Picornavirus Infections Workup

Updated: Apr 24, 2018
  • Author: Shivan Shah, MD; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
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Workup

Laboratory Studies

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. [41]

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)  [38]

To detect enteroviral RNA in clinical specimens, use reverse-transcriptase PCR (RT-PCR), which is rapid, sensitive, and specific. [42] RT-PCR can detect enteroviral RNA in CSF, throat swabs, serum, urine, and stool.

Rhinovirus can be detected on respiratory PCR testing.

Given the close genetic relationship between rhinovirus and enterovirus, they are indistinguishable on PCR testing and must be inferred based on clinical syndrome.

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

Immunohistochemistry can also be used to diagnose cutaneous viral infections. [43]