Enterovirus PCR - dermal lesion specimen
- LIS Mnemonic: ENTPCR
Collect
Dermal lesion swab submitted in viral transport medium. Collect cells and fluid from vesicular skin lesions and/or vesicular/ulcerative lesions in the mouth as the primary specimen sources. Detection may be enhanced by also submitting blood, urine, respiratory, and stool specimens for enterovirus detection by PCR.
Volume Required
N/A
Minimum Required
N/A
Transport
Keep specimen at 4C
Processing
Collect cells and fluid from fresh vesicles on the skin and/or from vesicles or ulcers in the mouth. Uncap the vesicle with a sterile needle or scalpel blade and use a sterile rayon or Dacron tipped, plastic shafted swab to collect the fluid and vigorously swab the opened lesion to obtain infected epithelial cells. To facilitate binding of the cellular material to the swab, the swab can be premoistened with sterile saline. Be certain to fully express the excess liquid from the swab before attempting to collect the specimen. For ulcers, use a sterile swab to vigorously swab the base of the lesion to obtain cells. Crusted lesions should have the crust removed and discarded before collection of cells from the lesion base. The swab should be immediately placed in viral transport medium and sent to the Clinical Virology Laboratory.
Unacceptable conditions
Swab specimen not received in viral transport medium or received in bacteriological transport medium are discouraged. DO NOT USE CALCIUM ALGINATE OR WOODEN SHAFT SWABS FOR COLLECTION OF SPECIMENS; ONLY USE DACRON OR RAYON TIPPED SWABS ON PLASTIC OR METAL SHAFTS. Also, specimens for molecular testing should not be stored at room temperature or frozen at -20C. This is critical to ensure the stability and amplification of nucleic acids, particularly for the detection of RNA viruses since RNA is unstable and easily degraded by RNAses from the surrounding environment.
Days Performed
Daily
Reported
Same day
Reflex Testing
N/A
CPT
87798
Methodology
Amplification and detection of enterovirus RNA 5'-untranslated region using TaqMan real-time PCR technology. This test is performed pursuant to an agreement with Roche Molecular Systems, Inc.
Disease Information
Utility:
Used for the laboratory diagnosis of hand-foot-mouth disease (HFMD; febrile illness with a vesicular rash on the palms of the hands and soles of the feet, and painful vesicular/ucerative sores in the mouth) and herpangina (vesicular rash of the fauces and soft palate of the mouth accompanied by fever, sore throat, and pain on swallowing). With HFMD due to coxsackievirus A6 (CVA6), the rash and fever are more severe, the rash is more extensive, and hospitalization is more common than with your typical cases of HFMD caused by other enteroviruses such as coxsackivirus A16 and enterovirus 71. The rash associated with CVA6 can be much more impressive and painful and can appear not only on the hands, feet and mouth but also on the arms, legs, trunk, face, nail matrices, and buttocks.
Interpretation
If positive, results are reported as enterovirus RNA detected.
Reference Values
Negative or no enterovirus RNA detected.
Remarks
Nonpolio enteroviruses are responsible for significant and frequent illnesses in infants and young children. The spectra of clinical diseases are diverse and often difficult to distinguish from other infectious or noninfectious processes. Mild infections include fever ± rash, hand-foot-mouth syndrome, herpangina, pleurodynia, pharyngitis, conjunctivitis, and croup. Potentially serious manifestations include aseptic meningitis, encephalitis, acute paralysis, neonatal sepsis, myocarditis/pericarditis, hepatitis, and chronic infection. Aseptic meningitis and neonatal sepsis generate the most medical attention in children during annual outbreaks. Detection of enteroviruses by PCR may be enhanced by collecting specimens from multiple different body sites. These may include CSF, urine, blood (serum or plasma), respiratory, stool, tissue (e.g., liver, myocardium), and sterile body fluids (e.g., pericardial fluid, pleural fluid). Cerebrospinal fluid (CSF) is the specimen of choice for detecting enteroviruses in patients with aseptic meningitis or other central nervous system (CNS) diseases. It is also recommended that urine and serum specimens be sent on all patients with CNS disease to increase the likelihood of finding an enterovirus. A positive result from any one of these specimens is diagnostic for enteroviral disease. Both urine and serum should be sent on neonates and other children that present with sepsis or acute nonfocal febrile illness. Please Note: positive results from respiratory and stool specimens do not always correlate with disease because of prolonged viral shedding. Positive results from these specimens should be interpreted accordingly.
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