What is included in a respiratory panel?

Components of a Respiratory Panel

A respiratory panel typically includes tests for multiple viral and bacterial pathogens that cause respiratory infections, using nucleic acid-based testing methods such as PCR on nasopharyngeal swab samples. 1

Common Viral Pathogens Included

Most respiratory panels include the following viral pathogens:

• Influenza viruses:

  • Influenza A (with H1, H1N1-2009, and H3 subtyping)
  • Influenza B

• Other common respiratory viruses:

  • Respiratory Syncytial Virus (RSV)
  • Human Metapneumovirus
  • Parainfluenza viruses (types 1,2,3, and 4)
  • Coronaviruses (229E, NL63, OC43, HKU1)
  • SARS-CoV-2 (in panels developed after 2020)
  • Rhinovirus/Enterovirus
  • Adenovirus

Common Bacterial Pathogens Included

Some respiratory panels also test for atypical bacterial pathogens:

• Bordetella pertussis (whooping cough)
• Bordetella parapertussis
• Mycoplasma pneumoniae
• Chlamydia pneumoniae

Testing Methodology

Respiratory panels utilize multiplex nucleic acid amplification tests (NAATs) that can simultaneously detect multiple pathogens from a single sample. Common methodologies include:

• Real-time RT-PCR
• Multiplex microarray competitive DNA hybridization
• Nested multiplex RT-PCR
• Isothermal nucleic acid amplification
• Loop-mediated isothermal DNA amplification
• RT-PCR followed by microarray hybridization 1

Sample Types

The most common specimen type used for respiratory panels is:

• Nasopharyngeal swab (most common)

Other acceptable specimen types may include:

• Nasal swabs
• Nasal aspirates
• Nasal washes
• Throat swabs
• Bronchoalveolar lavage (BAL) fluid (for certain panels) 1

Clinical Applications

Respiratory panels are particularly valuable in:

1. Immunocompromised patients: Hematology/oncology patients and transplant recipients benefit from comprehensive testing due to higher risk of severe disease and mortality from respiratory viral infections 1

2. ICU patients: Critical illness with respiratory symptoms warrants comprehensive testing due to the impact of viral infections on outcomes 1

3. Pediatric patients: Children with respiratory symptoms, especially those with underlying conditions like asthma or cystic fibrosis 1

4. During respiratory virus seasons: When multiple viruses are circulating simultaneously, panel testing helps identify the specific pathogen 1

Available Commercial Panels

Several FDA-cleared multiplex respiratory panels are available, including:

• FilmArray Respiratory Panel (BioFire Diagnostics) - detects 22 pathogens 2
• ePlex Respiratory Pathogen Panel (GenMark Diagnostics)
• Seegene Allplex Respiratory Panel - shows good performance for most respiratory targets 3
• BioCode Respiratory Pathogen Panel - detects 17 pathogens (14 viruses and 3 bacteria) 4

Limitations and Considerations

• Not all respiratory panels include the same pathogens - panel composition varies by manufacturer
• Detection of a virus doesn't always indicate it's the cause of symptoms, especially with certain viruses that can be carried asymptomatically
• Some panels may have varying sensitivity for certain pathogens (e.g., adenovirus detection has historically been challenging in some panels) 5
• Cost considerations may limit use in certain clinical settings 1

Respiratory panels provide rapid, comprehensive detection of multiple pathogens, which can improve patient management, reduce unnecessary antibiotic use, and help with infection control measures.