Encephalitis is an inflammatory process of the brain associated with varying degrees of brain dysfunction. The presentation can be acute or chronic.
Tests generally appear in the order most useful for common clinical situations
| Test name: CBC with Platelet Count and Automated Differential |
| ARUP #: 0040003 |
| Methodology: Automated Cell Count/Differential |
| Use: Initial screening Leukocytosis may indicate bacterial etiology; relative lymphocytosis may suggest viral etiology |
| Test name: Cell Count, CSF |
| ARUP #: 0095018 |
| Methodology: Cell Count/Differential |
| Use: Aid in differentiation of viral from bacterial etiology |
| Test name: Cerebrospinal Fluid (CSF) Culture and Gram Stain |
| ARUP #: 0060106 |
| Methodology: Stain/Culture/Identification |
| Use: Aid in differentiation of viral from bacterial etiology |
| Limitations: 70-80% sensitivity; sensitivity decreases if antibiotics given prior to lumbar punch |
| Test name: Glucose, CSF |
| ARUP #: 0020515 |
| Methodology: Enzymatic |
| Use: Aid in differentiation of viral from bacterial etiology |
| Limitations: Glucose loads are normal in >95% of viral cases |
| Test name: Protein, Total, CSF |
| ARUP #: 0020514 |
| Methodology: Reflectance Spectrophotometry |
| Use: Evaluate meningeal fluid to rule out meningitis |
| Test name: Electrolyte Panel |
| ARUP #: 0020410 |
| Methodology: Quantitative Ion-Selective Electrode/Enzymatic |
| Use: Rule out metabolic encephalopathy Panel includes anion gap, carbon dioxide, chloride, potassium, sodium |
| Test name: Hepatic Function Panel |
| ARUP #: 0020416 |
| Methodology: Quantitative Enzymatic/Quantitative Spectrophotometry |
| Use: Rule out metabolic encephalopathy Panel includes albumin; alkaline phosphatase; aspartate aminotransferase; alanine aminotransferase; bilirubin, direct; protein, total; bilirubin, total |
| Test name: Blood Culture |
| ARUP #: 0060102 |
| Methodology: Continuous Monitoring Blood Culture/Identification |
| Use: Identify cause of bacteremia |
| Limitations: Limited to the University of Utah Health Sciences Center only |
| Test name: Viral Meningoencephalitis Panel by PCR, Cerebrospinal Fluid |
| ARUP #: 2007062 |
| Methodology: Qualitative Polymerase Chain Reaction |
| Use: Identifies CMV, EBV, HSV, or VZV as etiological agents of meningoencephalitis Panel includes CMV, EBV, HSV, and VZV by PCR |
| Test name: Herpes Simplex Virus Culture |
| ARUP #: 0065005 |
| Methodology: Cell Culture/Immunoassay |
| Comments: Poor sensitivity in CSF Best to sample soon after symptom onset |
| Test name: Herpes Simplex Virus by PCR |
| ARUP #: 0060041 |
| Methodology: Qualitative Polymerase Chain Reaction |
| Comments: 96% sensitive; 99% specific when CSF is taken 2-7 days from symptom onset Poor sensitivity during the first 24-48 hours after symptom onset |
| Test name: Herpesvirus 6 (HHV6) (A and B), Quantitative PCR |
| ARUP #: 0060071 |
| Methodology: Quantitative Polymerase Chain Reaction |
| Comments: |
| Test name: Varicella-Zoster Virus DFA with Reflex to Varicella-Zoster Virus Culture |
| ARUP #: 0060282 |
| Methodology: Direct Fluorescent Antibody Stain |
| Comments: |
| Test name: Varicella-Zoster Virus Antibody, IgG, CSF |
| ARUP #: 0054444 |
| Methodology: Semi-Quantitative Chemiluminescent Immunoassay |
| Comments: Superior to PCR VZV test |
| Test name: Epstein-Barr Virus Antibody Panel I |
| ARUP #: 0050600 |
| Methodology: Semi-Quantitative Chemiluminescent Immunoassay |
| Comments: |
| Test name: Epstein-Barr Virus Antibody Panel II |
| ARUP #: 0050602 |
| Methodology: Semi-Quantitative Chemiluminescent Immunoassay |
| Comments: |
| Test name: Epstein-Barr Virus by PCR |
| ARUP #: 0050246 |
| Methodology: Qualitative Polymerase Chain Reaction |
| Comments: |
| Test name: Cytomegalovirus Antibodies, IgG and IgM |
