Respiratory virus detection in nasopharyngeal aspirate versus bronchoalveolar lavage is dependent on virus type in children with chronic respiratory symptoms

Danielle Wurzel, Julie Marchant, Julia Clark, Ian M Mackay, Claire Wang, Theo P Sloots, John Upham, Stephanie Yerkovich, Ian Brent Masters, Peter Baker, Sophie Anderson-James, Anne Chang

    Research output: Contribution to journalArticle

    Abstract

    Background: The comparative yield of respiratory virus detection from nasopharyngeal aspirate (NPA) versus bronchoalveolar lavage (BAL) is uncertain. Furthermore, the significance of virus detection and its relationship to lower airway neutrophilic inflammation is poorly studied.

    Objectives: To evaluate the sensitivity, specificity and predictive values of NPA for detecting respiratory viruses in BAL; and to determine the relationship between viruses and lower airway neutrophilia in children with non-acute respiratory illness.

    Study design:
    150 paired NPA and BAL samples were obtained from 75 children aged <18 years undergoing flexible bronchoscopy for investigation of chronic respiratory symptoms. Viral studies were performed using polymerase chain reaction (PCR). Cellularity studies were performed on BALs. Diagnostic parameters of NPA compared to BAL and associations between viruses and lower airway %neutrophils were evaluated.

    Results: NPA had a higher yield than BAL for detection of any respiratory virus (52 versus 38, respectively). NPA had a high sensitivity (92%) and low specificity (57%) for detecting HRV in BAL with poor kappa agreement value of 0.398 (95% CI 0.218-0.578, p < 0.001). NPA had a fair sensitivity (69%) and good specificity (90.3%) for detecting HAdV on BAL, kappa agreement was 0.561 (95% CI 0.321-0.801, p < 0.001). HAdV positivity on NPA, compared to negativity, was independently associated with heightened airway neutrophilia [mean difference (95% CI): 18 (1,35); p= 0.042].

    Conclusions: NPA has a higher yield for respiratory virus detection than BAL, however its diagnostic accuracy is dependent on viral species. Adenovirus positivity is associated with significantly heightened lower airway neutrophilia in children with chronic respiratory symptoms. � 2013.
    Original languageEnglish
    Pages (from-to)683-688
    Number of pages6
    JournalJournal of Clinical Virology
    Volume58
    Issue number4
    DOIs
    Publication statusPublished - 2013

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    Bronchoalveolar Lavage
    Viruses
    Dimercaprol
    Bronchoscopy
    Adenoviridae
    Neutrophils
    Inflammation
    Sensitivity and Specificity
    Polymerase Chain Reaction

    Cite this

    Wurzel, Danielle ; Marchant, Julie ; Clark, Julia ; Mackay, Ian M ; Wang, Claire ; Sloots, Theo P ; Upham, John ; Yerkovich, Stephanie ; Masters, Ian Brent ; Baker, Peter ; Anderson-James, Sophie ; Chang, Anne. / Respiratory virus detection in nasopharyngeal aspirate versus bronchoalveolar lavage is dependent on virus type in children with chronic respiratory symptoms. In: Journal of Clinical Virology. 2013 ; Vol. 58, No. 4. pp. 683-688.
    @article{c33c1f54273b4900be204d4276c6959b,
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    abstract = "Background: The comparative yield of respiratory virus detection from nasopharyngeal aspirate (NPA) versus bronchoalveolar lavage (BAL) is uncertain. Furthermore, the significance of virus detection and its relationship to lower airway neutrophilic inflammation is poorly studied. Objectives: To evaluate the sensitivity, specificity and predictive values of NPA for detecting respiratory viruses in BAL; and to determine the relationship between viruses and lower airway neutrophilia in children with non-acute respiratory illness. Study design: 150 paired NPA and BAL samples were obtained from 75 children aged <18 years undergoing flexible bronchoscopy for investigation of chronic respiratory symptoms. Viral studies were performed using polymerase chain reaction (PCR). Cellularity studies were performed on BALs. Diagnostic parameters of NPA compared to BAL and associations between viruses and lower airway {\%}neutrophils were evaluated. Results: NPA had a higher yield than BAL for detection of any respiratory virus (52 versus 38, respectively). NPA had a high sensitivity (92{\%}) and low specificity (57{\%}) for detecting HRV in BAL with poor kappa agreement value of 0.398 (95{\%} CI 0.218-0.578, p < 0.001). NPA had a fair sensitivity (69{\%}) and good specificity (90.3{\%}) for detecting HAdV on BAL, kappa agreement was 0.561 (95{\%} CI 0.321-0.801, p < 0.001). HAdV positivity on NPA, compared to negativity, was independently associated with heightened airway neutrophilia [mean difference (95{\%} CI): 18 (1,35); p= 0.042]. Conclusions: NPA has a higher yield for respiratory virus detection than BAL, however its diagnostic accuracy is dependent on viral species. Adenovirus positivity is associated with significantly heightened lower airway neutrophilia in children with chronic respiratory symptoms. � 2013.",
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    author = "Danielle Wurzel and Julie Marchant and Julia Clark and Mackay, {Ian M} and Claire Wang and Sloots, {Theo P} and John Upham and Stephanie Yerkovich and Masters, {Ian Brent} and Peter Baker and Sophie Anderson-James and Anne Chang",
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    Wurzel, D, Marchant, J, Clark, J, Mackay, IM, Wang, C, Sloots, TP, Upham, J, Yerkovich, S, Masters, IB, Baker, P, Anderson-James, S & Chang, A 2013, 'Respiratory virus detection in nasopharyngeal aspirate versus bronchoalveolar lavage is dependent on virus type in children with chronic respiratory symptoms', Journal of Clinical Virology, vol. 58, no. 4, pp. 683-688. https://doi.org/10.1016/j.jcv.2013.09.016

