Abstract
BackgroundThe gold standard for respiratory virus testing is a nasopharyngeal (NP) swab, which is collected by a healthcare worker. Midturbinate (MT) swabs are an alternative due to their ease of collection and possible self-collection by patients. The objective of this study was to compare the respiratory virus isolation of flocked MT swabs compared to flocked NP swabs.MethodsBeginning in October 2008, healthy adults aged 18 to 69 years were recruited into a cohort and followed up for symptoms of influenza. They were asked to have NP and MT swabs taken as soon as possible after the onset of a fever or two or more respiratory symptoms with an acute onset. The swabs were tested for viral respiratory infections using Seeplex® RV12 multiplex PCR detection kit. Seventy six pairs of simultaneous NP and MT swabs were collected from 38 symptomatic subjects. Twenty nine (38%) of these pairs were positive by either NP or MT swabs or both. Sixty nine (91%) of the pair results were concordant. Two samples (3%) for hCV OC43/HKU1 and 1 sample (1%) for rhinovirus A/B were positive by NP but negative by MT. One sample each for hCV 229E/NL63, hCV OC43/HKU1, respiratory syncytial virus A, and influenza B were positive by MT but negative by NP.ConclusionsFlocked MT swabs are sensitive for the diagnosis of multiple respiratory viruses. Given the ease of MT collection and similar results between the two swabs, it is likely that MT swabs should be the preferred method of respiratory cell collection for outpatient studies. In light of this data, larger studies should be performed to ensure that this still holds true and data should also be collected on the patient preference of collection methods.
Highlights
Viruses account for approximately 80% of acute respiratory diseases in developed countries [1]
Ciliated epithelium in the posterior nasopharynx is the site of infection for most of these viruses and the accepted standard diagnostic specimen for viral detection in adults has become the NP swab [2]
Nucleic acid amplification tests have been developed for respiratory pathogens and have the ability to simplify testing into a single multiplex polymerase chain reaction (PCR) test [1]
Summary
Viruses account for approximately 80% of acute respiratory diseases in developed countries [1]. Healthcare providers must be trained in the collection of NP swabs and their collection is uncomfortable for the patient. Virus detection from NP swabs has traditionally been performed using a combination of rapid antigen tests, and conventional and rapid cell culture techniques [3,4]. The sensitivity of these tests is suboptimal and newly discovered viruses cannot be detected by rapid antigen tests. The gold standard for respiratory virus testing is a nasopharyngeal (NP) swab, which is collected by a healthcare worker. The objective of this study was to compare the respiratory virus isolation of flocked MT swabs compared to flocked NP swabs
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