Hantavirus infection laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]
Overview
Diagnosis of hantavirus infection is usually made by a positive serological test result. Evidence of viral antigen in tissue by immunohistochemistry, or the presence of amplifiable viral RNA sequences in blood or tissue, with a compatible history of HPS, is considered diagnostic for HPS.
Laboratory Findings
The laboratory findings for hantavirus infection include:[1]
Serologic assays
- The most effective and widely used test for hantavirus screening is the enzyme-linked immunosorbent assay, which detects IgM antibodies.Enzyme-linked immunosorbent assay (ELISA) detects IgM antibodies to Sin Nombre virus (SNV). An IgG test can be used in conjunction with the IgM-capture test.[2]
- A Western blot assay using recombinant antigens and isotype-specific conjugates for IgM-IgG differentiation has also been developed and its results are generally in agreement with those of the IgM-capture format.
- Also in use is a rapid recombinant immunoblot strip assay (RIBA), to identify serum antibody to recombinant proteins and peptides specific for SNV and other hantaviruses.[3]
Polymerase Chain Reaction (PCR)
Reverse transcriptase-PCR (RT-PCR) can be used to detect hantaviral RNA in fresh frozen lung tissue, blood clots, or nucleated blood cells. Reverse transcriptase–PCR tests are useful for both HFRS and HPS, as it can identify viral genotype by the PCR sequencing.[2]
Immunohistochemistry (IHC)
IHC testing of formalin-fixed tissues with specific monoclonal and polyclonal antibodies can be used to detect hantavirus antigens and has proven to be a sensitive method for laboratory confirmation of hantaviral infections. IHC has an important role in the diagnosis of HPS in patients from whom serum samples and frozen tissues are unavailable for diagnostic testing and in the retrospective assessment of disease prevalence in a defined geographic region.
Other lab findings
Other lab findings are helpful in the diagnosis and management of the complications of Hemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome.[4]
Complete blood count
- Hemorrhagic fever with renal syndrome(HFRS):
- It may show
- Thrombocytopenia
- Leukocytosis
- Raised PT and aPTT
- It may show
- Hantavirus cardiopulmonary syndrome(HPS):
Serum electrolytes
- It may show
- Decreased magnesium
- Hyponatremia
Arterial Blood gases
- It may show Metabolic Acidosis and respiratory alkalosis in HPS.
Urinalysis
- It may show
Liver function tests
- It may show
- Raised aspartate transaminase (AST)
References
- ↑ Christova I, Panayotova E, Trifonova I, Taseva E, Hristova T, Ivanova V (2017). "Country-wide seroprevalence studies on Crimean-Congo hemorrhagic fever and hantavirus infections in general population of Bulgaria". J Med Virol. doi:10.1002/jmv.24868. PMID 28561377.
- ↑ 2.0 2.1 Lednicky JA (2003). "Hantaviruses. a short review". Arch. Pathol. Lab. Med. 127 (1): 30–5. doi:10.1043/0003-9985(2003)127<30:>2.0.CO;2. PMID 12521363.
- ↑ Levy H, Simpson SQ (1994). "Hantavirus pulmonary syndrome". Am. J. Respir. Crit. Care Med. 149 (6): 1710–3. doi:10.1164/ajrccm.149.6.8004332. PMID 8004332.
- ↑ Sargianou M, Watson DC, Chra P, Papa A, Starakis I, Gogos C, Panos G (2012). "Hantavirus infections for the clinician: from case presentation to diagnosis and treatment". Crit. Rev. Microbiol. 38 (4): 317–29. doi:10.3109/1040841X.2012.673553. PMID 22553984.