Middle East respiratory syndrome coronavirus infection other diagnostic studies
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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 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]
- The approach using serology testing is 2-step and includes screening followed by confirmation of results:[8]
- Screening with ELISA. Only positive results will be further tested for confirmation.
- Confirmation with indirect immunofluorescence or microneutralization test
References
- ↑ "MERS Clinical Features".
- ↑ "Laboratory Testing for Middle East Respiratory Syndrome Coronavirus" (PDF).
- ↑ name=WHO5>"Laboratory Testing for Middle East Respiratory Syndrome Coronavirus" (PDF).
- ↑ 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.
- ↑ 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.
- ↑ 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).
- ↑ 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.
- ↑ name=WHO5>"Laboratory Testing for Middle East Respiratory Syndrome Coronavirus" (PDF).