Specimen Requirements

• At least 0.5 ml CSF
  (non-centrifuged)
• Nasopharyngeal or throat swab
• Stool collected in sterile container
• Tissue
  (Freeze immediately upon collection)

Shipping Requirements
Transport overnight:

• CSF or tissue on dry ice
• Swab or stool at refrigerated temperature

Days Set Up
Monday - Saturday

Analysis Time
3 hours

Test Code: 68037

CPT Code: 87798

Additional Information

The enteroviruses include over 70 distinct serotypes (coxsackie A and B, echoviruses, polioviruses and enterovirus types 68-71) and are associated with a broad spectrum of disease. Enteroviral infection accounts for over 10-15 million cases of symptomatic infection each year in the USA alone. This includes infections such as respiratory disease, gastrointestinal disease, acute myopericarditis and CNS disease (aseptic meningitis and, rarely, encephalitis). Enteroviral aseptic meningitis accounts for over 85% of the aseptic meningitis cases reported and occurs primarily in the late summer and early fall.

The unnecessary and prolonged hospitalization and use of antibiotics/antiviral treatment often accompany enterovirus infections, especially in infants and children. This is because of the similarity of enterovirus disease in clinical presentation to other bacteria and viruses. Therefore, prompt and accurate identification of the agent is crucial to effective patient management and cost containment.

Laboratory diagnosis has been accomplished by cell culture isolation of the virus, averaging 6-7 days for identification and possibly 14 days for a negative report. Additionally, cell culture sensitivity may be as low as 65-75%. Although cell culture is a reliable diagnostic method, molecular methods such as RT-PCR offer more sensitive, highly specific and rapid test results for the support of an enterovirus diagnosis.

The use of Real Time PCR offers additional advantages over conventional PCR technology:

• Rapid detection (3 hour sample preparation/analysis time)
• PCR product quantitation available
• Closed system with minimal to no contamination after specimen processing

This sensitive and specific Real Time PCR method offers more information than other tests currently available. However, as with any laboratory test, this test should be used in conjunction with patient history and other laboratory data in support of a clinical diagnosis.

The PCR (Polymerase Chain Reaction) test is performed pursuant to an agreement with Roche Molecular Systems, Inc.

References

1. Ahmed, A., F. Brito, C. Goto, S. M. Hickey, K. D. Olsen, M. Trujillo, and G. H. McCracken Jr. 1997. Clinical utility of the polymerase chain reaction for diagnosis of enteroviral meningitis in infancy. J. Pediatr. 131(3):393-397.
2. Furione, M., M. Zavattoni, M. Gatti, E. Percivalle, N. Fioroni, and G. Gerna. 1998. Rapid detection of enteroviral RNA in cerebrospinal fluid (CSF) from patients with aseptic meningitis by reverse transcription-nested polymerase chain reaction. New. Microbiol. 21(4):343-351.
3. Hamilton, M. S., M. A. Jackson, and D. Abel. 1999. Clinical utility of polymerase chain reaction testing for enteroviral meningitis. Pediatr. Infect. Dis. J. 18(6):533-537.
4. Micevski, V. 1999. The use of molecular technologies for the detection of enteroviral ribonucleic acid in myocarditis. J. Cardiovasc. Nurs. 13(4):78-90.
5. Pichichero, M. E., S. McLinn, H. A. Rotbart, M. A. Menegus, M. Cascino, and B. E. Reidenberg. 1998. Clinical and economic impact of enterovirus illness in private pediatric practice. Pediatrics. 102(5):1126-1134.
6. Pozo, F., I. Casas, A. Tenorio, G. Trallero, and J. M. Echevarria. 1998. Evaluation of a commercially available reverse transcription-PCR assay for diagnosis of enteroviral infection in archival and prospectively collected cerebrospinal fluid specimens. J. Clin. Microbiol. 36(6):1741-1745.
7. Riding, M. H., J. Stewart, G. B. Clements, and D. N. Galbraith. 1996. Enteroviral polymerase chain reaction in the investigation of aseptic meningitis. J. Med. Virol. 50(2):204-206.
8. Romero, J. R. 1999. Reverse-transcription polymerase chain reaction detection of the enteroviruses. Arch. Pathol. Lab. Med. 123(12):1161-1169.
9. Rotbart, H. A. 1990. Enzymatic RNA amplification of the enteroviruses. J. Clin. Microbiol. 28(3):438-442.
10. Rotbart, H. A., M. H. Sawyer, S. Fast, C. Lewinski, N. Murphy, E. F. Keyser, J. Spadoro, S. Y. Kao, and M. Loeffelholz. 1994. Diagnosis of enteroviral meningitis by using PCR with a colorimetric microwell detection assay. J. Clin. Microbiol. 32(10):2590-2592.
11. Rotbart, H. A., A. Ahmed, S. Hickey, R. Dagan, G. H. McCracken Jr., R. J. Whitley, J. F. Modlin, M. Cascino, J. F. O'Connell, M. A. Menegus, and D. Blum. 1997. Diagnosis of enterovirus infection by polymerase chain reaction of multiple specimen types. Pediatr. Infect. Dis. J. 16(4):409-411.
12. Rotbart, H. A., P. J. Brennan, K. H. Fife, J. R. Romero, J. A. Griffin, M. A. McKinlay, and F. G. Hayden. 1998. Enterovirus meningitis in adults. Clin. Infect. Dis. 27(4):896-898.
13. Rotbart, H. A., G. H. McCracken Jr., R. J. Whitley, J. F. Modlin, M. Cascino, S. Shah, and D. Blum. 1999. Clinical significance of enteroviruses in serious summer febrile illnesses of children. Pediatr. Infect. Dis. J. 18(10):869-874.
14. Zoll, G. J., W. J. Melchers, H. Kopecka, G. Jambroes, H. J. van der Poel, and J. M. Galama. 1992. General primer-mediated polymerase chain reaction for detection of enteroviruses: application for diagnostic routine and persistent infections. J. Clin. Microbiol. 30(1):160-165.