Zika virus infection laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Nate Michalak, B.A.; Serge Korjian M.D.

Overview

The diagnosis of Zika virus infection is usually made by detection of elevated IgM and IgG Zika virus antibodies by ELISA or viral RNA by RT-PCR. Non-specific lab findings include elevated markers of inflammation, mild neutropenia, normal leukocyte count or mild leukocytosis with normal platelet count and liver function tests.

Laboratory Findings

• The diagnosis of Zika virus infection is usually made by detection of elevated IgM and IgG Zika virus antibodies by ELISA or viral RNA by RT-PCR.
• Patients with Zika virus may also have the following non-specific lab findings

Non-Specific Laboratory Findings

• Elevated markers of inflammation and acute phase reactants (e.g. ESR, C-reactive protein, ferritin)
• Elevated lactate dehydrogenase (LDH)
• Mild neutropenia
• Normal leukocyte count / mild leukocytosis
• Platelet count and liver function tests (LFTs) are usually normal (vs. thrombocytopenia and elevated LFTs in Dengue fever)

ELISA

• ELISA can be used to detect virus-specific IgM (anti-ZIKV-IgM) and neutralizing antibodies toward the end of the first week of illness.
• Cross-reaction with related flaviviruses (e.g., dengue and West Nile viruses) is common and may be difficult to discern.
• Plaque-reduction neutralization testing can be performed to measure virus-specific neutralizing antibodies and discriminate between cross-reacting antibodies in primary flavivirus infections.

PCR

• During the first week after onset of symptoms, Zika virus may be diagnosed by performing reverse transcriptase-polymerase chain reaction (RT-PCR) on serum.