Evaluation of a Rapid and Completely Automated Real-Time Reverse Transcriptase PCR Assay for Diagnosis of Enteroviral Meningitis

Nolte, Frederick S.; Rogers, Beverly Barton; Tang, Yi‐Wei; Oberste, M. Steven; Robinson, Christine C.; Kehl, K. Sue; Rand, Kenneth; Rotbart, Harley A.; Romero, José R.; Nyquist, Ann‐Christine; Persing, David H.

doi:10.1128/jcm.01570-10

Cited by 46 publications

(15 citation statements)

References 25 publications

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“…As the EV PCR test is currently only approved by the Federal Drug Administration (FDA) for testing CSF, we did not extract data related to the utilization of this PCR test on non-approved sample types. 15 …”

Section: Methodsmentioning

confidence: 99%

Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger

Aronson

Lyons

Cruz

et al. 2017

The Journal of Pediatrics

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Objective To determine the impact of a cerebrospinal fluid (CSF) enteroviral polymerase chain reaction (PCR) test performance on hospital length of stay (LOS) in a large multicenter cohort of infants undergoing evaluation for central nervous system infection. Study design We performed a planned secondary analysis of a retrospective cohort of hospitalized infants ≤60 days of age who had a CSF culture obtained at one of 18 participating centers (2005–2013). After adjustment for patient age and study year as well as clustering by hospital center, we compared LOS for infants who had an EV PCR test performed vs. not performed and among those tested, for infants with a positive vs negative test result. Results Of 19,953 hospitalized infants, 4,444 (22.3%) had an EV PCR test performed and 945 (21.3% of tested infants) had positive test results. Hospital LOS was similar for infants who had an EV PCR test performed compared with infants who did not (Incident rate ratio [IRR] 0.98 hours; 95% CI: 0.89–1.06 hours). However, EV PCR-positive infants had a 38% shorter LOS than EV PCR-negative infants (IRR 0.62 hours; 95% CI: 0.57–0.68). No infant with a positive EV PCR test had bacterial meningitis (0%; 95% CI: 0–0.4%). Conclusions While EV PCR testing was not associated with a reduction in LOS, infants with a positive EV PCR test had a one-third shorter LOS compared with infants with a negative EV PCR test. Focused EV PCR test use could increase the impact on LOS for infants undergoing CSF evaluation.

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Section: Methodsmentioning

confidence: 99%

Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger

Aronson

Lyons

Cruz

et al. 2017

The Journal of Pediatrics

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“…I agree with the authors that clinical judgment is the ultimate arbiter of discordant, conflicting, or otherwise unexplained laboratory results (2,10). In the cases cited by the authors, the differentiation of AVM from ABM could have been rapidly and easily made if CSF lactic acid levels were utilized (1,3,4).…”

mentioning

confidence: 81%

“…Nolte and Basmaci, et al, regarding potential concurrent acute viral meningitis (AVM) and acute bacterial meningitis (ABM) (2,10). I agree the probability of concurrent ABM/AVM is exceedingly rare, but their concerns merit a response.…”

mentioning

confidence: 99%

Cerebrospinal Fluid (CSF) Lactic Acid Levels: a Rapid and Reliable Way To Differentiate Viral from Bacterial Meningitis or Concurrent Viral/Bacterial Meningitis

Cunha¹

2012

J Clin Microbiol

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“…We are unaware of any reports of enteroviral meningitis with associated bacterial meningitis. 6,14,15 The rate of other concurrent bacterial infections in the setting of a known eneroviral infection is low, with 5.6% of neonates having a urinary tract infection and 1% having bacteremia. 6 In such mixed infections, the clinical presentations are usually severe enough that positive EV-PCR detection is unlikely to deter clinicians from use of antibiotics.…”

Section: Question: Should Csf Ev-pcr Be Used For All Neonates And/or mentioning

confidence: 98%

“…6 In such mixed infections, the clinical presentations are usually severe enough that positive EV-PCR detection is unlikely to deter clinicians from use of antibiotics. 15 Another po tential concern is that a false-positive EV-PCR result might allow a well-appearing patient with bacterial meningitis to be discharged. Current EV-PCR systems address the concern of false-positive test results by providing completely self-contained assay cartridges that perform all involved steps, including sample preparation.…”

Section: Question: Should Csf Ev-pcr Be Used For All Neonates And/or mentioning

confidence: 99%

Enterovirus Meningitis With Marked Pleocytosis

Hysinger

Mainthia

Fleming

2012

Hospital Pediatrics

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Introduction:In neonates and young infants, it can be diffi cult to distinguish bacterial from aseptic meningitis, especially in the setting of marked CSF (cerebrospinal fl uid) pleocytosis. This case series and review of the literature explores the role of early CSF EV-PCR (enterovirus-polymerase chain reaction) in these patients' diagnostic workup, management, and overall hospital stay.Case Series: Patient 1 was a 30-day-old female who presented with a fever of 102°F and increased irritability for 1 day. She was admitted to the hospital for an evaluation including complete blood cell count (CBC), blood culture, urine culture, urinalysis, and lumbar puncture (LP). Ampicillin, gentamicin, and acyclovir were initiated. Admission laboratory data included peripheral white blood cell (WBC) count of 9200 cells/µL and a normal urinalysis. Cerebrospinal fl uid (CSF) was remarkable for pleocytosis of 1005 cells/µL with 53% lymphocytes, 0 red blood cells (RBCs), protein of 92.8 mg/dL, and glucose of 44 mg/dL (Table 1). Gram-stain of the CSF revealed Gram-positive cocci in pairs; however, no bacteria were cultured. Results of the urine culture were negative. The blood culture grew coagulase-negative Staphylococcus, which was believed to be a contaminant. The patient continued to be febrile despite 72 hours of antibiotic therapy. Therefore, a repeat LP was performed, revealing 80 WBC/µL with 63% lymphocytes, 700 RBC/µL, protein of 138 mg/dL, and glucose of 38 mg/dL. Enterovirus-polymerase chain reaction (EV-PCR) performed on the repeat CSF was positive. Herpes simplex virus polymerase chain reaction (PCR) was negative. Antibiotic therapy was discontinued, and the patient was discharged from the hospital.

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Evaluation of a Rapid and Completely Automated Real-Time Reverse Transcriptase PCR Assay for Diagnosis of Enteroviral Meningitis

Cited by 46 publications

References 25 publications

Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger

Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger

Cerebrospinal Fluid (CSF) Lactic Acid Levels: a Rapid and Reliable Way To Differentiate Viral from Bacterial Meningitis or Concurrent Viral/Bacterial Meningitis

Enterovirus Meningitis With Marked Pleocytosis

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