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What Does My Blood Test Report Indicate?

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Posted on Wed, 30 Mar 2016
Question: i need some advice on a blood test.I had it was the iinfluenza complement fixation test that said my antibodies
For influenza a were 1:16 and influenza b were 1:8 normal is
1:8 and under so both said
High. It said
Could have been recent infection or past
Infection but it only lasts in system 4months. Can you just have been exposed but not have
Influenza with those titers? Need advice
Thanks
doctor
Answered by Dr. Panagiotis Zografakis (51 minutes later)
Brief Answer:
can't be sure with this test...

Detailed Answer:
Hello,

the complement fixation tests (CF) has a lot of limitations. A high titer (>1:32) usually indicates acute infection. Lower titers (>1:8 but <1:32) may be caused by recent infection or past infection. The only way to differentiate between them (besides the clinical information of course) is by measuring the titers again in the convalescent phase (3-4 weeks later). The titers should rise even more if the influenza virus was the cause of the disease.

Please note that while many patients with the influenza virus develop a disease with high fever and severe fatigue, muscle aches, etc, there are patients who develop only minor symptoms or no symptoms at all. So a rising titer without symptoms could indicate such a case.

Vaccination also influences the test result causing an increased titer.

The PCR test is the most accurate one.

I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (2 hours later)
The test was done December 9 but still feeling unwell but I have lupus and other medical conditions. My husband and I want to know if I was just exposed to it somehow could my Titers be 1:16 and 1:8. My PCP says she's not going to repeat it don't know why doesn't make any sense. Even if it was positive December 9 when the virus only last so long in my body and it would be out of my system by now please help


The test was done December 9 but still feeling unwell but I have lupus and other medical conditions seems like I have sinus issues that just won't ever go away my husband and I want to know if I was just exposed to influenza somehow could my titers be 1 to 16 and 1 to 8 my PCP says she's not going to repeat it don't know why doesn't make any sense even if it was positive December 9 does a virus only stay in your body so long and does it just work it's way out please help thank you
doctor
Answered by Dr. Panagiotis Zografakis (3 hours later)
Brief Answer:
I can't explain it...

Detailed Answer:
The CF test - unless the titer is highly suggestive (>1:32) - is useless for an acute infection. Usually you can only find out retrospectively whether influenza was the cause of the symptoms or not by repeating the test after the patient has already got better (or worse in case of complications!).

There are other tests for an acute disease like influenza like the rapid antigen tests (which provide the result in less than 10 minutes, but a negative test is not very reliable) and PCR which is the most accurate test.

Perhaps you'd like to get into more details about the timeline of your symptoms. Influenza is not supposed to last for that long. It may leave you with fatigue lasting for weeks but not the full clinical picture of influenza. So please tell me as much as you can about your symptoms. It would help me to understand your condition better. What about your lupus? Is it in remission or does it give you symptoms too?


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (39 hours later)
Thank you for caring. I would appreciate any help you can give me. The timeline was I had gotten a very bad sinus infection mid to late October was put on antibiotics and still never felt well. The month of November felt sick and weak tired and not feeling good headaches and just a really lousy feeling. My temperature never XXXXXXX above 99.7. And always went back down. My rheumatologist who has me on 16 mg of prednisone for mixed connective tissue disease. He told meto raise my prednisone 17 mg. I did and never felt any better.he did a blood culture which was negative my white count is 17 but always is cause of steroids may be a little bit higher than previous.Still feeling weak confused a little bit and fatigued. Dont know what to do or what is wrong can't seem to get any better. I also suffer from anxietyand depression I don't know how much this is playing into it. But have a viral and unwell feeling which I can't seem to shake don't know what to do? Don't know if I had gotten just really Deconditionef because I haven't gotten out of bed much in the couple of months.please help. Thank you
doctor
Answered by Dr. Panagiotis Zografakis (9 hours later)
Brief Answer:
a diagnosis is needed!

Detailed Answer:
You're welcome!

