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Test ID RP Respiratory Panel, PCR, Nasopharyngeal


Ordering Guidance


This assay is not predicted to detect severe acute respiratory syndrome (SARS)-associated coronavirus or Middle East respiratory syndrome (MERS)-coronavirus.

 

This test is not intended for otherwise healthy, immunocompetent patients who are likely to have a mild, self-limited respiratory infection. If testing is desired, these patients should be tested using the more targeted diagnostic assays based on their exposure history and clinical presentation.

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

-BPRP / Bordetella pertussis and Bordetella parapertussis, Molecular Detection, PCR

-MPRP / Mycoplasma pneumoniae, Molecular Detection, PCR

-COVOO / Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RNA Detection, Varies

 

It is not recommended that the following tests be concomitantly ordered when this test is ordered:

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

-LADV / Adenovirus, Molecular Detection, PCR, Varies

-LENT / Enterovirus, Molecular Detection, PCR, Varies

-BPRP / Bordetella pertussis and Bordetella parapertussis, Molecular Detection, PCR, Varies

-MPRP / Mycoplasma pneumoniae, Molecular Detection, PCR, Varies

-COVOO / Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RNA Detection, Varies

 

This test is appropriate for nasopharyngeal swabs only. For bronchoalveolar lavage or bronchial washings specimens, order RESLR / Respiratory Pathogen Panel, PCR, Varies.



Shipping Instructions


Specimens that cannot be shipped refrigerated to Mayo Clinic Laboratories within 3 days (72 hours) should be frozen prior to shipment. Specimens received older than 72 hours (refrigerated) or older than 30 days (frozen) will be canceled.



Specimen Required


Specimen Type: Nasopharyngeal swab

Supplies:

-Bartels FlexTrans VTM-3 mL (T892)

-Jiangsu VTM-3 mL (T891)

Collection Container/Tube: Swab

Submission Container/Tube: Viral transport medium. See Additional Information for acceptable media.

Specimen Volume: Nasopharyngeal swab in minimum volume of 1 mL of viral transport media

Collection Instructions: Nasopharyngeal swab specimens should be collected according to standard technique and immediately placed into viral transport media and submitted for testing.

Additional Information:

If any nasopharyngeal swab or viral transport media not listed below is utilized, testing may be canceled.

-Acceptable nasopharyngeal swabs are: Copan Rayon Swabs, Copan Nylon Flocked Swabs, Copan Polyester Swabs, Puritan Calcium Alginate Swabs.

-Acceptable viral transport media are: Remel M4, Remel M4-RT, Remel M5, Remel M6, BD Universal Viral Transport vial, PrimeStore Molecular Transport Medium (MTM), Sigma-Virocult Viral Collection and Transport System (Swab and transport medium), and Copan ESwab Sample Collection and Delivery System (Swab and Liquid Amies Medium).


Useful For

Rapid detection of respiratory infections caused by the following:

-Adenovirus

-Coronavirus (serotypes HKU1, NL63, 229E, OC43)

-Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

-Human metapneumovirus

-Human rhinovirus/enterovirus

-Influenza A (H1, H1-2009, H3)

-Influenza B

-Parainfluenza virus (serotypes 1-4)

-Respiratory syncytial virus (RSV)

-Bordetella pertussis

-Bordetella parapertussis

-Chlamydia pneumoniae

-Mycoplasma pneumoniae

 

This test is not recommended as a test of cure.

Method Name

Multiplex Polymerase Chain Reaction (PCR)

Reporting Name

Respiratory Panel, PCR, NP

Specimen Type

Varies

Specimen Minimum Volume

See Specimen Required

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Refrigerated (preferred) 72 hours
  Frozen  30 days
  Ambient  4 hours

Clinical Information

Respiratory infections are common and generally cause self-limited illnesses in healthy, immunocompetent hosts. Viruses account for a significant percentage of respiratory diseases, but bacteria can be associated with respiratory infections. Although respiratory illnesses are frequently mild, viruses may cause significant morbidity and mortality in immunocompromised hosts (eg, transplant recipients, patients with underlying malignancies).

 

Influenza viruses (types A and B) and respiratory syncytial virus (RSV) are 2 common causes of viral respiratory illness, with peak incidence in the winter and spring months in the Northern hemisphere. Both viruses can cause a clinically indistinguishable syndrome, characterized by fever, cough, headache, and general malaise. RSV is a leading cause of respiratory illness in young children. Early diagnosis of influenza and RSV is important so that 1) necessary infection control precautions can be taken if the patient is hospitalized, and 2) antiviral therapy can be considered if the patient is hospitalized or considered at high-risk for severe disease.(1) Human metapneumovirus is also a cause of respiratory illness in both children and adults.

 

Human rhinovirus and coronavirus serotypes HKU1, NL63, 229E, OC43 are the causative agents of the common cold, with symptoms including runny nose, sore throat, and malaise. Infections with rhinovirus and coronaviruses are extremely common, due to the large number of serotypes of these viruses. Most infections are mild and self-limiting; however, immunocompromised hosts may suffer more severe illnesses, including lower respiratory tract disease.

