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Diagnostic performance of different specimens in detecting enterovirus A71 in children with hand,foot and mouth disease

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Virologica Sinica 2023年第2期38卷 268-275页

作者： Yonghong Zhou Chongchen Zhou Kai Wang Qi Qiu Yibing Cheng Yu Li Peng Cui Lu Liang Peng Li Xiaowei Deng Lili Wang Wen Zheng Hui Gong Fang Wang Meng Xu Justin Jang Hann Chu lance turtle Hongjie Yu School of Public Health Fudan UniversityKey Laboratory of Public Health SafetyMinistry of EducationShanghai200032China Hospital Affiliated to Zhengzhou University Henan Children's HospitalZhengzhou450003China Division of Infectious Disease Key Laboratory of Surveillance and Early-warning on Infectious DiseaseChinese Centre for Disease Control and PreventionBeijing102206China West China School of Public Health Sichuan UniversityChengdu610041China Laboratory of Molecular RNA Virology and Antiviral Strategies Department of Microbiology and Immunology and Infectious Disease Translational Research ProgrammeYong Loo Lin School of MedicineNational University of SingaporeSingapore117597Singapore NIHR Health Protection Research Unit for Emerging and Zoonotic Infections Institute of InfectionVeterinary and Ecological Sciences University of LiverpoolLiverpoolL697BEUK Tropical&Infectious Disease Unit Royal Liverpool University Hospital(member of Liverpool Health Partners)LiverpoolL78XPUK

Hand,foot and mouth disease(HFMD)is a major public health problem among children in the Asia-Pacific *** optimal specimen for HFMD virological diagnosis remains *** A71(EV-A71)neutralizing antibody titres detected in paired sera were considered the reference standard for calculating the sensitivity,specificity,positive and negative predictive value of throat swabs,rectal swabs,stool,blood samples and cerebrospinal fluid(CSF)by RT-PCR or ELISA *** this study,clinical samples from 276 HFMD patients were collected for analysing the sensitivity of different kind of *** results showed that stool had the highest sensitivity(88%,95%CI:74%–96%)and agreement with the reference standard(91%).The order of diagnostic yield for EV-A71 infection was stool samplerectal swab>throat swab>blood sample>CSF sample,and using a combination of clinical samples improved sensitivity for enterovirus *** sensitivity of ELISA for IgM antibody detection in sterile-site specimens was significantly higher than that of RT-PCR(serum/plasma:62%vs.2%,CSF:47%vs.0%)(P<0.002).In conclusion,our results suggest that stool has the highest diagnostic yield for EV-A71-infected *** stool is unavailable,rectal swabs can be collected to achieve a similar diagnostic ***,throat swabs may be useful in detecting positive *** IgM in blood or CSF is diagnostically accurate,it lacks sensitivity,missing 40%–50%of *** higher proportion of severe cases and shorter interval between onset and sampling contributed to the increase in congruency between clinical testing and the serological reference standard.

关键词： Hand,foot and mouth disease(HFMD) Enterovirus A71(EV-A71) Sensitivity Specificity Evaluation of diagnostic methods

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