A1 Refereed original research article in a scientific journal
Myxovirus resistance protein A for discriminating between viral and bacterial lower respiratory tract infections in children – The TREND study
Authors: Rhedin Samuel, Eklundh Annika, Ryd-Rinder Malin, Peltola Ville, Waris Matti, Gantelius Jesper, Lindh Magnus, Andersson Maria, Gaudenzi Giulia, Mårtensson Andreas, Naucler Pontus, Alfvén Tobias
Publisher: ELSEVIER SCI LTD
Publication year: 2022
Journal: Clinical Microbiology and Infection
Journal name in source: CLINICAL MICROBIOLOGY AND INFECTION
Journal acronym: CLIN MICROBIOL INFEC
Volume: 28
Issue: 9
First page : 1251
Last page: 1257
Number of pages: 7
ISSN: 1198-743X
eISSN: 1469-0691
DOI: https://doi.org/10.1016/j.cmi.2022.05.008
Web address : https://www.sciencedirect.com/science/article/pii/S1198743X22002646?via%3Dihub
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/178161070
Objective:
Discriminating between viral and bacterial lower respiratory tract infection (LRTI) in children is challenging, leading to an excessive use of antibiotics. Myxovirus resistance protein A (MxA) is a promising biomarker for viral infections. The primary aim of the study was to assess differences in blood MxA levels between children with viral and bacterial LRTI. Secondary aims were to assess differences in blood MxA levels between children with viral LRTI and asymptomatic controls and to assess MxA levels in relation to different respiratory viruses.
Methods:
Children with LRTI were enrolled as cases at Sachs' Children and Youth Hospital, Stockholm, Sweden. Nasopharyngeal aspirates and blood samples for analysis of viral PCR, MxA, and C-reactive protein were systematically collected from all study subjects in addition to standard laboratory/radiology assessment. Aetiology was defined according to an algorithm based on laboratory and radiological findings. Asymptomatic children with minor surgical disease were enrolled as controls.
Results:
MxA levels were higher in children with viral LRTI (n = 242) as compared to both bacterial (n = 5) LRTI (p < 0.01, area under the curve (AUC) 0.90, 95% CI: 0.81 to 0.99), and controls (AUC 0.92, 95% CI: 0.88 to 0.95). In the subgroup of children with pneumonia diagnosis, a cutoff of MxA 430 μg/l discriminated between viral (n = 29) and bacterial (n = 4) aetiology with 93% (95% CI: 78-99%) sensi-tivity and 100% (95% CI: 51-100%) specificity (AUC 0.98, 95% CI: 0.94 to 1.00). The highest MxA levels were seen in cases PCR positive for influenza (median MxA 1699 μg/l, interquartile range: 732 to 2996) and respiratory syncytial virus (median MxA 1115 μg/l, interquartile range: 679 to 2489).
Discussion:
MxA accurately discriminated between viral and bacterial aetiology in children with LRTI, particularly in the group of children with pneumonia diagnosis, but the number of children with bacterial LRTI was low.
© 2022 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.
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