Viral load is strongly associated with length of stay in adults hospitalised with viral acute respiratory illness

Clark, Tristan; Ewings, Sean; Medina, Marie-Jo; Batham, Sally; Curran, Martin D.; Parmar, Surendra; Nicholson, Karl G.

doi:10.1016/j.jinf.2016.09.001

Cited by 20 publications

(31 citation statements)

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“…A growing body of evidence shows a correlation of respiratory viral load and patient outcome. In one study of immunocompetent adult patients, age and hospitalization time were associated with earlier reverse transcriptase PCR (RT-PCR) cycle threshold (C T ) values for FLUA/B of Յ20 than later C T values (242). Association of viral load and outcome can also vary by genotype, as RV-A viral loads were higher in patients with severe disease than in patients without severe disease, while no difference in viral load was observed for patient groups infected with RV-C (243).…”

Section: Understanding Applications Of Molecular Detection Approachesmentioning

confidence: 99%

Practical Guidance for Clinical Microbiology Laboratories: Viruses Causing Acute Respiratory Tract Infections

et al. 2018

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SUMMARYRespiratory viral infections are associated with a wide range of acute syndromes and infectious disease processes in children and adults worldwide. Many viruses are implicated in these infections, and these viruses are spread largely via respiratory means between humans but also occasionally from animals to humans. This article is an American Society for Microbiology (ASM)-sponsored Practical Guidance for Clinical Microbiology (PGCM) document identifying best practices for diagnosis and characterization of viruses that cause acute respiratory infections and replaces the most recent prior version of the ASM-sponsored Cumitech 21 document,Laboratory Diagnosis of Viral Respiratory Disease, published in 1986. The scope of the original document was quite broad, with an emphasis on clinical diagnosis of a wide variety of infectious agents and laboratory focus on antigen detection and viral culture. The new PGCM document is designed to be used by laboratorians in a wide variety of diagnostic and public health microbiology/virology laboratory settings worldwide. The article provides guidance to a rapidly changing field of diagnostics and outlines the epidemiology and clinical impact of acute respiratory viral infections, including preferred methods of specimen collection and current methods for diagnosis and characterization of viral pathogens causing acute respiratory tract infections. Compared to the case in 1986, molecular techniques are now the preferred diagnostic approaches for the detection of acute respiratory viruses, and they allow for automation, high-throughput workflows, and near-patient testing. These changes require quality assurance programs to prevent laboratory contamination as well as strong preanalytical screening approaches to utilize laboratory resources appropriately. Appropriate guidance from laboratorians to stakeholders will allow for appropriate specimen collection, as well as correct test ordering that will quickly identify highly transmissible emerging pathogens.

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Section: Understanding Applications Of Molecular Detection Approachesmentioning

confidence: 99%

Practical Guidance for Clinical Microbiology Laboratories: Viruses Causing Acute Respiratory Tract Infections

et al. 2018

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“…Previous studies have hypothesized that viral load of some respiratory viruses correlate with disease severity [2], but this association is not clear in the case of influenza virus infection [3,4]. On the contrary, other authors have found that high influenza viral load is associated with a longer duration of hospital stay in adults with viral acute respiratory illness [5]. On this basis, we decided to analyze the role of influenza viral load in the outcome of the patients included in the same cohort of our previous paper [1].…”

Section: Introductionmentioning

confidence: 96%

Influence of viral load in the outcome of hospitalized patients with influenza virus infection

Lalueza

Folgueira

Muñoz‐Gallego

et al. 2019

Eur J Clin Microbiol Infect Dis

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The role of viral load in the outcome of patients requiring hospital admission due to influenza is not well established. We aim to assess if there is an association between the viral load and the outcome in hospitalized patients with a confirmed influenza virus infection. A retrospective observational study including all adult patients who were hospitalized in our center with a confirmed influenza virus infection from January to May 2016. Viral load was measured by real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) cycle threshold (Ct) value on upper respiratory tract samples. Its value was categorized into three groups (low Ct,≤ 20; intermediate Ct,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and high Ct, > 30). Two hundred thirty-nine patients were included. Influenza A/ H1N1pdm09 was isolated in 207 cases (86.6%). The mean Ct value was 26.69 ± 5.81. The viral load was higher in the unvaccinated group when compared with the vaccinated patients (Ct 25.17 ± 5.55 vs. 27.58 ± 4.97, p = 0.004). Only 27 patients (11.29%) presented a high viral load. Patients with a high viral load more often showed abnormal findings on chest X-ray (p = 0.015) and lymphopenia (p = 0.097). By contrast, there were no differences between the three groups (according to viral load), in associated pneumonia, respiratory failure, need for mechanical ventilation, sepsis, or in-hospital mortality. Our findings suggest that in patients admitted to the hospital with confirmed influenza virus infection (mostly A/H1N1pdm09), a high viral load is associated with a higher presence of abnormal findings on chest X-ray but not with a significant worse prognosis. In these cases, standardized quantitative PCR could be useful.

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“…Other endpoints can include patient reported outcomes, such as the FluiiQ™ questionnaire (Osborne et al, 2011), or the Flu-Pro © survey (Powers et al, 2016). Virological endpoints have shown good correlation with clinical measures (Carrat et al, 2008) and virus load at admission has been shown to correlate with the length of hospital stay (Clark et al, 2016). Virus load may thus minimize the issues around the heterogeneity of the population.…”

Section: What Endpoints Make Sense In Clinical Trials Of Severe Influmentioning

confidence: 99%

Prevention and treatment of respiratory viral infections: Presentations on antivirals, traditional therapies and host-directed interventions at the 5th ISIRV Antiviral Group conference

et al. 2018

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The International Society for Influenza and other Respiratory Virus Diseases held its 5th Antiviral Group (isirv-AVG) Conference in Shanghai, China, in conjunction with the Shanghai Public Health Center and Fudan University from 14-16 June 2017. The three-day programme encompassed presentations on some of the clinical features, management, immune responses and virology of respiratory infections, including influenza A(H1N1)pdm09 and A(H7N9) viruses, MERS-CoV, SARS-CoV, adenovirus Type 80, enterovirus D68, metapneumovirus and respiratory syncytial virus (RSV). Updates were presented on several therapeutics currently in clinical trials, including influenza polymerase inhibitors pimodivir/JNJ6362387, S033188, favipiravir, monoclonal antibodies MHAA45449A and VIS410, and host directed strategies for influenza including nitazoxanide, and polymerase ALS-008112 and fusion inhibitors AK0529, GS-5806 for RSV. Updates were also given on the use of the currently licensed neuraminidase inhibitors. Given the location in China, there were also presentations on the use of Traditional Chinese Medicines. Following on from the previous conference, there were ongoing discussions on appropriate endpoints for severe influenza in clinical trials from regulators and clinicians, an issue which remains unresolved. The aim of this conference summary is to provide information for not only conference participants, but a detailed referenced review of the current status of clinical trials, and pre-clinical development of therapeutics and vaccines for influenza and other respiratory diseases for a broader audience.

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Viral load is strongly associated with length of stay in adults hospitalised with viral acute respiratory illness

Abstract: Background

Cited by 20 publications

References 32 publications

Practical Guidance for Clinical Microbiology Laboratories: Viruses Causing Acute Respiratory Tract Infections

Practical Guidance for Clinical Microbiology Laboratories: Viruses Causing Acute Respiratory Tract Infections

Influence of viral load in the outcome of hospitalized patients with influenza virus infection

Prevention and treatment of respiratory viral infections: Presentations on antivirals, traditional therapies and host-directed interventions at the 5th ISIRV Antiviral Group conference

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