Congenital rubella syndrome laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Congenital rubella syndrome}} | |||
{{CMG}}; {{AE}}{{DN}} | {{CMG}}; {{AE}}{{DN}} | ||
==Overview== | ==Overview== | ||
[[Prenatal]] testing consists of direct isolation of the [[virus]], [[viral]] [[nucleic acid]] quantification or detection of [[antibodies]] against [[rubella]] in [[fetal]] [[blood]] via various invasive techniques, such as [[amniocentesis]], [[fetal]] [[blood]] sampling, and [[Chorionic villus sampling|chorionic villi sampling]].<ref name="pmid16580940">{{cite journal |vauthors=De Santis M, Cavaliere AF, Straface G, Caruso A |title=Rubella infection in pregnancy |journal=Reprod. Toxicol. |volume=21 |issue=4 |pages=390–8 |year=2006 |pmid=16580940 |doi=10.1016/j.reprotox.2005.01.014 |url=}}</ref><ref name="pmid2857319">{{cite journal |vauthors=Morgan-Capner P, Hodgson J, Hambling MH, Dulake C, Coleman TJ, Boswell PA, Watkins RP, Booth J, Stern H, Best JM |title=Detection of rubella-specific IgM in subclinical rubella reinfection in pregnancy |journal=Lancet |volume=1 |issue=8423 |pages=244–6 |year=1985 |pmid=2857319 |doi= |url=}}</ref><ref name="pmid3351485">{{cite journal |vauthors=Ho-Terry L, Terry GM, Londesborough P, Rees KR, Wielaard F, Denissen A |title=Diagnosis of fetal rubella infection by nucleic acid hybridization |journal=J. Med. Virol. |volume=24 |issue=2 |pages=175–82 |year=1988 |pmid=3351485 |doi= |url=}}</ref><ref name="pmid3083942">{{cite journal |vauthors=Terry GM, Ho-Terry L, Warren RC, Rodeck CH, Cohen A, Rees KR |title=First trimester prenatal diagnosis of congenital rubella: a laboratory investigation |journal=Br Med J (Clin Res Ed) |volume=292 |issue=6525 |pages=930–3 |year=1986 |pmid=3083942 |pmc=1339854 |doi= |url=}}</ref><ref name="pmid8034496">{{cite journal |vauthors=Valente P, Sever JL |title=In utero diagnosis of congenital infections by direct fetal sampling |journal=Isr. J. Med. Sci. |volume=30 |issue=5-6 |pages=414–20 |year=1994 |pmid=8034496 |doi= |url=}}</ref> Postnatal testing consists of isolation of the [[virus]] from [[throat]] or [[urine]] cultures<ref name="CDC"> Center for Disease Control and Prevention https://www.cdc.gov/vaccines/pubs/surv-manual/chpt15-crs.html. Accessed on Jan 16, 2017.</ref> and detection of [[serology]] ([[IgG]] or [[IgM]] [[antibodies]] against [[rubella]]).<ref name="pmid16580940">{{cite journal |vauthors=De Santis M, Cavaliere AF, Straface G, Caruso A |title=Rubella infection in pregnancy |journal=Reprod. Toxicol. |volume=21 |issue=4 |pages=390–8 |year=2006 |pmid=16580940 |doi=10.1016/j.reprotox.2005.01.014 |url=}}</ref><ref name="pmid7615708">{{cite journal |vauthors=Bosma TJ, Corbett KM, O'Shea S, Banatvala JE, Best JM |title=PCR for detection of rubella virus RNA in clinical samples |journal=J. Clin. Microbiol. |volume=33 |issue=5 |pages=1075–9 |year=1995 |pmid=7615708 |pmc=228107 |doi= |url=}}</ref><ref name="pmid15135741">{{cite journal |vauthors=Tipples GA, Hamkar R, Mohktari-Azad T, Gray M, Ball J, Head C, Ratnam S |title=Evaluation of rubella IgM enzyme immunoassays |journal=J. Clin. Virol. |volume=30 |issue=3 |pages=233–8 |year=2004 |pmid=15135741 |doi=10.1016/j.jcv.2003.11.006 |url=}}</ref><ref name="pmid11057968">{{cite journal |vauthors=Andrews N, Pebody RG, Berbers G, Blondeau C, Crovari P, Davidkin I, Farrington P, Fievet-Groyne F, Gabutti G, Gerike E, Giordano C, Hesketh L, Marzec T, Morgan-Capner P, Osborne K, Pleisner AM, Raux M, Tischer A, Ruden U, Valle M, Miller E |title=The European Sero-Epidemiology Network: standardizing the enzyme immunoassay results for measles, mumps and rubella |journal=Epidemiol. Infect. |volume=125 |issue=1 |pages=127–41 |year=2000 |pmid=11057968 |pmc=2869578 |doi= |url=}}</ref><ref name="pmid8576339">{{cite journal |vauthors=Bosma TJ, Corbett KM, Eckstein MB, O'Shea S, Vijayalakshmi P, Banatvala JE, Morton