Subacute sclerosing panencephalitis (SSPE) Diagnosis

<<Return to Laboratory

Accredited by the Standards Council of Canada to Laboratory no. 594 - CAN-P-4E (ISO/IEC 17025)

Requisition Forms

Reference Details

Description:

Measles specific antibody assay in serum and cerebrospinal fluid (CSF) to diagnose measles SSPE.

Test Category:
Serology
Pathogen:
Measles virus
Illnesses and Diseases:
  • Measles
  • Subacute sclerosing panencephalitis (SSPE)
Specimen:

Paired serum (500 µL minimum) and CSF (500 µL minimum), collected at the same time if possible (within an hour at most) with total IgG and total albumin concentrations (mg/L) determined.

Collection Method:

Collect blood in serum separator tubes (SST) or EDTA tubes and CSF in a sterile collection vial.

Specimen Processing, Storage and Shipping:

Follow standard laboratory techniques to prepare serum. Store serum and CSF at 4°C and ship on wet ice for arrival at the NML within 6 days of collection. Otherwise, freeze (-20°C or below) and ship frozen on dry ice.

 

Transportation of Dangerous Goods:

Shipping of specimens shall be done by a TDG certified individual in accordance with TDG regulations. For additional information regarding classification of specimens for the purposes of shipping, consult either Part 2 Appendix 3 of the TDG Regulations or section 3.6.2 of the IATA Dangerous Goods Regulations as applicable.

For additional guidance on the transport of infectious substances in other languages, please click on the link below.

http://www.who.int/ihr/capacity-strengthening/infectious-substances/en/

Patient Criteria:

Suspected SSPE.

Accompanying Documentation:

Completed Measles, Mumps, and Rubella requisition form including both total IgG and albumin concentrations (mg/L) in both the serum and CSF samples.

Comments:

Total IgG and total albumin concentrations (mg/L) in both serum and CSF must be determined and provided. Testing will only begin when these concentrations are provided. The NML does not test for total IgG or albumin concentration. Kits for this test are ordered on an as needed basis so please contact the lab in advance of sending samples.

Methods and Interpretation of Results:

Paired serum and CSF samples are tested using the Euroimmun kit for antibodies of the IgG class against measles virus in cerebrospinal fluid. The ratio of measles specific antibodies in the CSF and the serum in comparison to the ratio of total IgG or total albumin in the CSF and the serum (CSQrel) is used to determine whether there is an indication of measles-specific antibody production in the central nervous system (CNS). Please note that CSQrel values between 1.5 and 4.0 should be interpreted with caution when diagnosing measles SSPE. Non-infectious diseases, such as multiple sclerosis, can also cause an elevated CSF/serum ratio. While the CSF/serum quotients measured in these cases are elevated, they are significantly lower than those found in SSPE cases where the CSQrel is typically greater than 4.0. As always, the result should be interpreted within the context of all relevant clinical information [i.e. age of the patient, past history of wild-type measles infection, evidence of a CNS infection of viral etiology, and other laboratory results, such as elevated serum levels of measles IgG (>5000 mIU/mL)]. For questions regarding the interpretation of measles SSPE results please contact the lab at 204-789-7055.

Turnaround Time:

21 calendar days from date of receipt of all required materials (samples and total IgG and total albumin concentrations). Turnaround time can be as short as 3 calendar days, with proper notification and provided the lab has kits in stock.

Contact:
Phone: (204) 789-6024 or (204) 789-7055
Fax: (204) 318-2222
References:
  1. Euroimmun kit insert for Antibodies of the IgG class against measles virus in cerebrospinal fluid.
  2. Reiber H, P Lange. Quantification of virus-specific antibodies in cerebrospinal fluid and serum: sensitive and specific detection of antibody synthesis in brain. Clin Chem 1991; 37: 1153-1160.
  3. Measles and Rubella Elimination Working Group, Health Canada, Public Health Agency of Canada. Guidelines for the prevention and control of measles outbreaks in Canada. CCDR. 2013; 39:ACS-3. Available at http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/13vol39/acs-dcc-3/index-eng.php#appa