The Quidel QuickVue influenza test was compared to viral culture and reverse transcriptase PCR by the use of three different respiratory specimen types. Of 122 pediatric subjects enrolled, 59 had influenza virus infections: 44 were infected with influenza A virus and 15 were infected with influenza B virus. The sensitivity of the QuickVue test was 85% with nasopharyngeal swabs, 78% with nasal swabs, and 69% with nasopharyngeal washes. Specificities were equivalent (97% to 98%) for all three collection methods.During annual outbreaks of influenza A and B virus infection, it is estimated that 10 to 20% of the residential population of the United States may be affected and that the highest attack rates occur in school-age children (1,5,6,16,18,20). The rapid and accurate diagnosis of cases of influenza is desirable for management of children presenting to a pediatric hospital's emergency department (ED). A laboratory-confirmed diagnosis of influenza supports the appropriate use of antiviral therapy for patients to be admitted to the hospital as well as for patients to be discharged from the ED and managed as outpatients. A specific diagnosis also decreases the inappropriate use of antibiotics, other diagnostic testing, and the patient's length of stay in the ED (1,15,18,20).Several methods for laboratory diagnosis of influenza are available; these include viral culture, direct antigen detection, and direct nucleic acid amplification and detection. Viral culture is still considered the "gold standard" method, but traditional culture generally requires at least 3 days or longer to obtain a positive result. Rapid viral culture methods using "shell vial" assays have been applied to speed up the time to detection (8-11). Nucleic acid amplification methods offer very high test sensitivities and same-day results, but there are no FDA-cleared nucleic acid amplification tests for influenza virus detection. Respiratory virus antigen detection by direct or indirect immunofluorescence assay is widely used in laboratories with expertise in fluorescence microscopy, but these assays are often performed as "batch tests" a few times per day and are thus not truly rapid. Antigen detection methods which utilize single-use immunoassay test devices offer the potential for widespread test availability, relative ease of testing, and rapid turnaround (2-4, 8, 10, 12-14, 17, 21).There are limited published data on the impact of specimen type from the respiratory tract on the relative efficiencies of rapid immunoassay tests for influenza diagnosis (7, 12). Studies have examined nasopharyngeal (NP) aspirates and washes, posterior NP and throat swabs, and sputa; however, most studies have not included the collection of multiple specimen types from the same subjects. Aspirates and washes are generally considered superior to swab collections for detection of a variety of respiratory viruses, but swab samples are easier and faster to collect and may be preferred by healthcare providers in a busy ambulatory setting. In this study, we evaluated th...

Rapid antigen testing of upper respiratory secretions collected with various swab types is often utilized for laboratory diagnoses of influenza virus infection. There are limited data on the effects of swab composition on test performance. This study compared the performance of the Quidel QuickVue Influenza A؉B test on secretions from the anterior nares when a polyurethane foam swab was used for collection to that when a nylon flocked swab was used for collection. One hundred subjects who presented to a pediatric emergency department with symptoms suggestive of an influenza virus infection were recruited for the study.

Background La Crosse virus (LACV) is the most common neuroinvasive arboviral infection in children in the United States. However, data regarding predictors of disease severity and neurologic outcome are limited. Additionally, long-term neurologic and neurobehavioral outcomes remain relatively sparse. Methods This was a single-center, retrospective cohort study, followed by recruitment for a cross-sectional analysis of long-term neurobehavioral outcomes, among children aged 0–18 years with proven or probable LACV neuroinvasive disease (LACV-ND) between January 2009 and December 2018. Case ascertainment was assured by International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes cross-referenced with laboratory results detecting LACV. Demographics, diagnostics, radiographs, and outcomes were evaluated. Recruitment of patients with prior diagnosis of LACV-ND occurred from January 2020 to March 2020, with assessment performed by validated pediatric questionnaires. Results One-hundred fifty-two children (83 males; median age, 8 years [interquartile range, 5–11.5 years]) were diagnosed with proven (n = 61 [47%]) and probable (n = 91 [60%]) LACV-ND. Sixty-five patients (43%) had severe disease. Altered mental status (AMS) (odds ratio [OR], 6.36 [95% confidence interval {CI}, 2.03–19.95]; P = .0002) and seizures at presentation (OR, 10.31 [95% CI, 3.45–30.86]; P = .0001) were independent predictors of severe disease. Epileptiform discharges on electroencephalogram (EEG) were independently associated with epilepsy diagnosis at follow-up (OR, 13.45 [95% CI, 1.4–128.77]; P = .024). Fifty-four patients were recruited for long-term neurobehavioral follow-up, with frequent abnormal assessments identified (19%–54%) irrespective of disease severity. Conclusions Severe disease was observed frequently among children with LACV-ND. Seizures and AMS at presentation were independent predictors of severe disease. EEG may help determine long-term epilepsy risk. Long-term neurobehavioral issues are frequent and likely underrecognized among children with LACV-ND.

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