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There are five approaches to the diagnosis of viral diseases by the use of clinical specimens: (1) identification of the virus in cell culture, (2) microscopic identification directly in the specimen, (3) serologic procedures to detect a rise in antibody titer or the presence of IgM antibody, (4) detection of viral antigens in blood or body fluids, and (5) detection of viral nucleic acids in blood or the patient’s cells.


The growth of viruses requires cell cultures because viruses replicate only in living cells, not on cell-free media the way most bacteria can. Because many viruses are inactivated at room temperature, it is important to inoculate the specimen into the cell culture as soon as possible; brief transport or storage at 4°C is acceptable.

Virus growth in cell culture frequently produces a characteristic cytopathic effect (CPE) that can provide a presumptive identification. CPE is a change in the appearance of the virus-infected cells. This change can be in such features as size, shape, and the fusion of cells to form multinucleated giant cells (syncytia). CPE is usually a manifestation of virus-infected cells that are dying or dead. The time taken for the CPE to appear and the type of cell in which the virus produces the CPE are important clues in the presumptive identification.

If the virus does not produce a CPE, its presence can be detected by several other techniques:

  1. Hemadsorption (i.e., attachment of erythrocytes to the surface of virus-infected cells). This technique is limited to viruses with a hemagglutinin protein on their envelope, such as mumps, parainfluenza, and influenza viruses.

  2. Interference with the formation of a CPE by a second virus. For example, rubella virus, which does not cause a CPE, can be detected by interference with the formation of a CPE by certain enteroviruses, such as echovirus or Coxsackie virus.

  3. A decrease in acid production by infected, dying cells. This can be detected visually by a color change in the phenol red (a pH indicator) in the culture medium. The indicator remains red (alkaline) in the presence of virus-infected cells but turns yellow in the presence of metabolizing normal cells as a result of the acid produced. This technique can be used to detect certain enteroviruses.

A definitive identification of the virus grown in cell culture is made by using known antibody in one of several tests. Complement fixation, hemagglutination inhibition, and neutralization of the CPE are the most frequently used tests. Other procedures such as fluorescent antibody, radioimmunoassay, enzyme-linked immunosorbent assay (ELISA), and immunoelectron microscopy are also used in special instances. A brief description of these tests follows. They are described in more detail in the section on immunology.

Complement Fixation

If the antigen (the unknown virus in the culture fluid) and the known antibody are homologous, ...

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