Let me start from the basics. The main symptom in sinusitis is headache and facial pain (above the involved sinus). Congestion and stuffy nose is another symptom. Acute sinusitis may cause high fever while a chronic one may only cause the rest of the symptoms. Radiological assessment may help in the diagnosis but is rarely needed. Proper treatment usually results in rapid relief (within a few days).

Influenza may cause severe fatigue lasting for weeks, even when the other symptoms have subsided.

You white blood cells are not very high for a patient on corticosteroids but significant differences between tests may be indicative of acute conditions. Your rheumatologist was right to advise you to increase the prednisone dosage because more corticosteroid is needed during acute illness. I don't know if 17mg was enough, that's up to your doctor to decide. I suppose a 10-15% increase should suffice...

Another thing to consider is lupus. Does your rheumatologist believe that lupus is involved in your symptoms? An ESR and CRP test might provide some clues. A high CRP would be a positive finding for infections. A low CRP with high ESR might be caused by lupus (but other causes may also apply). Please note that the steroids may blunt the CRP response.

So in conclusion, it's a matter of clinical judgement. Your doctor should examine you thoroughly. Clinical examination may provide the additional clues needed to reach a diagnosis. Unfortunately the rest of your symptoms are not diagnostic.

I hope I've helped you somehow!

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (4 days later)
I have a question very important another physician did a influenza ANB antibodies quantitive so I believe that is the acute convalescent test not sure so my question is the other physician on December 9 just did antibodies and they where 1 to 8 to 1 to 16. But now this doctor did this new test I think it's a little bit more involved if you could please explain that to me but the test was done six weeks after the December 9 test from what I think I understand the test for the Antibodies and
Titers should be done between two and four weeks after the first test to see acute or convalescent can you please help me and clarify all this for me thank you
doctor
Answered by Dr. Panagiotis Zografakis (5 hours later)
Brief Answer:
it's OK...

Detailed Answer:
The peak antibody titers develop between 4-7 weeks after the infection which means that your test should provide the necessary information for the second doctor. The antibody titers may decline afterwards.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (13 hours later)
If you could help me with this so if the Titers go higher it means I have An infection or had an infection and if their lower what does that mean that I never had an infection please explain thank you
doctor
Answered by Dr. Panagiotis Zografakis (49 minutes later)
Brief Answer:
high titers means infection

Detailed Answer:
The antibodies start to develop once the body gets into contact with the infectious agent. The highest titers are reached in the 4th-7th week after infection. So this is the plan when measuring antibodies. The first measurement is the baseline. In acute infection we expect the antibodies to rise significantly (x4) in the second measurement.

If they fail to rise then the most likely explanation is an infection of different etiology (that is negative for influenza).

The positive antibodies might mean past infection or cross-reactivity, none of which means current influenza infection.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (32 minutes later)
So if the antibodies on this test are fourfold from the first test does that mean I have a current infection or past infection thanks
doctor
Answered by Dr. Panagiotis Zografakis (14 minutes later)
Brief Answer:
x4 means recent infection

Detailed Answer:
For influenza 4 weeks later means recent infection because it's not supposed to last that long! But for the point of your question, the answer is that x4 means current infection. A lower titer means that the antibodies were formed in the past and that influenza had nothing to do with your symptoms.

I hope this is more clear now!

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (2 days later)
Please help got back the blood test for the influenza complement fixation test the influenza a titter was 1 to 32 and influenza B was 1 to 16 this was seven weeks later after the first one the first one as you remember the results were influenza A1 to 16 and 1 to 8 for B what does this mean please help
doctor
Answered by Dr. Panagiotis Zografakis (1 hour later)
Brief Answer:
probably no infection

Detailed Answer:
As I've already told you a four-fold increase is required to establish the diagnosis. Without it there is no diagnosis. I understand that the test was done at a later time but still it doesn't fulfill the diagnostic criteria. It's too long a time for influenza anyway. The increase in titer could be related to the activation of your immune system but not from influenza virus.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (24 minutes later)
I'm sorry I don't mean to sound like I don't know what I'm talking about but feels a little confusing to me. I understand you're saying about the fourfold do you think it means I had a past infection or there was never an infection. And what do you mean about my immune system activating it thank you.
doctor
Answered by Dr. Panagiotis Zografakis (33 minutes later)
Brief Answer:
it's a past infection

Detailed Answer:
Influenza is a very common disease. Most individuals will get it numerous times throughout their lives. The antibody titers decline in a short time (they will be in very low levels a few months after recovery from influenza) and the influenza itself alters its genome, so that the same strain may reinfect the patient.

