Clinical Virology. Yung-Ching Liu Shuang Ho Hospital
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1 Clinical Virology Yung-Ching Liu Shuang Ho Hospital
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6 Laboratory of Virology Service since October 2016 Taipei Medical University Shuang Ho Hospital
7 Scenario 1
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13 Scenario 2
14 severe adult community-acquired pneumonia J Thorac Dis 2017;9:
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17 Three very basic questions Is my patient s illness caused by a microbe? If so, what is it? What is the susceptibility profile of the organism so therapy can be targeted?
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19 A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by IDSA and ASM CID 2018 June 28
20 Impact of Specimen Management It is the key to accurate lab diagnosis and confirmation It directly affects patient care and patient outcomes It influences therapeutic decisions It impacts hospital infection control, patient length of stay, hospital and lab costs It influences antibiotic stewardship It drives lab efficiency
21 採檢容器 病毒傳送培養基 黃蓋無菌盒 無菌試管 ( 橘蓋 ) EDTA( 紫頭管 )
22 Contents Bloodstream infections and infections of the cardiovascular system CNS infections Ocular infections Soft tissue infections of the head and neck URT bacterial and fungal infections LRTI Infections of the GI tract
23 Contents Intra-abdominal infections Bone and joint infections UTI Genital infections Skin and soft tissue infections Arthropod-borne infections Viral infections Blood and tissue parasite infections
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29 細胞培養 OR 細胞株 培養基 天數 MRC-5(M) MEM 5 HEp-2(P) MEM 3 A-549(A) F-12 5 RD cell(d) DMEM cells/ml tissue culture flask 培養 分裝 tissue culture tube (1 ml/ tube)
30 MRC-5 A549 Hep-2 RD MDCK
31 每週換一次新鮮維持培養基 MRC-5:CPE 觀察 30 天 HEp-2:CPE 觀察 天 A549: CPE 觀察 14 天 RD:CPE 觀察 天
32 Cell line MRC-5 CPE HSV ( 變圓 ) CMV( 麥穗 ) HEp-2 RSV ( 融合 ) A-549 ADV ( 網狀花邊 ) RD cell Enterovirus ( 芝麻狀 )
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36 Viral Syndromes While molecular assays offer strong lab evidence for the presence of a viral agent, serologic tests may not be as conclusive Notably, detection of IgM-class abs against a variety of viral agents may be associated with false-positive results
37 Therefore, if the pretest probability of acute infection is low to moderate, it is good practice to measure IgG abs at the time of presentation (acute phase) and 2-3 weeks later (convalescent phase) to assess for seroconversion to demonstrate a 4-fold or greater rise in ab titers
38 False-positive results may also occur in assays measuring IgG-class abs, esp. between closely related viruses (eg, flaviviruses). Additionally, maternal IgG abs readily cross the placenta and may confound lab results in neonates.
39 Finally, the possibility of false-negative serologic results must also be recognized, particularly for patients who present soon after (-7days) symptom onset or in patients who are significantly immunosuppressed.
40 It is therefore important to carefully consider all patient factors, including age, co-circulating viruses, exposure and vaccination history, immunostatus, and timing of presentation when interpreting serologic results for diagnostic purposes.
41 HIV
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43 HIV The current Association of Public Health Laboratories/CDC HIV testing algorithm no longer recommends supplemental HIV-1 antibody Western blot testing because of the subjectivity, labor intensity, and limited access of this manual assay.
44 EBV EBV is a cause of mononucleosis among immunocompetent individuals and lymphoproliferative disease in immunocompromised patients. EBV-VCA IgG, IgM EBNA, EBEA
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46 Cytomegalovirus
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50 Varicella Zoster Virus
51 Varicella Zoster Virus
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53 Herpes Simplex Virus
54 Herpes Simplex Virus
55 Herpes Simplex Virus
56 Herpes Simplex Virus
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58 Human Herpesvirus Type 6 Roseola infantum in children Reactivation in immunocompromised pt.
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60 Parvovirus (Erythrovirus) B19 Erythema infectiosum Arthralgia/arthritis Transient aplastic crisis Congenital infection and possibly fetal death (eg, hydrops fetalis)
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62 Measles (Rubeola) Virus Classic : 3C Modified/atypical SSPE (subacute sclerosing panencephalitis)
63 Measles (Rubeola) Virus
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67 Parotitis Mumps Virus
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69 Rubella Virus
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71 BK Virus Allograft nephropathy in renal transplant recipients Hemorrhagic cystitis in bone marrow transplant patients
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73 JC Virus PML ( progressive multifocal leukoencephalopathy )in immunocompromised hosts
74 HE-40X Inclusion-bearing infected oligodendrocytes
75 SV40-40X Infected oligodendrocytes are highlighted by SV-40
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77 Dengue Virus
78 皮疹變化 融合性紅色丘疹 登革熱皮疹 皮下點狀出血
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80 Hepatitis A and E Viruses
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82 Hepatitis B and D Viruses
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84 Hepatitis C Virus
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86 Enterovirus and Parechovirus
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88 Respiratory Syncytial Virus Bronchiolitis and/or pneumonia in infants and young children Respiratory illness in adults
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90 Influenza A and B Viruses
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92 Adenovirus
93 2012/10/06
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95 Rabies
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97 Zika Virus
98 Zika and birth defects Microcephaly Dr. Vanessa Van Der Linden
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101 Human Coronavirus Alphacoronavirus (229E and NL63) Betacoronavirus, lineage A (OC43 and HKU1) lineage B (SARS coronavirus) lineage C (MERS coronavirus) NAAT
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103 Thanks
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