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  IMMUNITY PROFILES- INFECTIONS SCREENINGS
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MEASLES - MUMPS - RUBELLA
MEASLES & MUMPS
Measles and mumps tests are primarily used to confirm that a person is immune to the viruses due to previous infections or vaccination. Doctors most frequently diagnose current measles and mumps infections based upon characteristic clinical findings. Testing may sometimes be performed to confirm a diagnosis of an active or recent infection, especially if typical symptoms are not present. It may also be ordered along with other tests to distinguish between different causes of complications, such as an investigation of meningitis or swelling of the salivary glands found below and in front of the ear (parotitis) that may also be caused by bacterial infections.
There are several methods of detecting a measles or mumps infection:

Antibody testing
Measles and mumps antibodies are virus-specific proteins produced by the immune system in response to an infection by the measles or mumps virus, or in response to vaccination. There are two types of antibodies produced, IgM and IgG. The first type to appear in the blood after exposure or vaccination is IgM antibodies. Levels of IgM antibodies increase for several days to a maximum concentration and then begin to taper off over the next few weeks. IgG antibodies take a bit longer to appear, but once they do, they stay in the bloodstream for life, providing protection against re-infection.

Viral detection
Viral detection involves finding the mumps or measles virus in a body fluid sample. This can be done either by culturing the virus or by detecting the virus's genetic material. Viral culture is the traditional method of virus detection and is considered the "gold standard" for diagnosing mumps or measles.

Viral detection testing may occasionally be performed to identify the cause of severe complications that may be associated with an infection from one of these viruses. Since patients with compromised immune systems may not have a typical antibody response, a viral culture or a test to detect viral genetic material may be performed to confirm the diagnosis of a mumps or measles infection, especially if antibody results do not match clinical findings or a doctor's suspicions.

Measles or mumps IgM and IgG antibody tests and/or acute and convalescent IgG antibody testing may be ordered when a doctor suspects that a person has a current or recent measles or mumps infection. An IgG antibody test for measles or mumps may be ordered whenever a doctor wants to determine whether a person is immune to one or both of the viruses, either because of a previous infection or due to vaccination.


RUBELLA
To determine if you have sufficient rubella antibodies to protect you from the rubella virus; to verify a past infection or detect a recent infection.
Prior to or at the beginning of a pregnancy to verify immunity; if a pregnant woman has symptoms of rubella, such as fever and rash; if a newborn shows signs of abnormal development or birth defects that may be caused by an in utero infection; if there is need to verify a recent rubella infection or to verify immunity.
This test measures the presence of rubella antibodies in the blood. Rubella antibodies are produced in response to an infection by the rubella virus. There are two types of rubella antibodies: IgM and IgG. The first type to appear in the blood after exposure is the IgM rubella antibody. The level of this protein in the blood rises and peaks within about 7 to 10 days after infection and then tapers off over the next few weeks, except in an infected newborn, where it may be detected for several months to a year. The IgG rubella antibody takes a bit longer to appear than the IgM, but once it does, it stays in the bloodstream for life, providing protection against re-infection. The presence of IgM rubella antibodies in the blood can indicate a recent infection while the presence of IgG antibodies may indicate a recent or past rubella infection or that a rubella vaccine (a measles, mumps, rubella vaccine) has been given and is providing adequate protection.
The rubella virus generally causes a mild infection marked by a fine red rash that appears on the face and neck and then travels to the trunk and limbs before disappearing a few days later. The virus is passed through nasal and throat secretions and can cause symptoms such as fever, enlarged lymph nodes, runny nose, red eyes, and joint pain. Symptoms may be so minimal, especially in children, that they are not perceived as being from a viral illness. In most patients, rubella goes away within a couple of days without any special medical treatment and causes no further health issues. The primary concern with rubella infection is when a pregnant woman contracts it for the first time during the first three months of her pregnancy. The developing fetus is the most vulnerable to the virus at this time and, if it is passed on to the fetus by the mother, it can cause miscarriage, stillbirth, and/or congenital rubella syndrome (CRS), a group of serious birth defects that will permanently affect the child. CRS can cause delayed development, mental retardation, deafness, cataracts, an abnormally small head, liver problems, and heart defects.

