Lecture 5: infectious Disease Serology

uses for infectious disease serology

post streptococcal sequelae

spirochetal serology

immune status testing

detection of other active virus infections

possible post streptococcal sequelae

acute rheumatic fever

glomerulonephritis

what __% of children with strep develop acute rheumatic fever

2-3%

symptoms of acute rheumatic fever

fever

joint inflammation

heart inflammation

cause of acute rheumatic fever

strep throat

strep throat Ab

M protein immunogen

cross reactivity in tissue leads to damage

testing for acute rheumatic fever

Anti streptolysin O

Anti DNase B

acute rheumatic fever Anti streptolysan O (ASO) peaks

increases 2 weeks after initial infection. Peak at 3-6 weeks after initial infection

anti DNase B is tested when

ASO is negative but we are suspicious of acute rheumatic fever

how does post streptococcal glomerulonephritis happen

strep immune complexes deposit on the glomerulus

post streptococcal glomerulonephritis common age range

2-12 years old

what time of year is most common in post streptococcal glomerulonephritis

winter

is renal failure seen or not seen in post streptococcal glomerulonephritis

not seen

symptoms of post streptococcal glomerulonephritis

hematuria

proteinuria

edema

hypertension

pathogenesis for post streptococcal glomerulonephritis

Ab to strep is made, Ag remains in system. Immune complex (Ag+Ab) is deposited in the glomerulus and triggers an immune response.

testing for post streptococcal glomerulonephritis

Anti streptolysin O (ASO)

Anti DNase B

information on ASO testing timing for post streptococcal glomerulonephritis

increases 2 weeks after initial infection. Peak at 3-6 weeks after initial infection

when is Anti DNase B testing done for post streptococcal glomerulonephritis

done when we have suspicion of post streptococcal glomerulonephritis but ASO is negative

which spirochetes can be tested for with spirochetal serology

treponema pallidum

leptospirosis

borrelia burgdorferi

treponema pallidum causes this disease

syphilis

types of syphilis testing

treponemal

non treponemal

non treponemal tests

RPR

VDLR

what does RPR stand for

rapid plasma reagin

what does VDRL stand for

venereal disease research laboratory

non treponemal tests are tests which detect ________

reagin

in non treponemal tests we look for this kind of reaction

flocculation

wooly look when positive

non treponemal tests can be done on these specimens

plasma and serum

false positive on non treponemal tests can be caused by

lyme disease

malaria

HIV

lupus

pregnancy

spirochetal diseases

false negative on non treponemal tests can be caused by

primary/early syphilis

prozone effect

treponemal tests detect this

antibody specific to treponemal pallidum

when treponemal test is positive, it remains positive this long

for life!

examples of treponemal tests

IgG EIA

FTA Abs: fluorescent treponemal Ab

TPPA: treponema pallidum particle agglutination

in the primary stage of syphilis, this rises first

IgM

in the secondary and all following stages of syphilis, this rises and remains raised

IgG

two kinds of syphilis algorithms

traditional

reverse

traditional algorithm for syphilis

RPR (non treponemal)

EIA (treponemal)

reverse algorithm for syphilis

EIA

RPR (non treponemal)

EIA

leptospirosis is caused by this disease

leptospira intrigants

another name for leptospira intrigants disease

weils disease

method of acquisition for leptospirosis

zoonotic

cattle urinate in water

people drink the water

disease

what kind of testing is good for leptospirosis (Ig__)

IgM

common this kind of testing for lyme borreliosis

two tiered approach

EIA

western blot immunoassay

describe EIA

screening test

antigen on bottom well. Add patient Ab. sensitive but not specific

describe western blot immunoassay

confirmatory test

nitrocellulose and patient serum

Western Blot Immunoassay IgM

22 KDa, 39 KDa, and 41 KDa proteins.

2/3 proteins have to be positive to call it positive

western blot immunoassay igG

10 protein bands of interest.

5/10 must be positive to call it positive

current CDC recommendation for lyme borreliosis testing

EIA of brand 1

EIA of brand 2

what is the purpose of immune status testing

can tell us if someone is vaccinated

immune testing can be done on these conditions

measles

mumps

rubella (ToRCH panel)

Varicella Zoster

what is in a ToRCH panel

Toxoplasma gondii

Rubella

CMV

Herpes

when Toxoplasma gondii serology is positive it means we don't know _________

we don't know when the exposure to Toxoplasma gondii happened

what is the purpose of testing IgM for Toxoplasma gondii

it would indicate if infection happened within the last 18 months

what is the purpose of testing IgG avidity for Toxoplasma gondii

to see if an infection is current

Toxoplasma gondii avidity interpretation

low avidity:

high avidity:

low avidity: current infection

high avidity: old infection

rubella is also called

german measles

symptoms of rubella

maculopapular rash starts on the face and then goes to the trunk and to the limbs. Should go away in 3-5 days. Low grade fever, malaise, swollen lymphs, upper respiratory infection

expected result for rubella immune status testing

positive due to immunization

what is the potential concern with rubella and pregnancy?

