《儿童呼吸道感染微生物检验标本采集转运与检测建议(病毒篇)》解读
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摘要
病毒是儿童呼吸道感染的主要病原,由于临床表现各异,病原学检测非常重要。由于种种原因,呼吸道感染微生物检验标本的采集、处理、转运等常成为整个检验过程中最薄弱的环节,临床医师对常用的呼吸道病毒检测方法和临床价值也缺乏足够的了解。该文围绕《儿童呼吸道感染微生物检验标本采集转运与检测建议(病毒篇)》,就标本采集的重要性和存在的问题、呼吸道病毒检测方法和结果判读中需要注意的问题等展开讨论。
The virus is a major pathogen of respiratory tract infection in children. Detection of viral etiology of respiratoty illnesses can provide valuable information to direct the management of patients over the different clinical manifestations. The procedures of the collection,transport and processing of specimens is the most error-prone parts in microbiological testing. Clinicians also lack sufficient understanding of the procedures and clinical value for respiratory virus detection. The paper covers the main content of Advice on Collection,Transport and Detection of Microbiological Testing Specimen in Children with Respiratory Infection(Focusing on Virus),the importance and problems involved in specimen collection,laboratory testing of respiratory viruses,and interpretation of the results.
The virus is a major pathogen of respiratory tract infection in children. Detection of viral etiology of respiratoty illnesses can provide valuable information to direct the management of patients over the different clinical manifestations. The procedures of the collection,transport and processing of specimens is the most error-prone parts in microbiological testing. Clinicians also lack sufficient understanding of the procedures and clinical value for respiratory virus detection. The paper covers the main content of Advice on Collection,Transport and Detection of Microbiological Testing Specimen in Children with Respiratory Infection(Focusing on Virus),the importance and problems involved in specimen collection,laboratory testing of respiratory viruses,and interpretation of the results.
引文
[1]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(上)[J].中华儿科杂志,2013,51(10):745-752.
[2]Rudan I,O’Brien KL,Nair H,et al.Epidemiology and etiology of childhood pneumonia in 2010:estimates of incidence,severe morbidity,mortality,underlying risk factors and causative patho?gens for 192 countries[J].J Glob Health,2013,3(1):010401.
[3]Jain S,Williams DJ,Arnold SR,et al.Community-acquired pneumonia requiring hospitalization among U.S.children[J].NEngl J Med,2015,372(9):835-845.
[4]Liu P,Xu M,He L,et al.Epidemiology of respiratory pathogens in children with lower respiratory tract infections in Shanghai,China,from 2013 to 2015[J].Jpn J Infect Dis,2018,71(1):39-44.
[5]中华医学会儿科学分会呼吸学组呼吸道感染协作组,《中国实用儿科杂志》编辑委员会.儿童呼吸道感染微生物检验标本采集转运与检测建议(病毒篇)[J].中国实用儿科杂志,2018,33(9):657-662.
[6]Hawkins R.Managing the pre-and post-analytical phases of the total testing process[J].Ann Lab Med,2012,32(1):5-16.
[7]胡婷婷,刘维薇.医学实验室质量和能力认可准则(ISO15189:2012)专用要求概述[J].临床检验杂志,2013,31(11):867-871.
[8]J Michael Miller.美国微生物学会临床微生物标本送检指南[M].马小军,周炯,杨启文,等.译.2版.北京:科学技术文献出版社,2015:92.
[9]蔡晓华,单红霞,张品忠.儿童急性下呼吸道感染病原菌分布及耐药性监测[J].中华医院感染学杂志,2014,24(12):3075-3079.
[10]Jorgensen JH,Pfaller MA.临床微生物学手册[M].王辉,马筱玲,钱渊,等.译.11版.北京:中华医学电子音像出版社,2017:1811-1833.
[11]美国疾病预防和控制中心.疑似严重急性呼吸综合征病例标本采集导则[J].中华检验医学杂志,2003,26(5):324-326.
[12]Baron EJ,Miller JM,Weinstein MP,et al.Executive summary:a guide to utilization of the microbiology laboratory for diagnosis of infectious diseases:2013 recommendations by the Infectious Diseases Society of America(IDSA)and the American Society for Microbiology(ASM)(a)[J].Clin Infect Dis,2013,57(4):485-488.
