Gold (SST - Clot activator & gel)
2 ml blood
1 ml serum
If multiple viral serologies are being requested from the same specimen, the general rule is to collect a total of 2-4 ml of blood for every 2-3 tests ordered. A single serum specimen is required to determine the immune status of an individual or to test for viral-specific IgM antibodies. Paired sera specimens, collected two to three weeks apart, are required for the diagnosis of a current or recent viral infection when examining specimens for IgG antibody. Obtain the acute phase serum as soon as possible after the onset of illness. The most useful results are obtained by submitting acute and convalescent phase sera together to be tested simultaneously. Evaluation of serum for antibodies to TORCH (Toxoplasma, Rubella, CMV, HSV, etc) agents can be used to detect congenital and perinatal infections in newborns. Two serum specimens should be submitted for testing; one from the mother and the other from her infant. Serological testing is not usually available for body fluids other than serum. However, in patients with viral neurologic disease, cerebrospinal fluid (CSF) may be tested for viral antibody if paired with a serum specimen from the same date.
Following an incubation period of 14-18 days, mumps begins with a nonspecific prodrome of low-grade fever, headache, respiratory symptoms, malaise, and myalgia. Most common feature is swelling of salivary glands in 30-40%, particularly the parotid glands. Swelling is usually bilateral; unilateral in 25% of cases. Severe illness with complications more likely in adults. The virus is transmitted from person to person through respiratory secretions and is quite contagious. Greatest communicability is 1-2 days before to 5 days after onset of parotid gland swelling. Illness lasts a week to 10 days. Complications include orchitis in 20-30% of infected postpubescent males, oophoritis and mastitis in 5% of postpubertal females; sterility and impaired fertility are uncommon. Mumps can also be complicated by meningitis and encephalitis.
Clinical diagnosis of mumps is unreliable; requires laboratory confirmation. Although once a common disease in children, fewer physicians now recognize the clinical features of mumps. Also, many viruses, including parainfluenza virus, enteroviruses, EBV, CMV, HIV, and influenza virus, can cause acute parotitis. Outbreaks of mumps still occur in the United States despite high coverage rates with vaccine. The disease is normally imported from abroad or associated with importation from other countries and outbreaks arise in people who have not been immunized and as a result of two-dose vaccine failure. Therefore, both unvaccinated and vaccinated persons are at risk for acquiring mumps themselves and transmitting the virus to others. Living in closed communities in crowded conditions is a contributing factor in the spread of the virus.
<0.9 - No mumps virus IgG antibody detected
0.9-1.10 - Equivocal for mumps virus IgG antibody
>1.10 - Positive for mumps virus IgG antibody
Detection of virus-specific IgG in a single serum specimen indicates exposure to mumps virus some time in the past or a response to vaccination. Demonstration of a seroconversion from a negative to a positive IgG antibody response between acute and convalescent sera collected 2-3 weeks apart can be diagnostic of recent or current mumps infection. Negative IgG antibody results may exclude mumps virus infection. For specimens with equivocal mumps virus IgG antibody results, repeat testing of another specimen collected after a period of 14 days may be helpful.
Negative or no mumps virus IgG antibody detected
Clinical Utility: Serological assays provide an indirect diagnostic approach by detecting specific antibody responses to viral infections. Detection of virus-specific IgM in a single acute-phase serum sample collected within 5-10 days of disease onset or demonstration of a seroconversion from a negative to a positive IgG antibody response between acute and convalescent sera collected 2-3 weeks apart can be diagnostic of primary viral infection. Detection of virus-specific IgG in a single serum specimen indicates exposure to a virus at some time in the past or a response to vaccination. Negative antibody titers may exclude viral infection. Results of serological tests must be interpreted with caution, as measurements of antibody responses to viral infections can be complicated by numerous factors. A definitive diagnosis of mumps infection based on measurements of IgG antibodies to mumps virus may be hampered by the production of cross-reactive antibodies between mumps virus and parainfluenza viruses. This is not usually a practical problem if the clinical findings are compatible with mumps. For most viral infections in the acute phase of illness,rapid antigen and/or nucleic acid detection methods or viral isolation are also available and may yield results in a more sensitive and timely manner.
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