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Using a field quantitative real-time PCR test to rapidly identify highly viremic rift valley fever cases.

Abstract：

:Approximately 8% of Rift Valley fever (RVF) cases develop severe disease, leading to hemorrhage, hepatitis, and/or encephalitis and resulting in up to 50% of deaths. A major obstacle in the management of RVF and other viral hemorrhagic fever cases in outbreaks that occur in rural settings is the inability to rapidly identify such cases, with poor prognosis early enough to allow for more-aggressive therapies. During an RVF outbreak in Kenya in 2006 to 2007, we evaluated whether quantitative real-time reverse transcription-PCR (qRT-PCR) could be used in the field to rapidly identify viremic RVF cases with risk of death. In 52 of 430 RVF cases analyzed by qRT-PCR and virus culture, 18 died (case fatality rate [CFR] = 34.6%). Levels of viremia in fatal cases were significantly higher than those in nonfatal cases (mean of 10(5.2) versus 10(2.9) per ml; P < 0.005). A negative correlation between the levels of infectious virus particles and the qRT-PCR crossover threshold (C(T)) values allowed the use of qRT-PCR to assess prognosis. The CFR was 50.0% among cases with C(T) values of <27.0 (corresponding to 2.1 x 10(4) viral RNA particles/ml of serum) and 4.5% among cases with C(T) values of >or=27.0. This cutoff yielded 93.8% sensitivity and a 95.5% negative predictive value; the specificity and positive predictive value were 58% and 50%, respectively. This study shows a correlation between high viremia and fatality and indicates that qRT-PCR testing can identify nearly all fatal RVF cases.

journal_name

J Clin Microbiol

journal_title

Journal of clinical microbiology

authors

Njenga MK,Paweska J,Wanjala R,Rao CY,Weiner M,Omballa V,Luman ET,Mutonga D,Sharif S,Panning M,Drosten C,Feikin DR,Breiman RF

doi

10.1128/JCM.01905-08

subject

Has Abstract

pub_date

2009-04-01 00:00:00

pages

1166-71

issue

4

eissn

0095-1137

issn

1098-660X

pii

JCM.01905-08

journal_volume

47

pub_type

杂志文章

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