Poor positive predictive value of influenza-like illness criteria in adult transplant patients: a case for multiplex respiratory virus PCR testing

Clinical Transplantation
Jonathan A ClausKamaljit Singh

Abstract

Respiratory viral infections (RVIs) are a significant cause of morbidity and mortality among transplant patients. The CDC's influenza-like illness (ILI) criteria (fever ≥100°F with cough and/or sore throat) are a screening tool for influenza with unknown applicability to the transplant population. We reviewed all respiratory virus PCR tests performed on adult patients with a history of solid organ (SOT) or stem cell transplantation (HSCT) during the 2012-2013 influenza season. The positive (PPV) and negative predictive values (NPV) of ILI criteria were calculated. Of 126 transplant patients (66 HSCT, 60 SOT), 54 (42.8%) tested positive for an RVI by PCR: 24 influenza and 30 non-influenza. Of 30 patients who met ILI criteria, 12 (40%) were positive for influenza. The PPV and NPV of ILI for influenza were 50% and 82.4%, respectively. Mortality was low (3.7%), but morbidity was high (14.8% required ICU stay) among transplant patients diagnosed with RVI. Influenza and non-influenza RVIs are associated with significant morbidity among transplant patients. CDC ILI criteria correlate poorly with PCR-positive cases of influenza in transplant patients, but may be useful in excluding the diagnosis. Routine RVI PCR testing is recommended ...Continue Reading

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Citations

Mar 10, 2020·Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America·Melissa K AndrewUNKNOWN Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance Network Investigators
Oct 18, 2019·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Senu Apewokin, Ngozi Onyishi
Dec 20, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Timothy M UyekiAndrew T Pavia
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Dec 1, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Ilkka HelanteräPatrik Finne
Dec 5, 2020·Transplantation Proceedings·Mohammed SamannodiRodrigo Hasbun

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Methods Mentioned

BETA
PCR
bronchoalveolar lavage

Software Mentioned

SPSS

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