Simpson Jodie L, Moric Ivana, Wark Peter A B, Johnston Sebastian L, Gibson Peter G
Department of Respiratory and Sleep Medicine, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, Newcastle, New South Wales 2310, Australia.
J Clin Virol. 2003 Apr;26(3):339-46. doi: 10.1016/s1386-6532(02)00084-7.
Influenza (Flu) and respiratory syncytial virus (RSV) are important viral pathogens that cause lower respiratory tract infections and severe exacerbations of asthma. Molecular biological techniques are permitting a rapid and accurate diagnosis of infections caused by respiratory pathogens, and have typically been applied to upper respiratory samples. Sputum induction provides an opportunity to directly sample secretions from the lower respiratory tract.
OBJECTIVES/STUDY DESIGN: To determine the role of induced sputum reverse-transcription polymerase chain reaction (RT-PCR) in the detection of respiratory pathogens and compare this with detection using serology and immunofluorescent antigen (IFA) testing, we recruited 49 adults from emergency room with exacerbations of asthma. After a medical assessment and spirometry, sputum was induced using ultrasonically nebulised normal saline. Sputum was assayed using IFA and RT-PCR for flu and RSV. Flu serology was performed acutely and at convalescence, 4-5 weeks later.
Influenza A or B was detected in 24% of the samples by PCR, significantly more than the nine cases detected using serology and the one case using IFA (P<0.05). RSV was detected in 37% of samples using PCR and 20% by IFA (P<0.05).
The combination of induced sputum and RT-PCR provides a useful means of detecting respiratory infection. The technique is safe in both adults and children, and RT-PCR is more sensitive than conventional serology and IFA. The improved sensitivity of induced sputum RT-PCR also permits a more rapid diagnosis and the opportunity of early administration of effective treatments.
流感和呼吸道合胞病毒（RSV）是引起下呼吸道感染和哮喘严重加重的重要病毒病原体。分子生物学技术能够快速准确地诊断呼吸道病原体引起的感染，且通常已应用于上呼吸道样本。痰液诱导提供了直接从下呼吸道采样分泌物的机会。
目的/研究设计：为了确定诱导痰逆转录聚合酶链反应（RT-PCR）在呼吸道病原体检测中的作用，并将其与血清学检测和免疫荧光抗原（IFA）检测进行比较，我们从急诊室招募了49名哮喘加重的成年人。经过医学评估和肺活量测定后，使用超声雾化生理盐水诱导痰液。痰液用IFA和RT-PCR检测流感和RSV。急性期和4-5周后的恢复期进行流感血清学检测。
通过PCR在24%的样本中检测到甲型或乙型流感，显著多于血清学检测出的9例和IFA检测出的1例（P<0.05）。使用PCR在37%的样本中检测到RSV，使用IFA检测到20%（P<0.05）。
诱导痰和RT-PCR相结合提供了一种检测呼吸道感染的有用方法。该技术在成人和儿童中均安全，且RT-PCR比传统血清学和IFA更敏感。诱导痰RT-PCR提高的敏感性还允许更快速的诊断以及早期给予有效治疗的机会。
