한국에서의 2009 신종 인플루엔자 A의 임상양상과 다양한 진단 방법들의 비교
Clinical Characteristics and Comparison of the Various Methods Used for the Diagnosis of the New Influenza A Pandemic in Korea
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Background: Laboratory diagnosis of new influenza A (H1N1) is crucial for managing patients and establishing control and prevention measures. We compared the diagnostic accuracies of the real time RT-PCR (rRT-PCR) test recommended for the confirmation of the new flu and the viral culture method used conventionally for viral disease with that of the rapid antigen test (RAT). Methods: We performed RAT, R-mix culture, and real-time PCR by using 861 respiratory samples collected from December 2009 to January 2010and evaluated the abilities of these methods to detect new influenza A. The relationship among the positive rates of RAT, grades of culture, and the cycle threshold (Ct) values of rRT-PCR was also evaluated. Results: Of the 861 patients, 308 (35.8%) were diagnosed with new influenza A. The sensitivities, specificities, positive predictive values, and negative predictive values of the tests were respectively as follows: 59.7%, 99.5%, 98.4%, and 81.6% for RAT; 93.2%, 100%, 100%, and 96.3% for R-mix culture; and 95.8%, 100%, 100%, and 97.7% for rRT-PCR. Samples with weak positive grade in culture and those with Ct values of 30–37 in rRT-PCR showed positivities as low as 25.3% and 2.3% in RAT, respectively. The hospitalization rate and death rate of the confirmed patients were 3.2% and 0.3%, respectively, and gastrointestinal symptoms were observed in 7.2% of the patients. Conclusions: R-mix culture and rRT-PCR tests showed excellent reliability in the diagnosis of new influenza A and could be very useful, especially for samples with low viral load.
Abstract
Background: Laboratory diagnosis of new influenza A (H1N1) is crucial for managing patients and establishing control and prevention measures. We compared the diagnostic accuracies of the real time RT-PCR (rRT-PCR) test recommended for the confirmation of the new flu and the viral culture method used conventionally for viral disease with that of the rapid antigen test (RAT). Methods: We performed RAT, R-mix culture, and real-time PCR by using 861 respiratory samples collected from December 2009 to January 2010and evaluated the abilities of these methods to detect new influenza A. The relationship among the positive rates of RAT, grades of culture, and the cycle threshold (Ct) values of rRT-PCR was also evaluated. Results: Of the 861 patients, 308 (35.8%) were diagnosed with new influenza A. The sensitivities, specificities, positive predictive values, and negative predictive values of the tests were respectively as follows: 59.7%, 99.5%, 98.4%, and 81.6% for RAT; 93.2%, 100%, 100%, and 96.3% for R-mix culture; and 95.8%, 100%, 100%, and 97.7% for rRT-PCR. Samples with weak positive grade in culture and those with Ct values of 30–37 in rRT-PCR showed positivities as low as 25.3% and 2.3% in RAT, respectively. The hospitalization rate and death rate of the confirmed patients were 3.2% and 0.3%, respectively, and gastrointestinal symptoms were observed in 7.2% of the patients. Conclusions: R-mix culture and rRT-PCR tests showed excellent reliability in the diagnosis of new influenza A and could be very useful, especially for samples with low viral load.