    Respiratory virus detection in nasopharyngeal aspirate versus bronchoalveolar lavage is dependent on virus type in children with chronic respiratory symptoms. / Wurzel, Danielle; Marchant, Julie; Clark, Julia; Mackay, Ian M; Wang, Claire; Sloots, Theo P; Upham, John; Yerkovich, Stephanie; Masters, Ian Brent; Baker, Peter; Anderson-James, Sophie; Chang, Anne.

    In: Journal of Clinical Virology, Vol. 58, No. 4, 2013, p. 683-688.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Respiratory virus detection in nasopharyngeal aspirate versus bronchoalveolar lavage is dependent on virus type in children with chronic respiratory symptoms

    AU - Wurzel, Danielle

    AU - Marchant, Julie

    AU - Clark, Julia

    AU - Mackay, Ian M

    AU - Wang, Claire

    AU - Sloots, Theo P

    AU - Upham, John

    AU - Yerkovich, Stephanie

    AU - Masters, Ian Brent

    AU - Baker, Peter

    AU - Anderson-James, Sophie

    AU - Chang, Anne

    PY - 2013

    Y1 - 2013

    N2 - Background: The comparative yield of respiratory virus detection from nasopharyngeal aspirate (NPA) versus bronchoalveolar lavage (BAL) is uncertain. Furthermore, the significance of virus detection and its relationship to lower airway neutrophilic inflammation is poorly studied. Objectives: To evaluate the sensitivity, specificity and predictive values of NPA for detecting respiratory viruses in BAL; and to determine the relationship between viruses and lower airway neutrophilia in children with non-acute respiratory illness. Study design: 150 paired NPA and BAL samples were obtained from 75 children aged <18 years undergoing flexible bronchoscopy for investigation of chronic respiratory symptoms. Viral studies were performed using polymerase chain reaction (PCR). Cellularity studies were performed on BALs. Diagnostic parameters of NPA compared to BAL and associations between viruses and lower airway %neutrophils were evaluated. Results: NPA had a higher yield than BAL for detection of any respiratory virus (52 versus 38, respectively). NPA had a high sensitivity (92%) and low specificity (57%) for detecting HRV in BAL with poor kappa agreement value of 0.398 (95% CI 0.218-0.578, p < 0.001). NPA had a fair sensitivity (69%) and good specificity (90.3%) for detecting HAdV on BAL, kappa agreement was 0.561 (95% CI 0.321-0.801, p < 0.001). HAdV positivity on NPA, compared to negativity, was independently associated with heightened airway neutrophilia [mean difference (95% CI): 18 (1,35); p= 0.042]. Conclusions: NPA has a higher yield for respiratory virus detection than BAL, however its diagnostic accuracy is dependent on viral species. Adenovirus positivity is associated with significantly heightened lower airway neutrophilia in children with chronic respiratory symptoms. � 2013.

    AB - Background: The comparative yield of respiratory virus detection from nasopharyngeal aspirate (NPA) versus bronchoalveolar lavage (BAL) is uncertain. Furthermore, the significance of virus detection and its relationship to lower airway neutrophilic inflammation is poorly studied. Objectives: To evaluate the sensitivity, specificity and predictive values of NPA for detecting respiratory viruses in BAL; and to determine the relationship between viruses and lower airway neutrophilia in children with non-acute respiratory illness. Study design: 150 paired NPA and BAL samples were obtained from 75 children aged <18 years undergoing flexible bronchoscopy for investigation of chronic respiratory symptoms. Viral studies were performed using polymerase chain reaction (PCR). Cellularity studies were performed on BALs. Diagnostic parameters of NPA compared to BAL and associations between viruses and lower airway %neutrophils were evaluated. Results: NPA had a higher yield than BAL for detection of any respiratory virus (52 versus 38, respectively). NPA had a high sensitivity (92%) and low specificity (57%) for detecting HRV in BAL with poor kappa agreement value of 0.398 (95% CI 0.218-0.578, p < 0.001). NPA had a fair sensitivity (69%) and good specificity (90.3%) for detecting HAdV on BAL, kappa agreement was 0.561 (95% CI 0.321-0.801, p < 0.001). HAdV positivity on NPA, compared to negativity, was independently associated with heightened airway neutrophilia [mean difference (95% CI): 18 (1,35); p= 0.042]. Conclusions: NPA has a higher yield for respiratory virus detection than BAL, however its diagnostic accuracy is dependent on viral species. Adenovirus positivity is associated with significantly heightened lower airway neutrophilia in children with chronic respiratory symptoms. � 2013.

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