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Table 4 Diagnostics recommendations for suspected viral encephalitis/meningoencephalitis

From: A systematic review of clinical guidelines on the management of acute, community-acquired CNS infections

CMG Differential diagnostic recommendations
IEC* Children: HSV-1, HSV-2, enteroviruses, EBV, parechovirus (< 3 years), Mycoplasma pneumoniae, TBEV, WNV (S. Europe), TOSV (S. Europe)
Adults: HSV-1, HSV-2, enteroviruses, VZV, Treponema pallidum, Cryptococcus, HIV, TBEV, WNV (S. Europe), TOSV (S. Europe)
Others based on epidemiological and clinical features.
EFNS^ Unspecified: HSV-1, HSV-2, VZV, HHV 6/7, CMV, EBV, JCV, Dengue virus, respiratory viruses, RSV, HIV, adenovirus, influenza A and B, rotavirus, Coxsackie B5, non-typed enterovirus, Parainfluenza 1 virus
DNS Unspecified: HSV, VZV, HIV, EBV/CMV, syphilis, HHV 6–7, toxoplasma
DGN: VM Unspecified: HSV, VZV, CMV, coxsackievirus, echovirus, adenovirus, phlebovirus, measles, TBE, mumps, EBV, rubella, enterovirus 71, HIV, parvovirus B19, HHV-6, Dengue virus, FSME, rabies, vaccinia, Lassa virus, Japanese encephalitis, WNV, polioviruses, hantavirus, filovirus
Others based on epidemiological and clinical features.
IDSA* Neonates: HSV 2, CMV, rubella virus, L. monocytogenes, T. pallidum, Toxoplasma gondii
Infants and Children: Eastern equine encephalitis virus, Japanese encephalitis virus, Murray
Valley encephalitis virus, influenza virus, La Crosse virus
Unspecified: HSV, WNV, TBEV, A. phagocytophilum, B.burgdorferi
Elderly: Eastern equine encephalitis virus, St. Louis encephalitis virus, WNV, sporadic Creutzfeldt-Jakob Disease, L. monocytogenes
Person-to-person transmission: VZV, Venezuelan equine encephalitis virus (rare), poliovirus, non-polio enteroviruses, measles virus, mumps virus, rubella virus, EBV, HHV 6, B virus, WNV (transfusion transplantation, breast feeding), HIV, Nipah virus, rabies virus (transplantation), influenza virus, M. pneumoniae, Mycobacterium tuberculosis, T. pallidum.
Others based on specific clinical findings, epidemiology and risk factors.
PHE: VE* Children and adults: HSV-1, HSV-2, VZV, enteroviruses, parechovirus (< 3 years), HHV-6 (< 3 years), mumps (if epidemic), Influenza A, B (if epidemic), HIV,
Others based on specific epidemiology and risk factors
BIA/ABN Adults: HSV-1, HSV-2, VZV, enteroviruses, parechovirus, measles virus, mumps virus, TBEV (eastern Europe), WNV (southern Europe), HIV, EBV (immunocompromised), CMV (immunocompromised) influenza virus (rare), adenovirus (rare), Erythrovirus B19 (rare), lymphocytic choreomeningitis virus (rare), rubella virus (rare)
Others based on epidemiological and clinical features.
BIA/ABN/BPAIIG Children: HSV-1, HSV-2, VZV, enteroviruses, parechovirus, HHV 6/7, measles virus, mumps virus, rotavirus, HIV, TBEV (eastern Europe), WNV (southern Europe), HIV, EBV (immunocompromised), CMV (immunocompromised) influenza virus (rare), adenovirus (rare), Erythrovirus B19 (rare), lymphocytic choreomeningitis virus (rare), rubella virus (rare)
Others based on epidemiological and clinical features.
AEPED* Congenital: Lymphocytic Choriomeningitis virus, CMV, measles virus, T. gondii, T. pallidum,
Neonates (< 1 month): HSV, enteroviruses, adenovirus, Citrobacter spp., GBS, L. monocytogenes
Infants and children > 1 month: HSV, enteroviruses, arboviruses, EBV, adenovirus, HIV, M. pneumoniae, Borrelia burgdorferi, Bartonella henselae, Rickettsia rickettsii.
Others based on epidemiological and clinical features.
SPILF*^ Adults (metropolitan France): HSV, VZV, HIV, enterovirus, L. monocytogenes (higher risk > 65 years), M. tuberculosis (higher risk > 75 years)
NNF* Unspecified: HSV-1, HSV-2, VZV, EBV, HHV-6, enteroviruses, parechovirus (children), adenovirus, Influenza A, measles, mumps, rubella, HIV, Hepatitis E, Japanese B, WNV, rabies virus, TBE, Eastern equine encephalitis, S. pneumoniae, B. burgdorferi, M. pneumoniae, Chlamydia trachomatis, L. monocytogenes, M. tuberculosis, cerebral malaria, Cystericosis.
Others based on immune status.
PHE: ME* Unspecified: HIV, HSV-1, HSV-2, VZV, enteroviruses, parechovirus (< 3 years), N. meningitidis, S. pneumoniae, H. influenzae, E. coli, L. monocytogenes, GBS
  1. Abbreviations: HSV Herpes simplex virus, VZV Varicella-zoster virus, HIV human immunodeficiency virus, HHV human herpesvirus, CMV Cytomegalovirus, EBV Epstein-Barr virus, RSV respiratory syncytial virus, TBEV tick-borne encephalitis virus, WNV West Nile virus, JEV Japanese encephalitis virus, IEC International Encephalitis Consortium, EFNS European Federation of Neurological Societies, DNS Dansk Neurologisk Selskab, DGN: VM Deutsche Gesellschaft für Neurologie: Virale Meningoeczephalitis, PHE: VE Public Health England:Viral Encephalitis, BIA: ABN British Infection Association: Association of British Neurologists, BPAIIG The British Paediatric Allergy Immunology and Infections Group, AEPED Asociación Española de Pediatría, SPILF Société de Pathologie Infectieuse de Langue Française, NNF Norsk Nevrologisk Forening, PHE: ME Public Health England: Meningoencephalitis
  2. *Includes non-viral differential diagnostic recommendations
  3. ^Differential diagnostic recommendations not clearly defined