Home Self-Collection of Nasal Swabs for Diagnosis of Acute Respiratory Virus Infections in Children With Cystic Fibrosis
Home Self-Collection of Nasal Swabs for Diagnosis of Acute Respiratory Virus Infections in Children With Cystic Fibrosis
复制标题
DOI：
10.1093/jpids/pit039
复制
发表时间：
2013-12-01
影响因子：
3.2
通讯作者：
Campbell, Angela P.
中科院分区：
文献类型：
--
作者：
Emerson, Julia;Cochrane, Elizabeth;Campbell, Angela P.
背景了解呼吸道病毒在囊性纤维化（CF）儿童中的重要性受到限制，因为使用基于诊所或医院的诊断测试的挑战。我们进行了一项试点研究，以评估家庭自我（或父母）收集鼻拭子（NS）的可行性。6-18岁患有新发呼吸道疾病的囊性纤维化患者参加了研究。在临床中，研究人员收集了深鼻植绒拭子，并与盐水喷雾滴入后获得的前部泡沫NS进行了比较。在家中，收集最多2份成对泡沫NS（含和不含生理盐水）的自我收集物，并邮寄进行实时聚合酶链反应（PCR）检测。从28例患者中采集配对拭子：18组在诊所（深鼻vs盐水泡沫NS）和43组在家中（盐水vs干泡沫NS），分别检测到9例（50%）和35例（81%）病毒。家庭收集的NS更接近于疾病发作时获得，家庭和诊所收集的症状天数的平均差异为-2.3（95%置信区间[CI]-3.5，-1.2; P < .001）。鼻病毒占病毒检测的73%;在家中采集的拭子与诊所采集的拭子之间鼻病毒平均PCR循环阈值的差异为-3.8（95% CI - 6.8，-0.9; P = 0.014），表明家庭采集的拭子的病毒载量显著较高。与诊所采集的拭子相比，家庭采集的泡沫NS具有更高的阳性率，可能是因为采集更接近疾病发作。家庭自我采集对于及时诊断呼吸道病毒是可行的，并且耐受性良好，并且为CF患者中呼吸道病毒感染的临床诊断和监测提供了一种新方法。
Background. Understanding the importance of respiratory viruses in children with cystic fibrosis (CF) has been limited because of challenges using clinic-or hospital-based diagnostic testing. We conducted a pilot study to assess feasibility of home self-(or parent-) collection of nasal swabs (NS).Methods. Cystic fibrosis patients aged 6-18 years with new respiratory illness participated. In clinic, a deep nasal flocked swab was collected by research staff and compared with an anterior foam NS obtained after instillation of saline spray. At home, up to 2 self-collections of paired foam NS (with and without saline) were collected and mailed for real-time polymerase chain reaction (PCR) testing.Results. Paired swabs were collected from 28 patients: 18 sets in clinic (deep nasal vs saline foam NS) and 43 sets at home (saline vs dry foam NS) with 9 (50%) and 35 (81%) virus detections, respectively. Home-collected NS were obtained closer to illness onset, with a mean difference in symptom days of -2.3 between home and clinic collections (95% confidence interval [CI] - 3.5, -1.2; P < .001). Rhinovirus comprised 73% of virus detections; the difference in mean PCR cycle threshold values for rhinovirus between swabs collected at home versus clinic was -3.8 (95% CI - 6.8, -0.9; P = .014), indicating significantly higher viral load for home-collected swabs.Conclusions. Home-collected foam NS had a higher positivity rate compared with clinic-collected swabs, likely because collection was closer to illness onset. Home self-collection is feasible and well tolerated for timely respiratory virus diagnosis and provides a novel approach for clinical diagnostics and surveillance of respiratory virus infections among CF patients.