Polio laboratory findings: Difference between revisions
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== Laboratory Findings == | == Laboratory Findings == | ||
===Viral Isolation=== | ===Viral Isolation=== | ||
[[Poliovirus]] may be isolated from [[pharyngeal]] secretions during the first week of the disease, and from feces during several weeks. | [[Poliovirus]] may be isolated from [[pharyngeal]] secretions during the first week of the disease, and from feces during several weeks.<ref>{{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> | ||
Isolation of [[poliovirus|virus]] from the [[cerebrospinal fluid]] (CSF) is diagnostic, | Isolation of [[poliovirus|virus]] from the [[cerebrospinal fluid]] (CSF) is diagnostic, however this is rarely accomplished. If poliovirus is isolated from a person with acute [[flaccid paralysis]], it must be further tested, using oligonucleotide mapping (fingerprinting) or [[genomic]] sequencing, to determine if the virus is “wild type” or vaccine type.<ref name=CDC>{{cite web | title = Poliomyelitis | url = http://www.cdc.gov/vaccines/pubs/pinkbook/polio.html#epi }}</ref><ref>{{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=== | ||
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In sporadic cases of poliomyelitis occurring in areas of low incidence, it is important to characterize virus isolates as wild-type (naturally occur- ring strains), OPV virus, or cVDPVs that have evolved from OPV virus. In all cases, this is accomplished by genomic sequencing, available only in public health reference laboratories.50,51 Isolation from CSF (or brain and spinal cord in fatal cases), although uncommon, is especially valu- able in evaluating vaccine-associated paralytic poliomyelitis, because recovery of fecal virus is expected for several weeks following receipt of OPV and only a CNS virus isolate with vaccine characteristics pro- vides conclusive evidence of the causative association. | |||
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In the absence of a viral isolate, the diagnosis of poliovirus infection can be established serologically by testing paired acute and convales- cent sera for neutralizing antibodies to each of the three poliovirus serotypes. Serologic tests cannot distinguish between wild-type virus and vaccine virus infection. | In the absence of a viral isolate, the diagnosis of poliovirus infection can be established serologically by testing paired acute and convales- cent sera for neutralizing antibodies to each of the three poliovirus serotypes. Serologic tests cannot distinguish between wild-type virus and vaccine virus infection. | ||
Revision as of 15:26, 3 September 2014
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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
Laboratory Findings
Viral Isolation
Poliovirus may be isolated from pharyngeal secretions during the first week of the disease, and from feces during several weeks.[1]
Isolation of virus from the cerebrospinal fluid (CSF) is diagnostic, however this is rarely accomplished. If poliovirus is isolated from a person with acute flaccid paralysis, it must be further tested, using oligonucleotide mapping (fingerprinting) or genomic sequencing, to determine if the virus is “wild type” or vaccine type.[2][3]
Serology
Neutralizing antibodies appear early and may be at high levels by the time the patient is hospitalized; therefore, a fourfold rise in antibody titer may not be demonstrated.[2]
Cerebrospinal Fluid
In poliovirus infection, the CSF usually contains an increased number of white blood cells (10–200 cells/mm3, primarily lymphocytes) and a mildly elevated protein (40–50 mg/100 mL).[2] However, these findings are similar to those of aseptic meningitis caused by other viruses.
In the absence of a viral isolate, the diagnosis of poliovirus infection can be established serologically by testing paired acute and convales- cent sera for neutralizing antibodies to each of the three poliovirus serotypes. Serologic tests cannot distinguish between wild-type virus and vaccine virus infection.
References
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ 2.0 2.1 2.2 "Poliomyelitis".
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.