Virological diagnosis of respiratory virus infection in patients attending an emergency department during the influenza season (original) (raw)
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Health Technology Assessment, 2010
The five patients with poor outcomes had CURB-65 scores of zero, one (three cases) and two, and PMEWS scores of one, five, six, seven and eight. The swine flu hospital pathway was positive in three out of five cases. The C-statistic for each method was CURB-65 0.78 [95% confidence interval (CI) 0.58 to 0.99], PMEWS 0.77 (95% CI 0.55 to 0.99) and the swine flu hospital pathway 0.70 (95% CI 0.45 to 0.96). Patients with a higher CURB-65 score were more likely to be admitted (p < 0.001): 25 out of 101 (25%) with a score of zero, 11 out of 24 (46%) with a score of one, 7 out of 8 (88%) with a score of two, and the patient with a score of three were admitted. Admitted patients had a higher mean PMEWS score (4.6 vs 2.0, p < 0.001). The C-statistics for CURB-65, PMEWS and the swine flu hospital pathway in adults in terms of discriminating between those admitted and discharged were 0.65 (95% CI 0.54 to 0.76), 0.76 (95% CI 0.66 to 0.86) and 0.62 (95% CI 0.51 to 0.72) respectively. Limitations: The 2009 H1N1 pandemic was much smaller and less severe than predicted and resulted in a lack of sufficient data. Conclusions: Potential concerns were raised about the use of existing triage methods for patients with suspected pandemic influenza, as these methods may fail to discriminate between patients who will have an adverse outcome and those with a benign course. Clinicians in the study did not generally appear to admit or discharge on the basis of these methods, despite their recommended use. Further research is required to evaluate existing triage methods and develop new triage tools for suspected pandemic influenza.
Unmasking Influenza Virus Infection in Patients Attended to in the Emergency Department
Infection, 2004
Infection by the influenza virus may pass undetected in many adult patients attended to in the emergency department because its diagnosis usually relies on clinical manifestations, which can be distorted by symptoms of a preexisting disease, superposed complications or nontypical manifestations of influenza virus infection (confusing symptoms). Patients and Methods: We performed this observational, prospective study with an antigen detection test by indirect immunofluorescence assay (IFA) to estimate the presence of influenza virus infection in such patients. No confirmatory test was performed to validate a positive or negative IFA result. Then we compared those who were antigen positive to those who were negative and also analyzed those who were positive classified by age, comorbidity and clinical presentation. We also evaluated the use of medical and hospital resources and vaccination status. Posterior pharynx swab specimens from 136 consecutive adult patients, 74 women and 62 men with a mean age of 68.7 ± 17.9 (range: 18-97) years attended to in the emergency department of a university hospital in Barcelona during the 1999-2000 influenza epidemic were examined. Tested patients presented either a classical influenza syndrome, a deterioration of a previous condition or any abrupt onset of symptoms without an obvious cause. Results: Influenza A virus antigen was detected in 99 (72.8%) of the 136 patients included in the study. Confusing symptoms were present in 86 patients with laboratoryconfirmed influenza and 40 of them lacked influenza syndrome. Prostration, aching and fever out of proportion to catarrhal symptoms (disproportionate prostration) and cough were independent predictors for this diagnosis (OR = 5.14; 95% CI: 1.98-13.35, p = 0.001 and OR = 4.40, 95% CI, 1.65-11.75, p = 0.03, respectively).
Clinical Microbiology and Infection, 2012
To characterize respiratory virus infections during the first autumn-winter season of pandemic A (H1N1) 2009 influenza virus (A/H1N1/ 2009) circulation, a prospective study in children attending a paediatric emergency department at the Sapienza University hospital, Rome, was conducted from November 2009 to March 2010. By means of both nasal washings and pharyngeal swabs, enrolled children were checked for 14 respiratory viruses. The majority of acute respiratory infections resulted from viral pathogens (135/231, 58%). Overall, the most common was respiratory syncytial virus (RSV), in 64% of positive samples; A/H1N1/2009 was the only influenza virus found in 16% and rhinovirus (RV) in 15%. Virus-positive children did not differ significantly from virus-negative children in signs and symptoms at presentation; of the virus groups, RSV-infected children were younger and more frequently admitted to intensive-care units than those infected with A/H1N1/2009 and RV. Of the hospitalized children, stratified by age, both infants and children aged >1 year with RSV were most severely affected, whereas A/H1N1/2009 infections were the mildest overall, although with related pulmonary involvement in older children. Children with RV infections, detected in two flares partially overlapping with the A/H1N1/2009 and RSV peaks, presented with bronchiolitis, wheezing and pneumonia. Leukocytosis occurred more frequently in RV-infected and A/H1N1/2009-infected children, and numbers of blood eosinophils were significantly elevated in RV-infected infants. Given the fact that clinical and epidemiological criteria are not sufficient to identify viral respiratory infections, a timely virological diagnosis could allow different infections to be managed separately.
