Nasopharyngeal viral <scp>PCR</scp> in immunosuppressed patients and its association with virus detection in bronchoalveolar lavage by <scp>PCR</scp>

Lachant, D.; Croft, Daniel; Minton, Heather McGrane; Prasad, Paritosh; Kottmann, R. Matthew

doi:10.1111/resp.13049

Cited by 28 publications

(24 citation statements)

References 24 publications

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“…In patients receiving mechanical ventilation, endotracheal aspirates or BAL fluid should be collected, even when influenza tests on upper respiratory tract specimens are negative [59]. In a study of pulmonology ward patients that used BAL as the reference standard, nasopharyngeal PCR testing had positive and negative predictive values of 88% and 89%, respectively [62]. When a virus is identified in the respiratory tract, differentiating colonization from infection may be challenging [53].…”

Section: Viral Pneumoniamentioning

confidence: 99%

Diagnosis of severe respiratory infections in immunocompromised patients

et al. 2020

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An increasing number of critically ill patients are immunocompromised. Acute hypoxemic respiratory failure (ARF), chiefly due to pulmonary infection, is the leading reason for ICU admission. Identifying the cause of ARF increases the chances of survival, but may be extremely challenging, as the underlying disease, treatments, and infection combine to create complex clinical pictures. In addition, there may be more than one infectious agent, and the pulmonary manifestations may be related to both infectious and non-infectious insults. Clinically or microbiologically documented bacterial pneumonia accounts for one-third of cases of ARF in immunocompromised patients. Early antibiotic therapy is recommended but decreases the chances of identifying the causative organism(s) to about 50%. Viruses are the second most common cause of severe respiratory infections. Positive tests for a virus in respiratory samples do not necessarily indicate a role for the virus in the current acute illness. Invasive fungal infections (Aspergillus, Mucorales, and Pneumocystis jirovecii) account for about 15% of severe respiratory infections, whereas parasites rarely cause severe acute infections in immunocompromised patients. This review focuses on the diagnosis of severe respiratory infections in immunocompromised patients. Special attention is given to newly validated diagnostic tests designed to be used on non-invasive samples or bronchoalveolar lavage fluid and capable of increasing the likelihood of an early etiological diagnosis.

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Section: Viral Pneumoniamentioning

confidence: 99%

Diagnosis of severe respiratory infections in immunocompromised patients

et al. 2020

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“…LRT specimens obtained by bronchoscopy are often needed to diagnose suspected LRT infection in critically ill and immunocompromised patients (Brownback et al 2014). FA RP performed on bronchoscopy specimens has shown to increase diagnistic yield in patients who previously tested negative on NP specimens (Azadeh et al 2018;Lachant et al 2017).…”

Section: Introductionmentioning

confidence: 99%

FilmArray respiratory panel assay: An effective method for detecting viral and atypical bacterial pathogens in bronchoscopy specimens

Locher

Roscoe

Jassem

et al. 2019

Diagnostic Microbiology and Infectious Disease

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The BioFire FilmArray Respiratory Panel (FA RP) is a rapid multiplexed molecular assay approved for detection of viral and atypical bacterial pathogens in nasopharyngeal specimens. This study aimed to evaluate the performance of the BioFire FilmArray Respiratory Panel v1.7 on bronchoscopy specimens. We tested 133 bronchial specimens (87 archived and 46 prospectively collected) with the FA RP and compared the results to the Luminex NxTAG Respiratory Pathogen Panel (NxTAG RPP). After discordant analysis, 123 specimens gave concordant results using the FA RP and the NxTAG RPP for an overall agreement of 93.9% (kappa = 0.88 [95% CI 0.80-0.96]), a positive percent agreement of 93.7% (95% CI 83.7-97.7) and a negative percent agreement of 94.1% (95% CI 84.9-98.1). In conclusion, the BioFire FilmArray RP performed reliably to detect a broad range of respiratory pathogens in bronchoscopy specimens.

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“…For example, using older testing methods, nasopharyngeal wash was superior to nasopharyngeal or oropharyngeal swabs at detecting respiratory syncytial virus by indirect fluorescent antibody test and rapid enzyme immunoassay (16). More recent studies have compared multiplex NAT results between nasopharyngeal versus bronchoalveolar lavage (BAL) specimens from the same patient and obtained within 7 days (21,22) or during the same procedure (23). The reported concordance between assay results from nasopharyngeal and BAL specimens in the above studies ranged from 77% to 89%.…”

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confidence: 99%

Diagnostic Performance of Multiplex Nucleic Acid Testing of Bronchoalveolar Lavage and Bronchial Wash Specimens for Respiratory Viral Pathogens

et al. 2018

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There is limited knowledge on the yield of performing multiplex nucleic acid testing (NAT) on multiple lower respiratory tract specimens from a single patient with a single instance of infection. We evaluated the performance characteristics of multiplex NAT assays performed concurrently on bronchoalveolar lavage (BAL) and bronchial wash (BW) specimens to detect respiratory pathogens. A retrospective study of admitted patients from March 2013 through December 2016 was performed. Individual performance characteristics of BAL and BW specimens were compared to positive results from either set of specimens. Only contemporaneous BAL and BW specimens (received by the laboratory within 4 h of each other) were included. The final cohort included 170 patients, with 184 contemporaneous BAL and BW specimens submitted for multiplex NAT (median age, 58 years; 62% male). Of the patients with positive NAT results, 38 of 40 BW specimens tested positive (overall percent agreement with combined testing, 98.9%; 95% confidence interval [CI], 95.5 to 98.9%), and 34 of 40 BAL specimens tested positive (overall percent agreement with combined testing, 96.7%; 95% CI, 93.0 to 96.7%). Assays performed on BW specimens identified 4 additional specimens and had a higher positive percent agreement (95.0%) with combined testing results compared to those performed on BAL specimens (85.0%). There was exact concordance in 174 specimens (94.6%; negative and positive for respiratory pathogens, 144 and 34 specimens, respectively). We observed high concordance (95%) between multiplex NAT results from contemporaneous BAL and BW specimens. Performance characteristics of BW specimen testing were equivalent to those of BAL specimen testing. The benefit of performing additional testing should be carefully considered against the potential complications and health care costs.

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Nasopharyngeal viral PCR in immunosuppressed patients and its association with virus detection in bronchoalveolar lavage by PCR

Abstract: NP RVP-PCR testing has high concordance with testing performed on BAL samples. Repeat testing through BAL is beneficial when there is high concern for viral infection after initial NP RVP-PCR testing is negative.

Cited by 28 publications

References 24 publications

Diagnosis of severe respiratory infections in immunocompromised patients

Diagnosis of severe respiratory infections in immunocompromised patients

FilmArray respiratory panel assay: An effective method for detecting viral and atypical bacterial pathogens in bronchoscopy specimens

Diagnostic Performance of Multiplex Nucleic Acid Testing of Bronchoalveolar Lavage and Bronchial Wash Specimens for Respiratory Viral Pathogens

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