Mumps laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Mumps}} | {{Mumps}} | ||
{{CMG}}; {{AOEIC}} {{LG}} | {{CMG}}; {{AOEIC}} {{LG}}; {{NRM}} | ||
==Overview== | ==Overview== | ||
Laboratory findings for the mumps virus can be useful, and may include virus isolation from swabs of affected salivary ducts, | Laboratory findings for the mumps virus can be useful, and may include virus isolation from swabs of affected salivary ducts, urine, or serum samples. Serologic testing for [[IgM|IgM antibody]] or detecting a significant rise in [[IgG|IgG antibody]] confirms a mumps diagnosis. However, there are many important caveats to be aware of when interpreting the results. Antigen detection by [[PCR|polymerase chain reaction (PCR)]] is an efficient and rapid method to determine mumps as a diagnosis. It may be necessary to test for antibodies for other infections causing [[parotitis]] including: [[Epstein-Barr Virus]], [[parainfluenza virus]], [[parvovirus B19]], [[adenovirus]], and [[enterovirus]]. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
===Initial Lab Tests=== | ===Initial Lab Tests=== | ||
=====Complete blood count with differential:===== | =====Complete blood count with differential:===== | ||
*[[White blood cell|Total WBC count]] may be normal to elevated | *[[White blood cell|Total WBC count]] may be normal to elevated | ||
| Line 16: | Line 14: | ||
=====Serum studies:===== | =====Serum studies:===== | ||
*Elevated [[serum amylase]] secondary to the involvment of [[parotid gland]] and suspected [[pancreatitis]] associated with mumps <ref name="pmid499265">{{cite journal |author=Skrha J, Stĕpán J, Sixtová E |title=Amylase isoenzymes in mumps |journal=[[European Journal of Pediatrics]] |volume=132 |issue=2 |pages=99–105 |year=1979 |month=October |pmid=499265 |doi= |url= |accessdate=2012-03-08}}</ref> | *Elevated [[serum amylase]] secondary to the involvment of [[parotid gland]] and suspected [[pancreatitis]] associated with mumps <ref name="pmid499265">{{cite journal |author=Skrha J, Stĕpán J, Sixtová E |title=Amylase isoenzymes in mumps |journal=[[European Journal of Pediatrics]] |volume=132 |issue=2 |pages=99–105 |year=1979 |month=October |pmid=499265 |doi= |url= |accessdate=2012-03-08}}</ref> | ||
*Elevated [[serum lipase]] secondary to [[pancreatitis]] | *Elevated [[serum lipase]] secondary to [[pancreatitis]] | ||
*Elevated [[C-reactive protein]] may be seen secondary to [[orchitis]] | *Elevated [[C-reactive protein]] may be seen secondary to [[orchitis]] | ||
===Serology=== | ===Serology=== | ||
*Significant rise in [[IgG]] or [[IgM]] antibodies may be helpful to confirm the diagnosis. | *Significant rise in [[IgG]] or [[IgM]] antibodies may be helpful to confirm the diagnosis. <ref>{{cite web | url = http://www.cdc.gov/mumps/lab/qa-lab-test-infect.html | title = Mumps: Lab Testing for Mumps Infection | work = Centers for Disease Control and Prevention | date = 13 April 2010 | accessdate = 30 October 2011 }}</ref> | ||
*However, laboratory confirmation of mumps in previously vaccinated or previously infected individuals is challenging, and failure to detect [[IgM|mumps IgM]] in previously vaccinated persons has been well documented including the cross reactivity of mumps and parainfluenza viruses.<ref>{{cite web | url = http://www.cdc.gov/mumps/lab/qa-lab-test-infect.html | title = Mumps: Lab Testing for Mumps Infection | work = Centers for Disease Control and Prevention | date = 13 April 2010 | accessdate = 30 October 2011 }}</ref> | *However, laboratory confirmation of mumps in previously vaccinated or previously infected individuals is challenging, and failure to detect [[IgM|mumps IgM]] in previously vaccinated persons has been well documented including the cross reactivity of mumps and parainfluenza viruses.<ref>{{cite web | url = http://www.cdc.gov/mumps/lab/qa-lab-test-infect.html | title = Mumps: Lab Testing for Mumps Infection | work = Centers for Disease Control and Prevention | date = 13 April 2010 | accessdate = 30 October 2011 }}</ref> | ||
