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Published on: July 22, 2012
Identification of Enteric Viruses in Oral Swabs from Children with Acute Gastroenteritis
Ran Zhuo1, Brendon D Parsons1, Bonita E Lee2
1Departments of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
Insights
Oral swabs show high specificity but low sensitivity for detecting pediatric gastroenteritis viruses, making stool the preferred diagnostic specimen. Oral swabs may be used when stool is unavailable, but negative results require confirmation with stool testing.
Area of Science:
- Clinical Microbiology
- Pediatric Infectious Diseases
- Molecular Diagnostics
Background:
- Stool is the standard for diagnosing enteropathogens in pediatric gastroenteritis.
- Stool collection can be difficult, and the utility of oral swabs for isolated vomiting is unclear.
Purpose of the Study:
- To evaluate oral swabs as an alternative diagnostic specimen to stool for enteropathogen detection in children.
- To compare the diagnostic performance of oral swabs and stool specimens.
Main Methods:
- Collected 738 oral swabs and 577 stool specimens from 738 children with vomiting and/or diarrhea.
- Utilized a laboratory-developed quantitative RT-PCR Gastroenteritis Virus Panel and a commercial gastroenteritis pathogen panel for testing.
- Analyzed adenovirus, norovirus, and rotavirus detection rates and compared specimen sensitivities and specificities.
Main Results:
- Oral swabs commonly detected adenovirus, norovirus, and rotavirus, but with significantly lower sensitivity (18%) compared to stool.
- Stool specimens showed higher detection rates for rotavirus, norovirus, and adenovirus.
- Oral swabs demonstrated high specificity (99%) for enteric virus detection; enteric bacteria and parasites were only found in stool.
Conclusions:
- Stool remains the preferred specimen for detecting enteric viruses in pediatric gastroenteritis due to higher sensitivity.
- Oral swabs offer high specificity and can be considered when stool collection is not feasible.
- Negative oral swab results necessitate confirmatory testing using stool specimens.
Abstract:
Stool is the diagnostic specimen of choice to identify enteropathogens in pediatric gastroenteritis. However, stool collection is challenging and its diagnostic characteristics in patients with isolated vomiting are unknown. Therefore, we evaluated if oral swabs are a suitable alternative specimen to stools. In total, 738 oral swabs and 577 stool specimens were collected from 738 children with vomiting and/or diarrhea. All specimens were tested by a laboratory-developed quantitative RT-PCR Gastroenteritis Virus Panel; 150 oral swabs and 577 stool specimens were tested by the commercial gastroenteritis pathogen panel. The Gastroenteritis Virus Panel identified adenovirus (n = 38), norovirus (n = 21), and rotavirus (n = 16) commonly in oral swabs. In stool specimens, rotavirus (n = 139), norovirus (n = 86), and adenovirus (n = 69) were detected commonly. Compared with stool specimens, the specificity of oral swabs was 99% (95% CI, 96%-100%); the sensitivity of oral swabs was 18% (95% CI, 14%-22%) for the detection of enteric viruses. The Gastrointestinal Pathogen Panel identified enteric bacteria and parasites in stool but not in oral swabs. Given the lower sensitivity of oral swabs, stool remains a preferable specimen to detect enteric viruses. However, with their high specificity, oral swabs can be considered as a suitable specimen if stool specimens are unavailable. Nevertheless, negative oral swabs require a confirmative test of stool specimens.