| ARUP #: 0050622 |
| Methodology: Semi-Quantitative Chemiluminescent Immunoassay |
| Comments: |
| Test name: Cytomegalovirus by PCR |
| ARUP #: 0060040 |
| Methodology: Qualitative Polymerase Chain Reaction |
| Comments: |
| Test name: West Nile Virus Antibodies, IgG and IgM by ELISA, Serum |
| ARUP #: 0050226 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Comments: Superior sensitivity compared to PCR testing 10% sensitivity at day 1; increases 10%/day, peaking at 80% sensitivity by the end of first week of symptoms |
| Test name: Borrelia burgdorferi Antibodies, Total by ELISA with Reflex to IgG & IgM by Western Blot (Early Disease) |
| ARUP #: 0050267 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Qualitative Western Blot |
| Comments: Antibodies should be measured simultaneously in serum and CSF IgG and IgM useful if symptoms have been present less than or equal to 1 month |
| Test name: Borrelia Species by PCR (Lyme Disease) |
| ARUP #: 0055570 |
| Methodology: Qualitative Polymerase Chain Reaction |
| Comments: |
| Test name: Borrelia burgdorferi Antibodies, IgG & IgM by Western Blot (CSF) |
| ARUP #: 0055260 |
| Methodology: Qualitative Western Blot |
| Comments: For IgG, positive result reported when greater than or equal to 5 bands are present: 18, 23, 28, 30, 39, 41, 45, 58, 66, or 93kDA; all other bandings reported as negative For IgM, positive result reported when greater than or equal to 2 bands are present: 23, 39, or 41kDa; all others reported as negative |
| Test name: Rickettsia rickettsii (Rocky Mountain Spotted Fever) Antibodies, IgG & IgM by IFA |
| ARUP #: 0050371 |
| Methodology: Semi-Quantitative Indirect Fluorescent Antibody |
| Comments: Fourfold increase in titers from acute to convalescent stage (2-4 weeks) is diagnostic |
| Test name: Francisella tularensis Antibodies, IgG and IgM |
| ARUP #: 2005350 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Comments: |
| Test name: Francisella tularensis Antibody, IgG |
| ARUP #: 2005353 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Comments: |
| Test name: Francisella tularensis Antibody, IgM |
| ARUP #: 2005354 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Comments: |
| Test name: Ehrlichia chaffeensis Antibodies, IgG & IgM by IFA |
| ARUP #: 0051002 |
| Methodology: Semi-Quantitative Indirect Fluorescent Antibody |
| Comments: |
| Test name: Colorado Tick Fever Antibodies, IgG & IgM, IFA |
| ARUP #: 0093167 |
| Methodology: Immunofluorescence Assay (Indirect Fluorescent Antibody) |
| Comments: |
| Test name: Babesia microti Antibodies, IgG & IgM by IFA |
| ARUP #: 0093048 |
| Methodology: Semi-Quantitative Indirect Fluorescent Antibody |
| Comments: |
| Test name: Toxoplasma gondii by PCR |
| ARUP #: 0055591 |
| Methodology: Qualitative Polymerase Chain Reaction |
| Comments: |
| Test name: Echinococcus Antibody, IgG |
| ARUP #: 2007220 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Comments: |
| Test name: Mumps Virus Antibody, IgM |
| ARUP #: 0099589 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Comments: |
| Test name: Mumps Virus Antibody IgM, CSF |
| ARUP #: 0054443 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Comments: |
| Test name: Measles (Rubeola) Virus Culture |
| ARUP #: 0065055 |
| Methodology: Cell Culture/Immunofluorescence |
| Comments: |
| Test name: Measles (Rubeola) Antibodies, IgG and IgM |
| ARUP #: 0050375 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Semi-Quantitative Chemiluminescent Immunoassay |
| Comments: |
| Test name: Enterovirus Detection by RT-PCR |
| ARUP #: 0050249 |
| Methodology: Qualitative Reverse Transcription Polymerase Chain Reaction |
| Comments: Identify one of the most common causes of viral encephalitis 65-75% sensitive; 99% specific |
| Test name: Adenovirus Antibodies, IgG & IgM |