K, Best JM |title=Use of PCR for prenatal and postnatal diagnosis of congenital rubella |journal=J. Clin. Microbiol. |volume=33 |issue=11 |pages=2881–7 |year=1995 |pmid=8576339 |pmc=228600 |doi= |url=}}</ref><ref name="pmid12130613">{{cite journal |vauthors=Best JM, O'Shea S, Tipples G, Davies N, Al-Khusaiby SM, Krause A, Hesketh LM, Jin L, Enders G |title=Interpretation of rubella serology in pregnancy--pitfalls and problems |journal=BMJ |volume=325 |issue=7356 |pages=147–8 |year=2002 |pmid=12130613 |pmc=1123673 |doi= |url=}}</ref> Other laboratory findings in [[infants]] with congenital rubella syndrome include [[thrombocytopenia]] and elevated levels of [[PT]], [[Partial thromboplastin time|PTT]], and [[bilirubin]].<ref name="pmid25654000">{{cite journal |vauthors=Ajij M, Nangia S, Dubey BS |title=Congenital rubella syndrome with blueberry muffin lesions and extensive metaphysitis |journal=J Clin Diagn Res |volume=8 |issue=12 |pages=PD03–4 |year=2014 |pmid=25654000 |pmc=4316306 |doi=10.7860/JCDR/2014/10271.5293 |url=}}</ref> | |||
[[Prenatal]] testing consists of direct isolation of the [[virus]], [[viral]] [[nucleic acid]] quantification or detection of [[antibodies]] against [[rubella]] in [[fetal]] [[blood]] via various invasive techniques, such as [[amniocentesis]], [[fetal]] [[blood]] sampling and [[Chorionic villus sampling|chorionic villi sampling]].<ref name="pmid16580940">{{cite journal |vauthors=De Santis M, Cavaliere AF, Straface G, Caruso A |title=Rubella infection in pregnancy |journal=Reprod. Toxicol. |volume=21 |issue=4 |pages=390–8 |year=2006 |pmid=16580940 |doi=10.1016/j.reprotox.2005.01.014 |url=}}</ref><ref name="pmid2857319">{{cite journal |vauthors=Morgan-Capner P, Hodgson J, Hambling MH, Dulake C, Coleman TJ, Boswell PA, Watkins RP, Booth J, Stern H, Best JM |title=Detection of rubella-specific IgM in subclinical rubella reinfection in pregnancy |journal=Lancet |volume=1 |issue=8423 |pages=244–6 |year=1985 |pmid=2857319 |doi= |url=}}</ref><ref name="pmid3351485">{{cite journal |vauthors=Ho-Terry L, Terry GM, Londesborough P, Rees KR, Wielaard F, Denissen A |title=Diagnosis of fetal rubella infection by nucleic acid hybridization |journal=J. Med. Virol. |volume=24 |issue=2 |pages=175–82 |year=1988 |pmid=3351485 |doi= |url=}}</ref><ref name="pmid3083942">{{cite journal |vauthors=Terry GM, Ho-Terry L, Warren RC, Rodeck CH, Cohen A, Rees KR |title=First trimester prenatal diagnosis of congenital rubella: a laboratory investigation |journal=Br Med J (Clin Res Ed) |volume=292 |issue=6525 |pages=930–3 |year=1986 |pmid=3083942 |pmc=1339854 |doi= |url=}}</ref><ref name="pmid8034496">{{cite journal |vauthors=Valente P, Sever JL |title=In utero diagnosis of congenital infections by direct fetal sampling |journal=Isr. J. Med. Sci. |volume=30 |issue=5-6 |pages=414–20 |year=1994 |pmid=8034496 |doi= |url=}}</ref> Postnatal testing consists of isolation of the [[virus]] from [[throat]] or [[urine]] cultures<ref name="CDC"> Center for Disease Control and Prevention https://www.cdc.gov/vaccines/pubs/surv-manual/chpt15-crs.html. Accessed on Jan 16, 2017.</ref> and detection of [[serology]] ([[IgG]] or [[IgM]] [[antibodies]] against [[rubella]]).<ref name="pmid16580940">{{cite journal |vauthors=De Santis M, Cavaliere AF, Straface G, Caruso A |title=Rubella infection in pregnancy |journal=Reprod. Toxicol. |volume=21 |issue=4 |pages=390–8 |year=2006 |pmid=16580940 |doi=10.1016/j.reprotox.2005.01.014 |url=}}</ref><ref name="pmid7615708">{{cite journal |vauthors=Bosma TJ, Corbett KM, O'Shea S, Banatvala JE, Best JM |title=PCR for detection of rubella virus RNA in clinical samples |journal=J. Clin. Microbiol. |volume=33 |issue=5 |pages=1075–9 |year=1995 |pmid=7615708 |pmc=228107 |doi= |url=}}</ref><ref name="pmid15135741">{{cite journal |vauthors=Tipples GA, Hamkar R, Mohktari-Azad T, Gray M, Ball J, Head C, Ratnam