ABSTRACT
Although the current emphasis in clinical virology is on the direct identification of viruses using antigen- or nucleic acid–based assays, antibody detection continues to play a significant role in the diagnosis and management of many viral diseases. This is particularly true for human immunodeficiency virus types 1 and 2 (HIV-1 and -2), the hepatitis viruses A–E, the herpesviruses, measles, mumps, and rubella viruses, parvovirus B19, the arboviruses, and HTLV-I and -II. The performance of viral serologies is useful in the diagnosis of recent or chronic viral infections, for determining the immune status of a person or population to a specific virus, and to verify the immune response to vaccination (Table 1). Rapid determination of immune status in a hospital setting may aid in the prevention of unnecessary spread of certain viruses to nonimmune patients or healthcare workers. Screening for virus-specific antibodies in blood products and organ donors and recipients prior to transplantation is important in preventing transmission of blood-borne viruses to individuals at high risk for severe disease. Knowing the serostatus of the donor and recipient is also helpful in determining the treatment or prophylaxis to be used following transplantation and in considering the type of donor and blood products to be given. Prenatal antibody screening can supply useful information on the risk for contracting certain viral infections during pregnancy. Identification of virus-specific antibodies in a patient’s serum may also be the only means of making a viral diagnosis under certain circumstances. A number of viruses are difficult to grow in culture or to detect by other methods. Proper specimens for culture or direct detection assays may be difficult to obtain or may not be obtained. Specimens may also be collected too late in the course of the disease to detect viruses directly. The identified virus may also have an uncertain role in the current disease process, and serology may assist in establishing a causal relationship. Utility of Serological Determinations in Clinical Virology https://www.niso.org/standards/z39-96/ns/oasis-exchange/table">
Clinical application
Most common virus(es)
Diagnosis of recent or chronic infections
Hepatitis
HAV-HEV and HGV, CMV, EBV, HSV, VZV, HIV, coxsackievirus B, adenovirus, yellow fever virus
Central nervous system
HSV, CMV, VZV, EBV, HHV-6, enteroviruses, arboviruses, measles virus, mumps virus, rubella virus, rabies virus, HIV, LCMV
Congenital or perinatal
CMV, HSV, VZV, rubella virus, parvovirus B19, HBV, HCV, LCMV
Exanthems
Measles virus, rubella virus, parvovirus B19, HHV-6, HHV-7, arboviruses
Myocarditis or pericarditis
Coxsackievirus B types 1–5, influenza virus types A and B, CMV, parvovirus B19
Infectious mononucleosis
Heterophile antibody positive
EBV
Heterophile antibody negative a
EBV, CMV, HIV, rubella virus
Nonspecific febrile illness
CMV, EBV, HHV-6, HHV-7, parvovirus B19, HIV, dengue virus, Colorado tick fever virus
T-cell leukemia
HTLV-I and HTLV-II
Hemorrhagic fever
Filoviruses, arenaviruses, flaviviruses, bunyaviruses
Hantavirus pulmonary syndrome
Sin nombre virus, other hantaviruses
Sudden acute respiratory syndrome
SARS coronavirus
Screening for immune status
Preemployment
VZV, measles virus, mumps virus, rubella virus, HBV
Prenatal
Rubella virus, CMV, HSV, VZV, parvovirus B19, HBV, HCV, HIV
Pretransplant
CMV, HSV, EBV, VZV, HBV, HCV, HIV
Blood donation
HIV, HBV, HCV, HTLV-I, HTLV-II
Postexposure
HIV, HAV, HBV, HCV, VZV
Epidemiology/surveillance
All viruses
Verify response to vaccination
HAV, HBV, VZV, measles virus, mumps virus, rubella virus
A comprehensive panel of EBV-specific serologic tests should be performed for patients with heterophile-negative infectious mononucleosis.
Abbreviations: CMV, cytomegalovirus; EBV, Epstein–Barr virus; HSV, herpes simplex virus; VZV, varicella-zoster virus; HIV, human immunodeficiency virus; LCMV, lymphocytic choriomeningitis virus; HAV, hepatitis A virus; HBV, hepatitis B virus; HCV, hepatitis C virus; HEV, hepatitis E virus; HGV, hepatitis G virus; HHV-6, human herpesvirus 6; HHV-7, human herpesvirus 7; HTLV, human T-cell lymphocytic virus.