tetano
Editor, Senior Moderator
J Clin Virol. 2013 Sep 23. pii: S1386-6532(13)00407-1. doi: 10.1016/j.jcv.2013.09.016. [Epub ahead of print]
Respiratory virus detection in nasopharyngeal aspirate versus bronchoalveolar lavage is dependent on virus type in children with chronic respiratory symptoms.
Wurzel DF, Marchant JM, Clark JE, Mackay IM, Wang CY, Sloots TP, Upham JW, Yerkovich ST, Masters IB, Baker PJ, Anderson-James S, Chang AB.
Source
Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia; Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, Australia. Electronic address: daniellewurzel@netspace.net.au.
Abstract
BACKGROUND:
The comparative yield of respiratory virus detection from nasopharyngeal aspirate (NPA) versus bronchoalveolar lavage (BAL) is uncertain. Furthermore, the significance of virus detection and its relationship to lower airway neutrophilic inflammation is poorly studied.
OBJECTIVES:
To evaluate the sensitivity, specificity and predictive values of NPA for detecting respiratory viruses in BAL; and to determine the relationship between viruses and lower airway neutrophilia in children with non-acute respiratory illness.
STUDY DESIGN:
150 paired NPA and BAL samples were obtained from 75 children aged <18 years undergoing flexible bronchoscopy for investigation of chronic respiratory symptoms. Viral studies were performed using polymerase chain reaction (PCR). Cellularity studies were performed on BALs. Diagnostic parameters of NPA compared to BAL and associations between viruses and lower airway %neutrophils were evaluated.
RESULTS:
NPA had a higher yield than BAL for detection of any respiratory virus (52 versus 38, respectively). NPA had a high sensitivity (92%) and low specificity (57%) for detecting HRV in BAL with poor kappa agreement value of 0.398 (95% CI 0.218-0.578, p<0.001). NPA had a fair sensitivity (69%) and good specificity (90.3%) for detecting HAdV on BAL, kappa agreement was 0.561 (95% CI 0.321-0.801, p<0.001). HAdV positivity on NPA, compared to negativity, was independently associated with heightened airway neutrophilia [mean difference (95% CI): 18 (1,35); p=0.042].
CONCLUSIONS:
NPA has a higher yield for respiratory virus detection than BAL, however its diagnostic accuracy is dependent on viral species. Adenovirus positivity is associated with significantly heightened lower airway neutrophilia in children with chronic respiratory symptoms.
Copyright ? 2013. Published by Elsevier B.V.
KEYWORDS:
BAL, Bacteria, Co-infection, HAdV, HBoV, HCoV ? NL63, OC43, 229E, HKU1, HPIV1?3, HRV, Human adenovirus, Human rhinovirus, IFAV, IFBV, KI polyomavirus, KIPyV, NPA, Neutrophilic airway inflammation, PCR, Polymerase chain reaction, RSV, RVI, WU polyomavirus, WUPyV, bronchoalveolar lavage, hMPV, human adenovirus, human bocavirus, human coronaviruses, human influenza A virus, human influenza B virus, human metapneumovirus, human para-influenza virus 1?3, human rhinovirus, nasopharyngeal aspirate, polymerase chain reaction, respiratory syncytial virus, respiratory virus infection
PMID:
24125830
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/24125830
Respiratory virus detection in nasopharyngeal aspirate versus bronchoalveolar lavage is dependent on virus type in children with chronic respiratory symptoms.
Wurzel DF, Marchant JM, Clark JE, Mackay IM, Wang CY, Sloots TP, Upham JW, Yerkovich ST, Masters IB, Baker PJ, Anderson-James S, Chang AB.
Source
Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia; Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, Australia. Electronic address: daniellewurzel@netspace.net.au.
Abstract
BACKGROUND:
The comparative yield of respiratory virus detection from nasopharyngeal aspirate (NPA) versus bronchoalveolar lavage (BAL) is uncertain. Furthermore, the significance of virus detection and its relationship to lower airway neutrophilic inflammation is poorly studied.
OBJECTIVES:
To evaluate the sensitivity, specificity and predictive values of NPA for detecting respiratory viruses in BAL; and to determine the relationship between viruses and lower airway neutrophilia in children with non-acute respiratory illness.
STUDY DESIGN:
150 paired NPA and BAL samples were obtained from 75 children aged <18 years undergoing flexible bronchoscopy for investigation of chronic respiratory symptoms. Viral studies were performed using polymerase chain reaction (PCR). Cellularity studies were performed on BALs. Diagnostic parameters of NPA compared to BAL and associations between viruses and lower airway %neutrophils were evaluated.
RESULTS:
NPA had a higher yield than BAL for detection of any respiratory virus (52 versus 38, respectively). NPA had a high sensitivity (92%) and low specificity (57%) for detecting HRV in BAL with poor kappa agreement value of 0.398 (95% CI 0.218-0.578, p<0.001). NPA had a fair sensitivity (69%) and good specificity (90.3%) for detecting HAdV on BAL, kappa agreement was 0.561 (95% CI 0.321-0.801, p<0.001). HAdV positivity on NPA, compared to negativity, was independently associated with heightened airway neutrophilia [mean difference (95% CI): 18 (1,35); p=0.042].
CONCLUSIONS:
NPA has a higher yield for respiratory virus detection than BAL, however its diagnostic accuracy is dependent on viral species. Adenovirus positivity is associated with significantly heightened lower airway neutrophilia in children with chronic respiratory symptoms.
Copyright ? 2013. Published by Elsevier B.V.
KEYWORDS:
BAL, Bacteria, Co-infection, HAdV, HBoV, HCoV ? NL63, OC43, 229E, HKU1, HPIV1?3, HRV, Human adenovirus, Human rhinovirus, IFAV, IFBV, KI polyomavirus, KIPyV, NPA, Neutrophilic airway inflammation, PCR, Polymerase chain reaction, RSV, RVI, WU polyomavirus, WUPyV, bronchoalveolar lavage, hMPV, human adenovirus, human bocavirus, human coronaviruses, human influenza A virus, human influenza B virus, human metapneumovirus, human para-influenza virus 1?3, human rhinovirus, nasopharyngeal aspirate, polymerase chain reaction, respiratory syncytial virus, respiratory virus infection
PMID:
24125830
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/24125830