:'''''Persons with a history of mumps vaccination may not have detectable mumps IgM antibody regardless of timing of specimen collection.'''''[http://www.cdc.gov/mumps/lab/overview-serology.html CDC] | :'''''Persons with a history of mumps vaccination may not have detectable mumps IgM antibody regardless of timing of specimen collection.'''''[http://www.cdc.gov/mumps/lab/overview-serology.html CDC] | ||
*The ability to detect [[IgM]] varies by vaccination status and is: | *The ability to detect [[IgM]] varies by vaccination status and is: | ||
:*highest in unvaccinated persons (80%–100%),<ref name="pmid3833873">{{cite journal |author=Sakata H, Tsurudome M, Hishiyama M, Ito Y, Sugiura A |title=Enzyme-linked immunosorbent assay for mumps IgM antibody: comparison of IgM capture and indirect IgM assay |journal=[[Journal of Virological Methods]] |volume=12 |issue=3-4 |pages=303–11 |year=1985 |month=December |pmid=3833873 |doi= |url= |accessdate=2012-03-13}}</ref> | :*highest in unvaccinated persons (80%–100%),<ref name="pmid3833873">{{cite journal |author=Sakata H, Tsurudome M, Hishiyama M, Ito Y, Sugiura A |title=Enzyme-linked immunosorbent assay for mumps IgM antibody: comparison of IgM capture and indirect IgM assay |journal=[[Journal of Virological Methods]] |volume=12 |issue=3-4 |pages=303–11 |year=1985 |month=December |pmid=3833873 |doi= |url= |accessdate=2012-03-13}}</ref> | ||
:*intermediate in one-dose vaccine recipients (60%–80%),<ref name="pmid8277201">{{cite journal |author=Briss PA, Fehrs LJ, Parker RA, Wright PF, Sannella EC, Hutcheson RH, Schaffner W |title=Sustained transmission of mumps in a highly vaccinated population: assessment of primary vaccine failure and waning vaccine-induced immunity |journal=[[The Journal of Infectious Diseases]] |volume=169 |issue=1 |pages=77–82 |year=1994 |month=January |pmid=8277201 |doi= |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=8277201 |accessdate=2012-03-13}}</ref><ref name="pmid9801337">{{cite journal |author=Narita M, Matsuzono Y, Takekoshi Y, Yamada S, Itakura O, Kubota M, Kikuta H, Togashi T |title=Analysis of mumps vaccine failure by means of avidity testing for mumps virus-specific immunoglobulin G |journal=[[Clinical and Diagnostic Laboratory Immunology]] |volume=5 |issue=6 |pages=799–803 |year=1998 |month=November |pmid=9801337 |pmc=96204 |doi= |url=http://cvi.asm.org/cgi/pmidlookup?view=long&pmid=9801337 |accessdate=2012-03-13}}</ref> | :*intermediate in one-dose vaccine recipients (60%–80%),<ref name="pmid8277201">{{cite journal |author=Briss PA, Fehrs LJ, Parker RA, Wright PF, Sannella EC, Hutcheson RH, Schaffner W |title=Sustained transmission of mumps in a highly vaccinated population: assessment of primary vaccine failure and waning vaccine-induced immunity |journal=[[The Journal of Infectious Diseases]] |volume=169 |issue=1 |pages=77–82 |year=1994 |month=January |pmid=8277201 |doi= |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=8277201 |accessdate=2012-03-13}}</ref><ref name="pmid9801337">{{cite journal |author=Narita M, Matsuzono Y, Takekoshi Y, Yamada S, Itakura O, Kubota M, Kikuta H, Togashi T |title=Analysis of mumps vaccine failure by means of avidity testing for mumps virus-specific immunoglobulin G |journal=[[Clinical and Diagnostic Laboratory Immunology]] |volume=5 |issue=6 |pages=799–803 |year=1998 |month=November |pmid=9801337 |pmc=96204 |doi= |url=http://cvi.asm.org/cgi/pmidlookup?view=long&pmid=9801337 |accessdate=2012-03-13}}</ref> | ||
