Viral Sepsis in Children

Gupta, Neha; Richter, Robert; Robert, Stephen; Kong, Michele

There are currently no standard approaches to viral diagnostic testing. Point-of-care (POC) antigen-based testing is relatively inexpensive and provides rapid detection of common respiratory viruses from a nasopharyngeal swab, such as RSV or common strains of human influenza. However, POC testing may lack the sensitivity needed to determine the etiology of life-threatening sepsis (106) . Direct fluorescent antibody (DFA) testing may provide better specificity and a broader range of viral strain detection than POC testing, but the test depends on the collection of sufficient numbers of epithelial cells for adequate viral detection (107) . Cell culture is the traditional gold-standard for viral diagnoses, including for HSV, however the long turn-around time for results significantly limits its utility for expedient diagnosis (108) . Commercial or laboratory-developed nucleic acid amplification tests (NAATs) (e.g., polymerase chain reaction, PCR, or reverse transcription-loop-mediated isothermal amplification) may provide greater sensitivity and specificity than POC or DFA testing but requires sophisticated equipment and specially trained laboratory staff to complete (109, 110) . NAATs have the added benefit of being highly multiplexed with new commercially available technology like Biofire R FilmArray R multiplex PCR (111) . Unfortunately, the use of NAATs is limited by the high cost, delay in results and the inability to distinguish between viral nucleic acids from live viruses (112) . Ultimately, the methods available for timely viral detection are limited by technique of sample collection and institutional resource availability.