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<< Ebola Virus Disease: Epidemiology, Clinical Presentation, and Diagnostic and Therapeutic Modalities (Pharmacology CME)

Diagnostic Studies

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Diagnostic Studies

Diagnostic Studies

The overlapping presentations of EVD and a number of other illnesses make diagnostic testing necessary for disease confirmation. Available methods for diagnosis include RT-PCR, viral antigen detection by enzyme-linked immunosorbent assay (ELISA), detection of IgM and IgG by ELISA, viral culture, and immunohistochemical staining.49,50 Currently, RT-PCR is recommended for the diagnosis of EVD and should be performed on samples from patients with signs and symptoms consistent with EVD and at least 1 risk factor. In the acute phase of illness, RT-PCR has a sensitivity of 100% and a specificity of 97% for the diagnosis of EVD. When RT-PCR is considered the gold standard, antigen and IgM detection have reported sensitivities of 83% and 67%, respectively. Both methods have reported specificities of 100%.49

Emergency clinicians should be aware that RT-PCR may give false-negative results if performed within the first 72 hours of illness, but is generally positive during the 3 to 14 days after the onset of symptoms. Viral antigen may be detected by ELISA as early as 4 days after the onset of symptoms. Viral antigen becomes negative before RT-PCR, often by the second week of illness. Serology (detection of IgM and IgG) may be positive later in the disease course or during recovery, but is generally not helpful in the initial phases of EVD when a definitive diagnosis is needed. IgM can be detected 8 to 30 days after the onset of symptoms, with a peak in the second week, while IgG is not detected until the third week of illness. Cell culture and immunohistochemistry can be performed on tissue from deceased patients; however, these techniques are not very helpful for clinical decision-making.51

As shown in Table 4, there are a number of additional laboratory studies that can be suggestive of EVD in the appropriate clinical context. Electrolyte abnormalities are due to gastrointestinal losses and may be severe. A calcium level < 6 mg/dL may be a poor prognostic indicator.52

Table 4_ Laboratory Abnormalities In Ebola Virus Disease

 
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Publication Information
Authors

Marlie Dulaurier, MD;Katherine Moyer, DO;Rebecca Wallihan, MD

Publication Date

July 2, 2016

CME Expiration Date

August 2, 2019

CME Credits

4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits.
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 0.5 Pharmacology CME credits

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CME Information

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