| ARUP #: 0051077 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Comments: |
| Test name: Arbovirus Antibodies, IgM, CSF |
| ARUP #: 2001595 |
| Methodology: Semi-Quantitative Indirect Fluorescent Antibody/Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Comments: |
| Test name: Arbovirus Antibodies, IgM, Serum |
| ARUP #: 2001592 |
| Methodology: Semi-Quantitative Indirect Fluorescent Antibody/Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Comments: |
| Test name: Lymphocytic Choriomeningitis (LCM) Virus Antibodies, IgG & IgM |
| ARUP #: 2001635 |
| Methodology: Semi-Quantitative Indirect Fluorescent Antibody |
| Comments: |
| Test name: Lymphocytic Choriomeningitis (LCM) Virus Antibodies, IgG & IgM, CSF |
| ARUP #: 2001628 |
| Methodology: Semi-Quantitative Indirect Fluorescent Antibody |
| Comments: |
| Test name: Human Immunodeficiency Virus Types 1 and 2 (HIV-1, HIV-2) Antibodies with Reflex to HIV-1 Antibody Confirmation by Western Blot |
| ARUP #: 2005377 |
| Methodology: Qualitative Chemiluminescent Immunoassay/Qualitative Western Blot |
| Comments: |
| Test name: Chlamydia pneumoniae by PCR |
| ARUP #: 0060715 |
| Methodology: Qualitative Polymerase Chain Reaction |
| Comments: |
| Test name: Mycoplasma pneumoniae by PCR |
| ARUP #: 0060256 |
| Methodology: Qualitative Polymerase Chain Reaction |
| Comments: |
| Test name: Legionella Species by PCR |
| ARUP #: 0056105 |
| Methodology: Qualitative Polymerase Chain Reaction |
| Comments: |
| Test name: Listeria Antibody, Serum by CF |
| ARUP #: 0099529 |
| Methodology: Semi-Quantitative Complement Fixation |
| Comments: |
| Test name: Acid-Fast Bacillus (AFB) Culture and AFB Stain |
| ARUP #: 0060152 |
| Methodology: Stain/Culture/Identification/Susceptiblity |
| Comments: |
| Test name: Acid Fast Stain, Partial or Modified (for Nocardia spp.) |
| ARUP #: 0060325 |
| Methodology: Stain/Microscopy |
| Comments: |
| Test name: Anaerobe Culture and Gram Stain |
| ARUP #: 0060143 |
| Methodology: Stain/Culture/Identification |
| Comments: |
| Test name: Bartonella Species by PCR |
| ARUP #: 0093057 |
| Methodology: Qualitative Polymerase Chain Reaction |
| Comments: |
| Test name: Leptospira Culture |
| ARUP #: 0060158 |
| Methodology: Culture |
| Comments: |
| Test name: Rapid Plasma Reagin (RPR) with Reflex to Titer |
| ARUP #: 0050471 |
| Methodology: Semi-Quantitative Charcoal Agglutination |
| Comments: |
| Test name: Acanthamoeba and Naegleria Culture |
| ARUP #: 0060245 |
| Methodology: Qualitative Culture/Microscopy |
| Comments: |
| Test name: Trypanosoma cruzi Antibody, IgG |
| ARUP #: 0051076 |
| Methodology: Semi-Quantitative Immunoassay |
| Comments: |
| Test name: Cryptococcus Antigen, Serum |
| ARUP #: 0050196 |
| Methodology: Semi-quantitative Enzyme Immunoassay |
| Comments: |
| Test name: Cryptococcus Antigen, CSF |
| ARUP #: 0050195 |
| Methodology: Semi-quantitative Enzyme Immunoassay |
| Comments: |
| Test name: Histoplasma Antigen by EIA, Serum |
| ARUP #: 0092522 |
| Methodology: Semi-quantitative Enzyme Immunoassay |
| Comments: |
| Test name: Blastomyces Antibodies by CF & ID |
| ARUP #: 0050626 |
| Methodology: Semi-Quantitative Complement Fixation/Qualitative Immunodiffusion |
| Comments: |
| Test name: Fungal Culture |
| ARUP #: 0060149 |
| Methodology: Culture/Identification |
| Comments: |
| Test name: Blood Culture, Fungal |
| ARUP #: 0060070 |
| Methodology: Continuous Monitoring Blood Culture/Identification |
| Comments: |
| Test name: Sedimentation Rate, Westergren (ESR) |
| ARUP #: 0040325 |
| Methodology: Visual Identification |
| Comments: Determine symptoms involved in vasculitic-like infections |
| Test name: C-Reactive Protein |
| ARUP #: 0050180 |
| Methodology: Quantitative Immunoturbidimetry |
| Comments: Determine symptoms involved in vasculitic-like infections |