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United States Centers for Disease Control and Prevention laboratory criteria for diagnosis of West Nile virus disease

United States Centers for Disease Control and Prevention laboratory criteria for diagnosis of West Nile virus disease
A CONFIRMED case of West Nile virus infection in a patient with clinically compatible disease is determined by meeting one of the following criteria:
  • Isolation of virus from, or demonstration of specific viral antigen or nucleic acid in, tissue, blood, CSF, or other body fluid, or
  • Fourfold or greater change in virus-specific quantitative antibody titers (PRNT) in paired sera, or
  • Virus-specific IgM antibodies (MAC-ELISA) in serum with confirmatory virus-specific neutralizing antibodies (PRNT) in the same or a later specimen, or
  • Virus-specific IgM antibodies in the CSF (MAC-ELISA) and negative IgM in the CSF for other arboviruses endemic to the region where the exposure occurred
A PROBABLE case of West Nile virus is considered if:
  • Virus-specific IgM antibodies (MAC-ELISA) are present in CSF or serum but no other testing (eg, PRNT, PCR) is performed
A diagnosis of probable disease is sufficient for the vast majority of patients. This is particularly true for those with a clinically compatible illness and epidemiologic risk factors for West Nile virus (eg, no travel history outside the United States and/or presenting during outbreaks). In such patients, there is little need for further PRNT confirmatory testing. Refer to the UpToDate topic review that discusses the diagnosis of West Nile virus for additional information on diagnostic testing.
CSF: cerebrospinal fluid; PRNT: plaque reduction neutralization test; IgM: immunoglobulin M; MAC-ELISA: IgM antibody on serum using an enzyme-linked immunosorbent assay; PCR: polymerase chain reaction.
Adapted from: United States Centers for Disease Control and Prevention. Arboviral Diseases, Neuroinvasive and Non-neuroinvasive: 2015 Case Definition. Available at: https://ndc.services.cdc.gov/case-definitions/arboviral-diseases-neuroinvasive-and-non-neuroinvasive-2015/ (Accessed on February 11, 2022).
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