Enterovirus 68 laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with EV-D68 infection often have [[leukocytosis]] with [[lymphocyte]] predominance. [[Reverse transcription polymerase chain reaction]] ([[RT-PCR]]) assay of an oral or nasopharyngeal swab is usually positive. Viral culture is less likely to be ordered, but will often show positive results for the infective agent. [[Serology]] tests have a low [[sensitivity]] for the diagnosis of EV-D68 infection. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
*Routine tests such as a [[complete blood count]] may not show any abnormalities. | *Routine tests such as a [[complete blood count]] may not show any abnormalities. | ||
*[[Leukocytosis]] with an increased number of [[lymphocytes]] can be observed among some patients. <ref name="LuWo2013">{{cite journal|last1=Lu|first1=Q.-B.|last2=Wo|first2=Y.|last3=Wang|first3=H.-Y.|last4=Wei|first4=M.-T.|last5=Zhang|first5=L.|last6=Yang|first6=H.|last7=Liu|first7=E.-M.|last8=Li|first8=T.-Y.|last9=Zhao|first9=Z.-T.|last10=Liu|first10=W.|last11=Cao|first11=W.-C.|title=Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China|journal=Journal of Medical Microbiology|volume=63|issue=Pt_3|year=2013|pages=408–414|issn=0022-2615|doi=10.1099/jmm.0.068247-0}}</ref> <ref name="JacobsonRedd2012">{{cite journal|last1=Jacobson|first1=Lara M.|last2=Redd|first2=John T.|last3=Schneider|first3=Eileen|last4=Lu|first4=Xiaoyan|last5=Chern|first5=Shur-Wern W.|last6=Oberste|first6=M. Steven|last7=Erdman|first7=Dean D.|last8=Fischer|first8=Gayle E.|last9=Armstrong|first9=Gregory L.|last10=Kodani|first10=Maja|last11=Montoya|first11=Jennifer|last12=Magri|first12=Julie M.|last13=Cheek|first13=James E.|title=Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children|journal=The Pediatric Infectious Disease Journal|volume=31|issue=3|year=2012|pages=309–312|issn=0891-3668|doi=10.1097/INF.0b013e3182443eaf}}</ref> | *[[Leukocytosis]] with an increased number of [[lymphocytes]] can be observed among some patients. <ref name="LuWo2013">{{cite journal|last1=Lu|first1=Q.-B.|last2=Wo|first2=Y.|last3=Wang|first3=H.-Y.|last4=Wei|first4=M.-T.|last5=Zhang|first5=L.|last6=Yang|first6=H.|last7=Liu|first7=E.-M.|last8=Li|first8=T.-Y.|last9=Zhao|first9=Z.-T.|last10=Liu|first10=W.|last11=Cao|first11=W.-C.|title=Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China|journal=Journal of Medical Microbiology|volume=63|issue=Pt_3|year=2013|pages=408–414|issn=0022-2615|doi=10.1099/jmm.0.068247-0}}</ref> <ref name="JacobsonRedd2012">{{cite journal|last1=Jacobson|first1=Lara M.|last2=Redd|first2=John T.|last3=Schneider|first3=Eileen|last4=Lu|first4=Xiaoyan|last5=Chern|first5=Shur-Wern W.|last6=Oberste|first6=M. Steven|last7=Erdman|first7=Dean D.|last8=Fischer|first8=Gayle E.|last9=Armstrong|first9=Gregory L.|last10=Kodani|first10=Maja|last11=Montoya|first11=Jennifer|last12=Magri|first12=Julie M.|last13=Cheek|first13=James E.|title=Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children|journal=The Pediatric Infectious Disease Journal|volume=31|issue=3|year=2012|pages=309–312|issn=0891-3668|doi=10.1097/INF.0b013e3182443eaf}}</ref> | ||
*The serum [[C-reactive protein]] could be elevated among some patients with asthma. <ref name="HasegawaHirano2011">{{cite journal|last1=Hasegawa|first1=S.|last2=Hirano|first2=R.|last3=Okamoto-Nakagawa|first3=R.|last4=Ichiyama|first4=T.|last5=Shirabe|first5=K.|title=Enterovirus 68 infection in children with asthma attacks: virus-induced asthma in Japanese children|journal=Allergy|volume=66|issue=12|year=2011|pages=1618–1620|issn=01054538|doi=10.1111/j.1398-9995.2011.02725.x}}</ref> | |||
*Infection with [[non-polio enterovirus]]es can be confirmed by:<ref name="CDC">{{cite web| url=http://www.cdc.gov/non-polio-enterovirus/lab-testing/testing-procedures.html| title=CDC Non-Polio Enterovirus Laboratory Testing}}</ref> | *Infection with [[non-polio enterovirus]]es can be confirmed by:<ref name="CDC">{{cite web| url=http://www.cdc.gov/non-polio-enterovirus/lab-testing/testing-procedures.html| title=CDC Non-Polio Enterovirus Laboratory Testing}}</ref> | ||
:* Isolating or identifying the virus in cell culture | :* Isolating or identifying the virus in cell culture | ||
:* [[Polymerase chain reaction]] ([[PCR]]) assay. | :* [[Polymerase chain reaction]] ([[PCR]]) assay. | ||
*[[Non-polio enterovirus]]es can be detected in | *[[Non-polio enterovirus]]es can be detected in [[respiratory]] specimens (including nasopharyngeal or oral swabs and bronchoalveolar lavage). | ||
==Cerebrospinal fluid== | |||
*ED-V68 is rarely present in cerebrospinal fluid (CSF). Nonetheless, it has been previously reported among 1 patient who had unusual neurological symptoms due to EV-D68. | |||
===PCR=== | ===PCR=== | ||
