Alberta Precision Laboratories

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Organization:

Alberta Precision Laboratories

Message Alert:

PLEASE NOTE: This Test Directory is in an interim state and due to changes pertaining to the DynaLIFE transition, performing site for routing has not been updated. Please refer to Laboratory Information System for appropriate routing.

Test Name/Synonym:

Congenital Infections
[Cytomegalovirus (CMV), Enterovirus, Hepatitis B Virus (HBV), Hepatitis C virus (HCV), Herpes Simplex Virus (HSV), Human Immunodeficiency virus (HIV 1 & 2), Parvovirus B19, Rubella, Syphilis, Toxoplasma gondii, Varicella Zoster virus (VZV), Zika virus]

Test Includes:

Serology
NAT or PCR – refer to table below for guidance
TORCH testing panel request is of limited value – contact Public Health Lab (ProvLab) Microbiologist On-Call when testing is required

Specimen Collection Requirements:

Please refer to the table for specific specimen type and testing based on causative agent.

Testing Area:

Referred Out

Referral Lab:

Some samples may be referred to the National Microbiology Laboratory, Winnipeg, Manitoba for testing

Performing Site:

Provincial Laboratory for Public Health (Calgary and Edmonton)

Additional Test Information:

Suspected Causative Agent	Neonate	Mother	Additional Notes
Cytomegalovirus (CMV)	NAT testing on: Urine	IgM antibody IgG seroconversion IgG avidity index NAT testing on amniotic fluid	Intrauterine transmission is highest (30-40%) after primary infection and 1% or less in reactivations or secondary infections. A positive finding on a urine collected within 10 days of birth is considered diagnostic of a congenital infection. After 10 days, CMV infection could be acquired postnatally. Low avidity index on maternal blood suggests recent infection NAT testing on amniotic fluid has the highest sensitivity 7 weeks after onset of maternal infection and after 21 weeks of gestation Contact the Virologist-on-Call to facilitate NAT testing on amniotic fluid
Enterovirus	NAT testing on: EDTA Blood Throat swab Stool CSF	NAT testing on: EDTA blood Throat swab Stool	Infection is usually acquired in the immediate perinatal period; the majority of cases occur between days 3 to 5 after delivery
Hepatitis B (HBV)	HBsAg serology Collect blood BEFORE administering the vaccine HBV DNA on EDTA blood	HBsAg serology	STAT HBsAg testing is available for mothers with no prenatal testing or recent results by contacting the Virologist On-Call
Hepatitis C (HCV)	HCV Viral Load – at 2 months and after 6 months HCV serology after 18 months		Risk of perinatal transmission is 5% Testing for HCV RNA at birth can occasionally result in a false positive finding, whereas testing at two separate time points later is a better predictor of transmission Passive maternal antibody can be detectable for up to 18 months
Herpes simplex virus (HSV)	NAT testing on: Mouth swab Nasopharyngeal swab Eye swab Skin swab Rectum swab Lesion swab CSF EDTA Blood	NAT testing on genital lesions	In up to 20% of neonatal infections there is an absence of vesicular lesions, hence swabs from the mouth, skin, nasopharynx, rectum and eye should be collected
Human immunodeficiency virus (HIV 1 & 2)	HIV proviral DNA at three suggested time points: 14 days, 2 months and 6 months		Vertical transmission rates can range from 15 to 20% when untreated, but are less than 1% if the mother’s viral load is undetectable and the baby is treated at birth HIV proviral DNA is the preferred assay and is performed at the National Laboratory for HIV Reference Services, Winnipeg Samples must be shipped to Winnipeg within 24 hours of collection, i.e., only Monday, Tuesday & Wednesday, to maintain sample integrity Passive maternal antibody can be detectable for up to 18 months
Parvovirus B19	NAT testing on EDTA blood	IgM antibody IgG seroconversion NAT testing on amniotic fluid	Parvovirus B19 infections can be either symptomatic or asymptomatic Vertical transmission ranges from 17 to 33% Contact the Virologist-on-Call to facilitate NAT testing on amniotic fluid
Rubella	IgM antibody IgG antibody after 7 to 12 months NAT testing on throat swab and urine	IgM antibody IgG seroconversion IgG avidity index NAT testing on throat swab and urine	Detection of rubella IgM antibody in the first 3 months after birth is indicative of a congenital infection Rubella virus is shed in the urine and throat for up to 6 months after birth The detection of rubella IgG after 7 to 12 months is highly suggestive of a congenital infection
Syphilis	Serology VDRL on CSF	Serology NAT testing on lesions	Any RPR titre on the neonate’s blood is suggestive of infection and should be tested in parallel with mother’s blood Contact the Microbiologist On Call to discuss molecular tesing on the neonate
*Toxoplasma gondii*	IgM antibody Other tests as needed	IgM antibody IgG antibody NAT testing on amniotic fluid	Congenital toxoplasmosis is likely if neonatal IgM is positive and persists after I month of age or if the IgG antibodies persist after 12 months Contact the Microbiologist-on-Call to arrange for testing
Varicella zoster virus (VZV)	NAT testing on lesion swabs IgG antibody after 8 months	IgG seroconversion NAT testing on lesion swabs and amniotic fluid	Molecular detection of VZV is highly sensitive and specific The persistence if IgG antibody after 8 months in the baby is suggestive of a congenital infection
Zika virus	IgM antibody NAT testing on EDTA blood and urine	IgM antibody IgG seroconversion NAT testing on blood, amniotic fluid and placental tissue	Testing for congenital infection should be considered only when the mother has been shown to be previously positive by molecular testing on blood, urine, or a positive serology result including a plaque reduction neutralization test (PRNT) result On the neonate submit samples for both serologic and molecular testing and contact the Virologist-on-Call to discuss testing

Last Updated On:

Monday, February 26, 2024

Date of Last Review:

Feb 14 2024 12:00AM