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Meningitis (viral) Profile IgG & IgM by CLIA - Serum
Bacterial/ Viral
1 parameters
Report in 144Hrs
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Viral antibody panel for meningitis.
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Parameters
- List of Tests
- Meningitis (viral) Profile IgG & IgM by CLIA - Serum
Meningitis (viral) Profile IgG & IgM by CLIA - Serum
- Why is it done?
- Detects serological evidence of viral meningitis caused by common viral pathogens including enteroviruses, arboviruses, and other neurotropic viruses
- Assists in differentiating viral meningitis from bacterial meningitis, enabling appropriate clinical management and reducing unnecessary antibiotic use
- Identifies acute infections (IgM antibodies) versus past exposure or immunity (IgG antibodies) to specific viral agents
- Ordered when patients present with symptoms of meningitis including severe headache, fever, neck stiffness, photophobia, and altered mental status
- Particularly useful in acute phase illness (first 3-7 days) when CSF cultures may be negative but serological markers are detectable
- Helps guide clinical decisions regarding hospitalization, isolation precautions, and therapeutic interventions in suspected meningitis cases
- Combined IgG and IgM testing provides comprehensive temporal information about infection status and immune response
- Normal Range
- Viral Meningitis Profile IgM: Negative or <0.90 Index; Values <0.90 are considered negative; Values ≥0.90 and <1.10 are considered equivocal/borderline; Values ≥1.10 are considered positive
- Viral Meningitis Profile IgG: Negative or <0.90 Index; Values <0.90 are considered negative; Values ≥0.90 and <1.10 are considered equivocal/borderline; Values ≥1.10 are considered positive
- Normal/Negative Results: Absence of detectable IgM and IgG antibodies against viral meningitis-associated pathogens, indicating no evidence of current or past infection
- Equivocal/Borderline Results: Index values between 0.90-1.10 require repeat testing or clinical correlation; often recommend retesting in 1-2 weeks
- Positive IgM Results: Index ≥1.10 suggests acute or recent viral meningitis infection, typically appearing within the first 7-10 days of illness
- Positive IgG Results: Index ≥1.10 indicates past infection, immunity, or chronic/latent infection; may persist for years after acute infection
- Immunoassay methodology (CLIA-certified) uses standardized index values for objective interpretation across all testing laboratories
- Interpretation
- IgM Positive (≥1.10) + IgG Negative: Highly suggestive of acute/early viral meningitis infection; typically represents primary infection or early immune response
- IgM Positive + IgG Positive: May indicate either acute infection with concurrent IgG response or reactivation of prior infection; clinical context critical
- IgM Negative + IgG Positive: Indicates past infection, vaccination-induced immunity, or chronic carrier state; not consistent with acute meningitis
- IgM Negative + IgG Negative: Rules out tested viral meningitis pathogens; alternative etiologies or non-specific meningitis should be considered
- Equivocal IgM (0.90-1.10): Recommend clinical correlation with symptoms and repeat testing if high clinical suspicion; may represent early infection or false positive
- Equivocal IgG (0.90-1.10): Clinical correlation needed; borderline results may reflect waning immunity, recent vaccination, or low-level prior exposure
- Timing of test critical: IgM may not be detectable in first 3-5 days of illness; peak IgM response occurs at 1-2 weeks; early negative IgM does not exclude viral meningitis
- False positives may occur with rheumatoid factor, other autoimmune conditions, or cross-reactivity with related viral infections
- False negatives possible in immunocompromised patients with impaired antibody production or in very early acute infection before adequate immune response
- CLIA methodology provides standardized, sensitive, and specific immunoassay detection; serum samples reflect systemic immune response to CNS infection
- Associated Organs
- Central Nervous System (CNS): Primary target organ affected in viral meningitis; inflammation of meninges (dura, arachnoid, pia mater) surrounding brain and spinal cord
- Brain: Direct viral infection and immune-mediated inflammation can cause encephalitis, altered mental status, seizures, and long-term neurological sequelae
- Spinal Cord: Viral infection and inflammation can cause myelitis, weakness, paralysis, and sensory dysfunction; may result in transient or permanent neurological deficits
