Polio laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
[[Poliovirus]] may be isolated from [[pharyngeal]] secretions during the first week of the disease, and from feces during several weeks. Isolation of [[poliovirus|virus]] from the [[cerebrospinal fluid]] ([[CSF]]) is diagnostic, however this is rarely accomplished. Following isolation, the [[serotype]] and origin of the virus may be characterized by [[genomic]] sequencing. The [[CSF]] may show unspecific findings of [[aseptic meningitis]], which are common to those found in [[infections]] by other [[virus]]es. When the virus cannot be isolated, [[serologic]] tests, using [[antibodies]] targeted to the 3 different [[serotype]]s may be used.<ref name=CDC>{{cite web | title = Poliomyelitis | url = http://www.cdc.gov/vaccines/pubs/pinkbook/polio.html#epi }}</ref><ref name="mand">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> | |||
== Laboratory Findings == | == Laboratory Findings == | ||
===Viral Isolation=== | ===Viral Isolation=== | ||
[[ | If [[poliovirus]] is isolated from a person with acute [[flaccid paralysis]], or if it occurs in an area where there is low [[incidence]] of the disease, it must be further tested in order to assess the source of the virus. The virus may be "wild-type" (occurs naturally) or vaccine related (OPV).<ref name=CDC>{{cite web | title = Poliomyelitis | url = http://www.cdc.gov/vaccines/pubs/pinkbook/polio.html#epi }}</ref><ref name="mand">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> The characterization of the source of the virus may be achieved by [[genomic]] sequencing.<ref name="KewMulders1995">{{cite journal|last1=Kew|first1=Olen M.|last2=Mulders|first2=Mick N.|last3=Lipskaya|first3=Galina Yu.|last4=da Silva|first4=Edson E.|last5=Patlansch|first5=Mark A.|title=Molecular epidemiology of polioviruses|journal=Seminars in Virology|volume=6|issue=6|year=1995|pages=401–414|issn=10445773|doi=10.1016/S1044-5773(05)80017-4}}</ref><ref name="mand">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> | ||
===Cerebrospinal Fluid=== | |||
In [[poliovirus infection]], the [[CSF]] usually contains an increased number of [[white blood cell]]s (10–200 cells/mm3, primarily [[lymphocytes]]) and mildly elevated [[protein]] (40–50 mg/100 mL).<ref name=CDC>{{cite web | title = Poliomyelitis | url = http://www.cdc.gov/vaccines/pubs/pinkbook/polio.html#epi }}</ref> However, these findings are similar to those of [[aseptic meningitis]] caused by other viruses. | |||
The isolation of [[poliovirus]] from the [[CSF]] is particularly important in cases of [[paralytic]] poliomyelitis following administration of the [[vaccine]]. Since viral shedding in feces occurs during several weeks after the person has been [[vaccinated]], isolation of the virus in the [[CNS]], and its characterization as "wild-type" or "vaccine related", is the only way of proving an association between the disease and the [[vaccine]].<ref name="mand">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> | |||
===Serology=== | ===Serology=== | ||
If the virus cannot be isolated, the diagnosis of poliomyelitis may be established serologically. Serology tests may be performed by pairing patient's acute and convalescent [[serum|sera]], with neutralizing [[antibodies]], targeted to all three [[serotype]]s of the [[poliovirus|virus]]. However, [[serologic]] tests cannot distinguish between the "wild-type" and "vaccine-type" polioviruses.<ref name="mand">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Disease]] | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Poliovirus may be isolated from pharyngeal secretions during the first week of the disease, and from feces during several weeks. Isolation of virus from the cerebrospinal fluid (CSF) is diagnostic, however this is rarely accomplished. Following isolation, the serotype and origin of the virus may be characterized by genomic sequencing. The CSF may show unspecific findings of aseptic meningitis, which are common to those found in infections by other viruses. When the virus cannot be isolated, serologic tests, using antibodies targeted to the 3 different serotypes may be used.[1][2]
Laboratory Findings
Viral Isolation
If poliovirus is isolated from a person with acute flaccid paralysis, or if it occurs in an area where there is low incidence of the disease, it must be further tested in order to assess the source of the virus. The virus may be "wild-type" (occurs naturally) or vaccine related (OPV).[1][2] The characterization of the source of the virus may be achieved by genomic sequencing.[3][2]
Cerebrospinal Fluid
In poliovirus infection, the CSF usually contains an increased number of white blood cells (10–200 cells/mm3, primarily lymphocytes) and mildly elevated protein (40–50 mg/100 mL).[1] However, these findings are similar to those of aseptic meningitis caused by other viruses.
The isolation of poliovirus from the CSF is particularly important in cases of paralytic poliomyelitis following administration of the vaccine. Since viral shedding in feces occurs during several weeks after the person has been vaccinated, isolation of the virus in the CNS, and its characterization as "wild-type" or "vaccine related", is the only way of proving an association between the disease and the vaccine.[2]
Serology
If the virus cannot be isolated, the diagnosis of poliomyelitis may be established serologically. Serology tests may be performed by pairing patient's acute and convalescent sera, with neutralizing antibodies, targeted to all three serotypes of the virus. However, serologic tests cannot distinguish between the "wild-type" and "vaccine-type" polioviruses.[2]
References
- ↑ 1.0 1.1 1.2 "Poliomyelitis".
- ↑ 2.0 2.1 2.2 2.3 2.4 Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ Kew, Olen M.; Mulders, Mick N.; Lipskaya, Galina Yu.; da Silva, Edson E.; Patlansch, Mark A. (1995). "Molecular epidemiology of polioviruses". Seminars in Virology. 6 (6): 401–414. doi:10.1016/S1044-5773(05)80017-4. ISSN 1044-5773.