Use of immunochromatographic tests in a laboratory diagnostic algorithm for influenza


Yatsyshina S.B., Kulichenko T.V., Artemova I.V., Rybalka O.B., Elkina M.N.

1 Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; 2 National Medical Research Center for Children’s Health, Ministry of Health of Russia, Moscow, Russia
Objective. To estimate the diagnostic significance of identifying the antigens of influenza A and B viruses by immunochromatography (ICG) versus that of detecting influenza virus nucleic acids (NAs) by a real-time polymerase chain reaction (RT-PCR) assay, as well as to determine the optimal procedure for their use in the diagnosis of influenza.
Subjects and methods. Nasopharyngeal swabs from 211 children with influenza-like symptoms were concurrently examined by ICG and RT-PCR for NAs of influenza viruses and 19 other pathogen species of acute respiratory diseases.
Results. 85.8% of the children were found to have NAs in the pathogens of acute respiratory infections; influenza was confirmed in 62.6%. ICG was used to detect influenza virus antigens in 31.3% of the children. The diagnostic sensitivity of ICG for influenza A(H3N2) and B viruses was 58 and 20%, respectively; its diagnostic specificity was 97.5 and 97.7%.
Conclusion. The negative result of ICG cannot be an exception to the diagnosis of influenza due to the low sensitivity of this technique. Examinations on 1-2 days of the disease allow one to increase the sensitivity of ICG for the diagnosis of influenza A; this technique is minimally informative for the diagnosis of influenza B. It is advisable to use RT-PCR to rule out the diagnosis of influenza and to determine respiratory infection of another etiology.
Keywords: immunochromatography, rapid tests, polymerase chain reaction, respiratory viruses, influenza, diagnosis
Read entire article