 

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an RNA virus that causes coronavirus disease 2019 (COVID-19). Like other coronaviruses that infect humans, SARS-CoV-2 can cause both upper and lower respiratory tract illness. Symptoms can range from mild (eg, the common cold) to severe (eg, pneumonia) in both healthy and immunocompromised patients. SARS-CoV-2 transmission occurs primarily via respiratory droplets. During the early stages of COVID-19 disease, the symptoms may be nonspecific and resemble other common respiratory infections, such as influenza.

 

Parainfluenza viruses and adenovirus are also common causes of viral infection, especially in young children. Parainfluenza viruses are most common during the spring, summer, and fall months, with symptoms including fever, runny nose, and cough. However, parainfluenza viruses may also cause more severe lower respiratory disease, such as croup or pneumonia. Adenoviruses may infect a range of organ systems, with sequelae ranging from cold-like symptoms (sore throat) to pneumonia, conjunctivitis (pink eye), or diarrhea. Similarly to the viruses described above, parainfluenza viruses and adenoviruses generally cause mild, self-limited infections but may cause severe disease in immunosuppressed patients.

 

Respiratory infections may also be caused by bacterial pathogens, including Bordetella pertussis, Bordetella parapertussis, Chlamydia pneumoniae, and Mycoplasma pneumoniae. B pertussis is the causative agent of pertussis, or whooping cough, a disease characterized by prolonged cough that may be associated with an inspiratory whoop and post-tussive vomiting. B parapertussis causes a similar, but generally less severe, illness. M pneumoniae is a cause of upper respiratory infection, pharyngitis, tracheobronchitis, and pneumonia. C pneumoniae is a rare cause of pneumonia.

Reference Values

Undetected (for all targets)

Interpretation

Results are intended to aid in the diagnosis of illness and are meant to be used in conjunction with other clinical and epidemiological findings.

 

A negative result should not rule out infection in patients with a high pretest probability for a respiratory infection. The assay does not test for all potential infectious agents of respiratory disease. Specimens collected too early or too late in the clinical course may not yield the organism causing disease. Negative results should be considered in the context of a patient's clinical course and treatment history, if applicable.

 

For patients who are immunocompromised and have a negative FilmArray respiratory panel test from a nasopharyngeal sample but a high suspicion for infection, there may be additional value in testing a bronchoalveolar lavage specimen (RESLR / Respiratory Pathogen Panel, PCR, Varies).

 

Positive results do not distinguish between a viable or replicating organism and the presence of a nonviable organism or nucleic acid, nor do they exclude the potential for coinfection by organisms not included in the panel. Nucleic acid may persist in some patients for days to weeks, even following appropriate therapy. Detection of 1 or more organisms included in this test suggests that the virus or bacteria is present in the clinical sample; however, the test does not distinguish between organisms that are causing disease and those that are present but not associated with a clinical illness. Coinfections (eg, detection of multiple viruses or bacteria or viruses and bacteria) may be observed with this test. In these situations, the clinical history and presentation should be reviewed thoroughly to determine the clinical significance of multiple pathogens in the same specimen.

Clinical Reference

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

2. Miliander C, Espy M, Binnicker MJ: Evaluation of the BioFire FilmArray for the detection of respiratory viruses in clinical samples. Clinical Virology Symposium Annual Meeting. Daytona, Florida; April 2013

3. Ramanan P, Bryson AL, Binnicker MJ, Pritt BS, et al: Syndromic panel-based testing in clinical microbiology. Clin Microbiol Rev. 2017 Nov 15;31(1):e00024-17. doi: 10.1128/CMR.00024-17

Test Classification

This test has received Emergency Use Authorization (EUA) by the U.S. 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

0202U

LOINC Code Information

Test ID Test Order Name Order LOINC Value
RP Respiratory Panel, PCR, NP 82159-5

 

Result ID Test Result Name Result LOINC Value
SS021 Specimen Source 31208-2
609644 Adenovirus 82160-3
609645 Coronavirus 229E 82163-7
609646 Coronavirus HKU1 82161-1
609647 Coronavirus NL63 82162-9
609648 Coronavirus OC43 82164-5
609649 SARS Coronavirus-2 94565-9
609651 Human Metapneumovirus 82165-2
609650 Human Rhinovirus/ Enterovirus 82175-1
609652 Influenza A 82166-0
609653 Influenza B 82170-2
609654 Parainfluenza Virus 1 82171-0
609655 Parainfluenza Virus 2 82172-8
609656 Parainfluenza Virus 3 82173-6
609657 Parainfluenza Virus 4 82174-4
609658 Respiratory Syncytial Virus 82176-9
609659 Bordetella parapertussis 87621-9
609660 Bordetella pertussis 82179-3
609661 Chlamydia pneumoniae 82178-5
609662 Mycoplasma pneumoniae 82177-7
609663 Interpretation 59464-8

Day(s) Performed

Monday through Sunday

Report Available

Same day/1 to 2 days