Research ArticleInfectious Disease

A Host-Based RT-PCR Gene Expression Signature to Identify Acute Respiratory Viral Infection

Science Translational Medicine  18 Sep 2013:
Vol. 5, Issue 203, pp. 203ra126
DOI: 10.1126/scitranslmed.3006280

You are currently viewing the editor's summary.

View Full Text
As a service to the community, AAAS/Science has made this article free with registration.

Diagnosing the Cause of Coughs and Sneezes

Diagnosis of viral respiratory infections remains a challenge. Early differentiation between a viral and bacterial etiology of respiratory symptoms would help to direct therapy more appropriately and prevent overuse of antibiotics. Measuring the host immune response to infection is an alternative to pathogen-based diagnostic testing and may improve diagnostic accuracy. Now, Zaas et al. have developed a reverse transcription polymerase chain reaction (RT-PCR) assay for blood RNA that can classify respiratory viral infections based on the host immune response. They developed their assay using two groups of individuals experimentally infected with either influenza A H3N2/Wisconsin or influenza A H1N1/Brisbane. They then validated their RT-PCR diagnostic in a sample of adults presenting to the emergency department with fever, who had microbiologically confirmed viral or bacterial illness. The sensitivity of the RT-PCR assay was 89% [95% confidence interval (CI), 72 to 98%], and the specificity was 94% (95% CI, 86 to 99%). These data establish an important “proof of concept” that host expression of a relatively small set of genes measured by RT-PCR can be used to classify viral respiratory illness in unselected individuals presenting at an emergency department for evaluation of fever. The development of this new assay and its validation in an independent “real-world” patient population is an important step on the translational pathway to establishing this platform for diagnostic testing in the clinic.