Ja. Englund et al., RAPID DIAGNOSIS OF RESPIRATORY SYNCYTIAL VIRUS-INFECTIONS IN IMMUNOCOMPROMISED ADULTS, Journal of clinical microbiology, 34(7), 1996, pp. 1649-1653
Although rapid antigen detection methods for the documentation of resp
iratory syncytial virus (RSV) infections are widely used with pediatri
c patients, these tests have not been prospectively evaluated in immun
ocompromised (IC) adults. For bone marrow transplant recipients and ad
ult patients undergoing chemotherapy for leukemia who had recent onset
of respiratory symptoms, respiratory samples (combined nasal wash [NW
]-throat swab [TS], endotracheal tube [ET] aspirate, or bronchoalveola
r lavage [BAL] samples) were collected for simultaneous culture and ra
pid antigen detection with the Directigen test kit (Becton Dickinson,
Cockeysville, Md.). NW specimens from hospitalized pediatric patients
with suspected RSV infection were also evaluated. Viral quantitation w
as performed on aliquots of the original specimens. A total of 539 sam
ples from 372 adult patients were evaluated. RSV was isolated from 56
specimens (40 NW-TS, 7 ET aspirate, and 9 BAL specimens). By using cul
ture as the ''gold standard,'' rapid antigen detection had a sensitivi
ty of 15% for adult NW-TS specimens, 71.4% for ET aspirate specimens,
and 88.9% for BAL specimens; the specificity was greater than or equal
to 97% for all specimen types. Significantly greater viral quantities
were present in pediatric NW specimens than in adult NW specimens. In
adults, more virus was present in BAL and ET aspirate specimens than
in NW-TS specimens. Rapid detection of antigen respiratory samples obt
ained from the lower respiratory tracts of IC adults is sensitive and
specific, but detection in upper respiratory tract samples is insensit
ive. The lower sensitivity of antigen detection in NW-TS specimens may
be due to decreased viral load. A BAL specimen is more sensitive than
an NW-TS specimen for the rapid diagnosis of RSV disease in IC adults
.