Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of California at San Francisco, San Francisco, CA, USA.
Pediatr Crit Care Med. 2011 Jul;12(4):e160-5. doi: 10.1097/PCC.0b013e3181f36e86.
To identify the respiratory viral pathogens associated with acute lower respiratory tract infection in critically ill pediatric patients by using real-time reverse transcription-polymerase chain reaction, and compare results with those of direct fluorescence antibody assay testing.
Observational cohort study.
Pediatric intensive care unit at a tertiary care academic hospital.
Pediatric patients admitted to the pediatric intensive care unit with severe respiratory symptoms consistent with viral lower respiratory tract infection.
None.
Respiratory samples of pediatric patients admitted to the pediatric intensive care unit with severe respiratory symptoms between January 2008 and July 2009 were tested with direct fluorescence antibody assay and real-time reverse transcription-polymerase chain reaction.
At least one viral agent was detected in 70.5% of specimens by real-time reverse transcription-polymerase chain reaction and in 16.5% by direct fluorescence antibody assay (p < .001). Real-time reverse transcription-polymerase chain reaction increased the total viral yield five-fold compared to direct fluorescence antibody assay. Rhinovirus was the most commonly identified virus (41.6%). For viruses included in the direct fluorescence antibody assay panel, direct fluorescence antibody assay had a sensitivity of 0.42 (95% confidence interval 0.25-0.61) and a specificity of 1 (95% confidence interval 0.86-1.00) compared with real-time reverse transcription-polymerase chain reaction. Coinfections were not uncommon, in particular with rhinovirus, and these patients tended to have higher mortality.
Direct fluorescence antibody assay testing is a suboptimal method for the detection of respiratory viruses in critically ill children with lower respiratory tract infection. Given the importance of a prompt and accurate viral diagnosis for this group of patients, we suggest that real-time reverse transcription-polymerase chain reaction becomes part of the routine diagnostic algorithm in critically ill children when a viral etiology is suspected, even if conventional tests yield a negative result.
通过实时逆转录聚合酶链反应（RT-PCR）鉴定危重症患儿急性下呼吸道感染的呼吸道病毒病原体，并与直接荧光抗体检测（DFA）的结果进行比较。
观察性队列研究。
三级学术医院的儿科重症监护病房（PICU）。
因严重呼吸道症状疑似病毒下呼吸道感染而入住 PICU 的儿科患者。
无。
2008 年 1 月至 2009 年 7 月期间入住 PICU 且有严重呼吸道症状的儿科患者的呼吸道样本，采用 DFA 和实时 RT-PCR 进行检测。
实时 RT-PCR 检测到 70.5%的标本中至少有一种病毒，而 DFA 检测到 16.5%（p<0.001）。实时 RT-PCR 比 DFA 检测到的病毒总载量增加了五倍。鼻病毒是最常见的病毒（41.6%）。对于 DFA 检测试剂盒中包含的病毒，实时 RT-PCR 的敏感性为 0.42（95%置信区间 0.25-0.61），特异性为 1（95%置信区间 0.86-1.00）。病毒的合并感染并不少见，尤其是鼻病毒，这些患者的死亡率较高。
DFA 检测是一种检测下呼吸道感染危重症儿童呼吸道病毒的不理想方法。鉴于快速准确的病毒诊断对这类患者非常重要，因此我们建议，当怀疑有病毒病因时，实时 RT-PCR 应成为危重症儿童常规诊断算法的一部分，即使常规检测结果为阴性。