:*lowest in two-dose vaccine recipients (13%–14%)<ref name="pmid18184850">{{cite journal |author=Bitsko RH, Cortese MM, Dayan GH, Rota PA, Lowe L, Iversen SC, Bellini WJ |title=Detection of RNA of mumps virus during an outbreak in a population with a high level of measles, mumps, and rubella vaccine coverage |journal=[[Journal of Clinical Microbiology]] |volume=46 |issue=3 |pages=1101–3 |year=2008 |month=March |pmid=18184850 |pmc=2268349 |doi=10.1128/JCM.01803-07 |url=http://jcm.asm.org/cgi/pmidlookup?view=long&pmid=18184850 |accessdate=2012-03-13}}</ref><ref name="pmid21666213">{{cite journal |author=Rota JS, Hickman CJ, Sowers SB, Rota PA, Mercader S, Bellini WJ |title=Two case studies of modified measles in vaccinated physicians exposed to primary measles cases: high risk of infection but low risk of transmission |journal=[[The Journal of Infectious Diseases]] |volume=204 Suppl 1 |issue= |pages=S559–63 |year=2011 |month=July |pmid=21666213 |doi=10.1093/infdis/jir098 |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=21666213 |accessdate=2012-03-13}}</ref> | :*lowest in two-dose vaccine recipients (13%–14%)<ref name="pmid18184850">{{cite journal |author=Bitsko RH, Cortese MM, Dayan GH, Rota PA, Lowe L, Iversen SC, Bellini WJ |title=Detection of RNA of mumps virus during an outbreak in a population with a high level of measles, mumps, and rubella vaccine coverage |journal=[[Journal of Clinical Microbiology]] |volume=46 |issue=3 |pages=1101–3 |year=2008 |month=March |pmid=18184850 |pmc=2268349 |doi=10.1128/JCM.01803-07 |url=http://jcm.asm.org/cgi/pmidlookup?view=long&pmid=18184850 |accessdate=2012-03-13}}</ref><ref name="pmid21666213">{{cite journal |author=Rota JS, Hickman CJ, Sowers SB, Rota PA, Mercader S, Bellini WJ |title=Two case studies of modified measles in vaccinated physicians exposed to primary measles cases: high risk of infection but low risk of transmission |journal=[[The Journal of Infectious Diseases]] |volume=204 Suppl 1 |issue= |pages=S559–63 |year=2011 |month=July |pmid=21666213 |doi=10.1093/infdis/jir098 |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=21666213 |accessdate=2012-03-13}}</ref> | ||
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==Other Laboratory Tests== | ==Other Laboratory Tests== | ||
*It may be necessary to test for antibodies for other infections causing [[parotitis]] including: [[Epstein-Barr Virus]], [[parainfluenza virus]], [[parvovirus B19]], [[adenovirus]], and [[enterovirus]]. | *It may be necessary to test for antibodies for other infections causing [[parotitis]] including: [[Epstein-Barr Virus]], [[parainfluenza virus]], [[parvovirus B19]], [[adenovirus]], and [[enterovirus]].<ref name="DavidkinJokinen2005">{{cite journal|last1=Davidkin|first1=Irja|last2=Jokinen|first2=Sari|last3=Paananen|first3=Anja|last4=Leinikki|first4=Pauli|last5=Peltola|first5=Heikki|title=Etiology of Mumps‐Like Illnesses in Children and Adolescents Vaccinated for Measles, Mumps, and Rubella|journal=The Journal of Infectious Diseases|volume=191|issue=5|year=2005|pages=719–723|issn=0022-1899|doi=10.1086/427338}}</ref> | ||
==References== | ==References== | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
Latest revision as of 18:07, 18 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]; Nate Michalak, B.A.
