Diagnosis of Pediatric Acute Adenovirus Infections: Is a Positive PCR Sufficient?
Diagnosis of Pediatric Acute Adenovirus Infections: Is a Positive PCR Sufficient?
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DOI：
10.1097/inf.0000000000001119
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发表时间：
2016-08
期刊：
影响因子：
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通讯作者：
Jaggi P
中科院分区：
文献类型：
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作者：
Song E;Wang H;Kajon AE;Salamon D;Dong S;Ramilo O;Leber A;Jaggi P
人腺病毒（HAdV），特别是C种（HAdV-C），可以通过PCR在鼻咽（NP）样本中偶然检测到，使得难以解释阳性结果的临床意义。我们根据呼吸道标本的HAdV培养阳性和确定的共病原体的存在将患者分组。我们假设HAdV-C在最有可能偶然检测到的患者（即病毒培养阴性和记录的共病原体）中过度表达，病毒负荷较低。将具有HAdV+ NP标本的免疫活性儿童分为4组：I组（HAdV培养（+）且无合并感染）、II组（培养（+）且合并感染）、III组（培养（-）且无合并感染）和IV组（培养（-）且合并感染）。比较各组间的病毒负荷（Ct）和种属。在483例NP标本中，252例（52%）在培养物中分离出HAdV; 265例（55%）患者中发现合并感染。组I（与急性疾病最一致）的Ct（中位数23.9 [IQR 22.2-28.1]）显著低于组IV（与偶然检测最一致，中位数37.3 [IQR 35.3-38.9]，p <0.0001）。HAdV-C占组I的41%样品和组IV的83%（p <0.0001）。我们确定了22例患者的细菌或真菌共病原体，其中18例在病毒培养上无生长（第IV组），中位Ct为37.4（IQR 33.9-39.2）。种属鉴定和病毒负荷可能有助于解释阳性HAdV结果。HAdV-C的低病毒负荷可能与偶然检测一致。
Human Adenovirus (HAdV), especially species C (HAdV-C), can be detected incidentally by PCR in nasopharyngeal (NP) samples, making it difficult to interpret clinical significance of a positive result. We classified patients into groups based on HAdV culture positivity from respiratory specimens, and the presence of an identified co-pathogen. We hypothesized that HAdV-C would be over-represented and viral burden would be lower in patients most likely to have incidental detection (i.e, with a negative viral culture and documented co-pathogen). Immunocompetent children with HAdV+ NP specimens were classified into 4 Groups: Group I (HAdV culture (+) and no co-infection), Group II (culture (+) and co-infection), Group III (culture (−) and no co-infection), and Group IV (culture (−) and co-infection). Viral burden (Ct) and species were compared among Groups. Of 483 NP specimens, HAdV was isolated in culture in 252 (52%); co-infection was found in 265 (55%) patients. Group I (most consistent with acute disease) had significantly lower Cts (median 23.9 [IQR 22.2–28.1]) compared with Group IV (most consistent with incidental detection, median 37.3 [IQR 35.3–38.9], p <0.0001). HAdV-C accounted for 41% samples of Group I and 83% of Group IV (p <0.0001). We identified a subset of 22 patients with bacterial or fungal co-pathogens, 18 of whom had no growth on viral culture (Group IV) with a median Ct of 37.4 (IQR 33.9–39.2). Species identification and viral burden may assist in interpretation of a positive HAdV result. Low viral burden with HAdV-C may be consistent with incidental detection.