Respiratory Syncytial Virus Outbreak in a Long-Term Care Facility Detected Using Reverse Transcriptase Polymerase Chain Reaction: An Argument for Real-Time Detection Methods

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2008.02153.x Keywords: respiratory syncytial virus; long-term care facilities; reverse transcriptase polymerase chain reaction (RT-PCR) Abstract: OBJECTIVES: To report an outbreak of respiratory synctyial virus (RSV) in a long-term care facility (LTCF) during ongoing routine respiratory illness surveillance. DESIGN: Rapid antigen testing, viral culture, direct fluorescent antibody (DFA) testing, and reverse transcriptase polymerase chain reaction (RT-PCR) testing for up to 15 viruses in symptomatic residents and chart review. SETTING: A 120-bed LTCF. MEASUREMENTS: Comparison of rapid antigen testing, respiratory viral cultures, and DFA testing and RT-PCR in residents with symptoms of a respiratory tract infection. RESULTS: Twenty-two of 52 residents developed symptoms of a respiratory tract infection between January 29, 2008, and February 26, 2008. RSV was detected using RT-PCR in seven (32%) of the 22 cases. None of the seven cases had positive RSV rapid antigen testing, and only two had positive culture or DFA results. This outbreak occurred during a time when state wide RSV rates were rapidly declining. One patient was admitted to the hospital during the infection and subsequently died. CONCLUSION: RSV may cause outbreaks in LTCFs that traditional diagnostic methods do not detect. RT-PCR can provide a more timely and accurate diagnosis of outbreaks, which allows for early symptomatic treatment, rational use of antibiotics, and improved infection control. Author Affiliation: (*)Division of Infectious Diseases, Duke University Medical Center, and Infectious Diseases Section, Durham Veterans Affairs Medical Center, Durham, NC ([dagger])Department of Medicine, Duke University Medical Center, Durham, North Carolina ([double dagger])Health Sciences Center (s.)ARUP Laboratories, University of Utah, Salt Lake City, Utah; and ([parallel])Division of Geriatrics, Duke University Medical Center, and Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina. Article note: Address correspondence to L. Brett Caram, Service 111-H, Durham VA Medical Center, Durham, NC 27705. E-mail: caram001@mc.duke.edu