Polio laboratory findings: Difference between revisions
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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 or cVDPV).<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> 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>{{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> | 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 or cVDPV).<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> 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>{{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 cells (10–200 cells/mm3, primarily lymphocytes) and a 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 through 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>{{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 the diagnosis of poliomyelitis may be established serologically. Serology tests may be performed in acute serum and convalescent serum, with neutralizing antibodies, targeted for all three serotypes of the virus. However, serologic tests cannot distinguish between the "wild-type" and "vaccine-type" of poliovirus.<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> | |||
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.<ref name=CDC>{{cite web | title = Poliomyelitis | url = http://www.cdc.gov/vaccines/pubs/pinkbook/polio.html#epi }}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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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. Isolation of virus from the cerebrospinal fluid (CSF) is diagnostic, however this is rarely accomplished.[1][2]
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 or cVDPV).[1][3] The characterization of the source of the virus may be achieved by genomic sequencing.[4][5]
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).[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 through 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.[6]
Serology
If the virus cannot be isolated, the the diagnosis of poliomyelitis may be established serologically. Serology tests may be performed in acute serum and convalescent serum, with neutralizing antibodies, targeted for all three serotypes of the virus. However, serologic tests cannot distinguish between the "wild-type" and "vaccine-type" of poliovirus.[7]
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.[1]
References
- ↑ 1.0 1.1 1.2 1.3 "Poliomyelitis".
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ 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.
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.