Because of the severe consequences for developing fetuses, a national campaign was started in 1969 to immunize all children in the United States and to work to eradicate rubella infection, first in the U.S. and then throughout the world. Prior to this time, rubella infections would emerge as cyclic outbreaks that lasted for several years. According to the Centers for Disease Control and Prevention (CDC), during the 1962-1965 rubella epidemic, 12.5 million cases of rubella occurred in the United States and there were 20,000 infants that were born with CRS. Due to vaccination efforts, these numbers have decreased drastically. In 2006, there were only 11 cases of rubella recorded in the United States and about half of the cases occurred in people who were born outside the U.S. (in countries without widespread vaccination programs). Each year since 2001, there have been fewer than 25 cases reported. The CDC now declares endemic rubella to be eradicated in the U.S., although the incidence continues to be monitored. People should not become complacent with this reduction, however, and the CDC cautions people to continue to have their children vaccinated. Anyone who has not received the vaccination as a child (and a few that have) may still be vulnerable to rubella infection.

How is the sample collected for testing?
A blood sample is drawn from a vein in the arm of an adult or from a heelprick or the umbilical cord of a newborn.verify that all pregnant women and those planning to become pregnant have a sufficient amount (titer) of rubella antibodies to protect them from infection
Both the IgM and IgG antibody tests may be ordered on a person, pregnant or not, who has symptoms that the doctor suspects are due to a rubella infection. They may also be ordered on a newborn that is suspected to have become infected during pregnancy or that presents with congenital birth defects that the doctor suspects may be due to a rubella infection.

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VARICELLA ZOOSTER VIRUS
VZV antibody tests may be ordered to check immune status and/or to identify a recent infection. VZV culture or DNA tests may be ordered when a newborn or immune-compromised person has been exposed to VZV and is ill with atypical and/or severe symptoms – to detect an active primary VZV infection in the baby or a primary or reactivated infection in the immune-compromised person.
Varicella zoster virus (VZV) causes the illness known as chickenpox. Although most (85% to 90%) of pregnant women have already been exposed to the virus and therefore are immune, some may not have had the infection. Since the virus can cause birth defects or illness in the baby (depending on when during the pregnancy an infection occurs), testing is available before or in early pregnancy to determine if the woman has antibodies to VZV. If she doesn’t and is therefore not immune, a vaccine can be given before the woman gets pregnant. If she is already pregnant and may have been exposed to the virus, treatment is available that can prevent or weaken the severity of the illness.
Active cases of chickenpox and shingles, which are caused by the varicella zoster virus (VZV), are usually diagnosed based upon the person’s symptoms and clinical presentation. Most adults have been infected with VZV, and children are now vaccinated; therefore, general population screening is not done. However, testing for VZV or for the antibodies produced in response to VZV infection may be performed in certain cases. For example, it may sometimes be performed in pregnant women, in newborns, in patients prior to organ transplantation, and in those with HIV/AIDS. The goals for testing may include:
to determine if someone has been previously exposed to VZV either through past infection or vaccination and has developed immunity to the disease
to distinguish between an active or prior infection
to determine whether someone with severe or atypical symptoms has an active VZV infection or has another condition with similar symptoms
There are several methods of testing for VZV:

Antibody testing
When you are exposed to VZV, your immune system responds by producing antibodies to the virus. Two types of VZV antibodies may be found in the blood: IgM and IgG. IgM antibodies are the first to be produced by the body in response to a VZV infection. They are present in most individuals within a week or two after the initial exposure. IgM antibody production rises for a short time period and declines. Eventually, the level (titer) of VZV IgM antibody usually falls below detectable levels. Additional IgM may be produced when latent VZV is reactivated. IgG antibodies are produced by the body several weeks after the initial VZV infection to provide long-term protection. Levels of IgG rise during the active infection, then stabilize as the VZV infection resolves and the virus becomes inactive. Once a person has been exposed to VZV, they will have some measurable amount of VZV IgG antibody in their blood for the rest of their life. VZV IgG antibody testing can be used, along with IgM testing, to help confirm the presence of a recent or previous VZV infection.

Viral detection
Viral detection involves finding VZV in a blood, fluid, or tissue sample. This can be done either by culturing the virus or by detecting the virus’s genetic material (VZV DNA).

VZV culture—a sample of fluid is collected from a vesicle (the most common sample). It is incubated in a culture of live cells and nutrients to grow and isolate the virus. This test is sensitive and specific, but it takes 2 or more days to complete. Fresh lesions are the best for this test. Viral shedding decreases over time and can lead to a false negative result.
VZV DNA testing–performed to detect VZV genetic material in a patient sample. This method is sensitive. It can identify and quantitate the virus.
Direct Fluorescent Antibody (DFA) – this test visualizes the presence of VZV in the cells taken from the patient’s skin lesion using a special microscope and labeled antibody. It is rapid, but less specific and sensitive than the VZV culture and DNA testing.
The choice of tests and samples collected depends on the patient, their symptoms, and on the doctor’s clinical findings.

