eMedicine Specialties > Infectious Diseases > Viral Infections

Orbivirus: Differential Diagnoses & Workup

Author: Nancy F Crum-Cianflone, MD, Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Naval Medical Center at San Diego; HIV Research Physician, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
Contributor Information and Disclosures

Updated: Mar 27, 2008

Differential Diagnoses

Eastern Equine Encephalitis
Rocky Mountain Spotted Fever
St. Louis Encephalitis
Western Equine Encephalitis

Other Problems to Be Considered

Powassan encephalitis
Colorado tick fever
Other arboviral infections

Workup

Laboratory Studies

  • Complete blood count: This test useful and may show thrombocytopenia, lymphopenia, and/or anemia. These findings may be transient.
  • Cerebrospinal fluid
    • In patients presenting with neurologic infection, collect cerebrospinal fluid (CSF) for cell count and differential, protein, glucose, bacterial culture, Gram stain, and viral culture.
    • In patients with the clinical signs of encephalitis or meningitis, obtain CSF to help establish a diagnosis, to rule out bacterial causes that may be life threatening if untreated, and to detect other viral causes.
    • In orbiviral infections, the protein and white blood cell count may be slightly elevated; however, little information on CSF findings is currently available in the literature. The CSF may be examined for evidence of an orbiviral infection with serology and/or viral isolation.
  • Serological testing
    • Testing specifically for orbiviral infection may be done via serological studies or viral isolation from the serum or CSF. The presence of viral-specific immunoglobin M (IgM) in the CSF suggests acute infection. Serologic studies may include complement fixation, enzyme immunoassay, and neutralizing antibodies. These tests are available at only a limited number of reference laboratories. Cases may be referred to the US Centers for Disease Control and Prevention at Fort Collins, Colorado or the US Army Medical Research Institute of Infectious Diseases in Fort Detrick, Md.
    • The serum may be used for viral isolation and for serology. Use the appropriate reference laboratory for these specimens.
    • The serologic diagnosis requires a 4-fold rise in acute and convalescent antibody titers. Viral isolation may be accomplished by the inoculation of suckling mice or by cell cultures (ie, Vero or BHK-21 cells). Only a limited number of reference laboratories test specifically for orbiviral infections.
  • Other
    • In order to rule out other causes of encephalitis, one also must test for other etiologies, depending on the location of exposure.
    • In the western United States, test for Rocky Mountain spotted fever, Powassan virus, Colorado tick fever, western equine encephalitis virus, West Nile virus, and St. Louis encephalitis virus.
    • Seek other viral etiologies, including herpes viruses and enteroviruses.

Imaging Studies

  • No specific imaging studies are recommended to assist in the diagnosis of orbiviral infections.

Procedures

  • In patients presenting with meningoencephalitis, the only procedure recommended in cases of suspected orbiviral infections is a lumbar puncture.

More on Orbivirus

Overview: Orbivirus
Differential Diagnoses & Workup: Orbivirus
Treatment & Medication: Orbivirus
Follow-up: Orbivirus
References
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References

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Further Reading

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Keywords

Orbivirus, orbiviruses, orbiviral infection, Kemerovo virus, Lipovnik virus, Tribec virus, Orungo virus, Lebombo virus, Changuinola virus, Oklahoma tick fever virus, bluetongue disease, African horse sickness, epizootic hemorrhagic deer fever, hydrocephalus, arthrogryposis, polyradiculitis, Ixodes ticks, meningoencephalitis, Aedes mosquitoes, anopheline mosquitoes, Culex mosquitoes, Mansonia mosquitoes, Phlebotomus flies

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Contributor Information and Disclosures

Author

Nancy F Crum-Cianflone, MD, Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Naval Medical Center at San Diego; HIV Research Physician, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
Nancy F Crum-Cianflone, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Thomas J Marrie, MD, Chair, Professor, Department of Medicine, Division of Infectious Diseases, University of Alberta College of Medicine
Thomas J Marrie, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Canadian Infectious Disease Society, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Charles V Sanders, MD, Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center
Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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