Molecular tests for infectious causes of transverse myelitis

Etiology	Availability*	When inclusion of NAT is indicated	Preferred testing method(s)^¶
Bacteria
Mycoplasma spp	Yes	When clinically suspected	NAT, serology
Mycobacterium tuberculosis^Δ	Yes	Potentially	AFB stain, culture, histologic exam +/– NAT
Viruses
Cytomegalovirus	Yes	When clinically suspected	NAT, preferably quantitative
Epstein-Barr virus	Yes	When clinically suspected	NAT, preferably quantitative
Enteroviruses	Widespread	When clinically suspected	NAT
Herpes simplex virus	Widespread	When clinically suspected	NAT
Mumps	Limited	Rarely	History, viral culture, serology, and NAT
Varicella-zoster virus	Yes	When clinically suspected	NAT (plus CSF serology in selected cases)^◊
West Nile virus^§	Yes	Rarely (unless immunocompromised)	Serology
Spirochetes
Treponema pallidum (syphilis)	Limited	No	Serology, CSF VDRL
Parasites
Schistosoma spp	Limited	Rarely	Serology, histologic exam

PPV: positive predictive value; CDC: Centers for Disease Control and Prevention; NAT: nucleic acid amplification testing; CNS: central nervous system; CSF: cerebrospinal fluid; AFB: acid-fast bacilli; VDRL: Venereal Disease Research Laboratories; VZV: varicella-zoster virus.
* Widespread: readily available; Yes: consistently available, but not yet common; Limited: one or two specialized laboratories (eg, CDC or research groups).
¶ Test on CSF except where noted.
Δ Limited experience, presumably variable sensitivity, high PPV.
◊ CSF serology should be performed when clinical suspicion for herpes zoster is high and the presentation is subacute (eg, VZV vasculopathy or onset of CNS symptoms following recent episode of zoster).
§ Virus is usually cleared from blood and CSF prior to symptom onset.

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Molecular tests for infectious causes of transverse myelitis