Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (1408 page)

Suggested Readings

Cruciani M, Marcati P, Malena M, et al. Meta-analysis of diagnostic procedures for
Pneumocystis carinii
pneumonia in HIV-1-infected patients.
Eur Respir J.
2002;20:982–989.

Procop GW, Haddad S, Quinn J, et al. Detection of
Pneumocystis jiroveci
in respiratory specimens by four staining methods.
J Clin Microbiol.
2004;42(7):3333–3335.

Thomas CF Jr, Limper AH.
Pneumocystis
pneumonia.
N Engl J Med.
2004;350:2487–2498.

RESPIRATORY ADENOVIRUS CULTURE (RULE OUT)

   Definition

   Adenovirus respiratory infections most commonly occur in young children and typically present with nonspecific findings of febrile viral respiratory tract infection. Immunocompromised, especially bone marrow transplant, patients may present with severe disease. Respiratory adenovirus infections do not show as strong a seasonal variability (winter months) as the other common respiratory viral pathogens.

   Use

   This test is used to detect respiratory viral infections caused by adenoviruses. Respiratory specimens for adenovirus are inoculated onto human cell lines; A549, HeLa, HEp-2, and MRC-5 cell lines are commonly used. Tube cultures or shell vial culture technique may be used. A presumptive diagnosis may be made on the basis of typical cytopathic effect and then confirmed by immunologic techniques. Adenovirus detection may be included in virus culture or molecular test panels for respiratory virus detection. Children with respiratory adenovirus infection frequently demonstrate leukocytosis (>15,000/mm
³
) and increased ESR and CRP, in contrast to the lack of these signs in other common viral respiratory tract infections.

   
Turnaround time:
Most cultures are positive within 2 weeks. Tube cultures may be incubated for up to 4 weeks before signing out as negative. Shell vial cultures are stained within 3 days of incubation.

   Special Collection and Transport Instructions

   Specimens should be collected in the first week after onset of symptoms.

   Nasopharyngeal swabs or aspirates are recommended; other respiratory tract specimens may be acceptable for culture.

   It is recommended that specimens be inoculated into a viral transport medium and transported to the laboratory at 4°C.

   Interpretation

   
Expected results:
Negative.

   Limitations