Laboratory parameters of the 1st order – obligatory laboratory tests.
- Small blood count
- Differential blood count
- Inflammatory parameter – CRP (C-reactive protein)
- Procalcitonin (acute phase protein): is mainly influenced by bacterial infections – for differential diagnosis between bacterial and viral meningoencephalitides.
- Fasting glucose (fasting blood glucose).
- Blood cultures (pathogens/resistance)
- CSF puncture (lumbar puncture/taking of cerebrospinal fluid by puncture of the spinal canal) for CSF diagnostics: determination of total protein, albumin, glucose, immunoglobulins, lactate (simultaneous submission of CSF and serum required! )[Lactate in CSF very well suited for differentiation: “viral – bacterial”: lactate values are normal (viral meningitis) or only slightly elevated (viral encephalitis: always ≤ 4.0 mmol/l)]
- Serology – antibodies against Borrelia, CMV (cytomegalovirus), EBV (Epstein-Barr virus), TBE (early summer meningo encephalitis virus), HSV (herpes simplex virus), measles virus, mumps virus, VZV (varicella zoster virus), Treponema pallidum.
Stage diagnosis of neurotropic viruses in adults (mod. after).
| Pathogen | Diagnostics 1st choice | Diagnostics 2nd choice |
| Stage 1: specifically treatable viral infections. | ||
| CMV | DNA PCR | ASl, antigen detection (pp65) in blood and CSF. |
| HIV 1/2 | RNA-PCR, blood serology | ASl |
| HSV 1/2 | DNA PCR | ASI (after 2 weeks) |
| VZV | DNA PCR | ASl (after 2 weeks) |
| Stage 2: viruses for which potentially effective agents are known but not available, not sufficiently tested, or not yet approved | ||
| EBV | DNA PCR | Special serology |
| Echoviruses, coxsackie viruses | RNA-PCR, serology | Pathogen isolation |
| Nipah virus | RNA-PCR | Serology |
| Stage 3: more common viruses (Western Europe) that have not yet been specifically treatable | ||
| Adenoviruses | Serology | Pathogen isolation |
| TBE virus | Serology in blood and cerebrospinal fluid (ASI). | RNA-PCR (early!) |
| HHV 6 | Serology (ASI) | DNA PCR |
| HHV 7/8 | DNA PCR | Serology |
| Influenza virus A and B, parainfluenza virus. | Serology | RNA-PCR |
| JCV (polyomavirus group) | DNA PCR | Serology |
| Measles virus | Serology (ASI) | RNA-PCR |
| Rubeolavirus | Serology (ASI) | RNA-PCR |
| Stage 4: special questions | ||
| Hantaviruses (due tocontact with excreta from mice and rats) | Serology (ASI) | RNA-PCR |
| Hepatitis C infection (wg. | RNA-PCR | Serology |
| HTLV1 (for spastic paraparesis) | RNA-PCR, serology | |
| LCM virus ( due to contact with rodents) | Serology | PCR |
| Poliovirus (due toflaccid paresis). | Virus culture from cerebrospinal fluid and stool | RNA-PCR, serology |
| Rabies virus (due torabies suspicion | RNA-PCR | Direct immunofluorescence |
Legend
- ASI: antibody specificity index
- CMV: cytomegalovirus
- DNA: deoxyribonucleic acid
- EBV: Epstein-Barr virus
- TBE: early summer meningoencephalitis
- HHV: human herpes virus
- HIV: human immunodeficiency virus
- HSV: herpes simplex virus
- HTLV: human lymphotropic virus
- JCV: John Cunningham virus
- LCM lymphocytic choriomeningitis
- PCR: polymerase chain reaction
- RNA: ribonucleic acid
- VZV: varicella zoster virus