RSV testing in bronchiolitis: which nasal sampling method is best?

Macfarlane, P I; Denham, Joshua; Assous, J; Hughes, C.

doi:10.1136/adc.2004.065144

Cited by 83 publications

(70 citation statements)

References 6 publications

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“…These findings expand on those of previous studies of nasal sampling in children (1,4,5,8,10) and have implications for the diagnosis and study of respiratory viruses. First, nasal selfsampling was simple, was preferred to staff collection, and may enable testing of more people earlier in the course of their illnesses.…”

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confidence: 73%

Development and Evaluation of a Flocked Nasal Midturbinate Swab for Self-Collection in Respiratory Virus Infection Diagnostic Testing

et al. 2010

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We developed and evaluated flocked nasal midturbinate swabs obtained from 55 asymptomatic and 108 symptomatic volunteers. Self-collected swabs obtained from asymptomatic volunteers yielded numbers of respiratory epithelial cells comparable to those of staff-collected nasal (n ‫؍‬ 55) or nasopharyngeal (n ‫؍‬ 20) swabs. Specific viruses were detected in swabs self-collected by 42/108 (38.9%) symptomatic volunteers by multiplex PCR.We report herein the design and evaluation of a novel selfcollected nasal midturbinate swab for respiratory virus diagnosis. We previously demonstrated that Copan flocked nasopharyngeal swabs (NPS) collected significantly more respiratory epithelial cells than conventional rayon swabs and improved sample collection for direct fluorescent antibody (DFA) testing of respiratory viruses (2). We observed that the cell yield obtained from sampling the nose using a flocked swab designed for nasopharyngeal sampling was equivalent to that obtained from nasopharyngeal sampling using rayon NPS. This led us to hypothesize that a flocked nasal swab designed to contact a larger nasal surface area would further improve cell sampling and enable self-collection.We measured the nasal passages of adult white cadavers at the Michael G. DeGroote School of Medicine anatomy laboratory, McMaster University, and designed a tapered coneshaped swab with a greater length and diameter of flocked nylon ( Fig. 1). A collar was added at 5.5 cm as a guide to maximum insertion depth for adults. The nasal swab samples a large surface area of respiratory mucosa, covering the inferior and middle turbinate bones, and is now commercially available in pediatric and adult sizes (FLOQSwabs; Copan Italia S.p.A., Brescia, Italy).Our primary study objectives were to determine the feasibility, acceptability, and performance characteristics of selfsampled nasal midturbinate swabs. We tested the adequacy of self-collected flocked nasal swabs, the equivalence of nasal and nasopharyngeal sampling, and the diagnostic yield for specific respiratory viruses by multiplex PCR. The study protocol was approved by the Research Ethics Board at St. Joseph's Healthcare, Hamilton, Ontario, Canada.To examine the adequacy of respiratory specimen self-collection, 55 healthy asymptomatic adult volunteers were recruited from hospital staff and visitors. After providing signed informed consent, volunteers self-collected two flocked nasal swabs by following the printed instructions with illustrations. Each swab was inserted up to 5.5 cm, as tolerated, into the same nostril of their choice. An experienced staff member then collected the following two additional nasal swabs, using the opposite nostril in randomized order: a flocked midturbinate nasal swab and a rayon pernasal swab. A self-administered questionnaire assessed the ease of self-collection, discomfort, and swab preferences.All four nasal swabs were placed into universal transport medium (UTM; Copan Italia S.p.A.) and coded to maintain blinding. Samples were processed identically, according to c...

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confidence: 73%

Development and Evaluation of a Flocked Nasal Midturbinate Swab for Self-Collection in Respiratory Virus Infection Diagnostic Testing

et al. 2010

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“…We have previously demonstrated equivalent positivity rates between NPA and NPS (4), although several other studies have shown differences (1,6,9). Swab sampling may be preferable to aspirate due to lower cost, less mucus contamination, and the lack of availability of a suction apparatus in many clinical settings.…”

mentioning

confidence: 97%

“…Several reports (5,6,8,9). have suggested that sensitivity increases when the nasopharynx is sampled instead of the nasal cavity.…”

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confidence: 99%

Comparison of Flocked and Rayon Swabs for Collection of Respiratory Epithelial Cells from Uninfected Volunteers and Symptomatic Patients

