| For immunocompetent patients |
| Blood tests |
- Complete blood count with differential count and platelets
- Serum electrolytes, glucose, blood urea nitrogen, creatinine
- Liver function tests and ammonia level
- Coagulation studies
- Blood culture
- Serologies for EBV, HIV, and Mycoplasma pneumoniae (IgM and IgG)
- EBV PCR
- Anti-NMDAR and anti-VGKC antibodies if clinically indicated
- Acute serum sample (to hold for subsequent serologic testing if necessary)
|
| CSF tests |
- Opening pressure (if feasible)
- CSF cell count and differential
- CSF protein and glucose
- CSF Gram stain and culture
- PCR by multiplex testing or individual PCR tests – Testing for HSV, enterovirus, and parechovirus should be performed in all patients; testing for additional pathogens may be warranted based upon history and epidemiology (eg, CMV, EBV, HHV-6, influenza, VZV, WNV)
- Acid fast stain and Mycobacterium tuberculosis culture, if clinically indicated
- CSF sample (to hold for subsequent testing)
|
| Respiratory samples |
- Respiratory panel/PCR (influenza, adenovirus, human metapneumovirus, and respiratory syncytial virus)
- Viral culture of respiratory secretions and nasopharynx
- Throat swab for HSV, enterovirus, M. pneumoniae PCRs
|
| Stool (or rectal swab) |
- Enterovirus PCR
- Viral culture of stool
|
| Urine |
- Urinalysis
- Urine toxicology screen
|
| Skin lesions (if present) |
- Biopsy for DFA and PCR for Rickettsia rickettsii
- Culture and/or DFA of skin lesions for HSV, VZV, and enteroviruses
|
| For immunocompromised patients |
| Above tests, plus: |
| Blood – Serum cryptococcal antigen, Toxoplasma gondii IgG |
| CSF – Cryptococcal antigen, Histoplasma antigen; PCR for CMV, Creutzfeldt-Jakob disease, HHV-6, WNV |
| Urine – Histoplasma antigen |