Virological surveillance of influenza virus in acute respiratory infection
IP Innovative Publication Pvt. Ltd., 2018
Introduction: Influenza is viral fever with the main symptom of respiratory tract like cough, fever, breathlessness, nasal discharge, sore throat. The influenza affects a large segment of the world population resulting in significant mortality, morbidity and economic loss. Objective: To monitor the trend of influenza A virus. To know the prevalence of influenza A, H1N1 and seasonal H3 subtypes of influenza virus. To study the seasonal pattern of influenza A virus. Materials and Methods: This prospective study was carried out in the department of Microbiology, B.J. Medical College, Ahmadabad from January 2014 to December 2014. Surveillance samples were taken as per ILI (Influenza like illness) case definition for out Patient department and SARI (sever acute respiratory syndrome) for indoor patients. Total 614 samples are taken and tested with PCR method. Result: Out of 614 samples total 201(32.73%) were positive for influenza. Out of 201 positive samples, 13 (2.11%) were positive for swine H1N1 and 11 (1.79%) for seasonal H3, 177 (28.82%) were positive for influenza A. Conclusion: Prevalence of influenza 201(32.73%). out of this 13 (2.11%) were positive for swine H1N1 and 11 (1.79%) for seasonal H3, 177 (28.82%) were positive for influenza A. swine H1N1 was common in winter and seasonal H3 was common in late monsoon. swine H1N1 and seasonal H3 both are more common in male than female. swine H1N1 is more in >12 age and seasonal H3 is more common in <12> Keywords: Influenza A, Swine H1N1, Seasonal H3, Fever, cough, Breathlessness.
Journal of Infectious Diseases, 2014
Background. The Influenza Incidence Surveillance Project (IISP) monitored outpatient acute respiratory infection (ARI; defined as the presence of ≥2 respiratory symptoms not meeting ILI criteria) and influenza-like illness (ILI) to determine the incidence and contribution of associated viral etiologies. Methods. From August 2010 through July 2011, 57 outpatient healthcare providers in 12 US sites reported weekly the number of visits for ILI and ARI and collected respiratory specimens on a subset for viral testing. The incidence was estimated using the number of patients in the practice as the denominator, and the virus-specific incidence of clinic visits was extrapolated from the proportion of patients testing positive. Results. The age-adjusted cumulative incidence of outpatient visits for ARI and ILI combined was 95/1000 persons, with a viral etiology identified in 58% of specimens. Most frequently detected were rhinoviruses/ enteroviruses (RV/EV) (21%) and influenza viruses (21%); the resulting extrapolated incidence of outpatient visits was 20 and 19/1000 persons respectively. The incidence of influenza virus-associated clinic visits was highest among patients aged 2-17 years, whereas other viruses had varied patterns among age groups. Conclusions. The IISP provides a unique opportunity to estimate the outpatient respiratory illness burden by etiology. Influenza virus infection and RV/EV infection(s) represent a substantial burden of respiratory disease in the US outpatient setting, particularly among children.
