Virology |
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For years
physicians have run tests to "rule out"
bacterial infections. Now they often have the option to "rule out" viral infections. For any physician who
ever questioned whether to initiate antiviral therapy, the
Stanford Diagnostic Virology Lab offers services and consultations of interest. This month Ann Warford, clinical virologist, and Hiroko Margesson, reference technologist, talk with Fact File about the
lab and about how physicians can make optimal use of recent advances in virology
in an age of HIV, hepatitis C and myriad other infectious disease challenges.
1. Stanford's Virology Lab offers comprehensive services, including some tests - such as gene sequencing for antiviral resistance - that are available rarely or not at all in other labs nationally. 2. The Diagnostic Virology Lab, room H1537, is open 24 hours a day, 7 days a week, for phlebotomy, samples, couriers and phone consultations. The lab may be contacted at (650) 723-5706. 3. In 1997, the lab processed 150,000 samples from private offices, clinics and hospitals throughout the Bay Area. Twenty percent of the volume comes from Stanford Hospital, and exotic tests are performed from samples sent nationally. It is the only Bay Area virology lab outside San Francisco or Berkeley. 4. Employees include 14 full- and part-time technologists and technicians. 5. Some currently available tests of interest to practitioners include: a. Viral culture (and chlamydia trachomatis culture). Rapid vial cultures with 16- to 48-hour turnaround are available. Available but rarely ordered tests include measles, mumps and rubella. b. Viral antigen tests - stat available. Herpes, varicella zoster, adenovirus, influenza/parainfluenza, respiratory syncytial. c. Viral and microbial serology - IgG and IgM antibodies. d. Hepatitis assays: hep A, B, C - serology and molecular assays. Testing for hep D through G is also available. e. HIV assays - HIV antibody screen, HIV P24 antigen screen, HIV RNA PCR, HIV antiviral resistance genotyping. f. Molecular assay -: chlamydia and gonorrhea DNA PCR/LCR; CMV DNA PCR (viral load); hepatitis PCR - hep B and C (viral load assays); HIV RNA PCR (viral load); and HIV antiviral resistance genotyping. 6. The proliferation of specific antivirals has increased the potential payoff for virology testing. New antivirals include: a. Herpes virus family (HSV, VZV, CMV, EBV) - acyclovir, famciclovir, valcyclovir, ganciclovir, cidofovir, foscarnet, immune globulins such as IVIG and concentrated anti-CMV immune globulin (Cytogam). b. HIV - currently 15 antiretrovirals (reverse transcriptase and protease inhibitors). c. Hepatitis B - interferon, famiclovir, lamivudine, adefovir. d. Hepatitis C - interferon, ribavirin, amantadine. e. Respiratory syncytial virus - ribavirin, RSV immune globulin (Respigam). f. Influenza - amantadine, rimantidine, new neuraminidase inhibitors, such as Zanamivir (from Gilead, Roche). g. Enteroviruses - pleconaril. 7. The lab works closely with the liver transplant team, providing laboratory diagnosis and ongoing monitoring of hepatitis patients, in addition to offering a comprehensive range of hepatitis testing. 8. Pricing is competitive and volume discounts are available. Some price examples: viral antigen (herpes, zoster, respiratory viruses), $33 each agent; herpes culture, $35; viral culture, $90; viral antibody serologies (IgG, IgM), $25 to $60; chlamydia culture or PCR, $45; molecular tests, $130 to $150; antiviral resistance (each gene), $300. 9. Medical director of the Diagnostic Virology Lab is Thomas C. Merigan, the George E. and Lucy Becker Professor of Medicine. Lucy S. Tompkins is medical director of clinical microbiology/virology. Susie Lu is UCSF Stanford's administrator of clinical laboratories. Ellen Jo Baron is director of microbiology and virology laboratories at Stanford Hospital and Clinics. 10. Ann Warford is a clinical instructor in the infectious diseases division, Department of Medicine, and an American Board of Medical Microbiology diplomate. She received a Dr.P.H. in public health epidemiology from UCLA. After serving as a postdoctoral fellow in UCLA's clinical laboratories and at the Wadsworth Veterans Administration Hospital from 1977 to 1979, Warford became a clinical microbiologist at Los Angeles County-USC Medical Center for two years before a 10-year term as regional virologist and supervisor for Kaiser-Permanente, Southern California. In 1991 she moved to San Diego to become clinical microbiologist at Children's Hospital. She came to Stanford to head the virology lab in 1992.
Hiroko Margesson received a master's degree in clinical microbiology from Thomas Jefferson University Philadelphia, in 1978. She began her career in microbiology at Northwestern Memorial Hospital, Chicago,and then worked in South Africa for Frontier Hospital, Queenstown. She came to Stanford in 1987. Her current responsibilities include introducing new protocols, training techs, troubleshooting and performing clinical trials on new products in the area of cell culture and direct viral antigen assays.
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