Clinical Utility of PCR for Common Viruses in Acute Respiratory Illness
Clinical Utility of PCR for Common Viruses in Acute Respiratory Illness
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DOI：
10.1542/peds.2013-3042
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发表时间：
2014-03-01
期刊：
影响因子：
8
通讯作者：
Naucler, Pontus
中科院分区：
文献类型：
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作者：
Rhedin, Samuel;Lindstrand, Ann;Naucler, Pontus
背景：急性呼吸道疾病 (ARI) 占儿科医疗机构就诊人数的很大一部分。实时定量聚合酶链反应（qPCR）分析可以灵敏地检测病毒核酸，但尚不清楚特定病毒在多大程度上导致疾病，因为许多病毒已在无症状儿童中检测到。更好地理解如何解释病毒检测结果对于减少不必要的抗生素使用非常重要。目的：比较 ARI 儿童与无症状对照受试者的病毒 qPCR 结果。方法：在非流感季节，从 5 岁 ARI 儿童和个体匹配的无症状人群对照受试者中收集鼻咽抽吸物。使用 qPCR 分析 16 种病毒的样本。 结果：72.3% 的病例患者 (n = 151) 和 35.4% 的对照受试者 (n = 74) 检测到呼吸道病毒 (P = .001)。鼻病毒是病例患者和对照受试者中最常见的发现（分别为 47.9% 和 21.5%），人群归因比例为 0.39（95% 置信区间：0.01 至 0.62）。偏肺病毒、副流感病毒和呼吸道合胞病毒在病例患者中所占比例过高。即使在调整与其他病毒的合并感染后，博卡病毒仍与 ARI 相关，并且与严重疾病相关。肠道病毒和冠状病毒在病例患者和对照受试者中同样常见。结论：qPCR 检测 ARI 儿童中的呼吸道合胞病毒、偏肺病毒或副流感病毒可能是导致疾病的原因；由于无症状儿童的检出率很高，因此必须谨慎解释其他几种呼吸道病毒的检出情况。
BACKGROUND:Acute respiratory illness (ARI) accounts for a large proportion of all visits to pediatric health facilities. Quantitative real-time polymerase chain reaction (qPCR) analyses allow sensitive detection of viral nucleic acids, but it is not clear to what extent specific viruses contribute to disease because many viruses have been detected in asymptomatic children. Better understanding of how to interpret viral findings is important to reduce unnecessary use of antibiotics.OBJECTIVE:To compare viral qPCR findings from children with ARI versus asymptomatic control subjects.METHODS:Nasopharyngeal aspirates were collected from children aged 5 years with ARI and from individually matched, asymptomatic, population-based control subjects during a noninfluenza season. Samples were analyzed by using qPCR for 16 viruses.RESULTS:Respiratory viruses were detected in 72.3% of the case patients (n = 151) and 35.4% of the control subjects (n = 74) (P = .001). Rhinovirus was the most common finding in both case patients and control subjects (47.9% and 21.5%, respectively), with a population-attributable proportion of 0.39 (95% confidence interval: 0.01 to 0.62). Metapneumovirus, parainfluenza viruses, and respiratory syncytial virus were highly overrepresented in case patients. Bocavirus was associated with ARI even after adjustment for coinfections with other viruses and was associated with severe disease. Enterovirus and coronavirus were equally common in case patients and control subjects.CONCLUSIONS:qPCR detection of respiratory syncytial virus, metapneumovirus, or parainfluenza viruses in children with ARI is likely to be causative of disease; detection of several other respiratory viruses must be interpreted with caution due to high detection rates in asymptomatic children.