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Comparison of molecular detection methods for pertussis in children during a state-wide outbreak
X Qin1, D M Zerr2, M P Kronman2
1Microbiology Laboratory, Seattle Children's Hospital, Seattle, WA, USA. xuan.qin@seattlechildrens.org.
Insights
During a 2012 pertussis outbreak, two PCR methods showed comparable performance for detecting Bordetella pertussis. Laboratory-developed PCR and rapid multiplex PCR effectively identified pertussis cases.
Area of Science:
- Clinical microbiology
- Infectious disease epidemiology
Background:
- A significant pertussis outbreak occurred in Washington in 2012, coinciding with the respiratory viral season.
- Evaluating diagnostic methods during outbreaks is crucial for public health surveillance and patient management.
Purpose of the Study:
- To compare the performance of a laboratory-developed pertussis PCR (LD-PCR) and a rapid multiplex PCR (RM-PCR) for detecting Bordetella pertussis.
- To assess diagnostic accuracy based on clinical suspicion and sample type.
Main Methods:
- Analysis of three patient cohorts based on physician testing orders for pertussis or respiratory viruses.
- Cohort 1: LD-PCR for pertussis pathogens (nasopharyngeal swab).
- Cohort 2: RM-PCR for respiratory viruses (mid-nasal turbinate swab).
- Cohort 3: Both LD-PCR and RM-PCR performed.
Main Results:
- In Cohort 3 (n=490), B. pertussis was detected in 25 patients; LD-PCR identified 80% and RM-PCR identified 96% (p=0.2).
- Pertussis pathogens were found in 3.6% of Cohort 1 samples (high suspicion) vs. 0.1% of Cohort 2 samples (lower suspicion) (p<0.001).
- Both methods demonstrated comparable performance for B. pertussis detection.
Conclusions:
- Laboratory-developed PCR and rapid multiplex PCR are comparable for detecting Bordetella pertussis.
- Diagnostic yield varies significantly with clinical suspicion for pertussis.
Abstract:
A state-wide pertussis outbreak occurred in Washington during the winter-spring months of 2012, concurrent with respiratory viral season. We compared performance characteristics of a laboratory-developed pertussis PCR (LD-PCR for Bordetella pertussis, Bordetella parapertussis, and Bordetella holmesii) and rapid multiplex PCR (RM-PCR) for respiratory viruses (FilmArray™, BioFire, B. pertussis data unblinded following FDA approval post outbreak). We analyzed three cohorts of patients using physician testing orders as a proxy for clinical suspicion for pertussis or respiratory viruses: Cohort 1, tested by LD-PCR for pertussis pathogens only by nasopharyngeal swab; Cohort 2, by RM-PCR for respiratory viruses only by mid-nasal turbinate swab; and Cohort 3, by both methods. B. pertussis was detected in a total of 25 of the 490 patients in Cohort 3 in which LD-PCR detected 20/25 (80 %) cases and the RM-PCR detected 24/25 (96 %; p = 0.2). Pertussis pathogens were detected in 21/584 (3.6 %) of samples from Cohort 1 where clinicians had a relatively strong suspicion for pertussis. In contrast, B. pertussis was detected in only 4/3071 (0.1 %) specimens from Cohort 2 where suspicion for pertussis was lower (p < 0.001 for comparison with Cohort 1). In summary, the two laboratory methods were comparable for the detection of B. pertussis.
