呼吸器系ウイルスは、より良い検査法がなければ容易に誤診される(Study: Respiratory viruses easily misdiagnosed without better tests)

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ロスアラモス研究所のチームは、オフィスでの診断とPCRおよびRNAテストを比較している。 Los Alamos team compares office diagnosis with PCR and RNA testing

2022-08-31 アメリカ・ロスアラモス国立研究所(LANL)

ロスアラモス国立研究所の科学者たちは、上気道感染症の誤診率を、症候学的診断法(医師の診察)と実験室の手法とを比較しながら測定している。研究チームは、診察室での早期診断の結果を、同じ患者のサンプルのポリメラーゼ連鎖反応(PCR)およびRNA配列決定と比較したところ、検査室での検査を行わない熟練の医療観察では、研究対象の呼吸器感染症患者の37%しか特定できないことを発見した。
ニューメキシコ州北部の診療所MANNMと協力した研究チームは、インフルエンザウイルスが呼吸器感染症の主役であることを発見し、これは予想されたことでした。しかし、コロナウイルス、呼吸器合胞体ウイルス、パラインフルエンザウイルス、ヒトメタニューモウイルスが上気道感染症に関連していることも、PCRとシークエンスのアプローチで明らかになった。

<関連情報>

シンドロミック法、次世代シークエンス法、PCR法を用いた患者の上気道感染症診断におけるばらつきの比較 Comparing variability in diagnosis of upper respiratory tract infections in patients using syndromic, next generation sequencing, and PCR-based methods

Andrew W. Bartlow,Zachary R. Stromberg,Cheryl D. Gleasner,Bin Hu,Karen W. Davenport,Shailja Jakhar,Po-E Li,Molly Vosburg,Madhavi Garimella,Patrick S. G. Chain,Tracy H. Erkkila,Jeanne M. Fair,Harshini Mukundan
PLOS Global Public Health  Published: July 20, 2022
DOI:https://doi.org/10.1371/journal.pgph.0000811

呼吸器系ウイルスは、より良い検査法がなければ容易に誤診される(Study: Respiratory viruses easily misdiagnosed without better tests)

Abstract

Early and accurate diagnosis of respiratory pathogens and associated outbreaks can allow for the control of spread, epidemiological modeling, targeted treatment, and decision making–as is evident with the current COVID-19 pandemic. Many respiratory infections share common symptoms, making them difficult to diagnose using only syndromic presentation. Yet, with delays in getting reference laboratory tests and limited availability and poor sensitivity of point-of-care tests, syndromic diagnosis is the most-relied upon method in clinical practice today. Here, we examine the variability in diagnostic identification of respiratory infections during the annual infection cycle in northern New Mexico, by comparing syndromic diagnostics with polymerase chain reaction (PCR) and sequencing-based methods, with the goal of assessing gaps in our current ability to identify respiratory pathogens. Of 97 individuals that presented with symptoms of respiratory infection, only 23 were positive for at least one RNA virus, as confirmed by sequencing. Whereas influenza virus (n = 7) was expected during this infection cycle, we also observed coronavirus (n = 7), respiratory syncytial virus (n = 8), parainfluenza virus (n = 4), and human metapneumovirus (n = 1) in individuals with respiratory infection symptoms. Four patients were coinfected with two viruses. In 21 individuals that tested positive using PCR, RNA sequencing completely matched in only 12 (57%) of these individuals. Few individuals (37.1%) were diagnosed to have an upper respiratory tract infection or viral syndrome by syndromic diagnostics, and the type of virus could only be distinguished in one patient. Thus, current syndromic diagnostic approaches fail to accurately identify respiratory pathogens associated with infection and are not suited to capture emerging threats in an accurate fashion. We conclude there is a critical and urgent need for layered agnostic diagnostics to track known and unknown pathogens at the point of care to control future outbreaks.

医療・健康
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