asmi
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What is the diagnostic test for congential CMV ?
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| TONY PAUL
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Congenital ---The most important study in the diagnostic evaluation of the congenitally infected infant with CMV is the CT scan of the head. A CT scan of the head is required for infants with microcephaly or when congenital CMV infection is suspected because abnormalities in this study, particularly the presence of calcifications, Infants with congenital CMV infection also may require abdominal imaging studies (eg, ultrasound, CT scan) for documentation and monitoring of organomegaly
2nd....
Viral culture
The most important diagnostic study in the evaluation of suspected CMV disease is the viral culture. CMV may be cultured from virtually any body fluid or organ system. Blood, urine, saliva, cervicovaginal secretions, cerebrospinal fluid.
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| usmleasr
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i think CT scan showing periventricular calcifications :?
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| asmi
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urine culture is the gold standard test .
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| Malaysian
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what will you see on culture....just the owl eyes or something else???
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| mdwannabe
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Large cells with huge nuclei. That microscopy owl eye also microscopy. How do u culture a virus?
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| bactitech
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http://www.labcorp.com/datasets/labcorp/html/chap...
Here are some specimen requirements.
Cultures consist of:
"Inoculation of specimen into cell cultures, incubation of cultures, observation for characteristic cytopathic effect, and identification by DFA [direct fluorescent antibody] or other methods."
Please also check out limitations - i.e. viruses that can't be cultured.
Here's some more information:
http://www-micro.msb.le.ac.uk/video/virus.html
http://www.mansfield.ohio-state.edu/~sabedon/biol...
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| Malaysian
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must you really culture the virus....can't you just do a microscopy??
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| bactitech
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What type of microscopy? You can't see viruses with a regular light microscope. Electron microscopy will cost more than a regular virus culture. Not sure what you can see histologically to confirm CMV - not my field. Why don't you want to culture?
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| mdwannabe
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I don't know of anybody culturing viruses in clinical med. You can, but why??? Just look for AB in serum. That will tell you about its presence and the acuteness of presentation. Just do microscopy, see the particular cellular chenges, remember which virus it most likely to be, and order specific AB titers.
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| bactitech
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Yes, that's also done quite a bit. We have a Virology laboratory, and they're quite busy. So, apparently some docs DO culture. Culturing is the gold standard. Many of the test out there lack some specificity. Some viruses cannot easily be cultured, so then you must rely on other methods.
We do a lot of STD Herpes cultures. Tzanck smears are pretty much passe. We get CSF for culture, and some respiratory specimens. All our rapid flu tests this year are going out with a caveat that a negative should be cultured. I don't have the exact wording. Our hospital is a large Level 1 trauma center. We also serve two community hospitals and a medical school. We are located in NW Ohio.
Where are you?
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| mdwannabe
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Hmmm... most of the time I personally would not culture the virus, I just don't see the advantage over doing the AB titers. The culture of the particular virus does not ulter the immediate treatment plan. Though it is possible that latter course of treatment may be affected.
Living and learning...thats what I do. Thanks. :-)
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| mdwannabe
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also...how is the culture superior to DNA amplification? should'nt that be GOLD standard?
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| bactitech
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It's not. The biggest problem with DNA testing is high cost. Most labs are too small and don't have enough volume to do it. It then becomes a sendout test with TAT ranging at a week or more. We do the work of four hospitals and just begin to have enough volume for this testing.
No lab will enter into any testing that they lose money on, believe me. The kits are so extremely expensive that they have to be used before the outdates. If they can't, and if you don't have trained people, you just don't offer the testing and you send it out. We only have a handful of people trained for this. Tech skills are highly specific. I am not one of the people. Most of our techs came when we took over the local medical school's molecular genetics laboratory. Only two of our in-house existing techs do the testing, and they've completed online and wet lab experience through a course offered by Michigan State. Nobody just goes out and finds these people on the street :-(.
We are expanding our DNA menu. We do a TON of Uriprobes now for Chlamydia and GC on a daily basis. Reimbursement apparently is very good for these according to management (that's the bottom line right now on any testing....). We also started doing Enterovirus PCR testing on CSF last year which has been extremely well received. We are the only hospital doing it locally. We have had some problems with the internal control, I guess. A couple of negatives HAVE grown Enterovirus.
So, they are not foolproof by any means. I would still say culturing is the Gold standard. PCR testing saves time, which is its primary goal. In the case of Chlamydia, it is probably superior, as this organism is extremely difficult to grow and can die in transport.
Just remember, NOTHING in micro is 100%.
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