key: cord-270579-rf933a0y
authors: van Kruijssen, Alida M.; Templeton, Kate E.; van der Plas, Roos N.; van Doorn, H. Rogier; Claas, Eric C. J.; Sukhai, Ram N.; Kuijper, Ed J.
title: Detection of respiratory pathogens by real-time PCR in children with clinical suspicion of pertussis
date: 2006-12-20
journal: Eur J Pediatr
DOI: 10.1007/s00431-006-0378-7
sha: 
doc_id: 270579
cord_uid: rf933a0y

The use of a multiplex respiratory real-time PCR in patients clinically suspected of pertussis increases the number of pathogens detected.

negative predictive value (NPV) of 45, 100, 100 and 48%, respectively. Other pathogens were detected in group I as shown in Table 3 . Some respiratory viruses were detected in Group II. All other respiratory pathogens had sensitivity and specificity lower than B. pertussis. Pathogens were detected by PCR in 31 out of 38 (82%) cases and 10 out of 21 (48%) cases in Group I and Group II, respectively. This difference was significant (p=0.01).

Detection of B. pertussis by PCR was indicated on the basis of clinical presentation and PPV of 100% was obtained. However, 21 out of 38 cases that met the clinical definition of pertussis were negative for B. pertussis. Therefore, either the B. pertussis PCR gave false-negative results or the definition gave a false-positive result. Different sample types have different sensitivities, with NPAs being the most sensitive. PCR can also give falsenegative results and fewer diagnoses in those patients with pertussis could be due to the quality of the sample.

Other pathogens were detected in 31 out of 38 patients with clinical diagnosis of pertussis. Other pathogens that cause a pertussis-like disease have previously been described using serological assays and Cherry et al. describe that pertussis can be misdiagnosed, as there are a number of viral and bacterial pathogens other than B. pertussis that can cause a paroxysmal cough [1, 2] . It has been well described that PCR is more sensitive than culture at detecting B. pertussis in the acute phase [3] . The use of PCR for diagnosis would help improve microbiological diagnosis, improve the speed of results, and reduce the need for the reliance on imperfect clinical criteria for diagnosis. This would prompt more appropriate treatment of B. pertussis and other atypical bacteria, differentiating them from viral infections as well as use of vaccination to prevent spread of pertussis.

In conclusion, multiplex PCR in a combined approach identifies B. pertussis and other pathogens causing pertussis-like symptoms and use of this form of diagnosis might help in treatment and improve management of patients.

Defining pertussis epidemiology: clinical, microbiologic and serologic perspectives

Frequency of serological evidence of Bordetella infections and mixed infections with other respiratory pathogens in university students with cough illnesses

Comparison of PCR, culture, and direct fluorescent-antibody testing for detection of Bordetella pertussis

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Evaluation of real-time PCR for detection of and discrimination between Bordetella pertussis, Bordetella parapertussis, and Bordetella holmesii for clinical diagnosis

Vaccines and biologicals. WHO-recommended standards for surveillance of selected vaccine-preventable diseases