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795Comparison of respiratory viral shedding with culture and PCR based method in persons with hematologic malignancy

Year: 2014
Type: conference-abstract
Abstract: Background. Community respiratory viruses (CRV) are a leading cause of infection related morbidity and mortality for patients undergoing cancer treatment. Molecular based testing (PCR) is a faster, more sensitive diagnostic method than culture. PCR does not differentiate between active viral replication and resolved infection, thus making test of cure and isolation policies for CRV-positive patients unclear. The goal of this analysis was to compare duration of CRV shedding as detected by culture and PCR for patients with hematologic malignancy. Methods. Results of respiratory virus tests from two study periods, January 2009-September 2011 (culture) and September 2011-April 2013 (PCR) were reviewed for patients with hematologic malignancy [hematopoietic stem cell transplant, leukemia, lymphoma, and pediatric oncology]. Patients were included if tested positive for influenza A, influenza B, parainfluenza (PIV), human metapneumovirus (HMPV), and/or respiratory syncytial virus (RSV), and if first re-tested within 5-30 days after initial diagnosis. The patients' symptoms at time of each re-test were also reviewed. Results. This study included 651 CRV infection episodes; 203 detected by culture and 448 by PCR. The figure shows the median and range of shedding for each virus. The median length of shedding by culture and PCR respectively is as follows, influenza A: 13 vs 15; influenza B: 14 vs 16; RSV:13 vs 18; PIV: 9 vs 17; HMPV 10 vs 16.5. Of the 72 (16%) PCR-positive patients who shed virus for >30 days, most (74%) were non-influenza viruses. There was no correlation between symptoms at time of test and result of test. Patients with ALC< 200 at time of retesting were more likely to still shed the virus (table). Viral shedding Symptoms at repeat test Conclusion. For our cohort of immunosuppressed patients, longer shedding was seen with PCR than culture. Shedding of influenza viruses was similar across both methods, seldom lasting > 1 month. Overall, shedding >1 month was rare, and seen most with RSV and PIV. Symptom based assessment of viral shedding is unreliable. Our findings should help guide infection control practices for CRV in high risk patients. Disclosures. All authors: No reported disclosures.
DOI: 10.1093/ofid/ofu052.503
Language: English
Subfield: Epidemiology
Field: Medicine
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2301643631
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