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Symptomatic Predictors for 2009 Influenza A Virus (H1N1) Infection with an Emphasis for Patients with a Negative Rapid Diagnostic Test
BACKGROUND: The clinical diagnosis of influenza is difficult because it shares nonspecific symptoms with a variety of diseases. Emergency departments and clinics were overwhelmed by a surge of anxious patients during the 2009 influenza A virus (H1N1) outbreak. Our objective was to identify symptomat...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2011
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229543/ https://www.ncbi.nlm.nih.gov/pubmed/22164233 http://dx.doi.org/10.1371/journal.pone.0028102 |
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author | Kuo, Chen-Yen Huang, Yhu-Chering Huang, Chung-Guei Tsao, Kuo-Chien Lin, Tzou-Yien |
author_facet | Kuo, Chen-Yen Huang, Yhu-Chering Huang, Chung-Guei Tsao, Kuo-Chien Lin, Tzou-Yien |
author_sort | Kuo, Chen-Yen |
collection | PubMed |
description | BACKGROUND: The clinical diagnosis of influenza is difficult because it shares nonspecific symptoms with a variety of diseases. Emergency departments and clinics were overwhelmed by a surge of anxious patients during the 2009 influenza A virus (H1N1) outbreak. Our objective was to identify symptomatic predictors of influenza virus infection for patients with a negative rapid diagnostic test. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a retrospective review of 805 patients who presented at Chang Gung Memorial Hospital, from August 1, 2009, to September 30, 2009. Respiratory specimens from these patients were subjected to rapid influenza tests and reverse-transcription polymerase chain reactions. In total, 36% of 308 children and 23% of 497 adults were positive for 2009 influenza A virus (H1N1) infection by polymerase chain reaction or virus culture. For pediatric patients, sore throat and influenza-like illness significantly increased the odds of having 2009 influenza A virus (H1N1) infection, by more than 3-fold (95% confidence interval (CI): 1.9–7.3) and 7-fold (95% CI: 4.00–14.2), respectively. For adult patients, cough and constitutional symptoms increased the odds of having 2009 influenza A virus (H1N1) by greater than 5-fold (95% CI: 3.1–10.2) and 3-fold (95% CI: 2.1–6.7), respectively. The negative likelihood ratio of the combination of fever and cough was 0.096 (95% CI: 0.01–0.69) for children with negative results of rapid influenza diagnostic tests. CONCLUSION/SIGNIFICANCE: In influenza epidemic settings, clinicians should be aware that rapid influenza diagnostic tests are relatively insensitive for the diagnosis of influenza virus infection. For patients with negative rapid influenza diagnostic tests, those lacking fever and cough have a low probability of influenza virus infection. The management strategy should be made individually and depend on the severity of illness. |
format | Online Article Text |
id | pubmed-3229543 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-32295432011-12-07 Symptomatic Predictors for 2009 Influenza A Virus (H1N1) Infection with an Emphasis for Patients with a Negative Rapid Diagnostic Test Kuo, Chen-Yen Huang, Yhu-Chering Huang, Chung-Guei Tsao, Kuo-Chien Lin, Tzou-Yien PLoS One Research Article BACKGROUND: The clinical diagnosis of influenza is difficult because it shares nonspecific symptoms with a variety of diseases. Emergency departments and clinics were overwhelmed by a surge of anxious patients during the 2009 influenza A virus (H1N1) outbreak. Our objective was to identify symptomatic predictors of influenza virus infection for patients with a negative rapid diagnostic test. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a retrospective review of 805 patients who presented at Chang Gung Memorial Hospital, from August 1, 2009, to September 30, 2009. Respiratory specimens from these patients were subjected to rapid influenza tests and reverse-transcription polymerase chain reactions. In total, 36% of 308 children and 23% of 497 adults were positive for 2009 influenza A virus (H1N1) infection by polymerase chain reaction or virus culture. For pediatric patients, sore throat and influenza-like illness significantly increased the odds of having 2009 influenza A virus (H1N1) infection, by more than 3-fold (95% confidence interval (CI): 1.9–7.3) and 7-fold (95% CI: 4.00–14.2), respectively. For adult patients, cough and constitutional symptoms increased the odds of having 2009 influenza A virus (H1N1) by greater than 5-fold (95% CI: 3.1–10.2) and 3-fold (95% CI: 2.1–6.7), respectively. The negative likelihood ratio of the combination of fever and cough was 0.096 (95% CI: 0.01–0.69) for children with negative results of rapid influenza diagnostic tests. CONCLUSION/SIGNIFICANCE: In influenza epidemic settings, clinicians should be aware that rapid influenza diagnostic tests are relatively insensitive for the diagnosis of influenza virus infection. For patients with negative rapid influenza diagnostic tests, those lacking fever and cough have a low probability of influenza virus infection. The management strategy should be made individually and depend on the severity of illness. Public Library of Science 2011-12-02 /pmc/articles/PMC3229543/ /pubmed/22164233 http://dx.doi.org/10.1371/journal.pone.0028102 Text en Kuo et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Kuo, Chen-Yen Huang, Yhu-Chering Huang, Chung-Guei Tsao, Kuo-Chien Lin, Tzou-Yien Symptomatic Predictors for 2009 Influenza A Virus (H1N1) Infection with an Emphasis for Patients with a Negative Rapid Diagnostic Test |
title | Symptomatic Predictors for 2009 Influenza A Virus (H1N1) Infection with an Emphasis for Patients with a Negative Rapid Diagnostic Test |
title_full | Symptomatic Predictors for 2009 Influenza A Virus (H1N1) Infection with an Emphasis for Patients with a Negative Rapid Diagnostic Test |
title_fullStr | Symptomatic Predictors for 2009 Influenza A Virus (H1N1) Infection with an Emphasis for Patients with a Negative Rapid Diagnostic Test |
title_full_unstemmed | Symptomatic Predictors for 2009 Influenza A Virus (H1N1) Infection with an Emphasis for Patients with a Negative Rapid Diagnostic Test |
title_short | Symptomatic Predictors for 2009 Influenza A Virus (H1N1) Infection with an Emphasis for Patients with a Negative Rapid Diagnostic Test |
title_sort | symptomatic predictors for 2009 influenza a virus (h1n1) infection with an emphasis for patients with a negative rapid diagnostic test |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229543/ https://www.ncbi.nlm.nih.gov/pubmed/22164233 http://dx.doi.org/10.1371/journal.pone.0028102 |
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