Testing for Respiratory Viruses in Adults With Severe Lower Respiratory Infection

Walter, James M.; Wunderink, Richard G.

doi:10.1016/j.chest.2018.06.003

Cited by 27 publications

(22 citation statements)

References 72 publications

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“…The IDSA recommends that all immunocompromised patients presenting with acute onset of respiratory symptoms be tested for influenza. PCR-based diagnostic panels can detect multiple respiratory viruses simultaneously within 2-3 h [60]. These new sensitive methods increase the ability to identify a broader range of viruses, such as rhinovirus, whose clinical significance should be carefully assessed.…”

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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“…As with influenza, RT-PCR for SARS-CoV-2 is associated with frequent false negative results (1). Therefore, patients may be diagnosed by a characteristic CT scan.…”

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confidence: 99%

Clinical phenotypes of SARS-CoV-2: implications for clinicians and researchers

et al. 2020

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Patients with COVID19 present a broad spectrum of clinical presentation. Whereas hypoxemia is the marker of severity, different strategies of management should be customized to five specific individual phenotypes. Many intubated patients present with phenotype 4, characterized by pulmonary hypoxic vasoconstriction, being associated with severe hypoxemia with "normal" (>40 ml/cm H20) lung compliance and likely represents pulmonary microvascular thrombosis. Phenotype 5 is often associated with high plasma procalcitonin, and has low pulmonary compliance, being a result of co-infection or acute lung injury after non-invasive ventilation. Identifying these clinical phenotypes and applying a personalized approach would benefit in optimization of therapies and improving outcomes. Tweeter feed:SARS-CoV-2 infections present different specific individual phenotypes. Applying a personalized approach would benefit in optimization of therapies and outcomes improvement. @COVID19

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“…PCR-based platforms are now commonly both "multiplex" (meaning that multiple analytes are tested on a single sample) and "high-throughput" (signifying that multiple samples-up to 96 depending on the manufacturer-can be processed in a single run). 18 Many commercially available platforms pair multiplex PCR with hybridization of the amplified products onto a microarray, which are often read with proprietary analyzers.…”

Section: Testing For Respiratory Viruses Traditional Approachesmentioning

confidence: 99%

“…8,[15][16][17] Finally, improved diagnostics now allow for the rapid identification of respiratory viral pathogens in suspected CAP. 18 Traditional testing platforms, including viral culture and acute and convalescent-phase viral serologies, are slow, labor-intensive, and impractical for routine clinical use. The advent of multiplex nucleic acid amplification platforms has revolutionized testing.…”

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confidence: 99%

“…A single patient sample can now be simultaneously tested for up to 35 pathogens including multiple respiratory viruses, with results typically available in under 6 hours. 18 Driven by the aforementioned trends, viral CAP is now frequently encountered in clinical practice. In the CDC EPIC study, 23% of patients had a virus identified on testing, far outpacing the detection of bacteria (►Fig.…”

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confidence: 99%

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Other Respiratory Viruses as a Cause of Community-Acquired Pneumonia

Walter

2020

Semin Respir Crit Care Med

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AbstractCommunity-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. There is growing appreciation of the burden of noninfluenza viral pathogens in CAP. Due to multiple factors including pneumococcal vaccination programs, declining rates of cigarette smoking, an aging population, and increasingly sensitive diagnostic tests, respiratory viruses are now the most common pathogens detected in CAP, outpacing Streptococcus pneumoniae. Noninfluenza respiratory pathogens are widely accepted as causal pathogens in CAP including in immunocompetent patients. This review provides an overview of five noninfluenza respiratory viral pathogens commonly implicated in CAP pathogenesis: rhinovirus, human metapneumovirus, respiratory syncytial virus, human parainfluenza virus, and human adenoviruses. Nucleic acid amplification testing platforms and their impact on antimicrobial stewardship efforts are also considered.

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Testing for Respiratory Viruses in Adults With Severe Lower Respiratory Infection

Cited by 27 publications

References 72 publications

Diagnosis of severe respiratory infections in immunocompromised patients

Diagnosis of severe respiratory infections in immunocompromised patients

Clinical phenotypes of SARS-CoV-2: implications for clinicians and researchers

Other Respiratory Viruses as a Cause of Community-Acquired Pneumonia

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