S |title=Evaluation of rubella IgM enzyme immunoassays |journal=J. Clin. Virol. |volume=30 |issue=3 |pages=233–8 |year=2004 |pmid=15135741 |doi=10.1016/j.jcv.2003.11.006 |url=}}</ref><ref name="pmid11057968">{{cite journal |vauthors=Andrews N, Pebody RG, Berbers G, Blondeau C, Crovari P, Davidkin I, Farrington P, Fievet-Groyne F, Gabutti G, Gerike E, Giordano C, Hesketh L, Marzec T, Morgan-Capner P, Osborne K, Pleisner AM, Raux M, Tischer A, Ruden U, Valle M, Miller E |title=The European Sero-Epidemiology Network: standardizing the enzyme immunoassay results for measles, mumps and rubella |journal=Epidemiol. Infect. |volume=125 |issue=1 |pages=127–41 |year=2000 |pmid=11057968 |pmc=2869578 |doi= |url=}}</ref><ref name="pmid8576339">{{cite journal |vauthors=Bosma TJ, Corbett KM, Eckstein MB, O'Shea S, Vijayalakshmi P, Banatvala JE, Morton K, Best JM |title=Use of PCR for prenatal and postnatal diagnosis of congenital rubella |journal=J. Clin. Microbiol. |volume=33 |issue=11 |pages=2881–7 |year=1995 |pmid=8576339 |pmc=228600 |doi= |url=}}</ref><ref name="pmid12130613">{{cite journal |vauthors=Best JM, O'Shea S, Tipples G, Davies N, Al-Khusaiby SM, Krause A, Hesketh LM, Jin L, Enders G |title=Interpretation of rubella serology in pregnancy--pitfalls and problems |journal=BMJ |volume=325 |issue=7356 |pages=147–8 |year=2002 |pmid=12130613 |pmc=1123673 |doi= |url=}}</ref> Other laboratory findings in [[infants]] with congenital rubella syndrome include [[thrombocytopenia]] and elevated levels of [[PT]], [[Partial thromboplastin time|PTT]] and [[bilirubin]].<ref name="pmid25654000">{{cite journal |vauthors=Ajij M, Nangia S, Dubey BS |title=Congenital rubella syndrome with blueberry muffin lesions and extensive metaphysitis |journal=J Clin Diagn Res |volume=8 |issue=12 |pages=PD03–4 |year=2014 |pmid=25654000 |pmc=4316306 |doi=10.7860/JCDR/2014/10271.5293 |url=}}</ref> | |||
== Laboratory Findings == | == Laboratory Findings == | ||
Revision as of 15:30, 11 April 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]
Overview
Prenatal testing consists of direct isolation of the virus, viral nucleic acid quantification or detection of antibodies against rubella in fetal blood via various invasive techniques, such as amniocentesis, fetal blood sampling, and chorionic villi sampling.[1][2][3][4][5] Postnatal testing consists of isolation of the virus from throat or urine cultures[6] and detection of serology (IgG or IgM antibodies against rubella).[1][7][8][9][10][11] Other laboratory findings in infants with congenital rubella syndrome include thrombocytopenia and elevated levels of PT, PTT, and bilirubin.[12]
Laboratory Findings
Prenatal Testing
Invasive Techniques
Several invasive techniques can be done during pregnancy, depending on the gestational age. These techniques include:[1][2][3][4][5]
| Technique | Timing/ Gestational age at which it is performed | Results | Complications |
|---|---|---|---|
| Amniocentesis | after 15 weeks |
|
|
| Fetal blood sampling | after 18-20 weeks | ||
| Chorionic villus sampling | after 11 weeks |
Post-natal Serologic Testing
Isolation of Virus
Rubella virus can be detected from nasal, throat, urine, and blood specimens from infants with CRS.[6]
Serological Testing
Several serological investigations can be done to confirm CRS. These include detection of IgM or IgG antibodies or IgG avidity. Several methods can be used, which include ELISA, hemagglutinin inhibition (HI) and immunofluorescent antibody assay (IFA).[1][7][8][9][10][11]
Other Laboratory Findings
Other laboratory findings in infants with CRS include:[12]
- Thrombocytopenia
- Elevated PT and PTT
- Elevated levels of bilirubin
References
- ↑ 1.0 1.1 1.2 1.3 De Santis M, Cavaliere AF, Straface G, Caruso A (2006). "Rubella infection in pregnancy". Reprod. Toxicol. 21 (4): 390–8. doi:10.1016/j.reprotox.2005.01.014. PMID 16580940.
