Laboratory Service Report

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Laboratory Service Report 1-00-533-1710 SA0004515 SA0004515 Client SA0004515 0/14/2012 13:00 C702-DLP ROCHESTER 0/17/2012 14:39 eningoencephalitis Comp Panel, S REPORTED 0/16/2012 14:26 Lymphocytic Choriomeningitis Ab LC IgG H 1:16 Y03 LC Ig H 1:40 Y03 COENT: Due to a low/negative IgG and a positive Ig, the presence easles (Rubeola) Ab Panel, IFA easles (Rubeola) IgG, IFA H 1: Y03 easles (Rubeola) Ig, IFA H 1:40 Y03 COENT: Due to a low/negative IgG and a positive Ig, the presence umps Antibody Panel, IFA umps Ab IgG, IFA H 1:16 Y03 umps Ab Ig, IFA H 1:40 Y03 COENT: Due to a low/negative IgG and a positive Ig, the presence E. Equine Enceph Virus Ab Panel, IFA E. Equine Enceph. Virus IgG H 1:64 Y03 ***ing Site Legend on Last Page of Report*** 0/14/2012 13:00 Page 1 of ** Reprinted ** >> Continued on Next Page >>

Laboratory Service Report 1-00-533-1710 SA0004515 SA0004515 Client SA0004515 0/14/2012 13:00 C702-DLP ROCHESTER 0/17/2012 14:39 E. Equine Enceph. Virus Ig H 1:12 Y03 RECENT/CURRENT INFECTION Calif Enceph Virus Ab Pnl, IFA CA Enceph. Virus IgG H 1:16 Y03 CA Enceph. Virus Ig H 1:32 Y03 COENT: Due to a low/negative IgG and a positive Ig, the presence St. Louis Enceph Virus Ab, IFA St. Louis Enceph. Virus IgG H 1:256 Y03 St. Louis Enceph. Virus Ig H >=1:256 Y03 RECENT/CURRENT INFECTION W. Equine Enceph Ab Panel, IFA W. Equine Enceph. Virus IgG H 1:16 Y03 W. Equine Enceph. Virus Ig H 1:32 Y03 COENT: Due to a low/negative IgG and a positive Ig, the presence IFA REFERENCE RANGES: IgG (ALL VIRUSES EXCEPT EASLES) <1:16 IgG (EASLES VIRUS) <1: Ig (LC, EASLES, UPS) <1:20 ***ing Site Legend on Last Page of Report*** 0/14/2012 13:00 Page 2 of ** Reprinted ** >> Continued on Next Page >>

Laboratory Service Report 1-00-533-1710 SA0004515 SA0004515 Client SA0004515 0/14/2012 13:00 C702-DLP ROCHESTER 0/17/2012 14:39 Ig (ENCEPHALITIS VIRUSES) <1:16 Cytomegalovirus (CV) Ab Pnl, ELISA Cytomegalovirus IgG, ELISA H 1.10 Y03 Cytomegalovirus Ig, ELISA H 1.10 Y03 REFERENCE RANGE: IgG <0.0 Ig <0.90 INTERPRETIVE CRITERIA: IgG: <0.0 Antibody not detected 0.0-0.99 Equivocal > or = 1.00 Antibody detected Ig: <0.90 Antibody not detected 0.90-1.09 Equivocal > or = 1.10 Antibody detected Antibody to lymphocytic choriomeningitis virus is often detectable within a few days of clinical symptoms. The presence of mumps IgG antibody in the absence of mumps Ig antibody indicates prior exposure and immunity to mumps virus. easles Ig antibody is typically detectable for only 30 days after rash onset. Detection of CV IgG antibody indicates prior exposure. CV Ig antibody may persist for up to 2 years following primary infection. Human infections caused by arboviruses are seasonal, from mid-summer to late summer. Typical geographic distributions are: Eastern equine encephalitis virus from New England to Texas, California encephalitis virus in the north central states, St. Louis encephalitis virus throughout the southern, southwestern, and west central states, and Western encephalitis virus throughout the western states. For all viruses mentioned, the presence of Ig antibody or a four fold increase in IgG titer between acute and convalescent sera indicates recent or current infection. NOTE: Positive results for arbovirus antibody ***ing Site Legend on Last Page of Report*** 0/14/2012 13:00 Page 3 of ** Reprinted ** >> Continued on Next Page >>

Laboratory Service Report 1-00-533-1710 SA0004515 SA0004515 Client SA0004515 0/14/2012 13:00 C702-DLP ROCHESTER 0/17/2012 14:39 are CDC reportable. Please contact your local public health agency. The LC, measles, and mumps antibody tests were developed and their performance characteristics have been determined by Focus Diagnostics. They have not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. ance characteristics refer to the analytical performance of the tests. Adenovirus Antibody Adenovirus Ab H 1: Y03 Influenza Virus A and B Ab Influenza A Ab H 1: Y03 Influenza B Ab H 1:16 Y03 Varicella-Zoster Virus Antibody Varicella-Zoster Virus Ab H 1: Y03 Coxsackie A Antibodies, Serum Coxsackie A2 Ab H 1: Y03 Coxsackie A4 Ab H 1:16 Y03 Coxsackie A7 Ab H 1:32 Y03 Coxsackie A9 Ab H >=1:64 Y03 Coxsackie A10 Ab H 1: Y03 Coxsackie A16 Ab H 1:16 Y03 Coxsackie B(1-6) Antibodies, Serum Coxsackie B1 Ab H >=1:64 Y03 Coxsackie B2 Ab H 1:32 Y03 Coxsackie B3 Ab H 1:16 Y03 Coxsackie B4 Ab H 1: Y03 ***ing Site Legend on Last Page of Report*** 0/14/2012 13:00 Page 4 of ** Reprinted ** >> Continued on Next Page >>

