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

Zhou, Yonghong, Zhou, Chongchen, Wang, Kai, Qiu, Qi, Cheng, Yibing, Li, Yu, Cui, Peng, Liang, Lu, Li, Peng, Deng, Xiaowei
et al (show 8 more authors) (2023) Diagnostic performance of different specimens in detecting enterovirus A71 in children with hand, foot and mouth disease. VIROLOGICA SINICA, 38 (2). pp. 268-275.

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Hand, foot and mouth disease (HFMD) is a major public health problem among children in the Asia-Pacific region. The optimal specimen for HFMD virological diagnosis remains unclear. Enterovirus 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 assay. In this study, clinical samples from 276 HFMD patients were collected for analysing the sensitivity of different kind of specimens. Our 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 sample ​≥ ​rectal swab ​> ​throat swab ​> ​blood sample ​> ​CSF sample, and using a combination of clinical samples improved sensitivity for enterovirus detection. The 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 HFMD. If stool is unavailable, rectal swabs can be collected to achieve a similar diagnostic yield. Otherwise, throat swabs may be useful in detecting positive samples. Although IgM in blood or CSF is diagnostically accurate, it lacks sensitivity, missing 40%-50% of cases. The 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.

Item Type: Article
Uncontrolled Keywords: Hand foot and mouth disease (HFMD), Enterovirus A71 (EV-A71), Sensitivity, Specificity, Evaluation of diagnostic methods
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Depositing User: Symplectic Admin
Date Deposited: 19 Apr 2023 16:37
Last Modified: 09 Jun 2023 16:53
DOI: 10.1016/j.virs.2022.11.004
Open Access URL: https://doi.org/10.1016/j.virs.2022.11.004
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3169775