- ↑ 2.0 2.1 Morgan-Capner P, Hodgson J, Hambling MH, Dulake C, Coleman TJ, Boswell PA, Watkins RP, Booth J, Stern H, Best JM (1985). "Detection of rubella-specific IgM in subclinical rubella reinfection in pregnancy". Lancet. 1 (8423): 244–6. PMID 2857319.
- ↑ 3.0 3.1 Ho-Terry L, Terry GM, Londesborough P, Rees KR, Wielaard F, Denissen A (1988). "Diagnosis of fetal rubella infection by nucleic acid hybridization". J. Med. Virol. 24 (2): 175–82. PMID 3351485.
- ↑ 4.0 4.1 Terry GM, Ho-Terry L, Warren RC, Rodeck CH, Cohen A, Rees KR (1986). "First trimester prenatal diagnosis of congenital rubella: a laboratory investigation". Br Med J (Clin Res Ed). 292 (6525): 930–3. PMC 1339854. PMID 3083942.
- ↑ 5.0 5.1 Valente P, Sever JL (1994). "In utero diagnosis of congenital infections by direct fetal sampling". Isr. J. Med. Sci. 30 (5–6): 414–20. PMID 8034496.
- ↑ 6.0 6.1 Center for Disease Control and Prevention https://www.cdc.gov/vaccines/pubs/surv-manual/chpt15-crs.html. Accessed on Jan 16, 2017.
- ↑ 7.0 7.1 Bosma TJ, Corbett KM, O'Shea S, Banatvala JE, Best JM (1995). "PCR for detection of rubella virus RNA in clinical samples". J. Clin. Microbiol. 33 (5): 1075–9. PMC 228107. PMID 7615708.
- ↑ 8.0 8.1 Tipples GA, Hamkar R, Mohktari-Azad T, Gray M, Ball J, Head C, Ratnam S (2004). "Evaluation of rubella IgM enzyme immunoassays". J. Clin. Virol. 30 (3): 233–8. doi:10.1016/j.jcv.2003.11.006. PMID 15135741.
- ↑ 9.0 9.1 Andrews N, Pebody RG, Berbers G, Blondeau C, Crovari P, Davidkin I, Farrington P, Fievet-Groyne F, Gabutti G, Gerike E, Giordano C, Hesketh L, Marzec T, Morgan-Capner P, Osborne K, Pleisner AM, Raux M, Tischer A, Ruden U, Valle M, Miller E (2000). "The European Sero-Epidemiology Network: standardizing the enzyme immunoassay results for measles, mumps and rubella". Epidemiol. Infect. 125 (1): 127–41. PMC 2869578. PMID 11057968.
- ↑ 10.0 10.1 Bosma TJ, Corbett KM, Eckstein MB, O'Shea S, Vijayalakshmi P, Banatvala JE, Morton K, Best JM (1995). "Use of PCR for prenatal and postnatal diagnosis of congenital rubella". J. Clin. Microbiol. 33 (11): 2881–7. PMC 228600. PMID 8576339.
- ↑ 11.0 11.1 Best JM, O'Shea S, Tipples G, Davies N, Al-Khusaiby SM, Krause A, Hesketh LM, Jin L, Enders G (2002). "Interpretation of rubella serology in pregnancy--pitfalls and problems". BMJ. 325 (7356): 147–8. PMC 1123673. PMID 12130613.
- ↑ 12.0 12.1 Ajij M, Nangia S, Dubey BS (2014). "Congenital rubella syndrome with blueberry muffin lesions and extensive metaphysitis". J Clin Diagn Res. 8 (12): PD03–4. doi:10.7860/JCDR/2014/10271.5293. PMC 4316306. PMID 25654000.