期刊
OPEN FORUM INFECTIOUS DISEASES
卷 7, 期 6, 页码 -出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/ofid/ofaa194
关键词
antimicrobial stewardship; diagnostic test; gene expression; respiratory tract infection; Sri Lanka
资金
- National Institutes of Allergy and Infectious Diseases [K23AI125677]
- US Army Medical Research and Materiel Command [W81XWH-16-C-0147]
- Office of Naval Research
- Duke-NUS Graduate Medical School, Singapore
- Duke Hubert-Yeargan Center for Global Health
Background. Pathogen-based diagnostics for acute respiratory infection (ARI) have limited ability to detect etiology of illness. We previously showed that peripheral blood-based host gene expression classifiers accurately identify bacterial and viral ARI in cohorts of European and African descent. We determined classifier performance in a South Asian cohort. Methods. Patients >= 15 years with fever and respiratory symptoms were enrolled in Sri Lanka. Comprehensive pathogen-based testing was performed. Peripheral blood ribonucleic acid was sequenced and previously developed signatures were applied: a panviral classifier (viral vs nonviral) and an ARI classifier (bacterial vs viral vs noninfectious). Results. Ribonucleic acid sequencing was performed in 79 subjects: 58 viral infections (36 influenza, 22 dengue) and 21 bacterial infections (10 leptospirosis, 11 scrub typhus). The pan-viral classifier had an overall classification accuracy of 95%. The ARI classifier had an overall classification accuracy of 94%, with sensitivity and specificity of 91% and 95%, respectively, for bacterial infection. The sensitivity and specificity of C-reactive protein (>10 mg/L) and procalcitonin (>0.25 ng/mL) for bacterial infection were 100% and 34%, and 100% and 41%, respectively. Conclusions. Previously derived gene expression classifiers had high predictive accuracy at distinguishing viral and bacterial infection in South Asian patients with ARI caused by typical and atypical pathogens.
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