Daley¹,

Castriciano²,

Chernesky³

et al. 2006

J Clin Microbiol

174

131

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“…The use of rapid tests for the diagnosis of RSV and hMPV infections allows implementation of appropriate infection control measures, thus reducing nosocomial spread, and is useful for consideration of timely treatment with antiviral agents (8,12). The clinical and financial benefits of the rapid detection of RSV in respiratory specimens have been demonstrated in several studies, indicating a direct correlation between a rapid turnaround time and decreased mortality, a decreased length of stay, overall costs, and better antibiotic stewardship (1,8,12,25). On the other hand, few rapid antigen assays for hMPV detection with hMPV-specific monoclonal antibodies have been reported (3,9,18).…”

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confidence: 99%

Prospective Evaluation of Rapid Antigen Tests for Diagnosis of Respiratory Syncytial Virus and Human Metapneumovirus Infections

Aslanzadeh

Zheng

Li³

et al. 2008

J Clin Microbiol

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Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are two important viral pathogens that cause respiratory tract infections in the pediatric population. The rapid detection of these agents allows the prompt isolation and treatment of infected patients. In the present prospective study, we evaluated the performances of four rapid antigen detection assays, including a rapid chromatographic immunoassay ( , the CIA had a sensitivity of 79.8% and a specificity of 89.5%. The RSV DFA with Bartels reagents showed a sensitivity of 94.1% and a specificity of 96.8%. For hMPV, the sensitivity and specificity were 62.5% and 99.8%, respectively, for the DHI DFA and 63.2% and 100%, respectively, for the Imagen DFA. The hands-on and test turnaround times for CIA were 10 and 30 to 60 min, respectively, and the hands-on and test turnaround times for the RSV and hMPV DFAs were 30 and 105 min, respectively. We conclude that while the RSV CIA is user-friendly, it lacks sensitivity and specificity, especially during off-peak months. In contrast, the RSV DFA is more sensitive and specific, but interpretation of its results is subjective and it demands technical time and expertise. Similarly, both hMPV DFAs are highly specific in comparison to the results of RT-PCR, but their sensitivities await further improvements.Respiratory syncytial virus (RSV) is the single most important cause of respiratory tract infections in children. It is estimated that each year in the United States, 100,000 hospitalizations and 4,500 deaths are attributed to RSV infection (20). Similar to RSV, human metapneumovirus (hMPV), identified in The Netherlands in 2001, is thought to cause upper and lower respiratory tract infections in children (23). Both RSV and hMPV are members of the family Paramyxoviridae (20). They are enveloped, single-stranded, negative-sense RNA viruses. Epidemiological studies indicate that, like RSV, hMPV is a significant human respiratory pathogen with a worldwide distribution (6,16,23,24). Indeed, hMPV appears to affect many of the same subpopulations and cause clinical manifestations, including upper respiratory tract infections, bronchiolitis, and pneumonia, similar to those caused by RSV, although they are of lesser severity (24). Both RSV and hMPV have been shown to infect the majority of children by the age of 5 years. Moreover, reinfections have been observed in all age groups (4).The laboratory diagnosis of RSV and hMPV infections can be made by virus isolation, detection of viral antigens, amplification of viral RNA by molecular techniques, demonstration of a rise in serum antibody levels, or a combination of these approaches (7,9,13,15,21,26). The use of rapid tests for the diagnosis of RSV and hMPV infections allows implementation of appropriate infection control measures, thus reducing nosocomial spread, and is useful for consideration of timely treatment with antiviral agents (8,12). The clinical and financial benefits of the rapid detection of RSV in respiratory specimens have been demonstrated in several...

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RSV testing in bronchiolitis: which nasal sampling method is best?

Cited by 83 publications

References 6 publications

Development and Evaluation of a Flocked Nasal Midturbinate Swab for Self-Collection in Respiratory Virus Infection Diagnostic Testing

Development and Evaluation of a Flocked Nasal Midturbinate Swab for Self-Collection in Respiratory Virus Infection Diagnostic Testing

Comparison of Flocked and Rayon Swabs for Collection of Respiratory Epithelial Cells from Uninfected Volunteers and Symptomatic Patients

Prospective Evaluation of Rapid Antigen Tests for Diagnosis of Respiratory Syncytial Virus and Human Metapneumovirus Infections

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