Middle East respiratory syndrome coronavirus infection other diagnostic studies: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
Line 4: Line 4:


==Overview==
==Overview==
Laboratory tests, such as [[PCR]] for [[MERS-CoV]] are available at state health departments, [[CDC]] and some international laboratories. Otherwise, [[MERS-CoV]] tests are not routinely available, despite the existence of a limited number of non-[[FDA]]-approved commercial tests.
Laboratory confirmation of [[MERS-CoV]] infection requires either a positive [[PCR]] test of ≥2 specific genomic targets or a single positive target followed by successful sequencing of a second.<ref name=CDC>{{cite web | title = MERS Clinical Features| url = http://www.cdc.gov/coronavirus/mers/clinical-features.html }}</ref> If a patient has a positive [[serologic]] test, but no [[PCR]] or [[sequencing]] test, the individual is considered a ''probable case''.


==Other Diagnostic Studies==
==Other Diagnostic Studies==
According to [[CDC]] guidelines:<ref name=MMWR>{{cite web | title = Updated Information on the Epidemiology of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection and Guidance for the Public, Clinicians, and Public Health Authorities, 2012–2013 | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6238a4.htm }}</ref>
*Investigations of [[MERS-CoV]] and other [[respiratory]] [[pathogens]] may now be conducted simultaneously and additionally, positive results for another [[respiratory]] [[pathogen]] should not hinder testing for [[MERS-CoV]].
*Health-care providers in the United States should continue to evaluate patients for [[MERS-CoV]] [[infection]] if they develop [[fever]] and [[pneumonia]] or [[acute respiratory distress syndrome]] within 14 days after traveling from countries in or near the Arabian Peninsula.
*Providers should also evaluate patients for [[MERS-CoV]] [[infection]], in the presence of [[ARDS]], [[fever]] or [[pneumonia]] and if they have been in close contact with recent travelers from the Arabian Peninsula who have [[fever]] and acute [[respiratory illness]].
*Clusters of patients with severe acute [[respiratory illness]], such as [[fever]] and [[pneumonia]] that requires hospitalization, must be evaluated for common [[respiratory]] [[pathogens]] and reported to local and state [[public health]] departments. In case a diagnosis isn't reached, particularly if the cluster includes health-care providers, testing for [[MERS-CoV]] should be considered, in consultation with state and local health departments. In this situation, all patients should be tested, even if they haven't had travel-related exposure.
*If [[symptoms]] have started more than 14 days prior, [[CDC]] guidelines recommend additional testing of a [[serum]] specimen via the ''[[CDC]] [[MERS-CoV]] serologic assay''
*Laboratory confirmation of [[infection]] by [[MERS-CoV]] now requires a positive [[PCR]] test of ≥2 specific genomic targets or, a single positive target followed by successful sequencing of a second.
* Laboratory tests, such as the [[PCR]] for [[MERS-CoV]] are available at state health departments, [[CDC]] and some international laboratories. Otherwise, [[MERS-CoV]] tests are not routinely available, despite the existence of a limited number of non-[[FDA]]-approved commercial tests.