Literature

  1. Chaves S.S., Pérez A., Miller L., Bennett N.M., Bandyopadhyay A., Farley M.M., Fowler B., Hancock E.B., Kirley P.D., Lynfield R., Ryan P., Morin C., Schaffner W., Sharangpani R., Lindegren M.L., Tengelsen L., Thomas A., Hill M.B., Bradley K.K., Oni O., Meek J., Zansky S., Widdowson M.A., Finelli L. Impact of Prompt Influenza Antiviral Treatment on Extended Care Needs After Influenza Hospitalization Among Community-Dwelling Older Adults. Clin Infect Dis. Clin. Infect. Dis. 2015; 61(12): 1807–4. DOI: 10.1093/cid/civ733.
  2. Yatsyshina S.B., Minenko A.N., Kushakova T.E., Praded M.N., Kudriavtseva A.V., Shipulin G.A., Maleev V.V., Pokrovsky V.I. [Pandemic influenza A/H1N1 (sw2009) in Russia: epidemiology, diagnosis, clinical picture, and treatment]. Ter. Arkhiv 2010; 82(11): 10–4. (In Russ.).
  3. Rorat M., Jurek T., Kuchar E., Szenborn L. The clinical course of late diagnosed fatal cases of A (H1N1) influenza in Poland. Postepy Hig Med Dosw (Online). 2013; 67:595-600. DOI: 10.5604/17322693.1053910.
  4. Tatochenko V.K. [Etiotropic and symptomatic therapy of acute respiratory-viral infections]. Pediatricheskaya farmakologiya 2008; (5): 101–5. (In Russ.).
  5. Fiore A.E., Fry A., Shay D., Gubareva L., Bresee J.S., Uyeki T.M.; Centers for Disease Control and Prevention (CDC). Antiviral Agents for the Treatment and Chemoprophylaxis of Influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm. Rep. 2011; 60(1): 1–24.
  6. Boivin G., Hardy I., Tellier G., Maziade J. Predicting influenza infections during epidemics with use of a clinical case definition. Clin. Infect. Dis. 2000; 31: 1166–9. DOI:10.1086/317425.
  7. Walsh E.E., Cox C., Falsey A.R. Clinical features of influenza A virus infection in older hospitalized persons. J. Am. Geriatr. Soc. 2002; 50: 1498–1503.
  8. Ohmit S.E., Monto A.S. Symptomatic predictors of influenza virus positivity in children during the influenza season. Clin. Infect. Dis. 2006; 43: 564–8. DOI:10.1086/506352.
  9. Babcock H.M., Merz L.R., Fraser V.J. Is influenza an influenza-like illness? Clinical presentation of influenza in hospitalized patients. Infect. Control. Hosp. Epidemiol. 2006; 27: 266–70. DOI:10.1086/501539.
  10. Van der Hoeven A.M., Scholing M., Wever P.C., Fijnheer R., Hermans M., Schneeberger P.M. Lack of discriminating signs and symptoms in clinical diagnosis of influenza of patients admitted to the hospital. Infection 2007; 35: 65–8. DOI:10.1007/s15010-007-6112-1.
  11. Miller M.R., Peters T.R., Suerken C.K., Snively B.M., Poehling K.A. J. Predictors of Influenza Diagnosis Among Patients With Laboratory-Confirmed Influenza. Infect. Dis. 2015; 212(10): 1604–12. DOI: 10.1093/infdis/jiv264.
  12. Ginocchio C.C. Strengths and weaknesses of FDA-approved/cleared diagnostic devices for the molecular detection of respiratory pathogens. Clin. Infect. Dis. 2011; 52(Suppl 4): S312–25. http://dx.doi.org/10.1093/ cid/cir046. DOI: 10.1093/cid/cir046.
  13. Ivanova V.T., Trushakova S.V., Oskerko T.A., Shevchenko E.S., Kolobukhina L.V., Vartanian R.V., Beliakova N.V., Iatsyshina S.B., Feodoritova E.L., Zueva N.D., Burtseva E.I. [The characteristics of epidemic influenza A and B virus strains circulating in Russia during the 2007–2008 season]. Voprosy Virusologii 2009; 54(5): 28–33. (In Russ.).
  14. Storch G.A. Rapid diagnostic tests for influenza. Curr. Opin. Pediatr. 2003; 15: 77–84.
  15. Grijalva C.G., Poehling K.A., Weinberg G.A., Staat M.A., Iwane M.K., Schaffner W., Griffin M.R. Accuracy and interpretation of rapid influenza tests in children. Pediatrics 2007; 119: e6–11. DOI:10.1542/peds.2006-1694.
  16. Uyeki T.M., Prasad R., Vukotich C., Stebbins S., Rinaldo C.R., Ferng Y.H., Morse S.S., Larson E.L., Aiello A.E., Davis B., Monto A.S. Low sensitivity of rapid diagnostic test for influenza. Clin. Infect. Dis. 2009; 48: e89–92. DOI: 10.1086/597828.
  17. Steininger C., Redlberger M., Graninger W., Kundi M., Popow-Kraupp T. Near-patient assays for diagnosis of influenza virus infection in adult patients. Clin. Microbiol. Infect. 2009; 15: 267–73. DOI: 10.1111/j.1469-0691.2008.02674.x.
  18. Hurt A.C., Alexander R., Hibbert J., Deed N., Barr I.G. Performance of six influenza rapid tests in detecting human influenza in clinical specimens. J. Clin. Virol. 2007; 39: 132–5. DOI:10.1016/j.jcv.2007.03.002.
  19. Rahman M., Vandermause M.F., Kieke B.A., Belongia E.A. Performance of Binax NOW Flu A and B and direct fluorescent assay in comparison with a composite of viral culture or reverse transcription polymerase chain reaction for detection of influenza infection during the 2006 to 2007 season. Diagn. Microbiol. Infect. Dis. 2008; 62: 162–6. DOI:10.1016/j. diagmicrobio.2007.10.012.
  20. Harper S.A., Bradley J.S., Englund J.A., File T.M., Gravenstein S., Hayden F.G., McGeer A.J., Neuzil K.M., Pavia A.T., Tapper M.L., Uyeki T.M., Zimmerman R.K.; Expert Panel of the Infectious Diseases Society of America. Seasonal influenza in adults and children – diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America. Clin. Infect. Dis. 2009; 48: 1003–32. DOI: 10.1086/598513.
  21. Faix D.J., Sherman S.S., Waterman S.H. Rapid-test sensitivity for novel swine-origin influenza A (H1N1) virus in humans. N. Engl. J. Med. 2009; 361(7): 728–9. DOI: 10.1056/NEJMc0904264.
  22. Bruning A. H. L., Susi P., Toivola H., Christensen A., Söderlund-Venermo M.,Hedman K., Aatola H., Zvirbliene A., Koskinen J.O. Detection and monitoring of human bocavirus 1 infection by a new rapid antigen test. New Microbe and New Infect. 2016; 11: 17–9. DOI: 10.1016/j.nmni.2016.01.015


About the Autors

For correspondence:
Svetlana B. Yatsyshina, Cand. Biol. Sci., Senior Researcher, Department of Molecular Diagnosis and Epidemiology, Central Research Institute of Epidemiology, Russian Federal Service for Surveillance on Consumer Rights Protection and Human Well-Being
Address: 3a, Novogireevskaya St., Moscow 111123, Russia
Telephone: +7(495)974-96-46, ext.2260
E-mail: svetlana.yatsyshina@cmd.su; syatsyshina@yandex.ru
Information about the authors:
Prof. Tatiana V. Kulichenko, MD, Head, Department of Urgent Pediatrics, National Medical Research Center for Children’s Health, Ministry of Health of Russia, Moscow, Russia;
e-mail: Tkulichenko@yandex.ru
Inga V. Artemova, Pediatrician, Department of Urgent Pediatrics, National Medical Research Center for Children’s Health, Ministry of Health of Russia, Moscow, Russia;
e-mail: sko-inga@yandex.ru
Olga B. Rybalka, Pediatrician, Department of Urgent Pediatrics, National Medical Research Center for Children’s Health, Ministry of Health of Russia, Moscow, Russia;
е-mail: olya.rybalka@yandex.ru
Mariya А. Elkina, Junior Researcher, Department of Molecular Diagnostics and Epidemiology, Central Research Institute of Epidemiology, Russian Federal Service for Surveillance on Consumer Rights Protection and Human Well-Being;
Moscow, Russia; e-mail: mariyaelkina@yahoo.com


Similar Articles

Back to Content

Бионика Медиа