An increased antibody titer usually means a past infection. If the second measurement is not x4 then it's not a recent one.

When a pathogen enters the body, the patient develops antibodies against the pathogen. During this procedure the titers of some seemingly unrelated antibodies may rise. This is what I meant before.

I hope it's more clear now!

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (4 hours later)
So when you said past infection do you mean months or what time period?
Also.when you said seemingly other antibodies
Could rise is it possible this was never flu?
I had gotten a cold and sinus issues about 3weeks ago could that be why the titers are higher now and this is a new infection.or are the titers moe related to the first test?
My concern is do I have flu now because I still
Am fatigued and somewhat confused and not so well?
I appreciate all your knowledge, I just want to
Feel better, thank you
doctor
Answered by Dr. Panagiotis Zografakis (10 hours later)
Brief Answer:
the time can't be estimated

Detailed Answer:
Unfortunately the time cannot be estimated. Since we get diseased from influenza so many times during our lifetime it's almost certain that everybody has some titers of antibodies but the titer cannot be used to estimate the time of illness.

The antibodies-test confirms (as credibly as it can) that there was no recent influenza infection.

Perhaps your infection was caused by another virus. Bacterial disease cannot be excluded also. If you still feel very fatigued then lab tests might help. A complete blood count, a quantitative c-reactive protein and a biochemical panel would be very helpful.

Please ask again, if you feel that you need more clarifications. I'll be glad to help!

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (14 hours later)
Can you do a viral culture for influenza through blood testing. What other blood test can be helpful in diagnosis. Had gotten a script for viral culture and antigen testing but I see he can only done through nasal swab and my doctors office I don't know if they do that please respond ASAP thank you
doctor
Answered by Dr. Panagiotis Zografakis (2 hours later)
Brief Answer:
PCR testing

Detailed Answer:
The best test is with PCR. A sample is taken with a swab too. The PCR will identify fragments of the virus so if you've got influenza now or even recently the test would be positive. It's more expensive though.

Kind regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (38 hours later)
In your opinion what do you think the rise was in the antibodies from the first test and it was six weeks later I made a mistake not seven from the second test. I had gotten some blood work done didn't see the doctor though he just ordered bloodwork my white blood cell countwhich was 17.6 and 17.3 in December 9 and December 22 now when it was redone January 27 was 13.9 Also my C-reactive protein was a little high 6.5 and my CMP panel was relatively OK just a little low on sodium. Still have a lot of nasal congestion and feel unwell just keep seeming like I have a cold or allergies or something but very fatigued. When you said that changes the genome here and it reinfect do you think possibly a couple weeks ago when I started getting a little cold again that was a reinfection. Not sure what you meant by reinfecting again. Do you think I need another flu tests or just leave it alone.
I had taken amoxicillin for about 10 days just stopped the other day not sure if I have a chronic sinusitis issue going on don't know whether I should continue it or not nasal discharge is clear but you know how I've been feeling. Please give me a feedback on a bug issues. Thank you
doctor
Answered by Dr. Panagiotis Zografakis (8 hours later)
Brief Answer:
I don't believe you've got the flu right now...

Detailed Answer:
The 1 week difference is not important. The results should be the same. Protracted "cold" is usually a sinusitis. If the sinusitis has been documented by your doctor then antibiotic treatment would be required. If you're unresponsive to courses of antibiotics then other causes should have to be sought. The doctor should first treat the patient according to the most likely cause and the proceed to the less likely causes. For example, Wegener's granulomatosis may causes a protracted 'sinusitis-like' disease but it's a very rare disease.

