Lack of sensitivity of rapid antigen tests for the diagnosis of respiratory syncytial virus infection in adults
Introduction
Respiratory syncytial virus (RSV) is the most important cause of lower respiratory tract infections in infants and young children (Hall, 1999, McBride, 1999). RSV is also an important cause of severe respiratory disease in certain adult populations including bone marrow transplant recipients, the frail elderly and persons with cardiopulmonary diseases (Englund et al., 1988, Falsey et al., 1992, Walsh et al., 1999). Furthermore, it has been estimated that RSV causes between 2 and 9% of adult community-acquired pneumonia throughout the year and up to 15% during the wintertime (Dowell et al., 1996, Falsey and Walsh, 2000).
The diagnosis of acute RSV infection in adults is difficult because of insensitive diagnostic tools, low viral titers in secretions and problems obtaining nasal washes in frail older adults (Ahluwalia et al., 1987, Kellogg, 1991, Masters et al., 1987). Secretions with the highest viral titers are those obtained early in the course of infection and those from young children (Englund et al., 1996). In adults, serology provides the best diagnostic sensitivity but is useful only for retrospective diagnosis. Reverse transcription polymerase chain reaction (RT-PCR) has recently been shown to be both sensitive and specific but is not widely available (Falsey et al., 2002). At the present time clinicians only have viral culture and rapid antigen tests available for diagnosis of acute infection. Most published evaluations of rapid antigen assays for the detection of RSV in respiratory secretions compare results to other rapid diagnostic tests or to isolation in cell culture in infants, and few studies describe their use in adult populations (Kellogg, 1991, Englund et al., 1996, Falsey et al., 1996, Hughes et al., 1988, Johnston and Siegel, 1990, Minnich and Ray, 1980). Only one study of rapid antigen testing has been reported in elderly adults (Falsey et al., 1996). This small study of 11 RSV infected older persons showed antigen detection in nasal specimens to be very insensitive.
The purpose of this study was to evaluate the performance of three rapid RSV antigen detection tests: Becton Dickinson Directigen RSV (BD), Bartels RSV Direct Fluorescent Antibody Test (DFA) and the VIDAS RSV assay (VIDAS) in 60 non-immunocompromised adults with documented RSV infection.
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Respiratory specimens
A total of 669 clinical specimens collected from adult subjects participating in a surveillance study of respiratory illness were analyzed for RSV infection. Of the 669 illnesses, 100% had culture, 100% RT-PCR and 80% had serology. Ill subjects were evaluated and specimens were collected within 72 h of onset of symptoms for outpatients and within 48 h of admission for inpatients. For nasopharyngeal (NP) specimen collection, a cotton tipped swab was rolled across the nasal mucosa for 5 s and
Results
Results for all 60 samples are shown in Table 1. Serology results were available for 54 of the 60 samples that were positive by one or more of the three reference methods (cell culture, serology and/or RT-PCR). Of the total specimens tested, 46 (85%) were detected by serology, 49 (82%) were detected by RT-PCR and 28 (46%) were detected by cell culture. Only 19 (32%) were reactive by one or more of the antigen detection assays. Of the 60 samples, BD detected 6 (10%), VIDAS detected 12 (20%) and
Discussion
RSV is an important cause of serious respiratory disease in older adults. These infections result in excess morbidity and mortality in nursing home residents as well as community dwelling adults, particularly those with chronic cardiac and pulmonary diseases (Falsey et al., 1992, Walsh et al., 1999). Unfortunately, the diagnosis of acute RSV infection in the adult is difficult. Of the currently available RSV diagnostic tests, only culture and antigen tests are generally available in
Acknowledgements
The authors wish to thank Edna Yellamaty, M.T. for excellent technical assistance.
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