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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]