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Diagnosis of whooping cough: a new era with rapid molecular diagnostics
N Cimolai1, C Trombley, D O'Neill
1Department of Pathology, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada.
Abstract:
A rapid diagnostic procedure, which is based upon the polymerase chain reaction (PCR) genetic amplification technology, was utilized to establish the presence of Bordetella pertussis in nasopharyngeal washes from children. Overall, 14.7% of 456 specimens were positive by either culture or the rapid assay. Culture and PCR were concordant for 62.7% of positive samples; PCR provided an additional increment of 37.3%. PCR-positive, culture-negative specimens were more likely to be found among older patients with more prolonged illness and previous erythromycin therapy (P < 0.01 for all three comparisons). As a single laboratory assay, PCR should be recognized as the current standard for diagnosis.
Insights
Polymerase chain reaction (PCR) offers a superior diagnostic method for detecting Bordetella pertussis in children. This rapid genetic amplification technology identifies more cases than traditional culture, establishing it as the current standard for pertussis diagnosis.
Area of Science:
- Microbiology
- Molecular Diagnostics
- Pediatric Infectious Diseases
Background:
- Pertussis, or whooping cough, remains a significant public health concern, particularly in pediatric populations.
- Accurate and timely diagnosis is crucial for effective treatment and control of pertussis outbreaks.
- Traditional diagnostic methods like bacterial culture have limitations in sensitivity and speed.
Purpose of the Study:
- To evaluate the utility of polymerase chain reaction (PCR) for the rapid detection of Bordetella pertussis in nasopharyngeal washes from children.
- To compare the diagnostic performance of PCR with conventional bacterial culture.
- To identify factors associated with discordant results between PCR and culture.
Main Methods:
- A prospective study involving 456 nasopharyngeal wash specimens from children.
- Utilized a rapid diagnostic procedure based on PCR genetic amplification technology.
- Compared PCR results with standard bacterial culture methods.
Main Results:
- Overall, 14.7% of specimens tested positive for Bordetella pertussis by either culture or PCR.
- PCR and culture showed concordance for 62.7% of positive samples.
- PCR provided an additional 37.3% of positive diagnoses compared to culture alone.
- PCR-positive, culture-negative results were more prevalent in older children, those with prolonged illness, and those who received prior erythromycin therapy (P < 0.01).
Conclusions:
- Polymerase chain reaction (PCR) is a highly sensitive and rapid method for diagnosing pertussis in children.
- PCR significantly increases the detection rate of Bordetella pertussis compared to culture alone.
- PCR should be considered the current standard laboratory assay for pertussis diagnosis due to its superior performance.