# 422
What do you do when you have a suspected bird flu patient, obviously ill, and two labs provide conflicting reports as to what is wrong?
That’s the situation the doctors at Sardjito Hospital in Indonesia are wrestling with as one of their patients, `A’, has tested positive twice for H5N1 using a new, highly sophisticated onsite RT-PCR (Reverse Transcriptase Polymerase Chain Reaction) testing device, while the central lab normally used has returned a negative result.
A hat tip to bgw in Mt on the Wiki for posting this.
Sardjito Positive, Department of Health Negatif
Thursday, February 08 2007
JOGJA - had the difference produced by the test of mucus of the throat of the bird flu patient of the sample laboratory between the Sardjito Hospital and the laboratory of Balitbang Department of Health Jakarta.
Results of the test of the Study of UGM Biotechnology of the central laboratory against the sample of mucus A of the patient's throat, 20, from Playen Gunungkidul showed positive was infected H5NI. Whereas results of the Balitbang laboratory showed results of the negative and the patient only terinveksi the virus H3 or the common flu virus.
But, although the difference produced by the laboratory test, happening Sardjito stayed stubborn held on to results of the test of the biotechnology laboratory UGM. this Matter it was stressed by the Chairman of the Team of the Control of Sardjito Bird Flu Dr Sumardi SpPD to the reporter, yesterday.
"I received the telephone from balitbang that stated results" of the "patient's test A the negative or only suffered common flu (the sub-type virus H3)."
Whereas results of our laboratory stated the negative.
We will continue to perpedoman towards results of the test that was carried out by us personally.
The patient will be treated by us in accordance with the procedure of the bird flu patient, he stressed.
This new, rapid RT-PCR testing device in use at Sardjito Hospital reportedly delivers results in 300 minutes and has a 95% accuracy rate. The tests have been run more than once, and continue to show the H5N1 infection present. Regardless of the negative tests from the lab in Balitbang, the doctors have decided to treat `A’ under the assumption that he is, indeed, positive for the virus.
False-negatives, and to a lesser extent, false-positives are not uncommon in medical testing. Samples must be properly collected, safely transported, and correctly processed. And even then, sometimes the tests yield incorrect results.
There are external factors in play. The administration of Tamiflu may help mask the virus, hindering detection. The virus might even be shifting slightly; enough to have affected the sensitivity of the tests. Or there could be contamination somewhere along the line, in the collection of the sample, or at the lab.
The doctors here have made the right choice, regardless of which test is correct. There is an old adage in medicine. Treat the patient, not the test.
But there remains a bigger problem. Hospitals in Indonesia are relying on their central laboratories to tell them when it is safe to release suspected H5N1 patients. Unless this first test of the new RT-PRC test just happened to catch a solitary lab error, it could indicate a larger problem.
Of course, the central lab could be right. This new, rapid RT-PCR test could have it all wrong, which would be a major disappointment to the manufacturer, and to hospitals eagerly awaiting a quick and reliable diagnostic tool.
Either way, it’s important they figure it out. And soon.
