Pediatric Echovirus Workup

Updated: Jan 07, 2021
  • Author: Jorge M Quinonez, MD; Chief Editor: Russell W Steele, MD  more...
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Workup

Laboratory Studies

Until recently, the criterion standard laboratory procedure to diagnose echovirus (EV) and other enterovirus infections was to isolate the virus in cell culture. An etiologic diagnosis is confirmed when virus is isolated from blood, CSF, tissue, or pericardial fluid. EV can also be isolated from stool or oropharynx, although these findings are less indicative of disease because asymptomatic shedding from these sites can occur for several weeks after acute infection.

Enteroviruses grow rapidly in cell culture, yet viral recovery occurs too slowly to provide data for decisions about treatment. Virus detection in cell culture typically takes 3-8 days, requires multiple cell lines for optimal recovery, is labor intensive and costly, and is not readily available in all clinical facilities. Antiviral therapy for enterovirus requires a faster and more efficient mechanism for diagnosis.

Enterovirus polymerase chain reaction (EV-PCR), based on amplification of conserved genetic sequences, has been thoroughly studied and is superior to viral culture for revealing many enteroviral infections, particularly enteroviral meningitis. [15, 16, 17]

EV-PCR can be used in samples other than CSF, although experience is not as extensive. EV-PCR has been successfully used in urine and serum to document neonatal infection and on throat swabs to document common outpatient illnesses. [18]

Quality control from laboratory to laboratory is necessary because no commercial kit is available. Because of its extreme sensitivity, EV-PCR is subject to false-positive results from contamination within the laboratory. The greatest benefit of EV-PCR is that the test can provide results in 5-24 hours, which can expedite patient management decisions (eg, decrease length of hospitalization, antibiotic use, overall costs).

Serologic tests for enteroviral infection diagnosis have limited value because they are slow, require acute and convalescent titers, and are not type-specific.