LABORATORY DIAGNOSIS

Jane Colmer-Hamood, PhD

Session 66
POPS Case Studies
 RESPONDERS
• CASE 1 – Groups K-L-M-N-O

• CASE 2 – Groups A-B-C-D-E

• CASE 3 – Groups F-G-H-I-J

 CASE 1
• A 7-year-old boy attending summer camp
complains of sore throat, headache, cough,
red eyes, and tiredness.
• He is sent to the infirmary where it is noted
that his temperature is 103°F and that his
throat is intensely red, as are his eyes,
which are also hyperemic
(pharyngoconjunctivitis).
• More than 40% of the children and staff at
the camp complain of the same symptoms.
• Cell lines that support the growth of this
virus and monoclonal antibodies that detect
 CASE 1
• 1. What type of tests could you do to
determine what virus is causing this
infection? A. Direct FA  
B. ELISA
C. Culture
D. All of the
above
E. None of the
above
 CASE 1
• 2. Would it really be necessary to
diagnose the specific etiologic agent of
this child's infection?
– A. Yes, because his illness is related to a
localized outbreak  
– B. Yes, because it is always necessary to
diagnose viral infections
– C. No, because you can diagnose the
infection clinically
– D. No, because he will be well before the
test results come back
 CASE 1
• 3. Which of the tests would take the
longest?

– A. Direct FA (about 2½ hours from start

of test)
– B. ELISA (about 2 hours from start of
test)
– C. Culture (a minimum of 3 days from
start of culture; possibly 10 days)
– D. All take the same amount of time  
 CASE 2
• It has been shown that specific types
of human papilloma virus have been
associated with cervical cancer.
However, early lesions caused by the
different types of HPV look similar. In
fact, specific intracellular changes
called koilocytosis have been found
to be pathognomic for this virus.
 CASE 2
• 4. If you want to screen a patient to
determine if she might have the HPV
virus, which of the following would be
best?
Koilocyt
es
A. Examination of cells for
koilocytes
B. RT-PCR for viral RNA  
C. ELISA
D. Serology for antibodies
against HPV
 CASE 2
• Your examination shows the presence of
HPV. Two specific types of HPV (16 and 18)
are associated with progression of cervical
lesions to cancer. The types of HPV are
distinguished by unique regions in their
genomes.
• 5. How would you determine if your
patient's lesions are caused by either of
these two types of HPV?
– A. ELISA
– B. DFA
– C. in situ hybridization  
– D. Western blot  
 CASE 2
• 6. It is often not possible to eradicate
the virus from the cervix. What test
would you think would be best to
follow this patient for progression of
her lesions?
– A. Continued screening PAP smears to
look for increase in koilocytosis
– B. Annual in situ hybridization studies
– C. Annual Western blots
– D. Some other type of test
 CASE 3
• A 6-month-old infant is brought to
your office with fever, coughing,
runny nose, and severe difficulty in
breathing. Heavy mucus is present in
his respiratory tract. You suspect
infection with respiratory syncytial
virus (RSV) and decide to admit the
child for respiratory support and
antiviral treatment. However, before
you begin the treatment, you want to
 CASE 3
• 7. Which of the following types of
tests would detect specific RSV
antigens within cells of the
respiratory tract?
– A. ELISA
– B. DFA
– C. Culture
– D. Serology
 CASE 3
• The laboratory notifies you that the
infant does indeed have RSV. You begin
therapy and want to follow the progress
of the treatment.
• 8. Which of the tests would rapidly
detect virions and/or viral antigens
released from cells of the respiratory
tract?
– A. ELISA
– B. DFA
– C. Culture
 CASE 3
• RSV is considered a winter pathogen in
Lubbock, TX, occurring between late
October through March. It is August
15th and your laboratory has just called
you that the ELISA for your patient is
positive for RSV.
• 9. Which of the following tests should
you request to confirm this finding?
– A. ELISA
– B. DFA
– C. Culture
– D. Serology