Pertussis laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{CMG}} ; {{AE}} {{ADI}}; {{Rim}} | {{CMG}} ; {{AE}} {{ADI}}; {{Rim}}; {{LRO}} | ||
{{Pertussis}} | {{Pertussis}} | ||
==Overview== | ==Overview== | ||
Several types of laboratory tests are commonly used to diagnose Pertussis. Culture, obtained by nasopharyngeal swab, is considered the gold standard because it is the only 100% specific method for identification. Other tests that can be performed include [[polymerase chain reaction]] (PCR) and serology. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
===Nasopharyngeal Swab=== | ===Nasopharyngeal Swab=== | ||
*Whenever possible, a nasopharyngeal swab or aspirate should be obtained from all suspected Pertussis patients for the best chance to obtain the most accurate diagnosis.<ref name=CDC3>[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection.html Pertussis (whooping cough). Specimen collection. CDC.gov. Accessed on June 15, 2014] </ref> | |||
If culture is planned | *If culture is planned: Once a nasopharyngeal swab has been collected it should be plated directly or placed into transport medium immediately.<ref name=CDC3>[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection.html Pertussis (whooping cough). Specimen collection. CDC.gov. Accessed on June 15, 2014] </ref> | ||
**Nasopharyngeal aspirates should be dispensed and plated within 24 hours of collection. | |||
**The same specimen can be used both for culture and [[polymerase chain reaction]] (PCR). | |||
===Culture=== | ===Culture=== | ||
Since culture has | *Since culture has 100% specificity, it is particularly useful for confirming pertussis diagnosis when an outbreak is suspected, differentiating it from other respiratory pathogens with similar clinical symptoms and possibility of co-infection.<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html Pertussis (whooping coug). Diagnosis confirmation. CDC.gov. Accessed on June 15, 2014]</ref> | ||
**Obtaining isolates from culture allows for strain identification of [[Bordetella pertussis]] and [[antimicrobial resistance]] testing. | |||
*Culture testing has advantageous specificity to Naspharyngeal Swabs, but is less rapid and takes up to seven days to display results. | |||
*Culture is best done from nasopharyngeal specimens collected during the first 2 weeks of cough when viable bacteria are still present in the [[nasopharynx]]. | |||
*The [[bacteria]] can be recovered from the patient only during the first three weeks of illness, rendering culturing useless after this period. | |||
**[[Sensitivity]] is decreased and the risk of false-negatives increases after the first 2 weeks. | |||
===PCR=== | ===PCR=== | ||
[[PCR]] is a rapid test | *[[PCR]] is a rapid test with excellent [[sensitivity]]; however, PCR tests can vary in specificity and it is therefore recommended to obtaine culture confirmation for at least one case for any suspicion of a pertussis outbreak. | ||
*PCR should be tested from nasopharyngeal specimens taken at 0-3 weeks following [[cough]] onset, but may provide accurate results for up to 4 weeks. | |||
**After the fourth week of [[cough]], the amount of bacterial [[DNA]] rapidly diminishes, which increases the risk of obtaining falsely-negative results. | |||
*PCR assay protocols that include multiple target sequences allow for speciation among Bordetella species. | |||
*The high sensitivity of PCR increases the risk of false-positivity, but following some simple best practices can reduce the risk of obtaining inaccurate results.<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html Pertussis (whooping coug). Diagnosis confirmation. CDC.gov. Accessed on June 15, 2014]</ref> | |||
===Serology=== | ===Serology=== | ||
CDC and FDA have developed a serologic assay that has been extremely useful for confirming diagnosis, especially during suspected outbreaks. Many State Public Health Labs have | *The CDC and FDA have developed a serologic assay that has been extremely useful for confirming pertussis diagnosis, especially during suspected outbreaks.<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html Pertussis (whooping coug). Diagnosis confirmation. CDC.gov. Accessed on June 15, 2014]</ref> | ||
**Many State Public Health Labs have include this assay as part of their testing regimen. | |||
*Serologic tests are generally more useful for diagnosis in later phases of the disease: | |||
**CDC single point serology: the optimal timing for specimen collection is 2 to 8 weeks following cough onset, when the antibody titers are at their highest. | |||
*Serology may still be performed on specimens collected up to 12 weeks following cough onset. | |||
*Serology is often used to determine whether antibody against [[pertussis toxin]] or another component of [[Bordetella pertussis]] is present at high levels in the blood of the patient in the case of adolescents and adults that do not often seek medical care until several weeks into the illness.<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html Pertussis (whooping coug). Diagnosis confirmation. CDC.gov. Accessed on June 15, 2014]</ref> | |||
Depicted below is an image of the optimal timing for the different tests used for the diagnosis of pertussis. | |||
[[Image:Pertussis-testing period.jpg|460px|thumb|center|Pertussis]] | [[Image:Pertussis-testing period.jpg|460px|thumb|center|Pertussis]]<ref name=CDC4>[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html Pertussis (whooping coug). Diagnosis confirmation. CDC.gov. Accessed on June 15, 2014]</ref> | ||
==References== | ==References== | ||
Revision as of 19:48, 12 January 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]; Rim Halaby, M.D. [3]; Luke Rusowicz-Orazem, B.S.
