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HelpTest Code STLP St. Louis Encephalitis Antibody, IgG and IgM, Serum
Reporting Name
St. Louis Enceph Ab, IgG and IgM, SUseful For
Aiding in the diagnosis of St. Louis encephalitis using serum specimens
Testing Algorithm
For more information see Mosquito-borne Disease Laboratory Testing.
Method Name
Immunofluorescence Assay (IFA)
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
SerumOrdering Guidance
This assay detects only St. Louis virus. For a complete arbovirus panel, order ARBOP / Arbovirus Antibody Panel, IgG and IgM, Serum.
Specimen Required
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 0.5 mL
Collection Instructions: Centrifuge and aliquot serum into plastic vial.
Specimen Minimum Volume
0.25 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 14 days | |
| Frozen | 14 days |
Reject Due To
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
Special Instructions
Reference Values
IgG: <1:10
IgM: <1:10
Reference values apply to all ages.
Day(s) Performed
Monday through Friday (May through October)
Monday, Wednesday, Friday (November through April)
CPT Code Information
86653 x 2
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| STLP | St. Louis Enceph Ab, IgG and IgM, S | 96255-5 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 8182 | St. Louis Enceph Ab, IgG, S | In Process |
| 87268 | St. Louis Enceph Ab, IgM, S | In Process |
Clinical Information
The onset of St. Louis encephalitis is characterized by generalized malaise, fever, chilliness, headache, drowsiness, nausea, and sore throat or cough followed in 1 to 4 days by the meningeal and neurologic signs. The severity of illness increases with advancing age; persons over 60 years have the highest frequency of encephalitis. Symptoms of irritability, sleeplessness, depression, memory loss, and headaches can last up to 3 years. Areas of outbreaks since 1933 have involved the western United States, Texas, the Ohio-Mississippi Valley, and Florida. The vector of transmission is the mosquito. Peak incidence of St. Louis encephalitis is associated with summer and early autumn.
Interpretation
In patients infected with the St. Louis encephalitis virus, IgG antibody is generally detectable within 1 to 3 weeks of onset, peaking within 1 to 2 months, and declining slowly thereafter.
IgM class antibody is also reliably detected within 1 to 3 weeks of onset, peaking and rapidly declining within 3 months.
A single serum specimen IgG of 1:10 or greater indicates exposure to the virus. Results from a single serum specimen can differentiate early (acute) infection from past infection with immunity if IgM is positive (suggests acute infection). While a 4-fold or greater rise in IgG antibody titer in acute and convalescent sera indicates recent infection.
Infections with St. Louis encephalitis can occur at any age. The age distribution depends on the degree of exposure to the particular transmitting arthropod relating to age and sex, as well as the occupational, vocational, and recreational habits of the individuals. St. Louis encephalitis tends to produce the most severe clinical infections in older persons.
Cautions
All results must be correlated with clinical history and other data available to the attending physician.
Specimens collected within the first 2 weeks after onset are variably negative for IgG antibody and should not be used to exclude the diagnosis of St. Louis encephalitis (SLE). If SLE is suspected, a second specimen should be collected and tested 10 to 21 days later.
Since cross-reactivity with dengue fever does occur with SLE antigens and, therefore, cannot be differentiated further. The specific virus responsible for such a titer may be deduced by the travel history of the patient, along with available medical and epidemiological data, unless the virus can be isolated.
Usually, when an infection with an arbovirus is suspected, it is too late to isolate the virus or draw serum specimens to detect a rise of antibody titer.
Clinical Reference
1. Gonzalez-Scarano F, Nathanson N: Bunyaviruses. In: Fields BN, Knipe DM, eds. Fields Virology. Vol 1. 2nd ed. Raven Press; 1990:1195-1228
2. Donat JF, Rhodes KH, Groover RV, Smith TF: Etiology and outcome in 42 children with acute nonbacterial meningoencephalitis. Mayo Clin Proc. 1980 Mar;55(3):156-160
3. Tsai TF: Arboviruses. In: Murray PR, Baron EJ, Pfaller MA, et al, eds. Manual of Clinical Microbiology. 7th ed. American Society for Microbiology; 1999:1107-1124
4. Calisher CH: Medically important arboviruses of the United States and Canada. Clin Microbiol Rev. 1994 Jan;7(1):89-116
5. Diaz A, Coffey LL, Burkett-Cadena N, Day JF: Reemergence of St. Louis Encephalitis Virus in the Americas. Emerg Infect Dis. 2018 Dec;24(12):2150-2157. doi: 10.3201/eid2412.180372
Method Description
The indirect immunofluorescent antibody (IFA) assay is a 2-stage “sandwich†procedure. In the first stage, the patient serum is diluted in Pretreatment Diluent for IgM and phosphate buffered saline (PBS) for IgG, added to appropriate slide wells in contact with the substrate, and incubated. Following incubation, the slide is washed in PBS which removes unbound serum antibodies. In the second stage, each antigen well is overlaid with fluorescein-labeled antibody to IgM and IgG. The slide is incubated allowing antigen-antibody complexes to react with the fluorescein-labeled anti-IgM and anti-IgG. After the slide is washed, dried, and mounted, it is examined using fluorescence microscopy. Positive reactions appear as cells exhibiting bright apple-green cytoplasmic fluorescence against a background of red negative control cells. Semi-quantitative endpoint titers are obtained by testing serial dilutions of positive specimens.(Package inserts: Arbovirus IFA IgM and Arbovirus IFA IgG Instructions for Use. Focus Diagnostics; Rev. 02, 05/01/2018)
Report Available
Same day/1 to 4 daysSpecimen Retention Time
2 weeksTest Classification
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.Forms
If not ordering electronically, complete, print, and send Infectious Disease Serology Test Request (T916) with the specimen.