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] |