The role of molecular diagnosis in acute respiratory tract infection.
The role of molecular diagnosis in acute respiratory tract infection.
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分子诊断在急性呼吸道感染中的作用。
DOI：
10.1016/j.resinv.2019.06.007
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Yanagihara K
中科院分区：
文献类型：
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作者：
Ogami C;Tsuji Y;To H;Yamamoto Y;Yanagihara K
急性呼吸道感染（ARTIs）是全球发病率和死亡率的主要原因。尽管急性呼吸道感染在儿童中通常更严重，但老年人和免疫功能低下的患者以及所有人群和年龄组的个体都是易感人群。这些感染对医疗办公室和急诊科（艾德）就诊、抗菌药物处方、住院治疗以及工作和学校的时间损失有重大影响。急性呼吸道感染又分为急性上呼吸道感染（URTI）、急性支气管炎或肺炎。除肺炎外，急性呼吸道感染的诊断主要基于临床体征和症状，因为病毒是URTI和急性支气管炎最常见的病原体，很难检测到。抗生素已被规定在许多患者URTI或急性支气管炎。然而，不适当的抗生素处方会促进抗生素耐药性。因此，应检测这些病毒，最好使用快速抗原测定试验。然而，这些测试的灵敏度相对较低。为了提高检测这些病毒的灵敏度，可以使用核酸扩增试验（NAAT）。NAAT是针对各种病毒开发的，可以检测多个目标。尽管有这些优点，NAAT的使用并不频繁，因为它的程序复杂，在社区医院很难执行。在过去的几年里，已经开发了几个全自动的NAAT平台。这些平台允许简单的测试，提供快速的结果，并可用作检测单个样品中多种微生物的测定。代表性器械之一FilmArray® Respiratory Panel（RP）可靶向19种微生物，包括腺病毒;甲型流感病毒H1、2009 H1、H3（分别为FluA-H1、FluA-2009 H1和FluA-H3）和FluB;副流感病毒1 - 4型（帕拉1 e4）;冠状病毒229 E、HKU 1、OC 43和NL 63（分别为Cov-HKU 1、NL 63、229 E和OC 43）;人偏肺病毒（hMPV）;呼吸道合胞病毒（RSV）;人鼻病毒/肠道病毒（Rhino/Entero）;以及肺炎嗜衣原体、肺炎支原体和百日咳博德特氏菌。
Acute respiratory tract infections (ARTIs) are a leading cause of morbidity and mortality worldwide. Although ARTIs are usually more severe in children, the elderly and immunocompromised patients, as well as individuals from all populations and age groups are susceptible. These infections have a significant impact on medical office and emergency department (ED) visits, antimicrobial prescriptions, hospitalizations, and lost time from work and school. ARTIs are further classified into acute upper respiratory tract infection (URTI), acute bronchitis, or pneumonia. The diagnosis of ARTIs except pneumonia is largely based on clinical signs and symptoms, because virusesdthe most common causative pathogens of URTI and acute bronchitisdare difficult to detect. Antibiotics have been prescribed in many patients with URTI or acute bronchitis. Nevertheless, the inappropriate prescription of antibiotics promotes antibiotic resistance. Therefore, these viruses should be detected, preferably by using rapid antigen determination tests. However, the sensitivity of these tests is relatively low. To improve the sensitivity in detecting these viruses, the nucleic acid amplification test (NAAT) can be used. The NAAT has been developed for various viruses and could detect multiple targets. Despite these advantages, the use of the NAAT has been infrequent because of its complicated procedures and difficulty in performing it at community hospitals. In the past few years, several fully automated platforms for the NAAT have been developed. These platforms allow for simple testing, provide rapid results, and can be used as assays for detecting multiple organisms in a single sample. One of the representative devices, the FilmArray® Respiratory Panel (RP), targets 19 organisms, including adenovirus; influenza A viruses H1, 2009H1, H3 (FluA-H1, FluA-2009H1, and FluA-H3, respectively), and FluB; parainfluenza virus types 1 to 4 (Para 1e4); coronaviruses 229E, HKU1, OC43, and NL63 (Cov-HKU1, NL63, 229E, and OC43, respectively); human metapneumovirus (hMPV); respiratory syncytial virus (RSV); human rhinovirus/enterovirus (Rhino/Entero); as well as Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Bordetella pertussis.