Download Respiratory Viral Panel testing by Multiplex PCR

LAB TEST CONNECT
Respiratory Viral Panel
Testing by Multiplex PCR
John J. Rushton, PhD, MBA
CLINICAL APPLICATION
ORDER CODE:
RVPCR
Our laboratory is now offering a multiplex PCR Respiratory Viral Panel (RVP) assay that
detects the following viral pathogens:
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INFLUENZA VIRUSES (A, A H1, A H3, A 2009 H1N1, B)
RESPIRATORY SYNCYTIAL VIRUS (RSV) A & B
PARAINFLUENZA (1, 2, 3)
HUMAN METAPNEUMOVIRUS (hMPV)
RHINOVIRUS (HRV)
ADENOVIRUS (B/E, C)
Quick Facts
Influenza viruses (A/B) are RNA viruses in the orthomyxoviridae family that continuously
undergo genetic changes that can leave the human population vulnerable to seasonal
changes. Currently circulating influenza A viruses include subtypes H1N1 (including the
seasonal 2009 H1N1) and H3N2.
n RVP detects 14 respiratory
virus types and subtypes
simultaneously
Respiratory Syncytial Viruses (A/B) are RNA viruses in the paramyxoviridae family.
Infection with RSV is common in children and adults. Infections with RSV A are thought to
be more severe than infections with RSV B.
n Increased sensitivity over
viral culture and DFA
Parainfluenza Viruses (1/2/3) are RNA viruses in the paramyxoviridae family. The
parainfluenza viruses are also commonly identified causative agents of lower respiratory
tract infections (LRTIs) in children, albeit at a lower frequency than RSV.
Human Metapneumovirus (hMPV) is a member of the same virus family as RSV and PIV
and has been identified as an important respiratory pathogen in young children with
further studies confirming hMPV infections in persons of all ages.
n Flu A Subtyping including:
2009 H1N1, H1, and H3
subtypes
n Turnaround time 1-3 days
Rhinovirus (HRV) is a RNA virus in the picornavirus family. The most common infectious
agent of both upper and lower respiratory illness, rhinoviruses can cause severe infection
in certain populations.
Adenoviruses are a diverse group of non-enveloped DNA viruses. The subgenera B,C, and
E are frequently associated with upper respiratory tract infections with high rates in closed
populations.
CLINICAL BACKGROUND
Respiratory viruses are responsible for a wide range of acute respiratory tract infections including the common cold, influenza, and
croup, and represent the most common cause of acute illness in the U.S. Disease severity can be especially high in the young, the
immunocompromised and elderly patients. Diagnosis of respiratory infection by clinical symptoms alone is extremely difficult and often
inaccurate due to non-specific symptoms.
Virus
Common Symptoms
Commonly Infected Demographic
Upper respiratory tract infections (URTIs) with fever
All ages, 5-20% of US population
Respiratory Syncytial Virus B (RSV B)
LRTIs in infants
*RSVA thought to be more severe than RSVB
Infants, children, older adults
Human Metapneumovirus
Bronchiolitis
Infants, children
Parainfluenza Virus 1 (PIV 1)
Laryngotracheobronchitis (croup)
Infants, children
Parainfluenza Virus 2 (PIV 2)
Laryngotracheobronchitis (croup)
Infants, children
Parainfluenza Virus 3 (PIV 3)
Bronchiolitis and pneumonia
Infants, children, immunocompromised
Rhinovirus (HRV)
Mild URTIs and severe LRTIs in at-risk populations
All ages
URTIs
All ages, immunocompromised
Influenza A (Flu A)
Influenza A H1 (Flu A H1)
Influenza A H3 (Flu A H3)
Influenza A 2009 H1N1 (2009 H1N1)
Influenza B (Flu B)
Respiratory Syncytial Virus A (RSV A)
Adenovirus (B/E)
www.paml.com Adenovirus (C)
Respiratory Viral Panel
Testing by Multiplex PCR
RESULT INTERPRETATION
TEST INFORMATION
Detection of the 14 respiratory viral targets listed occurs
simultaneously in a single reaction cartridge using a solid-phase
electrochemical detection methodology. Multiplex PCR -RVP
provides a qualitative result based upon the presence (Positive) or
absence (Target not Detected) of the viruses contained within the
panel. Negative results do not preclude respiratory viral infection
and should not be used as the sole basis for diagnosis, treatment, or
other patient management decisions. Because co-infections occur
approximately 10%-30% of the time, there may be more than one
virus detected and reported.
RESPIRATORY VIRAL PANEL TESTING
BY MULTIPLEX PCR
Description
Respiratory Viral Panel PCR
Method
PCR
Order Code
RVPCR
CPT Code
87633
Specimen Requirements
Flocked nasopharyngeal (NP)
swab preferred; polyester,
rayon or nylon tipped swabs
acceptable. Submit in viral
transport media.
Alternate Specimens
Bronchoalveolar Lavage (BAL),
bronchial washes, and throat
swabs in viral transport media.
Comments
Qualitative assay reports as
Detected or Not Detected
Schedule
Monday - Friday
Turnaround time
1-3 days
METHODOLOGY COMPARISON
Diagnostic Testing: Culture / DFA / PCR
MULTIPLEX
PCR
VIRAL
CULTURE
DIRECT
FLUORESCENT
ANTIBODY (DFA)
SENSITIVITY
91-100%
69-98%
40-80%
SUBTYPING
(Influenza A, RSV,
Adeno only)
YES
NO
NO
TURNAROUND
TIME
1-3 Days
7-14 Days
1 Day
# OF VIRUSES
DETECTED
14
7
8
DETECT
CO-INFECTIONS
YES
NO
NO
Multiplex Polymerase Chain Reaction (PCR) detection offers a highly
sensitive and specific method of respiratory virus detection and is
quickly replacing culture and DFA as the gold standard. In addition
to sensitivity and specificity, benefits of multiplex PCR testing
include the ability to obtain the results in hours and demonstrated
ability to detect more than one viral infection (co-infection) in a
patient specimen. Emerging evidence suggests patients with viral
co-infections have increased disease severity and more complex
clinical management.
SELECTED REFERENCES
1. Gharabaghi et. al Clin Micro and Infection 17(12):1900-06
2. Popowitch et. al J Clin Mircobiol 2013 51(5):1528-33
3. Virol J. 2013 Jun 7;10:184. doi: 10.1186/1743-422X-10-184.”A cost
effective real-time PCR for the detection of adenovirus from viral swabs.”
Al-Siyabi T, Binkhamis K, Wilcox M, Wong S, Pabbaraju K, Tellier R, Hatchette
TF, LeBlanc JJ.
For more information, please contact your local sales representative.