Medical Professional Publications

Many Respiratory Pathogens, One Test: The Respiratory Infection Array

Columbus, OH - November 2016

Clinical presentations are similar for a number of upper respiratory infections, so laboratory testing can be crucial in determining which treatment approach will be most effective. Conventional testing has its own set of issues, however. Rapid antigen tests for respiratory syncytial virus (RSV) and influenza A and B can have reduced sensitivity; direct fluorescent antibody tests can have better sensitivity, but they take substantially longer.

Enter the Respiratory Infection Array. Initially approved by the U.S. Food and Drug Administration in 2011, the array has been used with inpatients at Nationwide Children’s Hospital for years. Laboratory Services at Nationwide Children’s has now made it available for outpatient use as well.

“The Respiratory Infection Array is more comprehensive, and in most cases more sensitive and specific, than other tests,” says Stella Antonara, PhD, assistant director of Clinical Microbiology and Immunoserology at Nationwide Children’s Hospital. “Turnaround time is often only a few hours, meaning providers can initiate treatment very quickly.”

A 2015 study from the Emory University School of Medicine found that the array helped decrease antibiotic use, length of inpatient stay and time of isolation for pediatric patients admitted to the hospital with an acute respiratory tract illness.

The array detects eight viral and three bacterial targets, and also can detect coinfections:

  • Adenovirus
  • Coronavirus
  • Human metapneumovirus
  • Rhinovirus/Enterovirus
  • Influenza A
  • Influenza B
  • Parainfluenza virus 1-4
  • RSV
  • Bordetella pertussis
  • Chlamydophila pneumoniae
  • Mycoplasma pneumoniae

The array has slightly reduced sensitivity for adenovirus and Mycoplasma pneumoniae compared to singleplex PCR and does not include Bordetella parapertussis. In a seriously ill patient, a provider may consider confirming negative results with single PCR tests.

To use the Respiratory Infection Array in an outpatient setting, a medical professional should collect a specimen using a nasopharyngeal swab and transport the swab in M4 media. It will stay stable for four hours at room temperature, and for three days if refrigerated. Nationwide Children’s Laboratory Services requires the specimen to be collected in an office visit – it cannot be collected by technologists at Nationwide Children’s Laboratory Service Centers.

Reference:
Rogers BB, Shankar P, Jerris RC, Kotzbauer D, Anderson EJ, Watson JR, O'Brien LA, Uwindatwa F, McNamara K, Bost JE. Impact of a rapid respiratory panel test on patient outcomes. Archives of Pathology and Laboratory Medicine. 2015 May;139(5):636-41.. Archives of Pathology and Laboratory Medicine. 2015 May;139(5):636-41.

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