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Test ID FLUNP Influenza Virus Type A and Type B, and Respiratory Syncytial Virus (RSV), Molecular Detection, PCR, Nasopharyngeal Swab


Specimen Required


Specimen Type: Nasopharyngeal swab

Container/Tube: Sterile container with viral transport media

Collection Instructions:

1. Collect specimen by swabbing back and forth over mucosa surface to maximize recovery of cells.

2. Swab must be placed in viral transport media (for example, M4-RT, M4, or M4 media).


Forms

If not ordering electronically, complete, print, and send a Microbiology Test Request (T244) with the specimen.

Useful For

Rapid and accurate detection of influenza A, influenza B, and respiratory syncytial virus in a single test for nasopharyngeal swab specimens

Method Name

Multiplex Real-Time Polymerase Chain Reaction (RT-PCR)

Reporting Name

Influenza A/B and RSV, PCR, NP Swab

Specimen Type

Varies

Specimen Minimum Volume

Nasopharyngeal swab submitted in minimum volume of 0.3 mL of viral transport media (eg, M4-RT)

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Refrigerated (preferred) 7 days
  Frozen  7 days

Clinical Information

Influenza, otherwise known as the "flu," is an acute, contagious respiratory illness caused by influenza A, B, and C viruses. Of these, only influenza A and B are thought to cause significant disease, with infections due to influenza B usually being milder than infections with influenza A. Influenza A viruses are further categorized into subtypes based on the 2 major surface protein antigens: hemagglutinin (H) and neuraminidase (N).

 

Common symptoms of influenza infection include fever, chills, sore throat, muscle pains, severe headache, weakness, fatigue, and a nonproductive cough. Certain patients, including infants, the elderly, the immunocompromised, and those with impaired lung function, are at risk for serious complications. In the United States, influenza results in approximately 36,000 deaths and more than 200,000 hospitalizations each year.(1)

 

In the northern hemisphere, annual epidemics of influenza typically occur during the fall or winter months. However, the peak of influenza activity can occur as late as April or May, and the timing and duration of flu seasons vary. In 2009 to 2010, a novel influenza virus (called 2009 H1N1, previously "swine" flu) appeared in Mexico and quickly spread worldwide, causing the first influenza pandemic in more than 40 years. The resultant influenza season had an atypical distribution, with illness occurring during normally low-incidence months. Following a pandemic, disease incidence usually returns to the typical seasonal distribution within 1 to 2 years.(1)

 

Influenza infection may be treated with supportive therapy, as well as antiviral drugs such as the neuraminidase inhibitors, oseltamivir (TAMIFLU) and zanamivir (RELENZA). These drugs are most effective when given within the first 48 hours of infection, so prompt diagnosis and treatment are essential for proper management.

 

Respiratory syncytial virus (RSV) is a respiratory virus that also infects the respiratory system and can cause an influenza-like illness. Most otherwise healthy people recover from RSV infection in 1 to 2 weeks. However, infection can be severe in infants, young children, and older adults. RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia in children under 1 year of age in the United States, and is more frequently being recognized as an important cause of respiratory illness in older adults.(2)

 

RSV and influenza virus RNA can be detected by PCR in respiratory secretions, including upper and lower respiratory specimens. Nasopharyngeal swabs or aspirates are the preferred specimen types for detection of RNA from influenza A, influenza B, and RSV. Nasal swabs have also been shown to provide equivalent yield to nasopharyngeal specimens for molecular detection of influenza A and B RNA, but not RSV RNA.(3-4) Tracheal aspirates are generally not acceptable for testing due to the viscous nature of these specimens.

Reference Values

Negative

Interpretation

A positive test result indicates that the patient is presumptively infected with the indicated virus. The test does not indicate the stage of infection. Rarely, more than 1 virus may be detected from the same patient specimen. Laboratory test results should always be considered in the context of clinical observations and epidemiologic data in making a final diagnosis.

 

A negative test result suggests that the patient is not infected with influenza A, influenza B, or respiratory syncytial virus (RSV).

Clinical Reference

1. Centers for Disease Control and Prevention. Influenza Accessed April 2020. Available at: www.cdc.gov/flu/index.htm

2. Lee N, Lui GC, Wong KT, et al: High morbidity and mortality of adults hospitalized for respiratory syncytial virus infections. Clin Infect Dis 2013;57(8):1069-1077

3. Meerhoff TJ, Houben ML, Coenjaerts FE, et al: Detection of multiple respiratory pathogens during primary respiratory infection: nasal swab versus nasopharyngeal aspirate using real-time polymerase chain reaction. Eur J Clin Microbiol Infect Dis 2010;29:365-371

4. Heikkinen T, Marttila J, Salmi AA, Ruuskanen O: Nasal swab versus nasopharyngeal aspirate for isolation of respiratory viruses. J Clin Microbiol 2002;40(11):4337-4339

Test Classification

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

87631

LOINC Code Information

Test ID Test Order Name Order LOINC Value
FLUNP Influenza A/B and RSV, PCR, NP Swab 78922-2

 

Result ID Test Result Name Result LOINC Value
SS019 Specimen Source 31208-2
35975 Influenza A, PCR 76078-5
35976 Influenza B, PCR 76080-1
35977 Respiratory Syncytial Virus, PCR 76089-2

Day(s) Performed

Monday through Sunday

Report Available

Same day/1 to 3 days