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Orbivirus Workup

  • Author: Nancy F Crum-Cianflone, MD, MPH; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
Updated: Mar 10, 2015

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.


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.



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

Contributor Information and Disclosures

Nancy F Crum-Cianflone, MD, MPH Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Naval Medical Center at San Diego

Nancy F Crum-Cianflone, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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: American College of Physicians, Alliance for the Prudent Use of Antibiotics, The Foundation for AIDS Research, Southern Society for Clinical Investigation, Southwestern Association of Clinical Microbiology, Association of Professors of Medicine, Association for Professionals in Infection Control and Epidemiology, American Clinical and Climatological Association, Infectious Disease Society for Obstetrics and Gynecology, Orleans Parish Medical Society, Southeastern Clinical Club, American Association for the Advancement of Science, Alpha Omega Alpha, American Association of University Professors, American Association for Physician Leadership, American Federation for Medical Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association of American Medical Colleges, Association of American Physicians, Infectious Diseases Society of America, Louisiana State Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southern Medical Association

Disclosure: Received royalty from Baxter International for other.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Additional Contributors

Thomas J Marrie, MD Dean of Faculty of Medicine, Dalhousie University Faculty of Medicine, Canada

Thomas J Marrie, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Association of Medical Microbiology and Infectious Disease Canada, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

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