Orthopoxvirus (includes monkeypox) by PCR


Abbrev Code:OPOXPCR   
Order Code:LAB8262Order Name:Orthopoxvirus (includes monkeypox) by PCR
Synonyms:MonkeyPox
Methodology:Qualitative polymerase chain reaction
CPT Codes: 87593 x1, 87593 x1
Turnaround Time:Results are available within 2-4 days. Test performed 7 days/week.
Special Instructions:Sending laboratory should indicate "Suspected Monkeypox" on the specimen bag.
Associated Links:

Include ARUP Patient Demographic Form for Public Health Reporting for each patient



Collection Instructions

Specimen:Swab of lesion
Container:Viral Transport Media
Alternate Containers: floQ dry swabs
Collection Instructions:An order is required for each lesion collected using a separate container and swab. If multiple specimens are being submitted, record specimen source on collection container. Swab the lesion vigorously to collect adequate DNA. It is not necessary to deroof the lesion before swabbing.
  • Preferred: Use Viral Transport Media, swab lesion, then place into VTM.
  • If VTM is unavailable, use one dry swab per lesion (including, but not limited to polyester, nylon or Dacron swab). Place swab into sterile container.
Causes for Rejection:Calcium alginate swab, wooden swab. Specimens without swabs.


Processing and Shipping

Shipping Instructions:Ship at frozen temperature.
Stability:Frozen stability is 7 days.
Test Performed at or Referral Lab Lab Sendouts  (ARUP)
Referral Lab number:3005716


Interpretive

Use:This assay does not differentiate members of the orthopoxviruses. In the United States, a detected result is most likely due to monkeypox virus or vaccinia virus. Other orthopoxviruses may be considered if appropriate. Refer to the US Centers for Disease Control and Prevention if additional confirmatory testing is needed.

Monkeypox, an Orthopoxvirus, is a zoonotic infection endemic to several Central and West African countries Before May 2022, cases outside of Africa were reported either among people with recent travel to those countries or contact with a person with a confirmed monkeypox virus infection.

Since mid-May, 160 monkeypox cases have been confirmed in over 70 countries that do not normally have monkeypox, including the United States. There is evidence of community transmission of monkeypox and evidence of transmission in persons who self-identify as gay, bisexual, or men who have sex with men (MSM), though sexual transmission has not been considered a primary driver of transmission in previous outbreaks. This is an evolving investigation, and public health authorities hope to learn more about routes of exposure in the coming days. Clinicians have been given the following guidance:

Within 21 days of illness onset, consider monkeypox in people with an unexplained rash and:
  • Reports having contact with a person or people with a similar appearing rash or who received a diagnosis of confirmed or probable monkeypox OR
  • Had close or intimate in-person contact with individuals in a social network experiencing monkeypox activity, this includes men who have sex with men (MSM) who meet partners through an online website, digital application ("app"), or social event (e.g., a bar or party) OR
  • Traveled outside the US to a country with confirmed cases of monkeypox or where monkeypox virus is endemic OR
  • Had contact with a dead or live wild animal or exotic pet that is an African endemic species or used a product derived from such animals (e.g., game meat, creams, lotions,  powders, etc.)


Distinguishing features of the rash include papules, vesicles, pustules, or scabs that are deep-seated, firm or rubbery, and have well-defined round borders. Vesicular or pustular stages of lesions are often umbilicated (i.e. have a dent in the middle of them). They may be painful, painless, or itchy. People with monkeypox may develop symptoms including fever, headache, muscle aches, exhaustion or swollen lymph nodes during the prodromal period preceding the rash or with the rash.

Additional information: Monkeypox is an Orthopoxvirus , the same genus as smallpox, variola and vaccinia viruses. Incubation period is generally between 7-17 days. Clinical disease is very similar to smallpox and starts with a prodromal phase of 1-4 days consisting of fever, headache, and fatigue. Lymphadenopathy may occur as well. However, in the most recently reported cases, prodromal symptoms have not always occurred, and some cases only had lesions in the genital and perianal region, without other symptoms. The rash is well circumscribed, hard, deep-seated and umbilicated.

A person is infectious from symptom onset until lesions have crusted, those crusts have separated, and a fresh layer of healthy skin has formed underneath. Human-to-human transmission occurs through direct contact with body fluids or lesion material, or prolonged contact with respiratory droplets. Indirect contact with lesion material through fomites has also been documented. Animal-to-human contact may occur through a bite or scratch, preparation of wild game and direct or indirect contact with body fluids or lesion material.

There is no specific treatment for monkeypox virus infection, although antivirals developed for use in patients with smallpox may prove beneficial. Persons with direct contact (e.g., exposure to the skin, crusts, body fluids, or other materials) or indirect contact (e.g., presence within a six foot radius in the absence of an N-95 or filtering respirator for ≥3 hours) with a patient with monkeypox should be monitored by health departments, depending on their level of risk, some persons may be candidates for post-exposure prophylaxis with smallpox or monkeypox vaccine under an Investigational New Drug protocol after consultation with public health authorities.


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