Fever, Viral Symptoms and Testing for Viruses

 

Burgerpic

by Becky Burger, MD

BeckyBurger@emory.edu

As we approach respiratory viral season, we wanted to share our emergency department guideline for performing viral testing via the Respiratory Viral Panel (RVP) test. The RVP is a nasal swab test that detects viruses including influenza, RSV, and several other viruses. The turnaround time for the RVP result is between one and three hours. We have found that these tests sometimes delay disposition and often don’t change management of the patient in the ED. Our quality improvement committee developed the guidance below to optimize RVP testing in the ED.   Please note that we do not perform the new molecular rapid influenza test in the emergency departments at Children’s.

For ED patients being discharged home:

  • RVP usually not indicatedHealthy patients with viral symptoms.   This is because of the following reasons:
  • Prolonged positivity of RVPs from prior illnesses (unrelated to current symptoms)
  • Multiple positives
  • False sense of security
  • Management can usually be based on clinical grounds (e.g. treating influenza in high-flu season)
  • RVP may be done on a case-by-case basisPatients with underlying chronic medical condition, or patients in the age range 4-8 week old with fever etc. where a positive test may change management– in such instances, RVP is helpful only if we wait for result of the test for further decision making such as extent of work up, admission vs. discharge, etc.

For ED patients who require admission:

  • RVP indicatedImmunocompromised patients (such as transplants and certain chronic medical conditions) and other patients at high risk for complications of infection.
  • RVP usually not necessaryImmunocompetent patients (with or without chronic medical problems) – inpatient team may choose to order it themselves if desired.
  • All inpatient rooms at Children’s are private rooms so we don’t need to use RVPs for cohorting purposes.  Also, all respiratory illness patients need appropriate infection control precautions regardless of the result of the RVP.

We do not recommend referral to the emergency department just for RVP testing in well appearing children who have symptoms consistent with viral respiratory infection. For patients with symptoms concerning for influenza who are at higher risk (based on age, severity, or underlying medical conditions), treatment with antiviral medications can be started without the need for lab confirmation of influenza, (particularly during high flu prevalence).

If you have any questions about RVP testing, feel free to contact: Becky Burger, MD, BeckyBurger@emory.edu

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Zika virus: Overview and Testing

jbpic

By Jacob Beniflah

jacob.beniflah@emory.edu

By now you have undoubtedly heard from both patients and the media about Zika virus. The information out there can be confusing and contradictory. With the help of the CDC, we will give a general overview.

Zika virus is spread primarily by the Aedes species mosquito which is mostly a daytime biter but also bites at night. Active Zika virus transmission has been confirmed in all of North America (except Canada), Central America, South America and the Caribbean. The US has, as of 8/31, reported 35 locally spread cases (all in 2 areas of Miami-Dade country) and 2686 travel-associated cases.

Infection with Zika virus can be completely asymptomatic. If a patient shows symptoms they are usually mild and include fever, rash, joint pain, conjunctivitis, muscle pain, and headaches. Most people will only have symptoms for a few days to a week. Long term effects include a known risk of birth defects. Currently, a strong association between Guillain-Barre and Zika virus is being researched but nothing is conclusive yet.

Zika virus should be suspected in an infant or child who has traveled or lived in an affected area within the past 2 weeks and have 2 or more of the following: fever, rash, conjunctivitis, or arthralgia.

Testing at this time is only done thru the Georgia Department of Health (GDH). CHOA does not do in-house testing and will send samples to the GDH. A provider wishing to send testing must first call the GDH’s Epidemiology section for an approval code. During the day call 404-657-2588 or after-hours at 770-578-4104.

There is no current treatment for Zika. Treatment is with standard supportive care but the CDC recommends avoiding NSAIDs such as aspirin or ibuprofen until Dengue has been ruled out.