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MONO SCREEN      

 
The mono test is used to help determine whether a patient has infectious mononucleosis. It is frequently ordered along with a CBC (complete blood count). The CBC is used to determine whether the number of white blood cells (WBCs) is elevated and whether a significant number of reactive lymphocytes (a type of WBC) is present. A strep test may be ordered with the mono test to determine whether a person’s sore throat is due to a streptococcal infection instead of or in addition to mononucleosis.

Approximately 10% of mononucleosis syndromes have a mono test which is initially negative. If you still suspect mono, you may order a repeat test in a week or so to see if heterophile antibodies have developed and/or order EBV antibodies to help confirm or rule out the presence of a current EBV infection.

The heterophile antibodies is a human antibody that can attach to (agglutinate) the red blood cells of different animals. The mono test uses an antigen derived from the red blood cells of horses. The mixture of this test material with patient blood causes a clumping reaction if the patient has mononucleosis.

The mono test is primarily ordered when an adolescent patient has symptoms such as fever, headache, swollen glands, and fatigue that the doctor suspects are due to infectious mononucleosis. The test may be repeated when it is initially negative but suspicion of mono remains high.

If you have a positive mono test, an increased number of white blood cells, reactive lymphocytes, and symptoms of mononucleosis, then they will be diagnosed with infectious mononucleosis. If symptoms and reactive lymphocytes are present but the mono test is negative, then it may be too early to detect the heterophile antibodies or the affected patient may be in the small number of people who do not make heterophile antibodies. Other EBV antibodies and/or a repeat mono test may be performed to help confirm or rule out the mononucleosis diagnosis.

Most infants and young children will not make heterophile antibodies, so they will have negative mono tests even when infected with EBV. This population is rarely tested, however, because they do not usually have symptoms of infectious mononucleosis.

Patients with negative mono tests and few or no reactive lymphocytes may be infected by another microorganism that is causing mono-like symptoms (such as a cytomegalovirus (CMV) or toxoplasmosis). If the infection occurs during pregnancy, it can be important to determine the cause, as some of the mono-like infections (but not EBV infection) have been associated with pregnancy complications and damage to the fetus. It is also important to identify strep throat, whenever present, because it should be treated promptly with antibiotics.

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EBV (Epstein Barr Virus) Antibodies           

 

EBV is a member of the herpes virus family. Passed through the saliva, the virus causes an infection that is very common. According to the National Center for Infectious Diseases (NCID), as many as 95% of people in the United States will have been infected by EBV by the time they are 40 years old. After exposure to the virus, there is an incubation period of several weeks. EBV then causes an acute infection, followed by resolution and dormancy. Latent EBV remains in the patient’s body for the rest of his life, reactivating intermittently, but causing few problems unless the patient’s immune system is significantly compromised.

Most people are infected by EBV in childhood and experience few or no symptoms, even in the acute phase of the infection. However, when the initial infection is delayed until adolescence, EBV causes infectious mononucleosis (Mono) in about 35 – 50% of those infected. Mono is a condition that is associated with fatigue, fever, sore throat, swollen lymph nodes, an enlarged spleen, and, sometimes, an enlarged liver. Those who have it are usually symptomatic for a month or two before the initial infection resolves.

Patients with Mono are diagnosed by their symptoms and the findings of a complete blood count (CBC) and a Mono test (which tests for a heterophile antibody). A certain percentage of those who have mono will have a negative mono test – this is especially true with children. EBV antibodies can be used to determine whether or not the symptoms these patients are experiencing are due to a current infection with the EBV virus.

It can be important to distinguish EBV from other illnesses. For instance, the enlarged spleen of those with a Mono infection is vulnerable to rupture. Patients who have Mono should not be involved in contact sports for several weeks to months after infection, as a ruptured spleen can cause a medical emergency. Also, pregnant women with symptoms of a viral illness need to be able to distinguish a primary EBV infection (which has not been shown to affect the baby) from a cytomegalovirus (CMV), herpes simplex virus or toxoplasmosis infection, as these illnesses can cause complications during the pregnancy and damage the fetus. It can also be important to rule out EBV and to look for other causes for the symptoms. Patients with strep throat (a Group A streptococcus infection), for instance, need to be identified and treated with antibiotics. A patient may have strep throat instead of Mono, or they may have both conditions at the same time.