참고문헌 (29)
- 김우주, "대유행 신종인플루엔자 A (H1N1)의 역학, 임상 소견 및 치료", 대한내과학회지, 77(2), pp.157~164 (2009), 대한내과학회
- Taubenberger JK, "The pathology of influenza virus infections", Annu Rev Pathol, 3, pp.499~522 (2008)
- Neuzil KM, "Burden of interpandemic influenza in children younger than 5 years: a 25-year prospective study", J Infect Dis, 185, pp.147~152 (2002)
- McBean AM, "The impact and cost of influenza in the elderly", Arch Intern Med, 153, pp.2105~2111 (1993)
- Treanor JJ, "Clinical Virology. 2nd ed" (2002), ASM press
- Barenfanger J, "RMix cells are faster, at least as sensitive and marginally more costly than conventional cell lines for the detection of respiratory viruses", J Clin Virol, 22, pp.101~110 (2001)
- "virus: updated interim WHO guidance on global surveillance" (2009)[URL]
- Garten RJ, "Antigenic and genetic characteristics of swine-origin 2009 A(H1N1) influenza viruses circulating in humans", Science, 325, pp.197~201 (2009)
- Herzum I, "Diagnostic performance of rapid influenza antigen assays in patients infected with the new influenza A (H1N1) virus", Clin Chem Lab Med, 48, pp.53~56 (2010)
- Biggs C, "Performance of influenza rapid antigen testing in influenza in emergency department patients", Emerg Med J, 27, pp.5~7 (2010)
- 황유선, "Evaluation of the Efficacies of Rapid Antigen Test, Multiplex PCR, and Real-time PCR for the Detection of a Novel Influenza A (H1N1) Virus", Annals of Laboratory Medicine, 30(2), pp.142~152 (2010), 대한진단검사의학회
- Hancock K, "Cross-reactive antibody response to the 2009 pandemic H1N1 influenza virus", N Engl J Med, 361, pp.1945~1952 (2009)
- Perez-Padilla R, "Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico", N Engl J Med, 361, pp.680~689 (2009)
- Peltola VT, "Respiratory viruses predisposing to bacterial infections: role of neuraminidase", Pediatr Infect Dis J, 23, pp.87~97 (2004)
- Hament JM, "Respiratory viral infection predisposing for bacterial disease: a concise review", FEMS Immunol Med Microbiol, 26, pp.189~195 (1999)
- Flahault A, "First estimation of direct H1N1pdm virulence: From reported non consolidated data from Mauritius and New Caledonia", PLoS Curr (2009)
- Garske T, "Assessing the severity of the novel influenza A", H1N1 pandemic, 2009, pp.339, 2840~
- Ginocchio CC, "Evaluation of multiple test methods for the detection of the novel 2009 influenza A (H1N1) during the New York City outbreak", J Clin Virol, 45, pp.191~195 (2009)
- Chan KH, "Analytical sensitivity of rapid influenza antigen detection tests for swine-origin influenza virus (H1N1)", J Clin Virol, 45, pp.205~207 (2009)
- Yoo Y, "Clinical evaluation of the SD Bioline influenza virus antigen test for rapid detection of influenza viruses A and B in children and adults during the influenza season", Clin Vaccine Immunol, 14, pp.1050~1052 (2007)
- Weinberg A, "Sensitivity of diagnostic tests for influenza varies with the circulating strains", J Clin Virol, 33, pp.172~175 (2005)
- Mackie PL, "Evaluation of Binax NOW RSV as an acute point-of-care screening test in a paediatric accident and emergency unit", Commun Dis Public Health, 7, pp.328~330 (2004)
- Daisy JA, "Rapid diagnosis of influenza A infection by direct immunofluorescence of nasopharyngeal aspirates in adults", J Clin Microbiol, 9, pp.688~692 (1979)
- Gavin PJ, "Review of rapid diagnostic tests for influenza", Clin Applied Immunol Rev, 4, pp.151~172 (2004)
- St George K, "Rapid and sensitive detection of respiratory virus infections for directed antiviral treatment using R-Mix cultures", J Clin Virol, 24, pp.107~115 (2002)
- Mackay IM, "Real-time PCR in microbiology from diagnosis to characterization", pp.101~269 (2007), Caister Academic Press
- Ashihara Y, "Henry’s clinical diagnosis and management by laboratory methods. 21th ed", pp.812~814 (2007), WB Saunders
- "Interim guidance for the detection of novel influenza A virus using rapid influenza diagnostic tests"[URL]
- Yuen KY, "Clinical features and rapid viral diagnosis of human disease associated with avian influenza A H5N1 virus", Lancet, 351, pp.467~471 (1998)