Identification of Adenovirus, Influenza Virus, Parainfluenza Virus, and Respiratory Syncytial Virus by Two Kinds of Multiplex Polymerase Chain Reaction (PCR) and a Shell Vial Culture in Pediatric Patients with Viral Pneumonia

Lee, Jong-Han; Chun, Jin-Kyong; Kim, Dong Soo; Park, Yongjung; Choi, Jong Rak; Kim, Hyon-Suk

pneumonia of pediatric patients is essential to prevent disease propagation. It is also helpful for early initiation of proper management. An early start of proper anti-viral management can reduce unnecessary overuse of antibacterial agents. In addition, some respiratory viruses, including IFV, EnV, and AdV, may now benefit from specific antivi-ral treatment. 6 most commonly used method for identifying respiratory viruses. 9 An enzyme immunoassay may be quicker but it is less sensitive. These conventional methods may be affected by specimen quality, virus type, and technical skill. [10] [11] [12] The virus culture is still considered the gold standard for respiratory virus detection, but it has limitations in turnaround time, specimen transport, and storage conditions in maintaining the infectivity of the virus. 11, 13 To compare the test methods, Choi, et al. 14 reported that the positive rate of the direct antigen test, viral culture method, and multiplex PCR for detecting AdV, IFV, PIFV, and RSV was 28.4%, 36.2%, and 44.8%, respectively. Recently, virus identification by immunostaing after shell vial culture is the most widely accepted laboratory standard method of virus testing. But, this method is still not easy for routine testing in clinical laboratories. The nucleic acid amplification method including multiplex PCR is a powerful alternative, but it has some limitations of false positivity and false negativity. The nucleic acid amplification test is faster than the culture method and has been reported to be more sensitive 9,15-17 and can be automated these days. In addition, there are advantages in detecting some viruses which grow poorly in cell cultures such as HMPV. 18 A Korean national survey 19 of respiratory virus testing was performed and thirty-one clinical laboratories responded that they provided respiratory virus testing for clinical diagnosis in Korea. Among the responders, PCR and/or culture were most widely adopted, in 42% of the institutes, rapid immunochromatographic method 29%, immunofluorescent antigen assay 23%, and enzyme immunoassay 7%.