Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (1349 page)

ENTEROVIRUS CULTURE (RULE OUT)

   Definition

   Poliovirus, coxsackie viruses (A and B), and echoviruses are enteroviruses (EVs). As the name implies, EVs most commonly replicate in the GI tract, and fecal–oral transmission is typical. Most clinical manifestations of EV infection are outside the GI tract. EV infection is most commonly considered in children who present with signs and symptoms of aseptic meningitis in summer months. EVs also cause a severe sepsis syndrome in neonates (<2 weeks of age), pleurodynia, myocarditis and cardiomyopathy, and respiratory and oral mucosal diseases. Except for neonatal sepsis syndrome and endemic or vaccine-related poliomyelitis, EV infection is usually followed by complete recovery.

   Use

   This test is used to detect viral infections caused by EVs. A number of different cell lines are susceptible to EV infection. Different EVs show differing infectivity for specific cell lines, so a number of different lines are typically inoculated for EV isolation. Monkey kidney cells may be used for poliovirus, coxsackie B virus, and echoviruses. WI-38 and human embryonic lung fibroblast cells may be used for coxsackie A virus.

   
Turnaround time:

   Tube cultures may be incubated for up to 4 weeks before signing out as negative.

   CSF cultures are usually positive within 7 days (when positive).

   Stool cultures, or other specimen types with higher concentrations of virus, are often positive within several days.

   Special Collection and Transport Instructions

   Specimens should be collected within the first week after onset of symptoms.

   Specimens should be collected according to general recommendations for virus culture of the specimen type. For patients with aseptic meningitis, CSF should be transported to the laboratory on wet ice (4°C). Submission of stool for viral culture may improve the detection of EV CNS infection.

   Interpretation