Meningitis
a) Acute bacterial meningitis is an inflammation of the meninges and subarachnoid space that can also involve the brain cortex and parenchyma. Diagnosis of meningitis is mainly based on clinical presentation and cerebrospinal fluid analysis. Fever, headache, neck stiffness, and altered mental status are classic symptoms of meningitis.
b) Aseptic meningitis is an inflammation of the meninges caused mainly by nonbacterial organisms, specific agents, or other disease processes. Aseptic meningitis (including viral meningitis) is the most common infection of the central nervous system (CNS) in the pediatric population, occurring most frequently in children younger than 1 year.
Distinguishing aseptic from bacterial meningitis is not always easy due to considerable overlap in clinical symptoms and laboratory findings.
Lab tests
Encephalitis Panel include West Nile Virus (WNV), measles, mumps, VZV, HSV-1, and HSV-2
Neisseria meningitidis Tetravalent Antibodies (Serogroups A, C, W-135 and Y), IgG
West Nile Virus Antibodies, IgG and IgM
Lymphocytic Choriomeningitis (LCM) Virus Antibodies, IgG & IgM, CSF
Herpes Simplex Virus – HSV
Herpes simplex virus (HSV) occurs worldwide and produces a variety of clinical manifestations, ranging from mild stomatitis to fatal disease. Herpes simplex virus type 2 (HSV-2) causes recurrent genital herpes episodes more often than herpes simplex virus type 1 (HSV-1), although HSV-1 is responsible for a growing number of genital herpes cases.
Lab tests
Herpes Simplex Virus (HSV) Types I/II (Immunohistochemistry)
Herpes Simplex Type 1 and Type 2 Glycoprotein G-Specific Antibodies, IgG (chemiluminescent Immunoassay)
Human T-Lymphotropic Virus Types I, II – HTLV I, II
Human T-cell lymphotropic virus type I (HTLV-I) is etiologically associated with adult T-cell leukemia/lymphoma (ATLL); tropical spastic paraparesis (TSP), a demyelinating neurological disorder; and HTLV-I-associated myelopathy (HAM). Two types of HTLV testing are available – antibody and molecular testing.
Lab tests
Human T-Lymphotropic Virus (HTLV) Types I/II Antibodies (ELISA)
Human T-Lymphotropic Virus Types I/II Antibodies (Western Blot)
Infectious Encephalitis
Encephalitis is a devastating neurologic syndrome that is characterized by inflammation of the brain parenchyma. While infectious encephalitis is most often identified, the cause remains unknown in up to 50% of cases. An acute clinical presentation may suggest more virulent viruses and bacteria, while a subacute presentation is more often associated with indolent bacteria, fungi, parasites, and autoimmune and paraneoplastic causes. More than 90% of viral encephalitis is caused by herpes simplex virus (HSV), varicella-zoster virus (VZV), and enteroviruses (Venkatesan, 2014), with typical bacterial causes of cerebritis and abscesses consisting of polymicrobial streptococci, gram-negative bacilli, and Staphylococcus aureus infections. Early recognition and treatment for HSV, bacterial, Plasmodium falciparum, and rabies infections are critical and potentially lifesaving. Diagnosis requires a combination of clinical, laboratory, and neuroimaging findings.
Lab test
Cryptococcus antigen (CSF)
Lymphocytic Choriomeningitis – LCM
Lymphocytic choriomeningitis (LCM) virus is spread by rodents. It can be deadly to immunocompromised patients but rarely affects healthy individuals.
Lab test
Lymphocytic Choriomeningitis (LCM) Virus Antibodies, IgG & IgM (Serum, CSF)
Treponema pallidum – Syphilis
Treponema pallidum subspecies pallidum is the causative agent of venereal syphilis, a sexually transmitted infection (STI). If left untreated, syphilis can result in multisystem involvement with significant morbidity. Traditional serologic screening for syphilis initially uses nontreponemal testing, with confirmation of reactive results using a treponemal test. New reverse algorithms initially use treponemal testing (usually enzyme immunoassays [EIAs] or chemiluminescence immunoassays [CIAs]), with confirmation of reactive results using a nontreponemal test. Of note, mothers infected with syphilis can pass the infection to their children in utero (congenital syphilis).
Lab tests
Rapid Plasma Reagin (RPR)
Treponema pallidum (VDRL)
Treponema pallidum Antibody, IgG
Treponema pallidum Antibody, IgG by IFA (FTA-ABS), Serum
References
- Mount HR, Boyle SD. Aseptic and Bacterial Meningitis Evaluation, Treatment, and Prevention. Am Fam Physician. 2017; 96(5) 314-322. PubMed
- CDC STD Prevention. STD Curriculum for Clinical Educators Genital Herpes Simplex Virus (HSV) Module. Centers for Disease Control and Prevention. Atlanta, GA [Published Mar 2014; Accessed Oct 2017]
- US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW, Garcia FA, Kemper AR, Krist AH, Kurth AE, Landefeld S, Mangione CM, Phillips WR, Phipps MG, Pignone MP, Silverstein M, Tseng C. Serologic Screening for Genital Herpes Infection US Preventive Services Task Force Recommendation Statement. JAMA. 2016; 316(23) 2525-2530. PubMed
- Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL, Hartman BJ, Kaplan SL, Scheld M, Whitley RJ, Infectious Diseases Society of America. The management of encephalitis clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008; 47(3) 303-27. PubMed
- sukasaki K, Hermine O, Bazarbachi A, Ratner L, Ramos JC, Harrington W, O’Mahony D, Janik JE, Bittencourt AL, Taylor GP, Yamaguchi K, Utsunomiya A, Tobinai K, Watanabe T. Definition, prognostic factors, treatment, and response criteria of adult T-cell leukemia-lymphoma a proposal from an international consensus meeting. J Clin Oncol. 2009; 27(3) 453-9. PubMed
- Kang SS, McGavern DB. Lymphocytic choriomeningitis infection of the central nervous system. Front Biosci. 2008; 13 4529-43. PubMed
- Centers for Disease Control and Prevention. Morbidity and mortality weekly report (MMWR) Increase in incidence of congenital syphilis – United States, 2012-2014. CDC. Atlanta, GA [Released Nov 2015; Accessed Sep 2018]
