Application of myxovirus resistance protein A in the etiological diagnosis of infections in adults

doi:10.5847/wjem.j.1920-8642.2025.011

Abstract

Abstract:

BACKGROUND Inappropriate antibiotic treatment for patients with viral infections has led to a surge in antimicrobial resistance, increasing mortality and healthcare costs. Viral and bacterial infections are often difficult to distinguish. Myxovirus resistance protein A (MxA), an essential antiviral factor induced by interferon after viral infection, holds promise for distinguishing between viral and bacterial infections. This study aimed to determine the ability of MxA to distinguish viral from bacterial infections.

METHODS: We quantified MxA in 121 infected patients via dry immunofluorescence chromatography. The Kruskal-Wallis test and receiver operating characteristic (ROC) curve analysis were used to determine the diagnostic value of MxA, either alone or in combination with C-reactive protein (CRP) or procalcitonin (PCT), in patients with viral, bacterial, or co-infections.

RESULTS: The value of MxA (ng/mL) was significantly higher in patients with viral infections than in those with bacterial and co-infections (82.3 [24.5-182.9] vs. 16.4 [10.8-26.5], P<0.0001) (82.3 [24.5-182.9] vs. 28.5 [10.2-106.8], P=0.0237). The area under the curve (AUC) of the ROC curve for distinguishing between viral and bacterial infections was 0.799 (95% confidence interval [95% CI] 0.696-0.903), with a sensitivity of 68.9% (95% CI54.3%-80.5%) and specificity of 90.0% (95% CI 74.4%-96.5%) at the threshold of 50.3 ng/mL. Combining the MxA level with the CRP or PCT level improved its ability. MxA expression was low in cytomegalovirus (15.8 [9.6-47.6] ng/mL) and Epstein-Barr virus (12.9 [8.5-21.0] ng/mL) infections.

CONCLUSION: Our study showed the diagnostic efficacy of MxA in distinguishing between viral and bacterial infections, with further enhancement when it was combined with CRP or PCT. Moreover, Epstein-Barr virus and human cytomegalovirus infections did not elicit elevated MxA expression.

Key words: Myxovirus resistance protein A, Viral infections, C-reactive protein, Procalcitonin, Biomarker

Tianpeng Hu, Yan Li, Shengtao Yan, Lichao Sun, Rui Lian, Jieqiong Yu, Jie Chen, Xiaoyu Liu, Guoqiang Zhang. Application of myxovirus resistance protein A in the etiological diagnosis of infections in adults[J]. World Journal of Emergency Medicine, 2025, 16(1): 35-42.

Figures/Tables 5

Figure 1.

Table 1.

Demographic and clinical characteristics of the patients

Parameters	All patients (n=121)	Viral infection (n=45)	Bacterial infection (n=30)	Co-infection (n=46)	P-value
Sex
Males, n (%)	73 (60.3)	26 (57.8)	16 (53.3)	31 (67.4)	0.433
Females, n (%)	48 (39.7)	19 (42.2)	14 (46.7)	15 (32.6)
Age, years, median (IQR)	70.0 (59.5-77.0)	72.0 (54.5-77.0)	68.0 (59.5-77.0)	71.0 (60.0-79.3)	0.894
Comorbidities, n (%)
Hypertension	63 (52.1)	25 (55.6)	19 (63.3)	19 (41.3)	0.150
Diabetes mellitus	44 (36.4)	15 (33.3)	7 (23.3)	22 (47.8)	0.083
Coronary disease	25 (20.7)	10 (22.2)	2 (6.7)	13 (28.3)	0.070
Stroke	22 (18.2)	6 (13.3)	11 (36.7)	5 (10.9)	0.010
Cancer	13 (10.7)	1 (2.2)	4 (13.3)	8 (17.4)	0.044
Respiratory system diseases	19 (15.7)	5 (11.1)	5 (16.7)	9 (19.6)	0.569
Chronic kidney disease	6 (5.0)	2 (4.4)	1 (3.3)	3 (6.5)	1.000
Rheumatism	7 (5.8)	1 (2.2)	3 (10.0)	3 (6.5)	0.379
Hemopathy	3 (2.5)	3 (6.7)	0 (0)	0 (0)	0.063
Others	24 (19.8)	7 (15.6)	6 (20.0)	11 (23.9)	0.651
Sites of infection, n (%)
Lower respiratory tract infection	108 (89.3)	45 (100.0)	22 (73.3)	41 (89.1)	<0.001
Gastrointestinal infection	4 (3.3)	0 (0.0)	3 (10.0)	1 (2.2)	0.083
Urinary tract infection	2 (1.7)	0 (0.0)	1 (3.3)	1 (2.2)	0.715
Multisite infection	7 (5.8)	0 (0.0)	4 (13.3)	3 (6.5)	0.039
MxA, ng/mL, median (IQR)	28.9 (13.0-111.4)	82.3 (24.5-182.9)	16.4 (10.8-26.5)	28.5 (10.2-106.8)	<0.001
WBC, ×10⁹/L, median (IQR)	10.4 (7.5-13.6)	10.0 (5.9-12.5)	11.1 (7.2-18.0)	10.4 (7.9-13.9)	0.477
CRP, mg/L, median (IQR)	66.9 (21.7-126.4)	34.8 (10.8-95.1)	83.5 (40.1-123.8)	83.7 (22.9-160.0)	0.021
PCT, ng/mL, median (IQR)	0.4 (0.2-2.9)	0.2 (0.2-0.6)	0.5 (0.3-4.2)	0.8 (0.2-4.0)	0.001
APACHE Ⅱ score, median (IQR)	16.0 (12.0-21.0)	13.0 (11.0-16.5)	15.0 (12.0-23.0)	18.5 (13.0-26.0)	0.001
SOFA score, median (IQR)	6.0 (4.0-10.0)	5.0 (4.0-8.0)	6.0 (4.0-9.3)	7.0 (5.8-11.2)	0.002
Mortality, in hospital), n (%)	19 (15.7)	3 (6.7)	5 (16.7)	11 (23.9)	0.070

Table 1.

Figure 2.

Figure 3.

Figure 4.

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