Arbovirus Ab: All results must be correlated with clinical history and other data available to the attending physician.
Specimens drawn within the first 2 weeks after onset are variably negative for IgG antibody and should not be used to exclude the diagnosis of arboviral disease. If arboviral infection is suspected, a second specimen should be obtained and tested 10-21 days later.
Since cross-reactivity with dengue fever virus does occur with St. Louis encephalitis 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.
Eastern equine encephalitis and Western equine encephalitis viruses show some cross-reactivity; however, antibody response to the infecting virus is typically at least 8-fold higher.
West Nile Ab: Test results should be used in conjunction with a clinical evaluation and other available diagnostic procedures. The significance of negative test results in immunosuppressed patients is uncertain. Positive test results may not be valid in persons who have received blood transfusions or other blood products within the past several months.
False-negative results due to competition by high levels of IgG, while theoretically possible, have not been observed.
False-positive results may occur with persons vaccinated for flaviviruses (e.g., yellow fever, Japanese encephalitis, dengue), with persons infected with other flaviviruses, and with persons previously infected with West Nile Virus. Because closely related arboviruses exhibit serologic cross-reactivity, it sometimes may be epidemiologically important to attempt to pinpoint the infecting virus by conducting cross-neutralization tests using an appropriate battery of closely related viruses.
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