Acute Flaccid Myelitis — Additional Laboratory Studies — Clinical Pathway: Emergency and Inpatient

Evaluation of Suspected Acute Flaccid Myelitis Clinical Pathway — Emergency and Inpatient

Additional Laboratory Studies

Complete labs as soon as possible.
Specimens obtained at presentation are more likely to document a viral etiology.

Serum
  • CBC, Platelet w/ Differential
  • Comprehensive Metabolic Panel
  • Epstein-Barr Virus Serology
  • Enterovirus PCR
  • Neuromyelitis Optica Ab, IgG
  • Save Our Specimen
  • anti-MOG IgG
  •  
  • Consider:
  • Lyme Elisa IgG & IgM Panel
  • ANA Antibody Profile (if rheumatological disease suspected)
  • HIV Antigen/Antibody
  • Japanese Encephalitis IgG & IgM  
  • Arbovirus IgG & IgM   (includes St. Louis Encephalitis IgG/IgM and West Nile Virus IgG/IgM)
Respiratory
  • Enterovirus PCR (NP aspirate)
  • Respiratory Viral Testing
Stool
  • Enterovirus PCR, Stool

Recommended CSF Studies, in order of priority 1

Test Name Tube Number Minimum Volume
Cell count and differential
  • Tube 1, 4
  • 1 mL
Protein, glucose
  • Tube 3
  • 0.3 mL
Enterovirus PCR 2
  • Tube 2
  • 0.25 mL
Consider: Herpes Simplex Virus PCR Qual 2
  • Tube 2
  • 0.25 mL
Oligoclonal Bands (serum sample also required)
  • Tube 2
  • 0.25 mL
CSF Gram stain and culture
  • Tube 2
  • 0.2 - 0.5 mL
Save Our Specimen 3
  • Tube 2
  • 2 mL
  1. If there is limited CSF available, prioritize the CSF cell count/differential and protein.
  2. For viral PCRs, please submit separate orders for these tests at the time of collection.
  3. The “Save Our Specimen” order should be linked to Tube 2, as this tube is kept under sterile conditions in Microbiology and can be used for further testing such as PCR testing when needed.

AFM is a reportable disease to the CDC