4.4.5 What confirmatory test should be applied?

To confirm FAT- or DRIT – inconclusive results or FAT or DRIT-negative results in the context of a human exposure, either virus isolation or detection of viral genome using molecular techniques can be applied.

Virus isolation aimed at detecting replication competent viral particles can be performed on cells or upon intracranial inoculation of mice using the Rabies Tissue Culture Infection Test (RTCIT – for details see here) and the Mouse Inoculation Test (MIT – for details see here). Whenever possible the RTCIT should replace the MIT. For RTCIT at least three passages should be conducted to confirm a negative result.

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RTCIT - photo Friedrich Loeffler Institut
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[en]RTCIT positive cell culture-Photo Friedrich Loeffler Institut[fr]RTCIT positif - Photo Friedrich Loeffler Institut

Although the use of RT-PCR (and other amplification techniques - for details see here) is currently not recommended for routine post-mortem rabies diagnosis, it might often be the only possibility for confirmatory testing especially in the case where RTCIT or MIT have not been established in the laboratory. Strict laboratory quality assurance is a prerequisite for molecular techniques to prevent the potential risk of producing false-positive results due to cross-contamination as such methods are highly sensitive. For more information see here.

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[en]Version 1 Last updated December 2014[fr]Première version, dernière mise à jour Juin 2015