Self-collected mid-turbinate swabs for the detection of respiratory viruses in adults with acute respiratory illnesses

Oscar E Larios, Brenda L Coleman, Steven J Drews, Tony Mazzulli, Bjug Borgundvaag, Karen Green, STOP-Flu Study Group, Allison J McGeer, Kevin Katz, Jeffrey Kwong, Joanne Langley, Mark Loeb, Donald E Low, Shelly McNeil, Christine Moore, Matthew P Muller, Janet Raboud, Andrew Simor, Leslie Vincent, Oscar E Larios, Brenda L Coleman, Steven J Drews, Tony Mazzulli, Bjug Borgundvaag, Karen Green, STOP-Flu Study Group, Allison J McGeer, Kevin Katz, Jeffrey Kwong, Joanne Langley, Mark Loeb, Donald E Low, Shelly McNeil, Christine Moore, Matthew P Muller, Janet Raboud, Andrew Simor, Leslie Vincent

Abstract

Background: The gold standard for respiratory virus testing is a nasopharyngeal (NP) swab, which is collected by a healthcare worker. Midturbinate (MT) swabs are an alternative due to their ease of collection and possible self-collection by patients. The objective of this study was to compare the respiratory virus isolation of flocked MT swabs compared to flocked NP swabs.

Methods: Beginning in October 2008, healthy adults aged 18 to 69 years were recruited into a cohort and followed up for symptoms of influenza. They were asked to have NP and MT swabs taken as soon as possible after the onset of a fever or two or more respiratory symptoms with an acute onset. The swabs were tested for viral respiratory infections using Seeplex® RV12 multiplex PCR detection kit. Seventy six pairs of simultaneous NP and MT swabs were collected from 38 symptomatic subjects. Twenty nine (38%) of these pairs were positive by either NP or MT swabs or both. Sixty nine (91%) of the pair results were concordant. Two samples (3%) for hCV OC43/HKU1 and 1 sample (1%) for rhinovirus A/B were positive by NP but negative by MT. One sample each for hCV 229E/NL63, hCV OC43/HKU1, respiratory syncytial virus A, and influenza B were positive by MT but negative by NP.

Conclusions: Flocked MT swabs are sensitive for the diagnosis of multiple respiratory viruses. Given the ease of MT collection and similar results between the two swabs, it is likely that MT swabs should be the preferred method of respiratory cell collection for outpatient studies. In light of this data, larger studies should be performed to ensure that this still holds true and data should also be collected on the patient preference of collection methods.

Conflict of interest statement

Competing Interests: OEL received travel support from Copan Diagnostics Inc. (http://www.copanusa.com) to present this research. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials. AJM has read the journal's policy and wishes to disclose the follow: receipt of funding from GSK for the pilot study from which this sub-study sprang. The results of the sub-study are not directly applicable to GSK and this does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials. No other authors have competing interests to declare.

Figures

Figure 1. Results from matched nurse-collected nasopharyngeal…
Figure 1. Results from matched nurse-collected nasopharyngeal and self-collected mid-turbinate swabs from adults with acute respiratory illness.
Foot note: hCoV: human coronavirus, MT: mid-turbinate, neg: negative, NP: nasopharyngeal, pos: positive, RSV: respiratory syncytial virus.

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