===Polymerase Chain Reaction===
===Polymerase Chain Reaction===
According to the cases studied until now, [[reverse transcriptase polymerase chain reaction]] testing of specimens from the [[lower respiratory tract]], such as [[trachea|tracheal]] aspirates or [[bronchoalveolar lavage]], detain the highest [[sensitivity]] for the detection of [[MERS-CoV]]. However, [[upper respiratory tract]] specimens are still useful for [[diagnosis]], particularly in mild cases, when a [[lower respiratory tract|lower tract]] specimen cannot be obtained. <ref name="pmid23041020">{{cite journal| author=Corman VM, Eckerle I, Bleicker T, Zaki A, Landt O, Eschbach-Bludau M et al.| title=Detection of a novel human coronavirus by real-time reverse-transcription polymerase chain reaction. | journal=Euro Surveill | year= 2012 | volume= 17 | issue= 39 | pages=  | pmid=23041020 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23041020  }} </ref><ref name="pmid23718156">{{cite journal| author=Memish ZA, Zumla AI, Al-Hakeem RF, Al-Rabeeah AA, Stephens GM| title=Family cluster of Middle East respiratory syndrome coronavirus infections. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 26 | pages= 2487-94 | pmid=23718156 | doi=10.1056/NEJMoa1303729 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23718156  }} </ref><ref name=WHO>{{cite web | title = Novel coronavirus summary and literature update – as of 17 May 2013 | url = http://www.who.int/csr/disease/coronavirus_infections/update_20130517/en/ }}</ref><ref name="DrostenSeilmaier2013">{{cite journal|last1=Drosten|first1=Christian|last2=Seilmaier|first2=Michael|last3=Corman|first3=Victor M|last4=Hartmann|first4=Wulf|last5=Scheible|first5=Gregor|last6=Sack|first6=Stefan|last7=Guggemos|first7=Wolfgang|last8=Kallies|first8=Rene|last9=Muth|first9=Doreen|last10=Junglen|first10=Sandra|last11=Müller|first11=Marcel A|last12=Haas|first12=Walter|last13=Guberina|first13=Hana|last14=Röhnisch|first14=Tim|last15=Schmid-Wendtner|first15=Monika|last16=Aldabbagh|first16=Souhaib|last17=Dittmer|first17=Ulf|last18=Gold|first18=Hermann|last19=Graf|first19=Petra|last20=Bonin|first20=Frank|last21=Rambaut|first21=Andrew|last22=Wendtner|first22=Clemens-Martin|title=Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection|journal=The Lancet Infectious Diseases|volume=13|issue=9|year=2013|pages=745–751|issn=14733099|doi=10.1016/S1473-3099(13)70154-3}}</ref><ref name="GueryPoissy2013">{{cite journal|last1=Guery|first1=Benoit|last2=Poissy|first2=Julien|last3=el Mansouf|first3=Loubna|last4=Séjourné|first4=Caroline|last5=Ettahar|first5=Nicolas|last6=Lemaire|first6=Xavier|last7=Vuotto|first7=Fanny|last8=Goffard|first8=Anne|last9=Behillil|first9=Sylvie|last10=Enouf|first10=Vincent|last11=Caro|first11=Valérie|last12=Mailles|first12=Alexandra|last13=Che|first13=Didier|last14=Manuguerra|first14=Jean-Claude|last15=Mathieu|first15=Daniel|last16=Fontanet|first16=Arnaud|last17=van der Werf|first17=Sylvie|title=Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission|journal=The Lancet|volume=381|issue=9885|year=2013|pages=2265–2272|issn=01406736|doi=10.1016/S0140-6736(13)60982-4}}</ref><ref name="MemishAl-Tawfiq2014">{{cite journal|last1=Memish|first1=Z. A.|last2=Al-Tawfiq|first2=J. A.|last3=Makhdoom|first3=H. Q.|last4=Assiri|first4=A.|last5=Alhakeem|first5=R. F.|last6=Albarrak|first6=A.|last7=Alsubaie|first7=S.|last8=Al-Rabeeah|first8=A. A.|last9=Hajomar|first9=W. H.|last10=Hussain|first10=R.|last11=Kheyami|first11=A. M.|last12=Almutairi|first12=A.|last13=Azhar|first13=E. I.|last14=Drosten|first14=C.|last15=Watson|first15=S. J.|last16=Kellam|first16=P.|last17=Cotten|first17=M.|last18=Zumla|first18=A.|title=Respiratory Tract Samples, Viral Load and Genome Fraction Yield in patients with Middle East Respiratory Syndrome|journal=Journal of Infectious Diseases|year=2014|issn=0022-1899|doi=10.1093/infdis/jiu292}}</ref><ref name="AssiriAl-Tawfiq2013">{{cite journal|last1=Assiri|first1=Abdullah|last2=Al-Tawfiq|first2=Jaffar A|last3=Al-Rabeeah|first3=Abdullah A|last4=Al-Rabiah|first4=Fahad A|last5=Al-Hajjar|first5=Sami|last6=Al-Barrak|first6=Ali|last7=Flemban|first7=Hesham|last8=Al-Nassir|first8=Wafa N|last9=Balkhy|first9=Hanan H|last10=Al-Hakeem|first10=Rafat F|last11=Makhdoom|first11=Hatem Q|last12=Zumla|first12=Alimuddin I|last13=Memish|first13=Ziad A|title=Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study|journal=The Lancet Infectious Diseases|volume=13|issue=9|year=2013|pages=752–761|issn=14733099|doi=10.1016/S1473-3099(13)70204-4}}</ref>
*Laboratory confirmation of [[infection]] by [[MERS-CoV]] requires either a positive [[PCR]] test of ≥2 specific genomic targets or a single positive target followed by successful sequencing of a second.
For the routine detection of MERS-CoV, three [[Reverse transcriptase PCR|rRT-PCR]] assays have been developed.<ref name=WHO10>{{cite web | title = Laboratory Testing for Middle East Respiratory Syndrome Coronavirus | url = http://www.who.int/csr/disease/coronavirus_infections/MERS_Lab_recos_16_Sept_2013.pdf }}</ref> These tests target different regions of the [[viral]] [[genome]], namely:  
*For the routine detection of MERS-CoV, three [[Reverse transcriptase PCR|rRT-PCR]] assays have been developed.<ref name=WHO10>{{cite web | title = Laboratory Testing for Middle East Respiratory Syndrome Coronavirus | url = http://www.who.int/csr/disease/coronavirus_infections/MERS_Lab_recos_16_Sept_2013.pdf }}</ref> These tests target different regions of the [[viral]] [[genome]], namely:  
*Region upstream of the ''E protein'' [[gene]]- ''upE''
**Region upstream of the ''E protein'' [[gene]]- ''upE''
*Open ''reading frame 1a'' - ''ORF 1a''
**Open ''reading frame 1a'' - ''ORF 1a''
*Open ''reading frame 1b'' - ''ORF 1b''
**Open ''reading frame 1b'' - ''ORF 1b''
In some cases, when there is a need for confirmation of the results, [[sequencing]] is indicated.<ref name="pmid23041020">{{cite journal| author=Corman VM, Eckerle I, Bleicker T, Zaki A, Landt O, Eschbach-Bludau M et al.| title=Detection of a novel human coronavirus by real-time reverse-transcription polymerase chain reaction. | journal=Euro Surveill | year= 2012 | volume= 17 | issue= 39 | pages=  | pmid=23041020 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23041020  }} </ref><ref name="pmid23231891">{{cite journal| author=Corman VM, Müller MA, Costabel U, Timm J, Binger T, Meyer B et al.| title=Assays for laboratory confirmation of novel human coronavirus (hCoV-EMC) infections. | journal=Euro Surveill | year= 2012 | volume= 17 | issue= 49 | pages=  | pmid=23231891 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23231891  }} </ref>