Overview
Laboratory findings for the mumps virus can be useful, and may include virus isolation from swabs of affected salivary ducts, urine, or serum samples. Serologic testing for IgM antibody or detecting a significant rise in IgG antibody confirms a mumps diagnosis. However, there are many important caveats to be aware of when interpreting the results. Antigen detection by polymerase chain reaction (PCR) is an efficient and rapid method to determine mumps as a diagnosis. It may be necessary to test for antibodies for other infections causing parotitis including: Epstein-Barr Virus, parainfluenza virus, parvovirus B19, adenovirus, and enterovirus.
Laboratory Findings
Initial Lab Tests
Complete blood count with differential:
- Total WBC count may be normal to elevated
- Relative lymphocytosis may be observed
Serum studies:
- Elevated serum amylase secondary to the involvment of parotid gland and suspected pancreatitis associated with mumps [1]
- Elevated serum lipase secondary to pancreatitis
- Elevated C-reactive protein may be seen secondary to orchitis
Serology
- Significant rise in IgG or IgM antibodies may be helpful to confirm the diagnosis. [2]
- However, laboratory confirmation of mumps in previously vaccinated or previously infected individuals is challenging, and failure to detect mumps IgM in previously vaccinated persons has been well documented including the cross reactivity of mumps and parainfluenza viruses.[3]
- Persons with a history of mumps vaccination may not have detectable mumps IgM antibody regardless of timing of specimen collection.CDC
- The ability to detect IgM varies by vaccination status and is:
Adapted from CDC [3]
| Mumps Exposure History | IgM | IgG | Comments |
|---|---|---|---|
| Unvaccinated; No history of mumps | + | + or - | IgM may be detected for weeks to months; low levels of IgG may be present at symptom onset[9][4] |
| 1-dose vaccine history | + or - | Likely + | 50% of serum samples collected 1–10 days after symptom onset were IgM positive; 50%–80% of serum samples collected more than 10 days after symptom onset were IgM positive.[6][10][11] |
| 2-dose vaccine history | + or - | Likely + | 13%–15% of serum samples collected 1–3 days after symptom onset were IgM-positive (30%–35% of buccal samples collected 1–3 days after symptom onset were positive by real-time RT-PCR among persons with 2 doses of MMR)[7][8] |
Virus Isolation
- Infected patients remain contagious approximately 6 days before the onset of parotitis until about 9 days after the onset of parotitis, during which time the virus can be isolated. [12]
- Virus can be isolated in a cell culture inoculated with the virus obtained from swabs of affected salivary ducts, serum or urine.
- Antigen detection by polymerase chain reaction (PCR) is an efficient and rapid method to determine mumps as a diagosis.
Other Laboratory Tests
- It may be necessary to test for antibodies for other infections causing parotitis including: Epstein-Barr Virus, parainfluenza virus, parvovirus B19, adenovirus, and enterovirus.[13]
References
- ↑ Skrha J, Stĕpán J, Sixtová E (1979). "Amylase isoenzymes in mumps". European Journal of Pediatrics. 132 (2): 99–105. PMID 499265. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ "Mumps: Lab Testing for Mumps Infection". Centers for Disease Control and Prevention. 13 April 2010. Retrieved 30 October 2011.
- ↑ "Mumps: Lab Testing for Mumps Infection". Centers for Disease Control and Prevention. 13 April 2010. Retrieved 30 October 2011.
