Assay Sheet

Test ID

RV00 Respiratory Viral Panel (RVP)

CPT Code

87798   

Clinical Utility

The Respiratory Viral Panel is a comprehensive assay for the detection of a broad range of viruses and subtypes representing the majority of circulating respiratory disease-causing pathogens of particular importance to children, elderly, and immunocompromised patients. Detection of these pathogens will lead to more efficient management of patients with respiratory infections, play a key role in surveillance, and aid in limiting the spread of respiratory viruses through infection control practices.

Procedure

Viral nucleic acid is extracted from the specimen, which undergoes reverse transcription to generate complementary DNA (cDNA). The target cDNA is amplified using polymerase chain reaction (PCR), then analyzed with Luminex® xTag™ technology to detect the presence or absence of each virus in the panel. The Respiratory Viral Panel (RVP) has been cleared by the FDA for in vitro diagnostic use.

Specimens

* Nasopharyngeal swab (NP swab): sterile swab placed in 1-2 ml sterile saline or viral transport media; ship ambient.
**Nasopharyngeal aspirate (NP aspirate), tracheal aspirate, BAL: 2 ml; submitted in a sterile, screw-top tube; ship ambient.

Specificity

Detects 12 Respiratory viral targets: respiratory syncytial virus (RSV) A, respiratory syncytial virus (RSV) B, influenza A, influenza A subtype H1, influenza A subtype H3, influenza B, parainfluenza 1, parainfluenza 2, parainfluenza 3, human metapneumovirus (hMPV), rhinovirus, and adenovirus

Assay Range

Qualitative results (Positive/Not Detected) for: RSV A, RSV B, influenza A, influenza A subtype H1, influenza A subtype H3, influenza B, parainfluenza 1, parainfluenza 2, parainfluenza 3, hMPV, rhinovirus, and adenovirus

Turnaround Time

Within 24 hours of receiving specimen

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* NP swab has been cleared by the FDA for use in the RVP assay.
**In-house verification performed to establish as suitable specimen types.

Information derived from Respiratory Viral Panel Package Insert (Luminex Corporation).
Respiratory Viral Panel is a product of Luminex Corporation.
xTAG is a trademark of Luminex Corporation.
Luminex is a registered trademark of Luminex Corporation.
AS10-0108

Pathogen Overview

ABOUT THE RHINOVIRUS

Rhinoviruses are non-enveloped, single-stranded RNA viruses from the Picornaviridae family, along with enteroviruses. In contrast to enteroviruses, rhinoviruses do not replicate in the intestinal tract. Approximately 100 serotypes of human rhinovirus have been identified. Rhinoviruses are the most frequent cause of the common cold. Infections occur throughout the year, but are more prevalent in early fall and late spring.

RHINOVIRUS CLINICAL MANIFESTATIONS

Rhinovirus infections cause self-limited upper respiratory illness, characterized by sneezing, nasal obstruction, nasal discharge and sore throat. Headache, cough and malaise are common symptoms, though fever is rare in rhinovirus infections. Approximately one-third of rhinovirus infections are asymptomatic. The median duration of uncomplicated illness is 7 days, with symptoms peaking 1-3 days after onset before progressively improving. Rhinovirus infection is a major cause of asthma exacerbations in school aged children. The virus has also been associated with otitis media and exacerbations of cystic fibrosis in children and chronic bronchitis and COPD in adults. Rhinovirus infections in the elderly have been associated with severe and fatal illness, as evidenced by nursing home outbreaks.

Though previously a topic of debate, it has been established that rhinovirus has the ability to replicate in the lower respiratory tract. Recent studies have reported rhinovirus as a cause of lower respiratory tract infections in patients with predisposing conditions, such as a compromised immune status. In a study of hematopoietic stem cell transplant (HSCT) patients, 5 of 6 rhinovirus-positive patients died from severe lower respiratory tract disease. However, since all of the patients infected with rhinovirus had a coinfection, it is unclear which agent, rhinovirus or the copathogen, was the primary cause of mortality. Additional studies are needed to determine if rhinovirus causes lytic infection or acts primarily through an indirect immunosuppressive effect to predispose patients to superinfections. Another study describes 3 lung transplant recipients chronically infected with rhinovirus; 2 of the 3 patients had chronic upper respiratory tract symptoms and all 3 patients had recurring lower respiratory tract symptoms. All 3 patients had graft dysfunction and 2 patients died. Rhinovirus was the only pathogen identified. The patients failed to produce neutralizing antibodies against the virus due to significant immunosuppression; therefore, chronic rhinoviral infection could be considered an opportunistic event. Chronic infection lasting months or years with other members of the Picornaviridae family, such as enterovirus, is recognized in immunocompromised hosts. This scenario may be applicable to rhinovirus, which is structurally and functionally similar to other picornaviruses. While additional studies are needed to determine the impact of rhinovirus in the immunocompromised patient population, the virus is emerging as an important pathogen that needs to be considered, especially in lung transplant recipients.

RHINOVIRUS LABORATORY DIAGNOSIS

Virus isolation in cell culture, followed by an acid lability test, has been the conventional method to diagnose rhinovirus infections. However, fastidious growth requirements of rhinovirus make the technique time-consuming and laborious. Poor negative predictive values add to the method’s limitations. Serological tests are not useful because of the large number of rhinovirus serotypes. The need for a rapid and highly sensitive diagnostic method is significant. Polymerase Chain Reaction (PCR) is coming to the forefront as it has been shown to be a rapid, sensitive and specific method for detecting rhinovirus.

RHINOVIRUS TREATMENT

Rhinovirus is mainly a community acquired infection, though nosocomial spread does occur. Strict infection control practices, including isolation measures and careful hand hygiene practices, can help prevent the spread of infection.

Treatment options for rhinovirus infection are limited. Pleconaril, which inhibits viral uncoating and/or attachment, has been used in transplant patients with rhinoviral pneumonia, though its efficacy is still unknown.

Selected References

Kaiser L, Aubert J, Pache J, et al. Chronic rhinoviral infection in lung transplant recipients. Am J Respir Crit Care Med. 2006;(174):1392-1399.

Knipe D, Howley P. Fields Virology. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.

Lee I, Barton TD. Viral respiratory tract infections in transplant patients: epidemiology, recognition and management. Drugs. 2007;67(10):1411-1427.

Mahoney J, Chong S, Merante F, et al. Development of a respiratory virus panel (RVP) test for the detection of twenty human respiratory viruses using multiplex PCR and a fluid microbead-based assay. J Clin Microbiol. 2007;45(9):2965-2970.

PAO-21-09

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Collection & Shipping

PCR tests are performed pursuant to a license agreement with Roche Molecular Systems Inc.
ImmuKnow is a registered trademark of Cylex Incorporated.
Respiratory Viral Panel is a product of Luminex Corporation.

Abstracts & Publications

Ison M, Hayden F, Kaiser L, et al. Rhinovirus infections in hematopoietic stem cell transplant recipients with pneumonia. Clin Infect Dis.2003;(36):1139-1143.

Kaiser L, Aubert J, Pache J, et al. Chronic rhinoviral infection in lung transplant recipients. Am J Respir Crit Care Med. 2006;(174):1392-1399.

Knipe D, Howley P. Fields Virology. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.

Lee I, Barton TD. Viral respiratory tract infections in transplant patients: epidemiology, recognition and management. Drugs.2007;67(10):1411-1427.

Mahoney J, Chong S, Merante F, et al. Development of a respiratory virus panel (RVP) test for the detection of twenty human respiratory viruses using multiplex PCR and a fluid microbead-based assay. J Clin Microbiol. 2007;45(9):2965-2970.