===Serology===
===Serology===
In order to identify [[MERS-CoV]] [[antibodies]], different [[serology]] assays have been developed for this [[pathogen]], namely:<ref> name=WHO5>{{cite web | title = Laboratory Testing for Middle East Respiratory Syndrome Coronavirus | url = http://www.who.int/csr/disease/coronavirus_infections/MERS_Lab_recos_16_Sept_2013.pdf?ua=1&ua=1 }}</ref><ref>team, European Centre for Disease Prevention and Control (ECDC)-Health Comunication Unit- Eurosurveillance editorial. “Assays for Laboratory Confirmation of Novel Human Coronavirus (hCoV-EMC) Infections.” Text, June 12, 2012. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20334.</ref><ref>Chan, Kwok-Hung, Jasper Fuk-Woo Chan, Herman Tse, Honglin Chen, Candy Choi-Yi Lau, Jian-Piao Cai, Alan Ka-Lun Tsang, et al. “Cross-Reactive Antibodies in Convalescent SARS Patients’ Sera against the Emerging Novel Human Coronavirus EMC (2012) by Both Immunofluorescent and Neutralizing Antibody Tests.” The Journal of Infection 67, no. 2 (August 2013): 130–40. doi:10.1016/j.jinf.2013.03.015.</ref><ref>Buchholz, U, M A Müller, A Nitsche, A Sanewski, N Wevering, T Bauer-Balci, F Bonin, et al. “Contact Investigation of a Case of Human Novel Coronavirus Infection Treated in a German Hospital, October-November 2012.” Euro Surveillance: Bulletin Européen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin 18, no. 8 (2013).</ref><ref>Reusken, C, H Mou, G J Godeke, L van der Hoek, B Meyer, M A Müller, B Haagmans, et al. “Specific Serology for Emerging Human Coronaviruses by Protein Microarray.” Euro Surveillance: Bulletin Européen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin 18, no. 14 (2013): 20441.</ref>
*According to CDC guidelines, if a patient has a positive [[serologic]] test, but no [[PCR]] or [[sequencing]] test, the individual is considered a ''probable case'', considering that he meets the remaining criteria for this category.
*[[Immunofluorescence]] [[assays]]
*Clusters of patients with severe acute [[respiratory illness]], such as [[fever]] and [[pneumonia]] that requires hospitalization, must be evaluated for common [[respiratory]] [[pathogens]] and reported to local and state [[public health]] departments. In case a diagnosis isn't reached, particularly if the cluster includes health-care providers, testing for [[MERS-CoV]] should be considered, in consultation with state and local health departments. In this situation, all patients should be tested, even if they haven't had travel-related exposure.
*[[Protein microarray]] [[assay]]  
*If [[symptoms]] have started more than 14 days prior, [[CDC]] guidelines recommend additional testing of a [[serum]] specimen via the ''[[CDC]] [[MERS-CoV]] serologic assay''
For these assays, the [[CDC]] has developed an approach with two steps:<ref> name=WHO5>{{cite web | title = Laboratory Testing for Middle East Respiratory Syndrome Coronavirus | url = http://www.who.int/csr/disease/coronavirus_infections/MERS_Lab_recos_16_Sept_2013.pdf?ua=1&ua=1 }}</ref>
 
