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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Guillermo Rodriguez Nava, M.D. [2]

## Overview[edit | edit source]

While the diagnosis of Ebola may be suspected based on clinical findings, the diagnosis of Ebola can be confirmed by antigen-capture enzyme-linked immunosorbent assay (ELISA) testing, IgM ELISA, polymerase chain reaction (PCR), and virus isolation, within few days of the onset of symptoms. Persons tested later in the course of the disease, or after recovery, can be tested for IgM and IgG antibodies. The disease can also be diagnosed in deceased patients by using immunohistochemistry testing, virus isolation, or PCR.[1]

## Other Diagnostic Test[edit | edit source]

* Ebola virus can be detected in fatal cases, from a skin specimen using immunohistochemistry or RT-PCR tests developed by the Centers for Disease Control and Prevention (CDC)
* The skin specimen is fixed in formalin or chaotrope to kill the virus
* The specimen is no longer infectious once it is placed in formalin or chaotropeand the outside of the vial has been decontaminated.
* This vial can be shipped by mail or hand carried to the lab without risk, and the results are available within a week after the specimen arrives at the CDC.[2]

Table adapted from WHO: Infection Control for Viral Hemorrhagic Fevers in the African Health Care Setting [3]

Diagnostic test  | Samples required  | Preparation & Storage  | Shipping  | Viruses to be confirmed

|
|
|
|

ELISA (serology) detects:

* Viral Antigen
* IgM and IgG antibody

| Whole blood serum or plasma†

Acute and convalescent††

| Freeze or refrigerate

(as cold as possible)

| Frozen on dry ice or ice packs or both†††† | Ebola
Lassa
CCHF
Rift Valley
Marburg
Yellow fever
PCR detects:

DNA, RNA from the virus.

| Whole blood or clot††

Tissues (fresh frozen) Serum/plasma

| Refrigerate or freeze

Freeze

| Frozen on dry ice or ice packs or both†††† | Ebola
Lassa
CCHF
Rift Valley
Marburg
Yellow fever
Immunohisto-chemestry (liver) detects:

Viral antigen in cells

| Liver biopsy from fatal cases  | Fix formalin (can be stored up to 6 weeks)  | Room temperature (do not freeze)  | Ebola
Lassa
CCHF
Rift Valley
Marburg
Yellow fever
Immunohisto-chemestry (skin) detects:

Viral antigen in cells

| Skin biopsy from fatal cases (any site)  | Fix in formalin (can be stored up to 6 weeks)  | Room temperature (do not freeze)  | Ebola
Lassa
Immunohisto-chemestry (other tissues) detects:

Viral antigen in cells

| Tissue biopsy from fatal cases

(other tissues, spleen, lung, heart, kidney)

| Fix in formalin (can be stored up to 6 weeks)  | Room temperature (do not freeze)  | Ebola
Lassa
CCHF
Rift Valley
Marburg
Yellow fever

† Whole blood can be used for enzyme-linked immunosorbent assay (ELISA) and may be frozen. Do not centrifuge suspected VHF specimens because this increases the risk to the lab worker. If serum specimens have already been prepared these can be used. Place specimens in plastic tubes for shipping and storage and be sure that the tubes are sealed and properly labeled.
†† Collect acute-phase specimen when patient is admitted to hospital or diagnosed as suspected case and collect convalescent-phase specimen at death or when discharged from the hospital.
††† Whole blood or tissue is preferred, although serum or plasma may provide results.
†††† Use both ice packs and dry ice to provide best results. If dry ice or ice packs are not available, sample may be shipped at room temperature and still provide valid results in most cases.

## Gallery[edit | edit source]

* Produced by the National Institute of Allergy and Infectious Diseases (NIAID), under a magnification of 50,000X, this scanning electron micrograph (SEM) depicts numerous filamentous Ebola virus particles replicating from an infected VERO E6 cell. From Public Health Image Library (PHIL). [4]

* Produced by the National Institute of Allergy and Infectious Diseases (NIAID), under a very-high magnification, this digitally-colorized scanning electron micrograph (SEM) depicts a number of filamentous Ebola virus particles (red) that had budded from the surface of a VERO cell of the African green monkey kidney epithelial cell line. From Public Health Image Library (PHIL). [4]

* Produced by the National Institute of Allergy and Infectious Diseases (NIAID), under a very-high magnification, this digitally-colorized scanning electron micrograph (SEM) depicts a number of filamentous Ebola virus particles (red) that had budded from the surface of a VERO cell (blue-gray) of the African green monkey kidney epithelial cell line. From Public Health Image Library (PHIL). [4]

* Produced by the National Institute of Allergy and Infectious Diseases (NIAID), under a very-high magnification, this digitally-colorized scanning electron micrograph (SEM) depicts a number of filamentous Ebola virus particles (red) that had budded from the surface of a VERO cell (blue-gray) of the African green monkey kidney epithelial cell line. From Public Health Image Library (PHIL). [4]

## References[edit | edit source]

1. ↑ "Ebola Hemorrhagic Fever Information Packet" (PDF).
2. ↑ "CDC: Ebola Hemorrhagic Fever, Diagnosis".
3. ↑ "Infection Control for Viral Hemorrhagic Fevers in the African Health Care Setting" (PDF).
4. ↑ 4.0 4.1 4.2 4.3 "Public Health Image Library (PHIL)".

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