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 journalArticleResearchpeer-review

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.
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title = "Respiratory virus detection in nasopharyngeal aspirate versus bronchoalveolar lavage is dependent on virus type in children with chronic respiratory symptoms",
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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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 journalArticleResearchpeer-review

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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KW - controlled study

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