Meningitis/Encephalitis Panel Algorithm
Recommended testing for patients with findings suggestive of acute (<8 days of symptoms) meningitis or encephalitis.
NOTE: Not intended for patients with cerebrospinal fluid (CSF) shunts or possible central nervous system surgical site infections.
Infectious Diseases and/or Neurology specialty consultation is recommended.
■ Lumbar puncture to obtain CSF. Order the following tests and retain CSF for additional testing:
■ Opening pressure (may not be indicated in neonates/ infants)
■ Cytology, cell count and differential
■ Protein and glucose
■ Gram stain
■ Bacterial culture (aerobic with antimicrobial susceptibility testing)
■ Cryptococcal antigen, if indicated per patient risk factors
■ Blood cultures
Previously healthy patient Immunocompromised patient or patient
with current/recent antibiotic treatment
If CSF testing available on-site Order: CSFME / Meningitis/Encephalitis
Perform: Pathogen Panel, PCR, Spinal Fluid
■ Streptococcus pneumoniae antigen
■ Herpes simplex virus (HSV) PCR
■ Enterovirus PCR
POSITIVE NEGATIVE
Consider:
■ Varicella-zoster virus PCR
Pathogen-specific
POSITIVE infection management
NEGATIVE TESTING NOT CSF parameters CSF parameters do
AVAILABLE suggest infection not suggest infection
Order: MSCSF / Bacteria, Reevaluate patient
Pathogen-specific CSF parameters do CSF parameters
POSITIVE Virus, Fungus, and
infection management not suggest infection suggest infection
Parasite Metagenomic
Sequencing, Spinal Fluid
Pathogen-specific
Reevaluate patient infection management
NEGATIVE
Additional testing should be tailored based on clinical presentation, risk factors, CSF ■ Vector-borne testing
parameters, and exposure history. – Mosquito-borne pathogens
■ If not previously performed, consider: – Refer to the Mosquito-borne Disease Laboratory Testing Algorithm for
– CLFA / Cryptococcus Antigen Screen with Titer, Spinal Fluid information
– HSVC / Herpes Simplex Virus (HSV), Molecular Detection, PCR, Spinal Fluid – Tick-borne pathogens
■ Syphilis testing – LNBAB / Lyme Central Nervous System Infection IgG with Antibody Index
– SYPH1 / Syphilis IgG with Reflex, Enzyme Immunoassay, Serum Reflex, Serum and Spinal Fluid (see Lyme Neuroborreliosis Diagnostic Algorithm)
– NSAIP / Neurosyphilis IgG Antibody Index with VDRL, Serum and Spinal Fluid – LYMPV / Lyme Disease, Molecular Detection, PCR, Varies
■ Fungal and mycobacterial testing – POWV / Powassan Virus, IgM, Enzyme-Linked Immunosorbent Assay, Serum
– FGEN / Fungal Culture, Routine – POWVU / Powassan Virus, RNA, Molecular Detection, PCR, Urine
– FS / Fungal Smear, Varies – POWVB / Powassan Virus, RNA, Molecular Detection, PCR, Blood
– CTB / Mycobacteria and Nocardia Culture, Varies – POWVC / Powassan Virus, RNA, Molecular Detection, PCR, CSF
– SAFB / Acid-Fast Smear for Mycobacterium, Varies – POWVS / Powassan Virus, RNA, Molecular Detection, PCR, Serum
– MTBRP / Mycobacterium tuberculosis Complex, Molecular Detection, PCR – HRTVC / Heartland Virus, RNA, Molecular Detection, PCR, Spinal Fluid
– HBRP / Histoplasma capsulatum/Blastomyces species, – HRTVS / Heartland Virus, RNA, Molecular Detection, PCR, Serum
Molecular Detection, PCR, Varies – For emerging vector-borne diseases (eg, Jamestown Canyon virus) contact your
– HIBC / Histoplasma/Blastomyces Panel, Spinal Fluid local public health laboratory for more information
– HISER / Histoplasma Antibody Complement Fixation ■ Neuroimmunology testing (consider if antibody prevalence in epilepsy and
and Immunodiffusion, Serum encephalopathy [APE2] score is ≥4)
– FUNSF / Fungitell, CSF (1,3-beta-D-glucan) – ENS2 / Encephalopathy, Autoimmune Evaluation, Serum
– BLAST / Blastomyces Antibody by Enzyme Immunoassay, Serum – ENC2 / Encephalopathy, Autoimmune Evaluation, Spinal Fluid
– COXIS / Coccidioides Antibody with Reflex, Serum ■ Parasitic testing
– CCOC / Coccidioides Antibody, Spinal Fluid – FLARP / Free-Living Amebae, Molecular Detection, PCR, Spinal Fluid,
– CIMRP / Coccidioides immitis/posadasii, Fresh and Paraffin Tissue
Molecular Detection, PCR – PTOX / Toxoplasma gondii, Molecular Detection, PCR
– TXPAB / Toxoplasma gondii Antibody, IgM and IgG, Serum
■ Other considerations
– BRBPS / Broad Range Bacterial PCR and Sequencing, Varies
– JCPCR / JC Virus, Molecular Detection, PCR, Spinal Fluid
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