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Overview
Several types of laboratory tests are commonly used to diagnose Pertussis. Culture, obtained by nasopharyngeal swab, is considered the gold standard because it is the only 100% specific method for identification. Other tests that can be performed include polymerase chain reaction (PCR) and serology.
Laboratory Findings
Nasopharyngeal Swab
- Whenever possible, a nasopharyngeal swab or aspirate should be obtained from all suspected Pertussis patients for the best chance to obtain the most accurate diagnosis.[1]
- If culture is planned: Once a nasopharyngeal swab has been collected it should be plated directly or placed into transport medium immediately.[1]
- Nasopharyngeal aspirates should be dispensed and plated within 24 hours of collection.
- The same specimen can be used both for culture and polymerase chain reaction (PCR).
Culture
- Since culture has 100% specificity, it is particularly useful for confirming pertussis diagnosis when an outbreak is suspected, differentiating it from other respiratory pathogens with similar clinical symptoms and possibility of co-infection.[2]
- Obtaining isolates from culture allows for strain identification of Bordetella pertussis and antimicrobial resistance testing.
- Culture testing has advantageous specificity to Naspharyngeal Swabs, but is less rapid and takes up to seven days to display results.
- Culture is best done from nasopharyngeal specimens collected during the first 2 weeks of cough when viable bacteria are still present in the nasopharynx.
- The bacteria can be recovered from the patient only during the first three weeks of illness, rendering culturing useless after this period.
- Sensitivity is decreased and the risk of false-negatives increases after the first 2 weeks.
PCR
- PCR is a rapid test with excellent sensitivity; however, PCR tests can vary in specificity and it is therefore recommended to obtaine culture confirmation for at least one case for any suspicion of a pertussis outbreak.
- PCR should be tested from nasopharyngeal specimens taken at 0-3 weeks following cough onset, but may provide accurate results for up to 4 weeks.
- PCR assay protocols that include multiple target sequences allow for speciation among Bordetella species.
- The high sensitivity of PCR increases the risk of false-positivity, but following some simple best practices can reduce the risk of obtaining inaccurate results.[2]
Serology
- The CDC and FDA have developed a serologic assay that has been extremely useful for confirming pertussis diagnosis, especially during suspected outbreaks.[2]
- Many State Public Health Labs have include this assay as part of their testing regimen.
- Serologic tests are generally more useful for diagnosis in later phases of the disease:
- CDC single point serology: the optimal timing for specimen collection is 2 to 8 weeks following cough onset, when the antibody titers are at their highest.
- Serology may still be performed on specimens collected up to 12 weeks following cough onset.
- Serology is often used to determine whether antibody against pertussis toxin or another component of Bordetella pertussis is present at high levels in the blood of the patient in the case of adolescents and adults that do not often seek medical care until several weeks into the illness.[2]
Depicted below is an image of the optimal timing for the different tests used for the diagnosis of pertussis.
