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Epic Code LAB163 Varicella-Zoster Virus (VZV) Antibody, IgM, Serum

Additional Codes

Epic: LAB 163

Mayo: VZM

Cerner: 8546

Reporting Name

Varicella-Zoster Ab, IgM, S

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Clinical Information

Varicella-zoster virus (VZV), a herpes virus, causes 2 exanthematous (rash-associated) diseases, chickenpox and herpes zoster (shingles). Chickenpox is a highly contagious disease usually contracted during childhood and is characterized by a dermal vesiculopustular rash that develops in successive crops approximately 10 to 21 days following exposure.(1). Although primary infection results in immunity to subsequent exposure to chickenpox, the virus remains latent in the body, localized to the dorsal root or cranial nerve ganglia. Reactivation of latent infection manifests as herpes zoster. On reactivation, the virus migrates along neural pathways to the skin, producing a unilateral rash usually limited to a single dermatome. Reactivation occurs in older adults and in patients with impaired cellular immunity.(2)

 

Several populations are at risk of suffering unusually severe reactions to VZV infections. The infection in pregnant women may spread through the placenta to the fetus causing congenital disease in the infant. Immunocompromised patients in hospitals may contract severe nosocomial infections from others who have active VZV infections are at risk for developing severe VZV-related complications, which include cutaneous disseminated disease and visceral organ involvement.(2,3). Therefore, serologic screening of direct health care providers (physicians, allied health care personnel) and individuals in high-risk groups is necessary to avoid uncontrolled spread of infection.

 

While the clinical presentation of VZV infection is generally characteristic, serologic evaluation of patients with atypical and systemic infections is often required. For example, it is extremely important to serologically evaluate patients for the early detection of VZV infections in hospital settings. Nosocomial spread of VZV infection can be life-threatening to immunocompromised patients susceptible to infection.

Useful For

Diagnosing acute-phase infection with varicella-zoster virus

Specimen Type

Serum


Specimen Required


Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Specimen Volume: 0.5 mL


Laboratory Test Directory Note:

COLLECTION NOTE: Volumes listed are in serum or plasma, draw approximately 2 1/2 times the requested volume in whole blood.

Specimen Minimum Volume

0.2 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
Heat-inactivated specimen Reject

Day(s) Performed

Monday through Sunday

Reference Values

Negative

Reference values apply to all ages.

Interpretation

A positive IgM result indicates a recent infection with varicella-zoster virus (VZV).

 

A negative result does not rule out the diagnosis of VZV infection. The specimen may have been drawn before the appearance of detectable antibodies. Negative results in suspected early VZV infection should be followed by testing a new specimen in 2 to 3 weeks.

Cautions

The performance characteristics with individuals vaccinated with varicella-zoster virus (OKA strain) have not been established.

 

The test must be performed on serum. The use of whole blood, plasma, or cord blood has not been established.

 

Positive results from cord blood or neonates should be interpreted with caution.

 

Results from immunocompromised patients should be interpreted with caution.

Clinical Reference

1. Yankowitz J, Grose C: Congenital infections. In: Storch GA, ed. Essentials of diagnostic virology. Churchill Livingstone; 2000:187-201

2. Gnann JW, Whitley RJ: Herpes Zoster. N Engl J Med. 2002;347:340-346

3. Cvjetkovic D, Jovanovic J, Hrnjakovic-Cvjetkovic I, et al: Reactivation of herpes zoster infection by varicella-zoster virus. Med Pregl. 1999;52(3):125-128

4. Flamholc L: Neurological complications in herpes zoster. Scand J Infect Dis. 1996;100:35-40

5. Whitely RJ: Chickenpox and Herpes Zoster (Varicella-Zoster virus). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Elsevier; 2020:1849-1856

Method Name

Immunofluorescence Assay (IFA)

Method Description

The presence or absence of IgM-class antibody to varicella-zoster virus (VZV) is determined by an indirect immunofluorescence assay. Serum is incubated with VZV antigen that is adhered to a glass microscope slide. Antibodies, if present, will bind to the antigen forming stable antigen-antibody complexes. If no antibodies are present, the complexes will not be formed and the serum components will be washed away. Fluorescein-labeled antihuman-IgM antibody is added to the reaction side and binds to IgM antibodies, if present. This results in a positive reaction of bright apple-green fluorescence when viewed with a fluorescence microscope.(Package insert: Bion Varicella Zoster Antigen Substrate Slide. Bion Enterprises; 11/2015)

Report Available

Same day/1 to 3 days

Test 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.

CPT Code Information

86787

LOINC Code Information

Test ID Test Order Name Order LOINC Value
VZM Varicella-Zoster Ab, IgM, S 43588-3

 

Result ID Test Result Name Result LOINC Value
80964 Varicella-Zoster Ab, IgM, S 43588-3

Forms

If not ordering electronically, complete, print, and send a Microbiology Test Request (T244) with the specimen.