Ebola laboratory tests

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Michael Maddaleni, B.S.

Overview

Ebola would be categorized as a viral hemorrhagic fever. Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing, IgM ELISA, polymerase chain reaction (PCR), and virus isolation can be used to diagnose a case of Ebola HF within a few days of the onset of symptoms. Persons tested later in the course of the disease or after recovery can be tested for IgM and IgG antibodies; the disease can also be diagnosed retrospectively in deceased patients by using immunohistochemistry testing, virus isolation, or PCR.

Laboratory Findings

Diagnostic test	Samples required	Preparation & Storage	Shipping	Viruses to be confirmed
ELISA (serology) detects: Viral Antigen IgM and IgG antibody	Whole blood serum or plasma† Acute and convalescent††	Freeze or refrigerate (as cold as possible)	Frozen on dry ice or ice packs or both††††	Ebola Lassa CCHF Rift Valley Marburg Yellow fever
PCR detects: DNA, RNA from the virus.	Whole blood or clot†† Tissues (fresh frozen) Serum/plasma	Refrigerate or freeze Freeze	Frozen on dry ice or ice packs or both††††	Ebola Lassa CCHF Rift Valley Marburg Yellow fever
Immunohisto-chemestry (liver) detects: Viral antigen in cells	Liver biopsy from fatal cases	Fix formalin (can be stored up to 6 weeks)	Room temperature (do not freeze)	Ebola Lassa CCHF Rift Valley Marburg Yellow fever
Immunohisto-chemestry (skin) detects: Viral antigen in cells	Skin biopsy from fatal cases (any site)	Fix in formalin (can be stored up to 6 weeks)	Room temperature (do not freeze)	Ebola Lassa
Immunohisto-chemestry (other tissues) detects: Viral antigen in cells	Tissue biopsy from fatal cases (other tissues, spleen, lung, heart, kidney)	Fix in formalin (can be stored up to 6 weeks)	Room temperature (do not freeze)	Ebola Lassa CCHF Rift Valley Marburg Yellow fever

^† Whole blood can be used for enzyme-linked immunosorbent assay (ELISA) and may be frozen. Do not centrifuge suspected VHF specimens because this increases risk to the lab worker. If serum specimens have already been prepared these can be used. Place specimens in plastic tubes for shipping and storage and be sure that the tubes are sealed and properly labeled.
^†† Collect acute-phase specimen when patient is admitted to hospital or diagnosed as suspected case and collect convalescent-phase specimen at death or when discharged from the hospital.
^††† whole blood or tissue is preferred, although serum or plasma may provide results.
^†††† Use both ice packs and dry ice to provide best results. If dry ice or ice packs are not available, sample may be shipped at room temperature and still provide valid results in most cases.

Ebola virus can be detected in fatal cases from a skin specimen using immunohistochemistry or RT-PCR tests developed by the Centers for Disease Control and Prevention (CDC). The skin specimen is fixed in formalin or chaotrope which kills the virus. The specimen is no longer infectious once it is placed in formalin or chaotrope and the outside of the vial has been decontaminated. This vial can be shipped by mail or hand carried to the lab without risk. Results are available within a week after the specimen arrives at the CDC.