| Project
Background
Encephalitis is a devastating neurologic condition
with significant morbidity and mortality. Over 100 different
infectious agents are associated with encephalitis, yet no satisfactory
algorithm for testing exists. Few studies have characterized
the spectrum of disease and little is known about risk factors,
long-term prognostic indicators and optimal clinical management.
Objectives
of the California Encephalitis Project
The California Encephalitis Project (CEP) was initiated by the
California Department of Public Health Viral & Rickettsial
Disease Laboratory (VRDL) in collaboration with the Centers
for Disease Control and Prevention's (CDC) Emerging Infections
Program (EIP) to study encephalitis in California. The purpose
of the project is to better understand human encephalitis, including
causative agents, disease trends, risk factors, and clinical
features.
Case Definition
Case patients must be hospitalized with encephalopathy (depressed
or altered level of consciousness >=24 hours, lethargy, or
change in personality) or ataxia, AND have 1 or more of the
following: fever (T>=38C), seizure(s), focal neurologic findings,
CSF pleocytosis, abnormal EEG or neuroimaging study.
Case patients must be >=6 months of age and immunocompetent.
Core Testing
Information
Cerebrospinal
fluid (CSF):
PCR: HSV 1, HSV 2, VZV, HHV6, Enterovirus
Acute
phase serum:
Serology: Epstein-Barr virus (EBV), Mycoplasma pneumoniae, [WNV as indicated by season]
Nasopharyngeal
(NP)/Throat swab (in viral transport media):
PCR:
Enterovirus, Mycoplasma pneumoniae [Influenza A, Influenza B,
Adenovirus, Respiratory Syncytial Virus, and human metapneumovirus
if patient has respiratory symptoms]
Viral Isolation
Convalescent
phase serum (tested in parallel with acute serum):
Serology: Mycoplasma pneumoniae [West Nile Virus, Influenza A, Influenza B, or Adenovirus as indicated by season]
Additional testing will be performed as dictated by patients' clinical features and laboratory and neuroimaging findings.
Specimen
Collection Instructions:
CSF → ≥2cc CSF.
Acute Serum → ≥3cc serum collected during acute period (<=7
days after onset).
Nasopharyngeal or throat swab→ must be submitted in viral transport media
Convalescent Serum→ ≥3cc serum collected 10-14 days
after collection of acute serum.
Coroner’s cases: send the following tissue samples fresh-frozen:
brain (cross-sections of hippocampus, right & left cerebral
& cerebellar cortexes, & gray matter of brain stem),
liver, & lung.
All specimens must be clearly labeled and must accompany a specimen
submittal form. Specimens not clearly labeled will not be tested
per CLIA regulations.
Download
Study Documents
1) Case
History Form
2) Testing
Algorithm
3) Instructions
for Physicians and Labs
4) Instructions
for Transport of Specimens
5) Specimen
Submittal Form
6) Information
Sheet
Specimen
Shipping Instructions
Send all
samples ASAP (by overnight delivery) to VRDL at the following
address:
Specimen Receiving
Encephalitis Project
850 Marina Bay Parkway, Richmond, CA 94804
Please send samples for delivery Monday
through Friday ONLY
Results
Physicians: It is imperative that you include the name,
pager number, and fax number for both a current physician caring
for the patient as well as for the primary care physician, to
ensure that we can relay results in a timely manner.
Patients & family members: Please call the patient’s
physician for test results. The California Encephalitis Project
is not able to relay results to anyone other than a physician
caring for the patient in order to protect patient confidentiality.
If you wish for us to fax results to another physician, please
ask your physician to send us a letter with your signature, authorizing
us to fax results to him or her.
Questions
/ Contact information:
If you
have any questions about the California Encephalitis Project,
please contact
Heather Sheriff
California Encephalitis Project Data Manager
Phone: (510) 307-8608
Fax: (510) 307-8599
heather.sheriff@cdph.ca.gov
Note: for testing
unrelated to this project, specimens must be sent through your
local health department.
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