The white blood cells count denotes inflammation most of the times. It's another good reason to more actively seek a diagnosis.

Regarding the changes in genome and reinfection, I meant that influenza virus H1N1 for example is not the same virus as it was 40 years ago, when an epidemic was active. The individuals who contracted it then, may well contract it now too. They are not protected because the virus has induced changes in its DNA and because influenza antibodies titers drop significantly after even only 1 year from infection.

I don't believe that you need more influenza tests. If you'd like to be 100% certain then you should do the PCR test. You should contact an ear-nose-throat (ENT) specialist to assess your sinuses. Amoxicillin does not sound potent enough for your case but before trying more potent antibiotics, you'd better be sure about the diagnosis. I'm sure the ENT specialist would help you!

I wish you get over it soon! You seem to be really bothered by this situation.

Best Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (14 hours later)
What would you attribute the rise in antibodies then? Do
You think the 1:32 1week ago us a new infection.
doctor
Answered by Dr. Panagiotis Zografakis (20 minutes later)
Brief Answer:
it's not high enough

Detailed Answer:
1:32 is not enough to diagnose new infection. Of course an absent antibody, will later be detected in 1:8 and then in 1:16, then in 1:32 and so on in case of a new infection. But you had some antibodies (in low titers) and they didn't rise as much as a conclusive diagnosis of influenza would require. So no influenza has been detected.

I've already explained the rise by referring to the immune system activation by other (non-influenza) antigens. It's not important and that's why we've got the titer criteria. If it's less than fourfold then it's not enough!

Since you're so much concerned about it, you can just do the PCR test, to find out whether fragments of influenza virus are in your throat or not. If it's positive then you would have got the answer that at least at some time during your protracted illness, influenza played a role. If it's negative then it means that other pathogens or conditions caused your symptoms.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (3 days later)
Wanted to let you know a few things so. Saw an infectious disease doctor on Tuesday. She did a number of tests. She did a virus media culture for influenza, RSV culture, throat culture, Urine culture and a number of blood tests to see what's going on. She said I look like I feel unwell and probably got some nasty virus going on. She also had me right away do a chest x-ray and a sinus x-ray.both of those the chest x-ray and the sinus x-ray came back negative so that was good and the preliminary for the influenza and RSV one day later came back negative. Will find out more results on Friday and all the bloodwork will be in next week she did Epstein-Barr Lyme mono spot some Inr something not sure what else. My question is what do you think of all this and the influenza culture if it's negative now and negative on the final probably Friday does that mean I never had it or it's just negative now. Thanks
doctor
Answered by Dr. Panagiotis Zografakis (6 hours later)
Brief Answer:
influenza is not supposed to last for so long...

Detailed Answer:
A negative final result is expected because influenza is not supposed to last for so long. A simple explanation could be that you've got infected by a series of viruses which is not uncommon during winter, so that you become ill again right after recovering from the last virus. I suppose the tests will help to confirm or exclude potential causes. What's more important is that your radiological tests are negative.

If no infection can be confirmed then perhaps other causes might have to be considered. But you'll have to wait for the tests' results first.

Kind Regards!
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Panagiotis Zografakis

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What Does My Blood Test Report Indicate?

Brief Answer: can't be sure with this test... Detailed Answer: Hello, the complement fixation tests (CF) has a lot of limitations. A high titer (>1:32) usually indicates acute infection. Lower titers (>1:8 but <1:32) may be caused by recent infection or past infection. The only way to differentiate between them (besides the clinical information of course) is by measuring the titers again in the convalescent phase (3-4 weeks later). The titers should rise even more if the influenza virus was the cause of the disease. Please note that while many patients with the influenza virus develop a disease with high fever and severe fatigue, muscle aches, etc, there are patients who develop only minor symptoms or no symptoms at all. So a rising titer without symptoms could indicate such a case. Vaccination also influences the test result causing an increased titer. The PCR test is the most accurate one. I hope you find my comments helpful! You can contact me again, if you'd like any clarification or further information. Kind Regards!