Underascertainment of Respiratory Syncytial Virus Infection in Adults Due to Diagnostic Testing Limitations: A Systematic Literature Review and Meta-analysis.
Underascertainment of Respiratory Syncytial Virus Infection in Adults Due to Diagnostic Testing Limitations: A Systematic Literature Review and Meta-analysis.
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DOI：
10.1093/infdis/jiad012
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发表时间：
2023-07-14
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大多数基于人群的观察性研究仅通过鼻/鼻咽拭子逆转录酶实时PCR （RT-PCR）鉴定呼吸道合胞病毒（RSV）。我们进行了一项系统综述和荟萃分析，以量化基于标本和诊断测试的成人呼吸道合胞病毒感染的不确定。检索了EMBASE、PubMed和Web of Science（2000年1月至2021年12月）中使用/比较bbb1 RSV检测方法的成人研究。我们量化了测试性能和RSV检测增加与使用多种标本类型相关。在确定的8066篇文献中，154篇符合纳入标准。与RT-PCR相比，其他方法的灵敏度较低：快速抗原检测试验（RADT，综合灵敏度为64%）、直接荧光抗体（DFA, 83%）和病毒培养（86%）。与单一PCR相比，多重PCR的敏感性较低（93%）。与单独使用鼻/鼻咽拭子RT-PCR相比，增加另一种标本类型的检测增加：痰RT-PCR， 52%；配对血清学增加4倍，44%；口咽拭子RT-PCR， 28%。仅限成人（RADT、DFA和病毒培养）的敏感性较低，检出率的增加在很大程度上是可比性的。RT-PCR，尤其是单倍体检测，是成人RSV诊断最敏感的检测方法。在鼻咽拭子RT-PCR检测中增加其他标本类型可提高RSV的检出率。应评估使用≥3种标本类型的协同效应，因为这种方法可能提高成人RSV负担估计的准确性。大多数观察性研究仅通过鼻/鼻咽拭子RT-PCR鉴定成人RSV。我们的综述发现，虽然RT-PCR是最准确的，但在鼻咽拭子RT-PCR检测中添加额外的标本类型可将RSV检出率提高高达50%。
Most observational population-based studies identify respiratory syncytial virus (RSV) by nasal/nasopharyngeal swab reverse transcriptase real-time PCR (RT-PCR) only. We conducted a systematic review and meta-analyses to quantify specimen and diagnostic testing-based underascertainment of adult RSV infection. EMBASE, PubMed, and Web of Science were searched (January 2000−December 2021) for studies including adults using/comparing >1 RSV testing approach. We quantified test performance and RSV detection increase associated with using multiple specimen types. Among 8066 references identified, 154 met inclusion. Compared to RT-PCR, other methods were less sensitive: rapid antigen detection test (RADT; pooled sensitivity, 64%), direct fluorescent antibody (DFA; 83%), and viral culture (86%). Compared to singleplex PCR, multiplex PCR's sensitivity was lower (93%). Compared to nasal/nasopharyngeal swab RT-PCR alone, adding another specimen type increased detection: sputum RT-PCR, 52%; 4-fold rise in paired serology, 44%; and oropharyngeal swab RT-PCR, 28%. Sensitivity was lower in estimates limited to only adults (for RADT, DFA, and viral culture), and detection rate increases were largely comparable. RT-PCR, particularly singleplex testing, is the most sensitive RSV diagnostic test in adults. Adding additional specimen types to nasopharyngeal swab RT-PCR testing increased RSV detection. Synergistic effects of using ≥3 specimen types should be assessed, as this approach may improve the accuracy of adult RSV burden estimates. Most observational studies only identify RSV in adults by nasal/nasopharyngeal swab RT-PCR. Our review found that while RT-PCR is the most accurate, adding additional specimen types to nasopharyngeal swab RT-PCR testing increased RSV detection by up to 50%.
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