There are several EBV antibodies. They are proteins created by the body in an immune response to different antigens (protein parts) of the Epstein-Barr virus. They include IgM and IgG antibodies to the viral capsid antigen (VCA), IgG antibodies to the D early antigen (EA-D), and antibodies to the nuclear antigen (EBNA). During a primary EBV infection each of these EBV antibodies appears independently on its own time schedule. The VCA-IgM antibody appears first and then tends to disappear after about 4 to 6 weeks. The VCA-IgG antibody emerges, is at its maximum at 2 to 4 weeks, then drops slightly, stabilizes, and is present for life. The EA-D antibody appears during the acute infection phase and then tends to disappear within 3 to 6 months, but about 20% of those infected will continue to have detectible quantities of the EA-D antibody for several years after the EBV infection has resolved. The EBNA antibody does not usually appear until the acute infection has resolved. It usually develops about 2 to 4 months after the initial infection and then is present for life. Using a combination of these EBV antibody tests, a doctor is able to detect an EBV infection and to determine whether it is a current, recent, or past infection.

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LYME DISEASE TEST
Lyme disease tests measure Borrelia burgdorferi antibodies in the blood or in the cerebrospinal fluid (CSF) if there are signs and symptoms of central nervous system disease. These antibodies are produced by the body's immune system in response to exposure to Borrelia burgdorferi (B. burgdorferi), the bacterium that causes Lyme disease. Infected deer ticks or black-legged ticks transmit this bacterium to a person through a bite. The disease is most common in the spring and summer in the regions where these ticks live, the northeastern and western United States.
Lyme disease infection causes symptoms that may include a characteristic "bulls-eye" rash that spreads from the site of the bite, fever, chills, headache, and fatigue. If left untreated, Lyme disease may progress to cause intermittent joint pain, meningitis, facial paralysis (Bell's palsy), weakness and numbness in the arms and legs, memory problems, and may rarely affect the heart or eyes.

It takes the body some time to begin producing B. burgdorferi antibodies. B. burgdorferi IgM (immunoglobulin M) antibodies are usually detectable in the blood about two to three weeks after exposure. IgM levels increase to maximum concentrations at about six weeks and then begin to decline. IgG (immunoglobulin G) antibodies are detectable several weeks after exposure, increase to maximum levels at about four to six months, and may remain at high levels for several years.

Two tests are typically used to detect and confirm Lyme disease. The Centers for Disease Control and Prevention (CDC) recommend that an ELISA or IFA test method be used first to measure B. burgdorferi IgM and/or IgG antibodies. Since these tests may be positive with infections caused by other bacteria similar to B. burgdorferi, such as the bacterium that causes syphilis, the CDC recommends that any positive or indeterminate test results then be followed by a second test, called a Western Blot, in order to confirm the findings.


Lyme disease tests are used to determine if a person with characteristic symptoms has been infected by Borrelia burgdorferi. If the doctor suspects a recent infection, then she may order both an IgM and IgG antibody blood test. If they are negative but symptoms persist, then the tests may be ordered again a few weeks later.
Acute and convalescent samples may be used to track progression of the disease by looking for changes in the amount of antibody present. If the tests are positive, then a Western blot test is ordered to confirm the findings.

Lyme disease can sometimes be challenging to diagnose. If a person has removed a tick from his skin, had a known tick bite, and lives in or has visited an area of the country where Lyme disease is most prevalent, then the timing of the potential infection can be closely estimated. However, the tick is about the size of the head of a pin and the bite may not be noticed. Not everyone will develop the characteristic rash, and the symptoms that a person does have may be nonspecific and flu-like in the early stages, with joint pain that develops into chronic arthritis and/or with neurological symptoms that appear months later.

A blood test for antibodies to the bacterium is the preferred test for the diagnosis of Lyme disease. However, if a person has central nervous system symptoms, such as meningitis, then IgM, IgG, and Western blot testing may sometimes be performed on CSF.

Occasionally PCR (polymerase chain reaction) testing is performed on a sample because it is a more sensitive way of detecting an infection with B. burgdorferi. This method is useful in detecting the infection in samples such as fluid collected from a joint. It looks for the genetic material (DNA) of B. burgdorferi in the joint fluid (synovial fluid). This method, however has not been found to be sensitive for detecting the infection in samples of CSF.

Very rarely, a sample, such as a skin biopsy, may be cultured to grow the bacterium.

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