CRS (congenital rubella syndrome)

concerns with CRS in pregnancy

may result in miscarriage, still birth, or CRS

CRS symptoms

deafness

ocular issues

motor disability

cognitive issues

is a pregnant mom has a positive immune status for rubella we test this

IgM avidity

rubella IgM avidity interpretation

high avidity:

low avidity:

high avidity: rubella exposure was a while ago

low avidity: active infection

what is CMV

cytomegalovirus

CMV is the most common cause of

congenital infections

desired result for CMV immune status test

positive

means the mom has the Ab to CMV

symptoms of babies with CMV

Upon birth we see small heads, seizures, rash, lung issues, spleen issues, liver issues.

Long term we see hearing loss, cognitive issues, vision loss, lack of coordination, and weakness.

when CMV immune status test is negative, it means this

mom could have CMV

when a pregnant mom has a negative CMV immune status test the provider should do this

educate the mom to be careful with hygiene

CMV method of acquisition

gross children

saliva and urine

organ transplant utility for testing CMV immune status

Organ transplant recipients are highly immune suppressed. The donor and recipient should be tested to ensure they are not cross reactive

results which may indicate a risk of rejection

Donor CMV IgG positive

Recipient CMV IgG negative

Varicella Zoster is this disease

chicken pox

how is varicella zoster spread

respiratory

coughs and sneezes

what is the purpose for varicella zoster immune status testing

to see if someone has been vaccinated for chicken pox

infectious disease serology can be used for these other active viral infections

Hepatitis

EBV

HIV

Hepatitis A mode of acquisition

fecal oral

hepatitis A is this family of virus

picornaviridae

clinical criteria for hepatitis A

fever, headache, malaise, anorexia, nausea, vomiting, diarrhea, abdominal pain, dark urine, jaundice, ALT increased

lab criteria for hepatitis A

bilirubin (>3 mg/dL).

ALT >200.

IgM positive serology.

Reverse transcriptase PCR to diagnose

for every reported case of hep A, this amount of cases goes unreported

1 case

hepatitis C mode of acquisition

needle stick

sex

clinical criteria for Hep C

fever, headache, malaise, anorexia, nausea, vomiting, diarrhea, abdominal pain, dark urine, jaundice, ALT increased

lab tests for Hep C

molecular testing

Anti Hep C Ab testing

what __% of Hep C cases become chronic

85%

what __% of Hep C cases are acute

15%

for every one reported case of Hep C, this number of cases go unreported

14 cases

predisposition for Hep C

Male, over 50 years, alcohol, fatty liver disease, Hep B or HIV, immunosuppressants

most common genotype of Hep C

genotype 1

therapy for Hep C is most likely for these genotypes

genotypes 2-3

treatment for Hep C

pegylated interferon and ribavirin

who should be tested for Hep C

Baby boomers

Adults >18 should be screened once in their life

All women should be tested during pregnancy

People with risk factors

anyone who wants it

what are the risk factors for Hep C

HIV, IV drug abuse, needle stick exposure, medical conditions, transplant recipients, dialysis, transfusion recipients, babies born to moms with HepC

Hepatitis B mode of acquisition

needle stick

sex

mom to baby

is acute or chronic more common for Hep B

acute is more common

clinical criteria for Hep B

fever, headache, malaise, anorexia, nausea, vomiting, diarrhea, abdominal pain, dark urine, jaundice, ALT increased

laboratory criteria for Hep B

Jaundice (bilirubin >3 mg)

Hep B surface Ag test

Hep B core IgM

acute hepatitis panel

Hep B surface antigen

Hep B core IgM

Hep A IgM

anti Hep C total

hepatitis B panel

Hep B surface antigen

Hep B core IgM

Hep B core and total (IgM and IgG)

Hep B surface antibody

what does the surface antibody alone indicate about Hep B

indicates someone has had the vaccine

in chronic Hep B, _____________ remains elevated

surface antigen remains elevated

who has worse outcomes for chronic Hep B

children