- ↑ 4.0 4.1 Sakata H, Tsurudome M, Hishiyama M, Ito Y, Sugiura A (1985). "Enzyme-linked immunosorbent assay for mumps IgM antibody: comparison of IgM capture and indirect IgM assay". Journal of Virological Methods. 12 (3–4): 303–11. PMID 3833873. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Briss PA, Fehrs LJ, Parker RA, Wright PF, Sannella EC, Hutcheson RH, Schaffner W (1994). "Sustained transmission of mumps in a highly vaccinated population: assessment of primary vaccine failure and waning vaccine-induced immunity". The Journal of Infectious Diseases. 169 (1): 77–82. PMID 8277201. Retrieved 2012-03-13. Unknown parameter
|month=ignored (help) - ↑ 6.0 6.1 Narita M, Matsuzono Y, Takekoshi Y, Yamada S, Itakura O, Kubota M, Kikuta H, Togashi T (1998). "Analysis of mumps vaccine failure by means of avidity testing for mumps virus-specific immunoglobulin G". Clinical and Diagnostic Laboratory Immunology. 5 (6): 799–803. PMC 96204. PMID 9801337. Retrieved 2012-03-13. Unknown parameter
|month=ignored (help) - ↑ 7.0 7.1 Bitsko RH, Cortese MM, Dayan GH, Rota PA, Lowe L, Iversen SC, Bellini WJ (2008). "Detection of RNA of mumps virus during an outbreak in a population with a high level of measles, mumps, and rubella vaccine coverage". Journal of Clinical Microbiology. 46 (3): 1101–3. doi:10.1128/JCM.01803-07. PMC 2268349. PMID 18184850. Retrieved 2012-03-13. Unknown parameter
|month=ignored (help) - ↑ 8.0 8.1 Rota JS, Hickman CJ, Sowers SB, Rota PA, Mercader S, Bellini WJ (2011). "Two case studies of modified measles in vaccinated physicians exposed to primary measles cases: high risk of infection but low risk of transmission". The Journal of Infectious Diseases. 204 Suppl 1: S559–63. doi:10.1093/infdis/jir098. PMID 21666213. Retrieved 2012-03-13. Unknown parameter
|month=ignored (help) - ↑ Meurman O, Hänninen P, Krishna RV, Ziegler T (1982). "Determination of IgG- and IgM-class antibodies to mumps virus by solid-phase enzyme immunoassay". Journal of Virological Methods. 4 (4–5): 249–56. PMID 6286705. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Samuel D, Sasnauskas K, Jin L, Beard S, Zvirbliene A, Gedvilaite A, Cohen B (2002). "High level expression of recombinant mumps nucleoprotein in Saccharomyces cerevisiae and its evaluation in mumps IgM serology". Journal of Medical Virology. 66 (1): 123–30. PMID 11748668. Retrieved 2012-03-13. Unknown parameter
|month=ignored (help) - ↑ Krause CH, Molyneaux PJ, Ho-Yen DO, McIntyre P, Carman WF, Templeton KE (2007). "Comparison of mumps-IgM ELISAs in acute infection". Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology. 38 (2): 153–6. doi:10.1016/j.jcv.2006.10.010. PMID 17142100. Retrieved 2012-03-13. Unknown parameter
|month=ignored (help) - ↑ UTZ JP, HOUK VN, ALLING DW (1964). "CLINICAL AND LABORATORY STUDIES OF MUMPS". The New England Journal of Medicine. 270: 1283–6. doi:10.1056/NEJM196406112702404. PMID 14133666. Retrieved 2012-03-09. Unknown parameter
|month=ignored (help) - ↑ Davidkin, Irja; Jokinen, Sari; Paananen, Anja; Leinikki, Pauli; Peltola, Heikki (2005). "Etiology of Mumps‐Like Illnesses in Children and Adolescents Vaccinated for Measles, Mumps, and Rubella". The Journal of Infectious Diseases. 191 (5): 719–723. doi:10.1086/427338. ISSN 0022-1899.