*Enterovirus 68 is diagnosed by [[reverse transcription polymerase chain reaction]] ([[RT-PCR]]) testing. | *Enterovirus 68 is diagnosed by [[reverse transcription polymerase chain reaction]] ([[RT-PCR]]) testing. | ||
*[[RT-PCR]] assay is conducted | *[[RT-PCR]] assay is conducted to target the 5'-nontranslated region, followed by partial sequencing of the structural protein genes, ''VP4''-''VP2'', ''VP1'', or both. RT-PCR provides definitive enterovirus type-specific information. <ref name="MMWR">{{cite web| url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6038a1.htm| title=Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68 --- Asia, Europe, and United States, 2008--2010}}</ref> | ||
===Serology=== | ===Serology=== | ||
* Detection of IgM levels or an increase in the IgG levels may also be performed to diagnose | * Detection of IgM levels or an increase in the IgG levels may also be performed to diagnose EV-D68 infection with a low sensitivity. Thus, this test is not routinely performed to diagnose EV-D68. <ref>{{Cite journal | ||
| author = [[B. Pozzetto]], [[O. G. Gaudin]], [[M. Aouni]] & [[A. Ros]] | | author = [[B. Pozzetto]], [[O. G. Gaudin]], [[M. Aouni]] & [[A. Ros]] | ||
| title = Comparative evaluation of immunoglobulin M neutralizing antibody response in acute-phase sera and virus isolation for the routine diagnosis of enterovirus infection | | title = Comparative evaluation of immunoglobulin M neutralizing antibody response in acute-phase sera and virus isolation for the routine diagnosis of enterovirus infection | ||
Latest revision as of 13:14, 12 September 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
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Overview
Patients with EV-D68 infection often have leukocytosis with lymphocyte predominance. Reverse transcription polymerase chain reaction (RT-PCR) assay of an oral or nasopharyngeal swab is usually positive. Viral culture is less likely to be ordered, but will often show positive results for the infective agent. Serology tests have a low sensitivity for the diagnosis of EV-D68 infection.
Laboratory Findings
- Routine tests such as a complete blood count may not show any abnormalities.
- Leukocytosis with an increased number of lymphocytes can be observed among some patients. [1] [2]
- The serum C-reactive protein could be elevated among some patients with asthma. [3]
- Infection with non-polio enteroviruses can be confirmed by:[4]
- Isolating or identifying the virus in cell culture
- Polymerase chain reaction (PCR) assay.
- Non-polio enteroviruses can be detected in respiratory specimens (including nasopharyngeal or oral swabs and bronchoalveolar lavage).
Cerebrospinal fluid
- ED-V68 is rarely present in cerebrospinal fluid (CSF). Nonetheless, it has been previously reported among 1 patient who had unusual neurological symptoms due to EV-D68.
PCR
- Enterovirus 68 is diagnosed by reverse transcription polymerase chain reaction (RT-PCR) testing.
- RT-PCR assay is conducted to target the 5'-nontranslated region, followed by partial sequencing of the structural protein genes, VP4-VP2, VP1, or both. RT-PCR provides definitive enterovirus type-specific information. [5]
Serology
- Detection of IgM levels or an increase in the IgG levels may also be performed to diagnose EV-D68 infection with a low sensitivity. Thus, this test is not routinely performed to diagnose EV-D68. [6]
References
- ↑ Lu, Q.-B.; Wo, Y.; Wang, H.-Y.; Wei, M.-T.; Zhang, L.; Yang, H.; Liu, E.-M.; Li, T.-Y.; Zhao, Z.-T.; Liu, W.; Cao, W.-C. (2013). "Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China". Journal of Medical Microbiology. 63 (Pt_3): 408–414. doi:10.1099/jmm.0.068247-0. ISSN 0022-2615.
- ↑ Jacobson, Lara M.; Redd, John T.; Schneider, Eileen; Lu, Xiaoyan; Chern, Shur-Wern W.; Oberste, M. Steven; Erdman, Dean D.; Fischer, Gayle E.; Armstrong, Gregory L.; Kodani, Maja; Montoya, Jennifer; Magri, Julie M.; Cheek, James E. (2012). "Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children". The Pediatric Infectious Disease Journal. 31 (3): 309–312. doi:10.1097/INF.0b013e3182443eaf. ISSN 0891-3668.
- ↑ Hasegawa, S.; Hirano, R.; Okamoto-Nakagawa, R.; Ichiyama, T.; Shirabe, K. (2011). "Enterovirus 68 infection in children with asthma attacks: virus-induced asthma in Japanese children". Allergy. 66 (12): 1618–1620. doi:10.1111/j.1398-9995.2011.02725.x. ISSN 0105-4538.
- ↑ "CDC Non-Polio Enterovirus Laboratory Testing".
- ↑ "Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68 --- Asia, Europe, and United States, 2008--2010".
- ↑ B. Pozzetto, O. G. Gaudin, M. Aouni & A. Ros (1989). "Comparative evaluation of immunoglobulin M neutralizing antibody response in acute-phase sera and virus isolation for the routine diagnosis of enterovirus infection". Journal of clinical microbiology. 27 (4): 705–708. PMID 2542363. Unknown parameter
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