Performance of influenza rapid antigen testing in influenza in emergency department patients
Emergency Medicine Journal, 2010
Background: The use of rapid antigen tests to triage specimens for polymerase chain reaction (PCR) testing from emergency department patients with influenza-like illness during surveillance for novel influenza viruses has been suggested. Objective: To measure the observed sensitivity and specificity for a widely used rapid antigen test (Binax) using a PCR-based assay (Medical Diagnostic Laboratories). Methods: Nasopharyngeal samples were taken with flocked swabs (Copan Diagnostics) from patients presenting to the emergency department of a community hospital. Samples were analysed using a rapid antigen and a PCR-based test. PCR testing was used as the criterion reference. Sensitivity and specificity were calculated for influenza and influenza A. Positive predictive values were calculated over a range of possible prevalence. Results: Samples from 566 unique patients were tested using both methods. Sensitivity was 69.1% (95% CI 58.9% to 78.1%) and specificity was 97.7% (95% CI 95.8% to 98.8%) for the detection of any influenza and 75.3% (95% CI 64.7% to 84.0%) and 97.8% (95% CI 95.9% to 98.9%), respectively, for influenza A only. The resultant positive predictive value ranges from 23% to 77% when the prevalence ranges from 1% to 10%. Conclusion: When planning early outbreak surveillance, provision of adequate PCR testing capacity rather than triaging specimens using rapid antigen testing for influenza is advisable.
Evaluation of epidemiological and clinical features of influenza and other respiratory viruses
Türk Pediatri Arşivi, 2015
Aim: In our study, we aimed to clinically and epidemiologically evaluate respiratory tract infections the viral agents of which were detected by molecular methods and to compare influenza and other respiratory tract viruses in this context. Material and Methods: The records of 178 patients aged above 2 years who presented to pediatric emergency outpatient clinic with fever and respiratory tract infection findings between December 2013 and April 2014 were examined retrospectively. Results: At least one respiratory tract pathogen was detected by polymerase chain reaction in 78.6% (n=140) of the patients: influenza A 33.5%, influenza B 16.4%, respiratory syncytial virus 9.2%, adenovirus 7.8%, rhinovirus 7.1%, coronavirus 7.1%, human metapneumovirus 5.7%, human bocavirus 5.7%, parainfluenza virus 3.5%, coinfection 2.8%. The mean age of the patients was 6.3±3.6 years. Sixty-nine patients (49.2%) were aged between 2 and 5 years. Seventy-one patients (50.7%) were aged 5 years and above. Upper respiratory tract infection was found with a rate of 65.7% and lower respiratory tract infection was found with a rate of 34.2%. It was observed that the distribution of respiratory tract viruses showed variance by age groups. Influenza A infection was observed with the highest rate in both age groups. Influenza B was the second leading agent (p=0.008) above the age of 5 years and respiratory syncytial virus was the second leading agent in the 2-5 year age group (p=0.003). Influenza viruses were detected in 55.9% of 118 patients who were found to be compatible with the definition of "influenza-like illness" specified in the Center for Disease Control and Prevention guidelines and other viral agenst were detected in 44%. No difference could be found between the clinical pictures and radiological findings caused by influenza and other respiratory tract viruses. Conclusions: In this study, it was concluded that influenza and other respiratory viruses can not be differentiated definitely by clinical and radiological findings, though there are some differences.
Survey of influenza and other respiratory viruses diagnostic testing in US hospitals, 2012–2013
Influenza and Other Respiratory Viruses, 2016
Background Little is known about laboratory capacity to routinely diagnose influenza and other respiratory viruses at clinical laboratories and hospitals. Aims We sought to assess diagnostic practices for influenza and other respiratory virus in a survey of hospitals and laboratories participating in the US Influenza Hospitalization Surveillance Network in 2012-2013. Materials and Methods All hospitals and their associated laboratories participating in the Influenza Hospitalization Surveillance Network (FluSurv-NET) were included in this evaluation. The network covers more than 80 counties in 15 states,
Clinical diagnosis of influenza virus infection: evaluation of diagnostic tools in general practice
British Journal of General Practice
With the development of new antiviral agents for influenza, the urge for rapid and reliable diagnosis of influenza becomes increasingly important. Respiratory virus infections are difficult to distinguish on clinical grounds. General practitioners (GPs) however, still depend on their clinical judgement. To evaluate the importance of clinical symptoms in the diagnosis of influenza virus infection. A multicentre questionnaire study. Eighty-one patients from 14 general practices. Patients with fever and at least one constitutional symptom and one respiratory symptom were included. A questionnaire with the medical history and clinical symptoms was completed and a combined nose-throat swab was taken. Virus culture, rapid culture, and polymerase chain reaction (PCR) amplification were performed on each specimen. Multivariate analysis was used to obtain the best predictive model. By using PCR, an increase was seen in the detection of the viral pathogens compared with the results of culture...