[13]La Sala PR,Bufton KK,Ismail N,et al.Prospective comparison of R-mix TM shell vial system with direct antigen tests and con?ventional cell culture for respiratory virus detection[J].J Clin Virol,2007,38(3):210-216.
[14]Leland DS,Ginocchio CC.Role of cell culture for virus detec?tion in the age of technology[J].Clin Microbiol Rev,2007,20(1):49-78.
[15]Das S,Dunbar S,Tang YW.Laboratory diagnosis of respiratory tract infections in Children-the state of the art[J].Front Micro?biol,2018,9:2478.
[16]Sails AD,Eltringham G,Valappil M,et al.Comparison of the Luminex Nx TAG respiratory pathogen panel and a multiplex inhouse real-time PCR panel for the detection of respiratory viruses in symptomatic patients[J].J Med Microbiol,2017.[Epub ahead of print].
[17]Brotons P,Henares D,Latorre I,et al.Comparison of Nx TAGrespiratory pathogen panel and anyplex II RV16 tests for multi?plex detection of respiratory pathogens in hospitalized chil?dren[J].J Clin Microbiol,2016,54(12),2900-2904.
[18]张海邻,陈小芳,吕芳芳,等.多重PCR技术检测儿童下呼吸道感染病毒和不典型病原体的价值[J].温州医科大学学报,2017,47(11):791-795.
[19]Deurenberg RH,Bathoorn E,Chlebowicz MA,et al.Application of next generation sequencing in clinical microbiology and in?fection prevention[J].J Biotechnol,2017,243:16-24.
[20]Graf EH,Simmon KE,Tardif KD,et al.Unbiased detection of respiratory viruses by use of RNA sequencing-based metage?nomics:a systematic comparison to a commercial PCR panel[J].J Clin Microbiol,254(4):1000-1007.
[21]Greninger AL,Waghmare A,Adler A,et al.Rule-out outbreak:24-hour metagenomic next-generation sequencing for charac?terizing respiratory virus source for infection prevention[J].JPediatric Infect Dis Soc,2017,6(2):168-172.
[22]Ling L,Kaplan SE,Lopez JC,et al.Parallel validation of three molecular devices for simultaneous detection and identification of influenza A and B and respiratory syncytial viruses[J].J Clin Microbiol,2018,56(3):pii:e01691-17.
[23]Azar MM,Landry ML.Detection of influenza A and B viruses and respiratory syncytial virus using CLIA-waived point-ofcare assays:a paradigm shift to molecular tests[J].J Clin Mi?crobiol,2018,56(7):pii:e00367-18.
[24]Brendish NJ,Malachira AK,Armstrong L,et al.Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness(Res POC):a pragmatic,open-label,randomised controlled trial[J].Lancet Respir Med,2017,5(5):401-411.
[25]Nicholls JM,Chan MC,Chan WY,et al.Tropism of avian influ?enza A(H5N1)in the upper and lower respiratory tract[J].Nat Med,2007,13(2):147-149.
[26]Willner D,Haynes MR,Furlan M,et al.Case studies of the spatial heterogeneity of DNA viruses in the cystic fibrosis lung[J].Am J Respir Cell Mol Biol,2012,46(2):127-131.
[2]Rudan I,O’Brien KL,Nair H,et al.Epidemiology and etiology of childhood pneumonia in 2010:estimates of incidence,severe morbidity,mortality,underlying risk factors and causative patho?gens for 192 countries[J].J Glob Health,2013,3(1):010401.
[3]Jain S,Williams DJ,Arnold SR,et al.Community-acquired pneumonia requiring hospitalization among U.S.children[J].NEngl J Med,2015,372(9):835-845.
[4]Liu P,Xu M,He L,et al.Epidemiology of respiratory pathogens in children with lower respiratory tract infections in Shanghai,China,from 2013 to 2015[J].Jpn J Infect Dis,2018,71(1):39-44.
[5]中华医学会儿科学分会呼吸学组呼吸道感染协作组,《中国实用儿科杂志》编辑委员会.儿童呼吸道感染微生物检验标本采集转运与检测建议(病毒篇)[J].中国实用儿科杂志,2018,33(9):657-662.
[6]Hawkins R.Managing the pre-and post-analytical phases of the total testing process[J].Ann Lab Med,2012,32(1):5-16.
[7]胡婷婷,刘维薇.医学实验室质量和能力认可准则(ISO15189:2012)专用要求概述[J].临床检验杂志,2013,31(11):867-871.
