S1 guidelines “lumbar puncture and cerebrospinal fluid analysis” (abridged and translated version)

Tumani, H.; Petereit, H. F.; Gerritzen, A.; Gross, C. C.; Huss, A.; Isenmann, S.; Jesse, S.; Khalil, M.; Lewczuk, P.; Lewerenz, J.; Leypoldt, F.; Melzer, N.; Meuth, S. G.; Otto, M.; Ruprecht, K.; Sindern, E.; Spreer, A.; Stangel, M.; Strik, H.; Uhr, M.; Vogelgsang, J.; Wandinger, K.-P.; Weber, T.; Wick, M.; Wildemann, B.; Wiltfang, J.; Woitalla, D.; Zerr, I.; Zimmermann, T.

doi:10.1186/s42466-020-0051-z

Neurological Research and Practice

Table 8 Spectrum of viral pathogens and diagnostic methods

From: S1 guidelines “lumbar puncture and cerebrospinal fluid analysis” (abridged and translated version)

Pathogen	Diagnostic method (1st choice)	Material	Diagnostic method (2nd Choice)	Material	Reference
Immunocompetent patients
Enterovirus (Echo, Coxsackie A/B)	RT-PCR Sensitivity 97% Specificity 100%	CSF Stool, rhinopharyngeal swab	Direct detection by electron microscopy	Stool	[18, 198]
Flavivirus (FSME)	Serology Sensitivity 99% Specificity 98%	Blood	RT-PCR (early Phase) AI after 10-14 days	CSF	[72]
Herpes simplex virus Type 1 & 2	DNA-PCR Sensitivity > 95% Specificity 100%	CSF	AI after 10-14 days	CSF	[63]
Varicella zoster virus	DNA-PCR Sensitivity 95% Specificity 100%	CSF	AI after 10-14 days	CSF	[104]
Immunocompromised patients
Cytomegaly virus	DNA-PCR Sensitivity 99% Specificity 99%	CSF	AI after 10-14 days pp65-Antigen	CSF Blood/ CSF	[4, 19, 96]
Epstein-Barr virus	DNA-PCR Sensitivity 100% Specificity 100%	CSF	AI after 10-14 days	CSF	[80]
Human immune deficiency virus	Serology RT-PCR Sensitivity 99% Specificity 100%	Blood	AI after 10-14 days	CSF	[5]
John Cunningham virus	DNA-PCR Sensitivity 95% Specificity > 90%	CSF	AI after 10-14 days	CSF	[20]
Other viral CNS infections
Adeno virus	DNA-PCR Sensitivity 100% Specificity 99%	CSF	Antigen detection	CSF	[28]
Hanta virus	DNA-PCR Sensitivity 95% Specificity 100%	CSF	AI after 10-14 days	CSF	[178]
Measles	Serology RT-PCR Sensitivity 100% Specificity 100%	Serum CSF	AI after 10-14 days	CSF	[2]
Mumps virus	Serology RT-PCR Sensitivity 90% Specificity 100%	Serum CSF	AI after 10-14 days pp65-Antigen	CSF Blood/ CSF	[148]
Polio virus	Serology RT-PCR Sensitivity 100% Specificity 100%	CSF	AI after 10-14 days	CSF	[69]
Rabies virus	RT-PCR Sensitivity 99% Specificity 99%	CSF Blood Saliva	Direct detection by electron microscopy	CSF Saliva Brain	[47]
Rubella virus	Serology RT-PCR Sensitivity 79% Specificity 100%	Serum CSF	AI after 10-14 days	CSF	[131]
Zika virus	Serology RT-PCR Sensitivity 91% Specificity 97%	Serum CSF / Urine	AI after 10-14 days	CSF	[168]

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