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Clinical laboratory tests for acute enteroviral infections

Serology - Serological examination can reveal an increase in antibodies to enteroviruses neutralizing antibody level to enteroviruses between the acute and convalescent phases of illness. This diagnostic modality can only identify coxsackie B1-6 and Echo 6, 7, 9, 11, and 30. The other known enteroviruses cannot be identified with this test. A negative serological test does not necessarily mean the absence of enterovirus.

Viral isolation - This is the criterion standard for diagnosing enteroviral infections. The virus can be isolated from cerebrospinal fluid, blood, or feces, depending on the site affected, and the yield is increased if multiple sites are sampled. The serotype of enteroviruses isolated by this method can be identified with neutralizing assays using type-specific antisera.

Polymerase Chain Reaction (PCR) - This test is highly sensitive and specific for detecting enteroviral RNA in cerebral spinal fluid specimens, with a sensitivity of 100% and specificity of 97%. PCR provides rapid results. PCR testing of the blood can only identify the virus in 30% of chronic fatigue syndrome/myalgic encephalomyelitis patients.

Cardiac enzyme levels and troponin 1 - These levels may be elevated in persons with myopericarditis, indicating myocardial damage.

Cerebrospinal fluid analysis - The cerebrospinal fluid profile of patients with aseptic meningitis reveals a mildly elevated white blood cell count. Glucose levels are normal or mildly decreased, while the protein level is normal or slightly increased.

Reverse Transcriptase-Polymerase Chain Reaction (RT- PCR) - This test is designed to detect a common genetic area of most of the enteroviruses. The results could be available in 24 hours, making detection more sensitive (95%), more specific (97%), and more time efficient. This test is approved for diagnosing enterovirus meningitis. For other body fluids such as the stool, respiratory secretions and blood, the yield is less certain.