[8]J Michael Miller.美国微生物学会临床微生物标本送检指南[M].马小军,周炯,杨启文,等.译.2版.北京:科学技术文献出版社,2015:92.
[9]蔡晓华,单红霞,张品忠.儿童急性下呼吸道感染病原菌分布及耐药性监测[J].中华医院感染学杂志,2014,24(12):3075-3079.
[10]Jorgensen JH,Pfaller MA.临床微生物学手册[M].王辉,马筱玲,钱渊,等.译.11版.北京:中华医学电子音像出版社,2017:1811-1833.
[11]美国疾病预防和控制中心.疑似严重急性呼吸综合征病例标本采集导则[J].中华检验医学杂志,2003,26(5):324-326.
[12]Baron EJ,Miller JM,Weinstein MP,et al.Executive summary:a guide to utilization of the microbiology laboratory for diagnosis of infectious diseases:2013 recommendations by the Infectious Diseases Society of America(IDSA)and the American Society for Microbiology(ASM)(a)[J].Clin Infect Dis,2013,57(4):485-488.
[13]La Sala PR,Bufton KK,Ismail N,et al.Prospective comparison of R-mix TM shell vial system with direct antigen tests and con?ventional cell culture for respiratory virus detection[J].J Clin Virol,2007,38(3):210-216.
[14]Leland DS,Ginocchio CC.Role of cell culture for virus detec?tion in the age of technology[J].Clin Microbiol Rev,2007,20(1):49-78.
[15]Das S,Dunbar S,Tang YW.Laboratory diagnosis of respiratory tract infections in Children-the state of the art[J].Front Micro?biol,2018,9:2478.
[16]Sails AD,Eltringham G,Valappil M,et al.Comparison of the Luminex Nx TAG respiratory pathogen panel and a multiplex inhouse real-time PCR panel for the detection of respiratory viruses in symptomatic patients[J].J Med Microbiol,2017.[Epub ahead of print].
[17]Brotons P,Henares D,Latorre I,et al.Comparison of Nx TAGrespiratory pathogen panel and anyplex II RV16 tests for multi?plex detection of respiratory pathogens in hospitalized chil?dren[J].J Clin Microbiol,2016,54(12),2900-2904.
[18]张海邻,陈小芳,吕芳芳,等.多重PCR技术检测儿童下呼吸道感染病毒和不典型病原体的价值[J].温州医科大学学报,2017,47(11):791-795.
[19]Deurenberg RH,Bathoorn E,Chlebowicz MA,et al.Application of next generation sequencing in clinical microbiology and in?fection prevention[J].J Biotechnol,2017,243:16-24.
[20]Graf EH,Simmon KE,Tardif KD,et al.Unbiased detection of respiratory viruses by use of RNA sequencing-based metage?nomics:a systematic comparison to a commercial PCR panel[J].J Clin Microbiol,254(4):1000-1007.
[21]Greninger AL,Waghmare A,Adler A,et al.Rule-out outbreak:24-hour metagenomic next-generation sequencing for charac?terizing respiratory virus source for infection prevention[J].JPediatric Infect Dis Soc,2017,6(2):168-172.
[22]Ling L,Kaplan SE,Lopez JC,et al.Parallel validation of three molecular devices for simultaneous detection and identification of influenza A and B and respiratory syncytial viruses[J].J Clin Microbiol,2018,56(3):pii:e01691-17.
[23]Azar MM,Landry ML.Detection of influenza A and B viruses and respiratory syncytial virus using CLIA-waived point-ofcare assays:a paradigm shift to molecular tests[J].J Clin Mi?crobiol,2018,56(7):pii:e00367-18.
[24]Brendish NJ,Malachira AK,Armstrong L,et al.Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness(Res POC):a pragmatic,open-label,randomised controlled trial[J].Lancet Respir Med,2017,5(5):401-411.
[25]Nicholls JM,Chan MC,Chan WY,et al.Tropism of avian influ?enza A(H5N1)in the upper and lower respiratory tract[J].Nat Med,2007,13(2):147-149.
[26]Willner D,Haynes MR,Furlan M,et al.Case studies of the spatial heterogeneity of DNA viruses in the cystic fibrosis lung[J].Am J Respir Cell Mol Biol,2012,46(2):127-131.