Used antigenic devices as a matrix for molecular detection of respiratory viruses
Authors: Jean-Michel Mansuy, Emma Da Horta, Camille Bréhin, Isabelle Claudet, Pauline Trémeaux
Journal: The Lancet Microbe (2024)

Acute infectious respiratory diseases are most commonly caused by viruses or bacteria. For instance, acute infectious pneumonia causes mild to life-threatening illness and is currently a major cause of morbidity and mortality in children worldwide.1GBD 2013 Mortality and Causes of Death CollaboratorsGlobal, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet. 2015; 385: 117-171Summary Full Text Full Text PDF PubMed Scopus (5932) Google Scholar Older adults are also affected by respiratory infections, as illustrated by the COVID-19 pandemic and the recurrent annual outbreaks of influenza and respiratory syncytial virus (RSV) infections. In addition, other respiratory viruses such as rhinoviruses, metapneumovirus, adenovirus, and parainfluenza viruses are causes of acute respiratory infections. Several biological tools exist for the diagnosis of respiratory infections; these tools are based on rapid and unitary point-of-care antigen devices and on viral genome molecular detection systems mainly located in laboratory wards. Antigen-based devices yield a rapid but less sensitive result than viral genome molecular detection systems, which are limited by the need of skilled personnel and longer turnaround times.2Basile K Kok J Dwyer DE Point-of-care diagnostics for respiratory viral infections.Expert Rev Mol Diagn. 2018; 1: 75-83Crossref Scopus (50) Google Scholar During the COVID-19 pandemic, with the use of rapid antigen tests, virological diagnosis had been largely moved from the laboratories to medical wards or non-medical settings (ie, schools, factories, community settings). Such a new approach met the needs of rapid decision making for individual treatment strategies, infection control measures, and public health actions.3Dinnes J Sharma P Berhane S et al.Rapid, point-of-care antigen tests for diagnosis of SARS-CoV-2 infection.Cochrane Database Syst Rev. 2022; 7: CD013705PubMed Google Scholar However, the above approach deprived virological laboratories of accurate samples for other viral detections or genome sequencing. We read with great interest an Article by Michael A Moso and colleagues.4Moso MA Taiaroa G Steinig E et al.Non-SARS-CoV-2 respiratory viral detection and whole genome sequencing from COVID-19 rapid antigen test devices: a laboratory evaluation study.Lancet Microbe. 2024; 5: e317-e325Summary Full Text Full Text PDF PubMed Google Scholar They showed the efficient use of two rapid antigen strip devices after the strips were loaded with respiratory viruses obtained from either viral cultures or frozen samples. After removal from the device and buffer incubation, the strips can deliver the viral genome tested using molecular tools and possibly sequencing. We found similar results but in real-life clinical conditions. During the 2023–24 winter, we evaluated the use of the All In Triplex antigenic test (AAZ) on a paediatric population with acute respiratory symptoms, sampled in the paediatric emergency unit of Toulouse University Hospital. We showed excellent sensitivities and specificities of the All In Triplex device in comparison with molecular detection on the Panther Fusion system (Hologic) for the viruses of the panel (ie, SARS-CoV-2, influenza A or B, and RSV) on nasal specimens with high viral burden. The main finding was that the device buffer is appropriate for viral RNA detection. Therefore, a new sampling for the molecular detection of other viruses of medical interest involved in paediatric (co)infections was not needed (appendix). In conclusion, we show that the virological diagnosis of a respiratory infection can be performed by reusing biological material that has already been collected and processed. Reusing material reduces the number of samples taken, thus improving patient comfort and decreasing the ecological footprint of this type of diagnosis.see online for appendix see online for appendix JMM declares that AAZ Laboratory supplied rapid immunochromatographic All In Triplex devices. EDH, CB, IC, and PT declare no competing interests. Download .pdf (.13 MB) Help with pdf files Supplementary appendix Non-SARS-CoV-2 respiratory viral detection and whole genome sequencing from COVID-19 rapid antigen test devices: a laboratory evaluation studyNon-SARS-CoV-2 respiratory viruses can be detected and sequenced from COVID-19 rapid antigen devices. Recovery of near full-length viral sequences from these devices provides a valuable opportunity to expand genomic surveillance programmes for public health monitoring of circulating respiratory viruses. Full-Text PDF Open Access