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Picornavirus-Overview Workup

  • Author: Larry I Lutwick, MD; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
Updated: Dec 17, 2014

Laboratory Studies

See the list below:

  • Viral isolation through cell culture
    • Sample multiple sites to optimize recovery.
      • Isolate virus from cerebrospinal fluid (CSF), pericardial fluid, tissue, or blood, depending on the clinical syndrome.[34]
      • Viral culture of stool late in enteroviral illnesses may be true or unrelated; pharyngeal secretion culture should be performed simultaneously.
    • Isolate rhinoviruses at the optimum temperature of 33-34°C.[5]
    • With the identification of characteristic cytopathic effect in any of 3 or 4 appropriately chosen cell lines, the laboratory can report a presumptive diagnosis of enteroviral infection within 2-5 days.
  • Polymerase chain reaction (PCR):[35] To detect enteroviral RNA in clinical specimens, use reverse-transcriptase PCR (RT-PCR), which is rapid, sensitive, and specific.[36] RT-PCR can detect enteroviral RNA in CSF, throat swabs, serum, urine, and stool.
  • Serology
    • Acute and convalescent serum studies should, if possible, be run in parallel. A single high-antibody result can be misleading.
    • The microneutralization test is the most widely used method to evaluate for antibodies to enteroviruses.
    • During the acute stage, viral hepatitis can be diagnosed based on liver dysfunction, as indicated by raised levels of serum bilirubin and aminotransferases.
  • Enzyme-linked immunosorbent assay (ELISA) or radioimmunoassay: A specific diagnosis of HAV infection is usually achieved with ELISA or radioimmunoassay for specific immunoglobulin M (IgM).
  • Immunohistochemistry can also be used to diagnose cutaneous viral infections.[37]
Contributor Information and Disclosures

Larry I Lutwick, MD Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: American College of Physicians, Alliance for the Prudent Use of Antibiotics, The Foundation for AIDS Research, Southern Society for Clinical Investigation, Southwestern Association of Clinical Microbiology, Association of Professors of Medicine, Association for Professionals in Infection Control and Epidemiology, American Clinical and Climatological Association, Infectious Disease Society for Obstetrics and Gynecology, Orleans Parish Medical Society, Southeastern Clinical Club, American Association for the Advancement of Science, Alpha Omega Alpha, American Association of University Professors, American Association for Physician Leadership, American Federation for Medical Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association of American Medical Colleges, Association of American Physicians, Infectious Diseases Society of America, Louisiana State Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southern Medical Association

Disclosure: Received royalty from Baxter International for other.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Additional Contributors

John M Leedom, MD Professor Emeritus of Medicine, Keck School of Medicine of the University of Southern California

John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Phi Beta Kappa

Disclosure: Nothing to disclose.


Yana Bron, MD Consulting Staff, Department of Pediatrics, Linden Children Services Inc

Yana Bron, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Informatics Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert L Holmes, DO Major, Medical Corps, US Air Force, Medical Director of Infectious Diseases, Chair, Infection Control Review Function, Associate Program Director, Internal Medicine Residency Training Program, Keesler Medical Center

Robert L Holmes, DO is a member of the following medical societies: American College of Physician Executives, American Osteopathic Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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