- Cerebrospinal Fluid (CSF): Virus invades CNS and triggers lymphocytic pleocytosis; serum antibodies reflect immune response to infection documented in CSF
- Blood: Viremia precedes CNS invasion; serum antibodies generated by B lymphocytes and plasma cells in response to systemic and neural infection
- Immune System: Activation of humoral (antibody) and cellular immune responses; elevated protein and altered glucose in CSF reflecting immune activation
- Secondary complications may involve: cranial nerves (hearing loss, vision changes), hydrocephalus (CSF obstruction), increased intracranial pressure, and vascular complications
- Systemic effects: Fever, myalgia, malaise reflect systemic viral infection; in enteroviral meningitis, may include gastrointestinal symptoms or myopericarditis
- Complications of abnormal results: Permanent neurological disability, recurrent meningitis, chronic headaches, cognitive impairment, and mortality if untreated
- Follow-up Tests
- Lumbar Puncture (CSF Analysis): Gold standard for meningitis diagnosis; provides CSF culture, cell counts, glucose, protein, Gram stain, and PCR confirmation of viral agents
- CSF Viral PCR/RT-PCR: Highly sensitive and specific molecular testing for enteroviruses, arboviruses, and other neurotropic viruses; more rapid than culture
- Repeat Serum IgG and IgM (1-2 weeks later): If initial serum results are equivocal or negative but clinical suspicion remains high; may detect seroconversion in acute infection
- CSF-specific Antibody Index: Determines if antibodies were intrathecally produced (CNS-specific) versus passive transfer from serum; improves diagnostic specificity
- Brain MRI or CT Imaging: Evaluates for complications such as hydrocephalus, ventriculitis, subdural effusion, or focal lesions; recommended if neurological deterioration occurs
- Blood Cultures: Important to rule out bacterial meningitis; should be obtained in all suspected meningitis cases before empiric antibiotic therapy
- Complete Blood Count (CBC) with Differential: Assesses for leukocytosis, lymphocytosis consistent with viral infection; helpful in differentiating bacterial versus viral etiology
- Bacterial Meningitis Panel (Serum): Culture, antigen detection, and PCR for Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae if not yet ruled out
- Specific Viral Serologies: Targeted testing for suspected viral agents including enterovirus, echovirus, coxsackievirus, West Nile virus, or Japanese encephalitis virus
- Audiometry: Recommended for all meningitis survivors to screen for sensorineural hearing loss, a potential complication of viral meningitis
- Neuropsychological Testing: Considered for patients with cognitive complaints post-meningitis to assess for persistent neurological sequelae and guide rehabilitation
- Enterovirus-Specific IgG Testing: Long-term follow-up assessment of immune status; may predict recurrence risk or need for specific preventive measures
- Fasting Required?
- No fasting required: The Meningitis (viral) Profile IgG & IgM by CLIA serum test can be performed on serum samples obtained at any time, with or without fasting
- Dietary considerations: No dietary restrictions required prior to blood draw; normal food and beverage intake does not affect antibody detection
- Medications: No medications need to be withheld prior to testing; immunosuppressive therapies should be noted on test requisition as they may reduce antibody titers
- Timing of collection: Blood samples should be collected as early as possible during acute illness for optimal IgM detection; repeat collection at 1-2 weeks if initial test negative but high clinical suspicion
- Sample preparation: Use serum separator tube (SST) or similar anticoagulant-free collection tube per laboratory protocol; allow specimen to clot at room temperature for 30-60 minutes
- Storage and transport: Maintain serum at room temperature during transport or refrigerate at 2-8°C if testing delayed; do not freeze unless long-term storage required
- General patient preparation: Ensure patient is comfortable and seated for venipuncture; document symptoms onset date and clinical presentation on requisition
- Immunization status: Note any recent vaccinations on request form as this may influence interpretation of results, particularly IgG positivity
- Concurrent testing: May be ordered simultaneously with blood culture, CBC, metabolic panel, and CSF analysis for comprehensive meningitis evaluation
- Emergency specimens: In acute meningitis presentations, expedited processing and stat result reporting are typically available through most certified CLIA laboratories
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