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Test ID EEPC Eastern Equine Encephalitis Antibody Panel, IgG and IgM, Spinal Fluid

Useful For

Aiding in the diagnosis of Eastern equine encephalitis using spinal fluid specimens

Method Name

Immunofluorescence Assay (IFA)

Reporting Name

East Equine Enceph Ab Panel, CSF

Specimen Type

CSF


Ordering Guidance


This assay detects Eastern equine antibodies only. For a complete arbovirus panel, order ABOPC / Arbovirus Antibody Panel, IgG and IgM, Spinal Fluid.

 

New York State clients: This test is not available for specimens originating in New York.



Specimen Required


Container/Tube: Sterile vial

Preferred: Vial number 1

Acceptable: Any vial

Specimen Volume: 0.8 mL


Specimen Minimum Volume

0.7 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
CSF Refrigerated (preferred) 14 days
  Frozen  14 days

Reject Due To

Gross hemolysis OK
Gross lipemia OK

Clinical Information

Eastern equine encephalitis (EEE) is within the alphavirus group. It is a low-prevalence cause of human disease in the Eastern and Gulf Coast states. EEE is maintained by a cycle of mosquito/wild bird transmission, peaking in the summer and early fall, when humans may become an adventitious host. The most common clinically apparent manifestation is a mild undifferentiated febrile illness, usually with headache.

 

Central nervous system involvement is demonstrated in only a minority of infected individuals and is more abrupt and more severe than with other arboviruses, with children being more susceptible to severe disease. Fatality rates are approximately 70% EEE.

 

Infections with arboviruses can occur at any age. The age distribution depends on the degree of exposure to the particular transmitting arthropod, relating to age, sex, and occupational, vocational, and recreational habits of the individuals. Once humans have been infected, the severity of the host response may be influenced by age.

Reference Values

IgG: <1:1

IgM: <1:1

Reference values apply to all ages.

Interpretation

Detection of organism-specific antibodies in the cerebrospinal fluid (CSF) may suggest central nervous system (CNS) infection. However, these results are unable to distinguish between intrathecal antibodies and serum antibodies introduced into the CSF at the time of lumbar puncture or from a breakdown in the blood-brain barrier. The results should be interpreted with other laboratory and clinical data prior to a diagnosis of CNS infection.

Cautions

All results must be correlated with clinical history and other data available to the attending physician.

 

False-positive results may be caused by breakdown of the blood-brain barrier, or by the introduction of blood into the cerebrospinal fluid at collection.

 

Eastern equine encephalitis viruses show some cross-reactivity; however, antibody response to the infection virus is typically at least 8-fold higher.

Clinical Reference

Piantadosi A, Kanjilal S: Diagnostic approach for arboviral infections in the United States. J Clin Microbiol. 2020 Nov 18;58(12):e01926-19. doi: 10.1128/JCM.01926-19

Method Description

The indirect immunofluorescent antibody (IFA) assay is a 2-stage “sandwich” procedure. In the first stage, the patient cerebrospinal fluid (CSF) is diluted in Pretreatment Diluent for IgM and phosphate buffered saline (PBS) for IgG, added to appropriate slide wells in contact with the substrate, and incubated. Following incubation, the slide is washed in PBS, which removes unbound CSF antibodies. In the second stage, each antigen well is overlaid with fluorescein-labeled antibody to IgM and IgG. The slide is incubated allowing antigen-antibody complexes to react with the fluorescein-labeled anti-IgM and anti-IgG. After the slide is washed, dried, and mounted, it is examined using fluorescence microscopy. Positive reactions appear as cells exhibiting bright apple-green cytoplasmic fluorescence against a background of red negative control cells. Semi-quantitative endpoint titers are obtained by testing serial dilutions of positive specimens.(Package inserts: Arbovirus IFA IgM and Arbovirus IFA IgG Instructions for Use. Focus Diagnostics; Rev 02, 05/01/2018)

Day(s) Performed

May through October: Monday through Friday

November through April: Monday, Wednesday, Friday

Report Available

Same day/1 to 4 days

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

86652 x 2

NY State Approved

No

Forms

If not ordering electronically, complete, print, and send Infectious Disease Serology Test Request (T916) with the specimen.

Testing Algorithm

For more information see Mosquito-borne Disease Laboratory Testing