#'''Screening''' with [[ELISA]]
In order to identify [[MERS-CoV]] [[antibodies]], different [[serology]] assays have been developed:<ref> name=WHO5>{{cite web | title = Laboratory Testing for Middle East Respiratory Syndrome Coronavirus | url = http://www.who.int/csr/disease/coronavirus_infections/MERS_Lab_recos_16_Sept_2013.pdf?ua=1&ua=1 }}</ref><ref>team, European Centre for Disease Prevention and Control (ECDC)-Health Comunication Unit- Eurosurveillance editorial. “Assays for Laboratory Confirmation of Novel Human Coronavirus (hCoV-EMC) Infections.” Text, June 12, 2012. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20334.</ref><ref>Chan, Kwok-Hung, Jasper Fuk-Woo Chan, Herman Tse, Honglin Chen, Candy Choi-Yi Lau, Jian-Piao Cai, Alan Ka-Lun Tsang, et al. “Cross-Reactive Antibodies in Convalescent SARS Patients’ Sera against the Emerging Novel Human Coronavirus EMC (2012) by Both Immunofluorescent and Neutralizing Antibody Tests.” The Journal of Infection 67, no. 2 (August 2013): 130–40. doi:10.1016/j.jinf.2013.03.015.</ref><ref>Buchholz, U, M A Müller, A Nitsche, A Sanewski, N Wevering, T Bauer-Balci, F Bonin, et al. “Contact Investigation of a Case of Human Novel Coronavirus Infection Treated in a German Hospital, October-November 2012.” Euro Surveillance: Bulletin Européen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin 18, no. 8 (2013).</ref><ref>Reusken, C, H Mou, G J Godeke, L van der Hoek, B Meyer, M A Müller, B Haagmans, et al. “Specific Serology for Emerging Human Coronaviruses by Protein Microarray.” Euro Surveillance: Bulletin Européen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin 18, no. 14 (2013): 20441.</ref>
#'''Confirmation''' with indirect [[immunofluorescence]] or microneutralization test
**[[Immunofluorescence]] [[assays]]
Every sample should first be screened with [[ELISA]] and in case of a positive result, then this should be confirmed with a neutralization assay. Unfortunately, the data concerning [[sensitivity]] and [[specificity]] of these tests using [[antibodies]] for the detection of [[MERS-CoV]], is very limited.
**[[Protein microarray]] [[assay]]  
According to the [[WHO]], if a patient has a positive [[serologic]] test, but no [[PCR]] or [[sequencing]] test, then that individual is considered a ''probable case'', considering that he meets the remaining criteria for this category.
*The approach using serology testing is 2-step and includes screening followed by confirmation of results:<ref> name=WHO5>{{cite web | title = Laboratory Testing for Middle East Respiratory Syndrome Coronavirus | url = http://www.who.int/csr/disease/coronavirus_infections/MERS_Lab_recos_16_Sept_2013.pdf?ua=1&ua=1 }}</ref>
**'''Screening''' with [[ELISA]]. Only positive results will be further tested for confirmation.
**'''Confirmation''' with indirect [[immunofluorescence]] or microneutralization test


==References==
==References==

Revision as of 13:48, 16 June 2015

Middle East Respiratory Syndrome Coronavirus Infection Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Middle East Respiratory Syndrome Coronavirus Infection from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

