Frequent detection of respiratory viruses without symptoms: toward defining clinically relevant cutoff values - PubMed (original) (raw)

Frequent detection of respiratory viruses without symptoms: toward defining clinically relevant cutoff values

Rogier R Jansen et al. J Clin Microbiol. 2011 Jul.

Abstract

Highly sensitive techniques, such as PCR, have greatly improved the detection of respiratory viruses. However, the sensitivity of PCR tests also complicates clinical interpretation, as the presence of small amounts of viral targets may not necessarily have clinical relevance. We performed a prospective case-control study in asymptomatic and symptomatic young children. PCR detection of 14 respiratory viruses was performed in nasal washes, and results were quantified in copies per milliliter. A total of 141 cases and 157 controls were included. In 72% of the cases and 28% of the controls, at least one virus was identified. When stratified for age, at least one virus was identified in 47% of the controls younger than 1 year old. Rhinovirus (RV) was frequently detected in both symptomatic and asymptomatic individuals. Receiver operating characteristic analysis for quantitative rhinovirus detection showed that cutoff values for clinical relevance are feasible for RV. In contrast to rhinovirus, respiratory syncytial virus (RSV) was rarely detected in controls, suggesting that a positive RSV test result is almost always of clinical relevance, independent of viral quantity. In conclusion, our study shows that asymptomatic carriage of a respiratory virus occurs frequently in young children. However, significant differences in the amount of virus present were observed between cases and controls. This suggests that defining cutoff levels should be feasible and represents the next necessary step for diagnosing viral respiratory infections using molecular tests.

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Figures

Fig. 1.

Fig. 1.

Viral prevalence in cases and controls, stratified by age. The percentage represents the amount of positive cases for the total group and for each specific age group. Data for single infections and double infections (i.e., two or more virus species detected) are shown.

Fig. 2.

Fig. 2.

Crossing point values for each positive sample. White diamonds denote single infections, and black diamonds denote positive samples as part of a double or triple infection. Horizontal lines represent the median. PIV 1, PIV2, PIV3, PIV4, and hMPV are not shown in this figure because no positive samples were found among controls for these species.

Fig. 3.

Fig. 3.

ROC curve for RV-positive samples, excluding double infections. The curve shows the relationship between sensitivity and specificity when different cutoffs in crossing point values for association with clinical illness were applied.

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