Multipathogen Detection in Patients with Respiratory TractInfections; Identification of Non-Respiratory Viruses Using MultiplexReal Time Polymerase Reaction (PCR)

Background and Aim : Respiratory tract infections (RTIs) impose a burden on healthcaresystems. Because of the overlapping clinical characteristics of RTIs and the unavailability ofappropriate diagnostic techniques, the diagnosis of RTIs is controversial. Besides, prospectivestudies have identified more than one pathogen in ۴-۳% of adults and ۲۳-۳۳% of children sufferingfrom community-acquired Pneumonia (CAP) by using sensitive diagnostic assays. Differentiatinga viral origin from bacterial or mixed viral-bacterial infection could substantially decreaseantibiotic use, avoid the associated risk of adverse reactions, reduce antibiotic resistancedevelopment, decrease hospital-acquired infections, and improve clinical outcomes. The studyaimed to prompt the diagnosis of RTIs using commercial multiplex real-time PCR.Methods : The survey undertook for two years (۲۰۱۹ - ۲۰۲۰) on ۱۴۴ flu-negativeimmunocompetent outpatients with moderate to severe respiratory symptoms. Respiratoryspecimens were collected from patients, including the sputum, anterior nasal swabs, and throatswabs. Commercial multiplex PCR assays were performed on these samples.Results : Study population consisted of females (n = ۷۷, ۵۳.۵%) and males (n = ۶۷, ۴۶.۵%). Themean age was ۴۲.۸ ± ۲۳.۷ years. Thirty-one (۲۱.۵%) patients were infected with only one viral orbacterial infection. Eighty-two (۵۷%) were infected with more than one pathogen. Ninety-five(۳۷%) and ۱۶۱ (۶۲%) tests were positive for bacterial and viral pathogens, respectively.Community-acquired Pneumonia (CAP) and atypical CAP pathogens included ۱۷% and ۱۰% ofrespiratory specimens, respectively. The predominant pathogens consisted of Human Herpes Virus۷ (HHV-۷) (n = ۳۸, ۱۵.۵%), Epstein-Barr Virus (EBV) (n = ۳۴, ۱۳.۸%), Mycoplasma pneumonia(n = ۲۴, ۹.۸%), and Human Herpes Virus ۶ (HHV-۶) (n = ۲۱, ۸.۵%). There were associationsbetween pathogen findings and special age categories. Fever, cough, dyspnea, and hemoptysiswere associated with certain pathogens. There was no substantial difference between viral andbacterial Ct concerning gender, age group, and comorbidities.Conclusion : The multiplex diagnostic assay provides the early detection of the pathogen spectrumand benefits patients in the clinical decision-making process. In this study, a significant proportionof non-respiratory viruses such as herpesviruses were detected in respiratory samples fromimmunocompetent symptomatic patients. However, the role of herpesviruses in disease worseningand complications deserves further investigation.

کلیدواژه ها:

Respiratory Tract Infections ، herpesviruses ، Co-infection