CT

Other Diagnostic Studies

Treatment

Medical Therapy

Contact and Airborne Precautions

Primary Prevention

Future or Investigational Therapies

Case Studies

Case #1

Middle East respiratory syndrome coronavirus infection other diagnostic studies On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Middle East respiratory syndrome coronavirus infection other diagnostic studies

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Middle East respiratory syndrome coronavirus infection other diagnostic studies

CDC on Middle East respiratory syndrome coronavirus infection other diagnostic studies

Middle East respiratory syndrome coronavirus infection other diagnostic studies in the news

Blogs on Middle East respiratory syndrome coronavirus infection other diagnostic studies

Directions to Hospitals Treating Middle East respiratory syndrome coronavirus infection

Risk calculators and risk factors for Middle East respiratory syndrome coronavirus infection other diagnostic studies

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 confirmation of MERS-CoV infection requires either a positive PCR test of ≥2 specific genomic targets or a single positive target followed by successful sequencing of a second.[1] If a patient has a positive serologic test, but no PCR or sequencing test, the individual is considered a probable case.

Other Diagnostic Studies

Polymerase Chain Reaction

  • Laboratory confirmation of infection by MERS-CoV requires either a positive PCR test of ≥2 specific genomic targets or a single positive target followed by successful sequencing of a second.
  • For the routine detection of MERS-CoV, three rRT-PCR assays have been developed.[2] These tests target different regions of the viral genome, namely:
    • Region upstream of the E protein gene- upE
    • Open reading frame 1a - ORF 1a
    • Open reading frame 1b - ORF 1b

Serology

  • According to CDC guidelines, if a patient has a positive serologic test, but no PCR or sequencing test, the individual is considered a probable case, considering that he meets the remaining criteria for this category.
  • Clusters of patients with severe acute respiratory illness, such as fever and pneumonia that requires hospitalization, must be evaluated for common respiratory pathogens and reported to local and state public health departments. In case a diagnosis isn't reached, particularly if the cluster includes health-care providers, testing for MERS-CoV should be considered, in consultation with state and local health departments. In this situation, all patients should be tested, even if they haven't had travel-related exposure.
  • If symptoms have started more than 14 days prior, CDC guidelines recommend additional testing of a serum specimen via the CDC MERS-CoV serologic assay

In order to identify MERS-CoV antibodies, different serology assays have been developed:[3][4][5][6][7]

References

  1. ↑ "MERS Clinical Features".
  2. ↑ "Laboratory Testing for Middle East Respiratory Syndrome Coronavirus" (PDF).
  3. ↑ name=WHO5>"Laboratory Testing for Middle East Respiratory Syndrome Coronavirus" (PDF).
  4. ↑ team, European Centre for Disease Prevention and Control (ECDC)-Health Comunication Unit- Eurosurveillance editorial. “Assays for Laboratory Confirmation of Novel Human Coronavirus (hCoV-EMC) Infections.” Text, June 12, 2012. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20334.
  5. ↑ Chan, Kwok-Hung, Jasper Fuk-Woo Chan, Herman Tse, Honglin Chen, Candy Choi-Yi Lau, Jian-Piao Cai, Alan Ka-Lun Tsang, et al. “Cross-Reactive Antibodies in Convalescent SARS Patients’ Sera against the Emerging Novel Human Coronavirus EMC (2012) by Both Immunofluorescent and Neutralizing Antibody Tests.” The Journal of Infection 67, no. 2 (August 2013): 130–40. doi:10.1016/j.jinf.2013.03.015.
  6. ↑ Buchholz, U, M A Müller, A Nitsche, A Sanewski, N Wevering, T Bauer-Balci, F Bonin, et al. “Contact Investigation of a Case of Human Novel Coronavirus Infection Treated in a German Hospital, October-November 2012.” Euro Surveillance: Bulletin Européen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin 18, no. 8 (2013).
  7. ↑ Reusken, C, H Mou, G J Godeke, L van der Hoek, B Meyer, M A Müller, B Haagmans, et al. “Specific Serology for Emerging Human Coronaviruses by Protein Microarray.” Euro Surveillance: Bulletin Européen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin 18, no. 14 (2013): 20441.
  8. ↑ name=WHO5>"Laboratory Testing for Middle East Respiratory Syndrome Coronavirus" (PDF).
Retrieved from "https://www.wikidoc.org/index.php?title=Middle_East_respiratory_syndrome_coronavirus_infection_other_diagnostic_studies&oldid=1110974"