRESUMO
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.
Assuntos
Vírus da Influenza A/isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Influenza Humana/diagnóstico , Sistema Respiratório/virologia , Criança , Humanos , Técnicas Imunoenzimáticas , Vírus da Influenza A/classificação , Vírus da Influenza B/classificação , Influenza Humana/epidemiologia , Kit de Reagentes para Diagnóstico , Estações do Ano , Texas/epidemiologiaRESUMO
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.