title: Non-invasive sample collection for respiratory virus testing by multiplex PCR.
abstract: BACKGROUND
  Identifying respiratory pathogens within populations is difficult because invasive sample collection, such as with nasopharyngeal aspirate (NPA), is generally required. PCR technology could allow for non-invasive sampling methods.
  
  
  OBJECTIVE
  Evaluate the utility of non-invasive sample collection using anterior nare swabs and facial tissues for respiratory virus detection by multiplex PCR.
  
  
  METHODS
  Children aged 1 month-17 years evaluated in a pediatric emergency department for respiratory symptoms had a swab, facial tissue, and NPA sample collected. All samples were tested for respiratory viruses by multiplex PCR. Viral detection rates were calculated for each collection method. Sensitivity and specificity of swabs and facial tissues were calculated using NPA as the gold standard.
  
  
  RESULTS
  285 samples from 95 children were evaluated (92 swab-NPA pairs, 91 facial tissue-NPA pairs). 91% of NPA, 82% of swab, and 77% of tissue samples were positive for ≥1 virus. Respiratory syncytial virus (RSV) and human rhinovirus (HRV) were most common. Overall, swabs were positive for 74% of virus infections, and facial tissues were positive for 58%. Sensitivity ranged from 17 to 94% for swabs and 33 to 84% for tissues. Sensitivity was highest for RSV (94% swabs and 84% tissues). Specificity was ≥95% for all viruses except HRV for both collection methods.
  
  
  CONCLUSIONS
  Sensitivity of anterior nare swabs and facial tissues in the detection of respiratory viruses by multiplex PCR varied by virus type. Given its simplicity and specificity, non-invasive sampling for PCR testing may be useful for conducting epidemiologic or surveillance studies in settings where invasive testing is impractical or not feasible.
authors.affiliation: University of Utah, Department of Pediatrics, Salt Lake City, UT 84108, USA. anne.blaschke@hsc.utah.edu
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Blaschke
authors.forename: Mandy A
authors.initials: MA
authors.lastname: Allison
authors.forename: Lindsay
authors.initials: L
authors.lastname: Meyers
authors.forename: Margarita
authors.initials: M
authors.lastname: Rogatcheva
authors.forename: Caroline
authors.initials: C
authors.lastname: Heyrend
authors.forename: Brittany
authors.initials: B
authors.lastname: Mallin
authors.forename: Marjorie
authors.initials: M
authors.lastname: Carter
authors.forename: Bonnie
authors.initials: B
authors.lastname: Lafleur
authors.forename: Trenda
authors.initials: T
authors.lastname: Barney
authors.forename: Mark A
authors.initials: MA
authors.lastname: Poritz
authors.forename: Judy A
authors.initials: JA
authors.lastname: Daly
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Byington
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005145:Face / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods*; D017817:Nasal Lavage Fluid / Q000821:virology*; D009305:Nasopharynx / Q000821:virology; D010850:Picornaviridae Infections / Q000175:diagnosis; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis; D012136:Respiratory Syncytial Viruses / Q000235:genetics / Q000302:isolation & purification*; D012137:Respiratory System / Q000821:virology*; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000821:virology; D012229:Rhinovirus / Q000235:genetics / Q000302:isolation & purification*; D012680:Sensitivity and Specificity; D013048:Specimen Handling; D014777:Virus Diseases / Q000175:diagnosis* / Q000821:virology