Infectious Encephalitis

Use to rapidly detect a panel of common viruses, bacteria, and fungi associated with meningitis and encephalitis

Do NOT use as a replacement for CSF bacterial and/or fungal culture and cryptococcal antigen testing for at-risk patients

A negative result does not exclude a diagnosis of meningitis or encephalitis due to infection

Identify bacteria in CSF

Limited to the University of Utah Health Sciences Center only

Aid in differentiation of viral from bacterial etiology

Detect presence of bacteria in blood

Limited to the University of Utah Health Sciences Center only

Identify Cryptococcus as an etiological agent of meningitis

CAP requires confirmation by culture for this test

When test is ordered by the University of Utah Hospital, Huntsman Cancer Hospital, or VA Hospital of SLC, CSF culture will be ordered automatically; other clients should order culture separately

Leukocytosis may indicate bacterial etiology; relative lymphocytosis may suggest viral etiology

Preferred test to detect acute phase inflammation (eg, autoimmune diseases, connective tissue disease, rheumatoid arthritis, infection, or sepsis)

Nonspecific test used to detect inflammation associated with infections, cancers, and autoimmune diseases

Gold standard; most sensitive test for diagnosing mycobacteria​

The laboratory should be notified when the presence of Mycobacterium genavense is suspected, as this organism will not grow on media routinely used for Mycobacterium isolation

Susceptibility testing will be performed on organisms isolated from a sterile source and for isolates of M. chelonae, M. abscesses, M. fortuitum complex, M. immunogenum, M. mucogenicum; susceptibility testing will be performed by request only on M. kansaii and M. marinum; susceptibility testing of M. gordonae is inappropriate

Use to detect aerobic actinomycetes (Nocardia and Gordonia spp, etc) in clinical specimens

Diagnose anaerobic bacterial infections

Gold standard test to diagnose fungi as agent of infection

Gold standard test to diagnose fungi as agent of infection in blood

Comprehensive panel for the evaluation of paraneoplastic and neuromuscular junction disorders, and/or encephalitis, in the presence or absence of malignancy

Comprehensive panel for the evaluation of paraneoplastic and neuromuscular junction disorders, and/or encephalitis, in the presence or absence of malignancy

Detect Acanthamoeba spp and N. fowleri in various specimen types

Useful if Giemsa stain is negative, but high suspicion of babesiosis exists

Will not detect Babesia duncani or strain MO-1

Detect Bartonella species in blood, CSF, or tissue

Use in conjunction with positive serologic testing for the workup of suspected acute Lyme neuroborreliosis

Do not order in the absence of clinical symptom

Preferred reflex test to detect Lyme disease in individuals with ≤4 weeks of clinical symptoms or exposure to tick

Positive/equivocal screen confirmed by immunoblot

Not a first-line test for Lyme disease; may be useful if strong suspicion of Lyme disease persists in spite of persistent negative serologic testing

Detect C. pneumoniae in bronchoalveolar lavage (BAL), nasal wash, nasopharyngeal swab, or pleural fluid

Identify Cryptococcus neoformans as the infectious agent of invasive cryptococcal disease

Aid in discriminating between current and past CMV infection in immunocompetent individuals

Detects CMV but does not quantify viral load; potentially useful for specimen types other than blood

CMV by quantitative PCR on plasma is preferred for most clinical indications

Adjunct to other diagnostic tests (eg, imaging) for echinococcosis

Patient's travel history is necessary to aid in test interpretation

Diagnose infection from E. chaffeensis

Detect enterovirus in blood, CSF, or nasopharyngeal specimens

Aid in diagnosis of primary EBV infectious mononucleosis after a suspected false-negative heterophile antibody (Monospot) test

Aid in determining past or present EBV infection as well as susceptibility to future EBV infection

May be used in conjunction with EBV nuclear antigen to diagnose primary EBV infectious mononucleosis

Do not use for diagnosis of infectious mononucleosis

Order to detect EBV in individuals suspected of having EBV-related disease

Preferred test for detecting antibodies during acute or convalescent phase

Convalescent sera may be required for diagnosis

Detect antibodies during convalescent phase

Convalescent sera may be required for diagnosis

Detect antibodies during convalescent phase

Convalescent sera may be required for diagnosis

Traditional gold standard test for identifying acute HSV infection in active lesions (eg, vesicles, ulcers, inflamed mucous membranes)

Molecular testing is generally preferred (refer to HSV by PCR)

Preferred test for detecting HSV infection in CSF, neonates, or when rapid diagnostic test for suspected HSV infection is necessary

Recommend testing in conjunction with the combined complement fixation and immunodiffusion antibody and urine galactomannan antigen tests

Detect and quantify HHV6 subtypes A and B in immunocompromised patients

A negative result (<3.0 log copies/mL or <1,000 copies/mL) does not rule out the presence of PCR inhibitors in the patient specimen or HHV6 DNA in concentrations below the level of detection of the test

2014 CDC Recommended Algorithm for Laboratory Diagnosis of HIV infection

Fourth generation test screens for HIV-1 p24 antigen and antibodies to HIV-1 (groups M and O) and HIV-2

Not available to New York clients; refer to New York HIV combo antigen/antibody (HIV-1/O/2) reflexive panel

Detect Legionella species

May provide definitive diagnosis, but sensitivity is low and culture may take several weeks to yield result

Aid in the diagnosis of lymphocytic choriomeningitis (LCM) viral infection

Aid in the diagnosis of LCM viral infection in CNS

Culture test for detecting measles virus in specimens other than CSF

Aid in the diagnosis of measles infection

Test may not be helpful in patients who have recently received an MMR vaccination

Aid in the diagnosis of measles infection

Test may not be helpful in patients who have recently received an MMR vaccination

Not recommended

Detect M. pneumoniae bacteria

Confirm diagnosis of anti-NMDAR encephalitis

May be used in monitoring treatment response in individuals who are antibody positive

CDC-recommended screening test for syphilis

May use to confirm reactive treponemal test (eg, enzyme immunoassay [EIA], chemiluminescence immunoassay [CIA]) if using so-called reverse algorithm testing

Preferred test for monitoring treatment response in established syphilis

Confirm toxoplasmosis infection in immunocompromised hosts as well as fetuses and newborns

May be used to confirm equivocal antibody testing

Aid in the diagnosis of nonacute (chronic phase) Chagas disease (T. cruzi)

Generally not recommended for the diagnosis of acute disease/encephalitis

May aid in diagnosing VZV vasculopathy

Detect VZV

Negative or inadequate direct fluorescent antibody (DFA) results are confirmed with culture

DFA sensitivity is highest when performed on scraping from the base of lesions; culture sensitivity is highest when specimens are collected soon after onset of symptoms

Molecular testing is generally preferred; refer to VZV by PCR

Detect VZV in blood, CSF, ocular fluid, tissue, or vesicle fluid

Preferred test for diagnosing West Nile encephalitis

Detect presence of IgG and IgM antibodies in individuals with a clinical suspicion of West Nile virus