Greenhow Tara L, Weintrub Peggy Sue
Department of Pediatrics, Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, USA.
Pediatr Infect Dis J. 2006 Jun;25(6):502-6. doi: 10.1097/01.inf.0000222401.21284.af.
Direct fluorescent antibody (DFA) testing of nasopharyngeal wash specimens is a rapid and reliable means of diagnosing respiratory viral infection. The utility of DFA testing in the evaluation of febrile children without respiratory symptoms has not been critically evaluated. It is not known whether clinical or demographic factors apart from respiratory symptoms are associated with a positive DFA or whether a positive DFA is more likely to be associated with lower or upper respiratory tract symptoms (RTS).
This is a retrospective case-series of 756 consecutive nasopharyngeal specimens with respiratory DFA testing performed at the University of California San Francisco from November 1, 2002 through October 31, 2003.
No RTS was a statistically significant predictor of negative DFA [odds ratio (OR), 0.03; 95% confidence interval (CI), 0.004-0.2; P = 0.001] compared with lower RTS. Male subjects were more likely than female subjects to have a positive DFA (OR 1.8; 95% CI 1.1-2.8; P = 0.02). Specimens collected from April to October were less likely to have a positive DFA (OR 0.4; 95% CI 0.2-0.7; P = 0.001). Specimens collected at the time of hospital admission and during a hospitalization were less likely to have a positive DFA (OR 0.5; 95% CI 0.3-0.9; P = 0.01 and OR, 0.07; 95% CI 0.02-0.2; P = 0.001, respectively) compared with specimens collected in the outpatient setting.
The yield of testing children without respiratory tract illness is extremely low.
对鼻咽冲洗标本进行直接荧光抗体（DFA）检测是诊断呼吸道病毒感染的一种快速且可靠的方法。DFA检测在评估无呼吸道症状的发热儿童中的效用尚未得到严格评估。除呼吸道症状外，尚不清楚临床或人口统计学因素是否与DFA阳性相关，也不清楚DFA阳性是否更可能与下呼吸道或上呼吸道症状（RTS）相关。
这是一项回顾性病例系列研究，对2002年11月1日至2003年10月31日在加利福尼亚大学旧金山分校进行呼吸道DFA检测的756份连续鼻咽标本进行了研究。
与下呼吸道症状相比，无呼吸道症状是DFA阴性的统计学显著预测因素[比值比（OR），0.03；95%置信区间（CI），0.004 - 0.2；P = 0.001]。男性受试者DFA阳性的可能性高于女性受试者（OR 1.8；95% CI 1.1 - 2.8；P = 0.02）。4月至10月采集的标本DFA阳性的可能性较小（OR 0.4；95% CI 0.2 - 0.7；P = 0.001）。与门诊采集的标本相比，入院时和住院期间采集的标本DFA阳性的可能性较小（分别为OR 0.5；95% CI 0.3 - 0.9；P = 0.01和OR，0.07；95% CI 0.02 - 0.2；P = 0.001）。
对无呼吸道疾病的儿童进行检测的阳性率极低。
