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HelpMayo Test ID LENT Enterovirus, Molecular Detection, PCR, Varies
Ordering Guidance
This test will detect enterovirus but will not differentiate viruses in this family or provide serotyping information.
Necessary Information
1. Specimen source is required.
2. Source information should include main anatomical site of collection.
Specimen Required
Submit a raw clinical sample (not a culture isolate) for enterovirus testing.
Submit only 1 of the following specimens:
Specimen Type: Body fluid
Sources: Pericardial, peritoneal
Container/Tube: Sterile container
Specimen Volume: 0.5 mL
Collection Instructions: Do not centrifuge.
Specimen Type: Spinal fluid
Container/Tube: Sterile vial
Specimen Volume: 0.5 mL
Collection Instructions:
1. Submit specimen from collection vial 2.
2. Do not centrifuge.
Specimen Type: Swab
Supplies: Culturette (BBL Culture Swab) (T092)
Sources: Dermal, eye, rectal, genital, nasopharyngeal, oropharyngeal, throat, nasal, or urethral
Container/Tube: Multimicrobe media (M4-RT) or similar viral transport media (M4 or M5) and Eswab
Specimen Volume: Entire specimen
Collection Instructions:
1. Rectal swab must have no visible fecal matter
2. Place swab back into multimicrobe media (M4-RT, M4, or M5)
Specimen Type: Respiratory
Sources: Bronchial washing, bronchoalveolar lavage, nasopharyngeal aspirate or washing, pleural fluid, sputum, or tracheal aspirate
Container/Tube: Sterile container
Specimen Volume: 1.5 mL
Collection Instructions: Do not centrifuge.
Useful For
Aiding in diagnosing enterovirus infections
This test should not be used to screen asymptomatic patients.
Method Name
Real-Time Polymerase Chain Reaction (PCR)/RNA Probe Hybridization
Reporting Name
Enterovirus PCRSpecimen Type
VariesSpecimen Minimum Volume
Body and Respiratory fluids: 0.5 mL; Spinal fluid: 0.3 mL; Swab: See Specimen Required
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Refrigerated (preferred) | 7 days | |
| Frozen | 7 days |
Reject Due To
| Calcium alginate-tipped swab Wood swab Transport swab containing gel Heat-inactivated specimen |
Reject |
Clinical Information
Enteroviruses are positive-sense RNA viruses in the Picornaviridae family. These viruses were initially classified by serotype as polioviruses (3 types), echoviruses (31 types, including types 22 and 23, which are now classified as parechoviruses), coxsackievirus A (23 types), and coxsackievirus B (6 types). However, genomic studies have demonstrated that there is significant overlap in the biological characteristics of different serotypes and more recently isolated enteroviruses are now named with consecutive numbers (eg, EV68, EV69).
The normal site of enterovirus replication is the gastrointestinal tract where the infection is typically subclinical. However, in a proportion of cases, the virus spreads to other organs, causing systemic manifestations, including mild respiratory disease (eg, the common cold); conjunctivitis; hand, foot, and mouth disease; aseptic meningitis; myocarditis; and acute flaccid paralysis. Collectively, enteroviruses are the most common cause of upper respiratory tract disease in children. In addition, the enteroviruses are the most common cause of central nervous system (CNS) disease; they account for almost all viruses recovered in culture from spinal fluid. Differentiation of enteroviruses from other viruses and bacteria that cause CNS disease is important for the appropriate medical management of these patients.
Traditional cell culture methods require 6 days, on average, for enterovirus detection. In comparison, real-time polymerase chain reaction (PCR) allows same-day detection. Detection of enterovirus nucleic acid by PCR is also the most sensitive diagnostic method for the diagnosis of CNS infection caused by these viruses.
Reference Values
Negative
Interpretation
A positive result indicates the presence of enterovirus RNA in the specimen.
Cautions
A negative result does not rule out the possibility of enterovirus infection.
This assay may detect virus from a variety of specimen types in asymptomatic individuals, including feces. This assay should only be used for patients with a clinical history and symptoms consistent with enterovirus infection and must be interpreted in the context of the clinical picture.
This is a qualitative assay. Results are reported as either negative or positive for targeted enterovirus RNA.
Clinical Reference
1. Khetsuriani N, Lamonte-Fowlkes A, Oberst S, et al. Enterovirus surveillance-United States, 1970-2005. MMWR Surveill Summ, 2006 Sep;55(8):1-20
2. Abedi GR, Watson JT, Nix WA, Oberste MS, Gerber S. Enterovirus and Parechovirus surveillance - United States, 2014-2016. MMWR Morb Mortal Wkly Rep. 2018;67(18):515–518
3. Foray S, Pailloud F, Thouvenot D, Aymard M, Lina B. Evaluation of combining upper respiratory tract swab samples with cerebrospinal fluid examination for the diagnosis of enteroviral meningitis in children. J Med Virol. 1999;57(2):193-197
4. Furione M, Zavattoni M, Gatti M, Percivalle E, Fioroni N, Gerna G. Rapid detection of enteroviral RNA in cerebrospinal fluid (CSF) from patients with aseptic meningitis by reverse transcription-nested polymerase chain reaction. New Microbiol. 1998;21(4):343-351
Method Description
For this real-time reverse-transcription laboratory-developed polymerase chain reaction (PCR) assay, viral nucleic acid is extracted from specimens, followed by amplification and detection on the Roche LightCycler 2.0 instrument. This PCR assay has been optimized to detect a target sequence in the polyprotein region. Primers amplify a 193 base-pair product.
Enterovirus genomic RNA is first transcribed to complementary DNA (cDNA) by reverse transcriptase, followed by amplification of the cDNA product. The LightCycler instrument can rapidly (30-40 minutes) detect amplicon development through stringent air-controlled temperature cycling in capillary cuvettes. The detection of amplified products is based on the fluorescence resonance energy transfer (FRET) principle. For FRET product detection, a hybridization probe with a donor fluorophore, fluorescein, on the 3'-end is excited by an external light source and emits light that is absorbed by a second hybridization probe with an acceptor fluorophore, LC-Red 640, at the 5'-end. The acceptor fluorophore then emits light of a different wavelength that can be measured with a signal proportional to the amount of specific PCR product. FRET (with subsequent production of a detectable fluorescent signal) only occurs when the probes have specifically annealed to the target sequence of the amplicon.
Melting-curve analysis is performed following PCR amplification and is the detection phase of the assay, since it offers greater sensitivity than the amplification phase and maintains high specificity.
The melting phase of the assay occurs as follows:
Starting at 45° C, which allows the probes to bind to the amplified product, the temperature in the thermal chamber is then slowly raised to 80° C and the fluorescence measured at frequent intervals to determine the point where half of the fluorescence is lost as the probes are denatured (ie, "melt") off of the target. This is called the melting temperature (Tm) of that virus. Analysis of the PCR amplification and probe melting curves is accomplished through the use of LightCycler software.(Bernard PS, Reiser A, Pritham GH. Mutation detection by fluorescent hybridization probe melting curves. In: Meuer S, Wittwer C, Nakagawara K, eds. Rapid Cycle Real-Time PCR Methods and Applications. Springer; 2012:11-20)
Day(s) Performed
Monday through Sunday
Report Available
2 to 3 daysSpecimen Retention Time
7 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
87498
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| LENT | Enterovirus PCR | 93856-3 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| SRC68 | Specimen Source | 31208-2 |
| 80066 | Enterovirus PCR | 93856-3 |
Testing Algorithm
For more information see Meningitis/Encephalitis Panel Algorithm