Viruses cause most pediatric infections. Mixed viral or viral-bacterial infections of the respiratory and intestinal tracts are common, as is prolonged asymptomatic shedding of many viruses in childhood, especially in young children. Thus, the detection of a virus is not always proof that it is the cause of a given illness. Viruses are often a predisposing factor for bacterial respiratory infections (eg, otitis, sinusitis, and pneumonia).
Many respiratory viruses and herpesviruses can now be detected within 24–48 hours by combining culture and monoclonal antibody techniques (“rapid culture technique”) or through antigen or nucleic acid detection techniques. Polymerase chain reaction (PCR) amplification of viral genes has led to detection of previously unrecognized infections. It is now possible to detect multiple organisms causing the same syndrome within a single test system (multiplex assay). Such assays are available for respiratory infections, gastroenteritis, and encephalitis/meningitis. The available tests vary in format, turnaround time, and can be limited to viral, bacterial, or both etiologies. The optimal use of this approach, and potential pitfalls, is under intense study. New diagnostic tests have changed some basic concepts about viral diseases and made diagnosis of viral infections both more certain and more complex. Only laboratories with excellent quality-control procedures should be used. The availability of specific antiviral agents increases the value of early diagnosis for some serious viral infections. Table 40–1 lists diagnostic tests. The viral diagnostic laboratory should be contacted for details regarding specimen collection, handling, and shipping. Table 40–2 lists common causes of red rashes in children that should be considered in the differential diagnosis of certain viral illnesses.
Table 40–1.Diagnostic tests for viral infections. ||Download (.pdf) Table 40–1. Diagnostic tests for viral infections.
|Agent ||Rapid Antigen Detection (Specimen) ||Tissue Culture Mean Days to Positive (Range) ||Serology ||PCR ||Comments |
|Acute ||Paired |
|Adenovirus ||+ (Respiratory, eye, and enteric) ||10 (1–21) ||– ||+ ||+ ||“Enteric” strains detected by culture on special cell line, antigen detection, or PCR |
|Arboviruses ||– ||– ||+ ||+ ||+ ||Acute serum (IgM) may diagnose many forms; these may be negative by Day 7. May cross-react with other prior arbovirus infections; confirm by neutralization |
|Astrovirus ||+ RL ||– ||– ||– ||+ RL ||Diagnosis by electron microscopy |
|Calicivirus (norovirus) ||RL ||– ||– ||– ||+ ||PCR generally available for norovirus; present in RL for others |
|Chikungunya virus ||– ||– ||+ ||+ ||+ || |
|Colorado tick virus ||On RBC ||– ||– ||RL, CDC ||+ ||IgM may be positive as late as 2–3 weeks |
|Coronavirus ||– ||RL ||– ||+ ||+ || |
|Cytomegalovirus ||+ (tissue, urine, blood, respiratory secretions, saliva) ||2 (2–28) ||+ ||+ ||+ ||Diagnosis by presence of IgM antibody; rapid culture or PCR; low avidity antibody indicates recent infection |
|Dengue virus ||+ (Days 1–6) ||5 (RL) ||+ ||+ ||+ (Days 1–5) ||Serologic testing may cross-react with Zika and yellow fever viruses, so PCR or NS1 antigen detection during acute disease is preferred |