Post-COVID Viral Reactivation Testing

AONM now has two Post-COVID Viral Reactivation Panels based on the fact that multiple infections have now been evidenced to reactivate with COVID-19, especially the herpes and enteroviruses.

Both test panels make use of the best available tests for measuring current immune responses which indicate possible current, ongoing or very recent infection, chronic persistent infection, reactivation or reinfections: T-cell tests (EliSpots) and Immunoglobulin A.

Using T-cells to show a cellular response against antigens is very sensitive and has a greater likelihood of indicating active infection than other tests commonly used (e.g. IgG and IgM). EliSpot (enzyme-linked immunosorbent spot) technology has long been used in Germany to do exactly this[iii]: it quantifies T-cells that secrete signature proteins (such as a given cytokine) against a specific antigen. EliSpots performed by ArminLabs in Augsburg, Germany, evaluate the number of spot-forming units using a stimulation index (SI) based on IGRA (Interferon Gamma Release Assay).

AONM together with ArminLabs has brought out two panels: a Basic Post-COVID Viral Reactivation Panel that tests for the “lytic” EliSpots of EBV and CMV only (the currently replicating form), as well as VZV and Coxsackie. The tests for the latter two are antibody tests that also include IgA, which are antibodies found in the mucous membranes of the lungs, sinuses, stomach, and intestines. This is an excellent additional immunoglobulin, as it indicates possible current, ongoing or very recent infection, as well as chronic persistent infection, reactivation or reinfections. Immunoglobulin A is however only useful for viruses and bacteria that primarily live in the mucosal membranes (which VZV and Coxsackie do).

The Advanced Panel also includes Herpes Simplex Viruses 1 and 2, as well as Human Herpes Virus 6 (HHV-6), Chlamydia pneumoniae and Mycoplasma, all of which have substantiated association with reactivation both in medical literature as well as testing laboratories and clinical practice.

[i] http://www.microbiologybook.org/mayer/Ab%20formation2000.htm

[ii] https://www.labtestsonline.org.au/learning/test-index/antibody-tests; 2. https://www.genscript.com/IgM-antibody.html

[iii] Sedegah M. The Ex Vivo IFN-γ Enzyme-Linked Immunospot (ELISpot) Assay Methods Mol Biol. 2015;1325:197-205; Humana Press; 3rd ed. 2018 edition (14 July 2018)