Laboratory Service Report 1-00-533-1710 SA0004515 SA0004515 Client SA0004515 0/14/2012 13:00 C702-DLP ROCHESTER 0/17/2012 14:39 Coxsackie B5 Ab H 1: Y03 Coxsackie B6 Ab H 1:16 Y03 Echovirus Antibodies Echovirus 4 Ab H 1: Y03 Echovirus 7 Ab H 1:16 Y03 Echovirus 9 Ab H 1:32 Y03 Echovirus 11 Ab H >=1:64 Y03 Echovirus 30 Ab H 1: Y03 CF REFERENCE RANGES: <1: CF INTERPRETIVE CRITERIA: <1: Antibody Not Detected 1: - 1:16 (Coxsackie A,B, Echovirus) Equivocal 1: - 1:32 (Adenovirus, Influenza A,B) Equivocal 1: - 1:12 (Varicella Zoster) Equivocal > or = 1:32 (Coxsackie A,B, Echovirus) Antibody Detected > or = 1:64 (Adenovirus, Influenza A,B) Antibody Detected > or = 1:256 (Varicella Zoster) Antibody Detected Single titers in the appropriate "antibody detected" range are suggestive of recent infection. Due to the shortlived nature of complement fixing antibodies, equivocal titers may also be indicative of recent infection. A four fold or greater change in titer between acute and convalescent sera is considered confirmatory evidence of infection. Among the enteroviruses (Coxsackie A, B, and Echovirus), there is considerable crossreactivity; however, the highest titer is usually associated with the infecting serotype. ***ing Site Legend on Last Page of Report*** 0/14/2012 13:00 Page 5 of ** Reprinted ** >> Continued on Next Page >>

Laboratory Service Report 1-00-533-1710 SA0004515 SA0004515 Client SA0004515 0/14/2012 13:00 C702-DLP ROCHESTER 0/17/2012 14:39 The complement fixation tests were developed and their performance characteristics have been determined by Focus Diagnostics. ance characteristics refer to the analytical performance of these tests. HSV 1/2 Ig and Type-Specific IgG HSV 1 IgG Index 5.25 Y03 HSV 1 IgG HSV-1 IgG ANTIBODY DETECTED HSV 2 IgG Index 4.12 Y03 HSV 2 IgG HSV-2 IgG ANTIBODY DETECTED HSV 1/2 Ig Index 1.51 Y03 HSV 1/2 Ig Confirmatory IFA POSITIVE Y03 HSV 1/2 Ig HSV 1/2 Ig ANTIBODY DETECTED REFERENCE RANGE: <0.90 IgG INDEX ANTIBODY STATUS ----------- --------------- <0.90 Antibody not detected 0.90-1.10 Equivocal >1.10 Antibody detected Ig INDEX ANTIBODY STATUS ----------- --------------- <0.90 Antibody not detected 0.90-1.09 Equivocal > or = 1.10 Antibody detected The HerpeSelect test system utilizes recombinant type-specific HSV-1 and HSV-2 antigens to detect only type-specific IgG antibodies. Results from these serologic assays must be correlated with ***ing Site Legend on Last Page of Report*** 0/14/2012 13:00 Page 6 of ** Reprinted ** >> Continued on Next Page >>

Laboratory Service Report 1-00-533-1710 SA0004515 SA0004515 Client SA0004515 0/14/2012 13:00 C702-DLP ROCHESTER 0/17/2012 14:39 clinical history and other data to evaluate the patient's HSV status. As with all serologic tests, false positives may occur. Repeat testing or utilization of a different assay may be indicated in some settings (e.g., patients with a low likelihood of HSV infection). The HSV Ig ELISA detects type-common as well as type-specific Ig antibodies; thus, the typespecificity of any HSV Ig antibodies detected cannot be reliably determined. All samples giving an equivocal or positive Ig ELISA result are confirmed by an IFA procedure. As with the HSV Ig ELISA, however, Ig reactivity in the IFA is not type-specific. West Nile Virus Ab Panel, ELISA West Nile Virus IgG H 1.31 Y03 West Nile Virus Ig H 1.31 Y03 RECENT/CURRENT INFECTION DUE TO EXPOSURE TO FLAVIVIRUSES WHICH AY INCLUDE WEST NILE VIRUS REFERENCE RANGE: IgG <1.30 Ig <0.90 INTERPRETIVE CRITERIA IgG: <1.30 Antibody not detected 1.30-1.49 Equivocal >=1.50 Antibody detected Ig: <0.90 Antibody not detected 0.90-1.10 Equivocal >1.10 Antibody detected West Nile Virus (WNV) Ig is usually detectable by the time symptoms appear, but IgG may not be detectable until day 4 or day 5 of illness. Although WNV Ig persists for more than a year in some patients with WNV encephalitis, detection of WNV Ig remains a reliable indicator of recent ***ing Site Legend on Last Page of Report*** 0/14/2012 13:00 Page 7 of ** Reprinted ** >> Continued on Next Page >>

Laboratory Service Report 1-00-533-1710 SA0004515 SA0004515 Client SA0004515 0/14/2012 13:00 C702-DLP ROCHESTER 0/17/2012 14:39 infection for most patients. Antibodies induced by other flavivirus infections (e.g., Dengue, St. Louis Encephalitis) may show crossreactivity with WNV; thus, antibody detection using this panel is not diagnostically conclusive for WNV infection. diagnosis should be based on clinical assessment and confirmatory assays, such as the plaque reduction neutralization test. * ing Site: Focus Diagnostics, Inc. Y03 575 Corporate Avenue Cypress, CA 90630-4750 Lab Director: 0/14/2012 13:00 Page of ** Reprinted ** ** End of Report **