Influenza Diagnostics: An Overview
Influenza is a seasonal disorder affecting millions of people around the world. Typical symptoms of influenza include fever, cough, and weakness. Sore throats and muscle aches may also accompany influenza. These symptoms may last for up to a week, with some persisting for a couple of weeks. Influenza can be difficult to diagnose, as the symptoms are similar to other diseases such as pneumonia, adenovirus-caused diseases, and diseases caused by rhinoviruses and parainfluenza viruses. As a result, a long list of diagnostic procedures has been developed for influenza. Here’s a look at the major diagnostic procedures used to diagnose influenza:
Respiratory samples must be collected for viral culture. Assessing the outbreak of influenza on an institutional basis is made much easier by viral cultures, as viral culturing helps identify the exact strain of influenza virus responsible for the outbreak. Viral cultures are a precise, exact way of identifying the virus responsible for the outbreak of influenza. However, viral cultures need to be prepared within a certain amount of time from the disease onset. Respiratory samples for viral cultures need to be collected within 3-4 days of disease onset. Given the collection of samples within this recommended timeframe, viral cultures represent a highly accurate way of identifying the influenza virus responsible and are widely used for the same.
RIDTs, or rapid influenza diagnostic tests, are antigen detection assays. RIDTs offer highly specific and quick influenza diagnosis, however, it comes at the cost of sensitivity, as RIDTs usually have low to moderate sensitivity. Some RIDTs can be used in any outpatient setting, whereas some require a fairly complex laboratory setting. RIDTs also differ in terms of the specification of viruses it can diagnose. Some RIDTs can only diagnose the influenza A virus, some can diagnose both type A and B without being able to distinguish between the two, while some can diagnose and distinguish between influenza A and B viruses. No RIDT provides information about influenza type A subtypes. Due to the low sensitivity of RIDTs, physicians are usually advised to complement RIDTs with other, more accurate influenza diagnostics.
Immunofluorescence is a specific type of RIDT and offers diagnosis in about 2-4 hours with the help of a fluorescent microscope. There are two types of immunofluorescence tests: direct and indirect. Respiratory tract specimens are needed for immunofluorescence testing.
Rapid Molecular Assays
Rapid molecular assays are a molecular influenza diagnostic procedure used to provide results with high sensitivity and specificity. There are two FDA-cleared rapid molecular assays available in the United States, with one providing diagnosis through isothermal nucleic acid amplification and the other using RT-PCR. These two assays can provide diagnostic results in about 20 minutes. Upper respiratory tract specimens are required for rapid molecular assays.
Other Molecular Assays
Apart from rapid molecular assays, other molecular assays are also available for influenza diagnosis. These can return results in about 1 to 8 hours, depending on the specific test. Some are able to distinguish between type A and B influenza viruses, while some are not.
Serologic testing is a highly specialized influenza diagnostic procedure that is only available at a certain number of laboratories and is not generally recommended.
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