Molecular analysis of cerebrospinal fluid in viral diseases of the central nervous system

Abstract

The use of nucleic acid (NA) amplification techniques has transformed the diagnosis of viral infections of the central nervous system (CNS). Because of their enhanced sensitivity, these methods enable detection of even low amounts of viral genomes in cerebrospinal fluid. Following more than 10 years of experience, the polymerase chain reaction or other NA-based amplification techniques are nowadays performed in most diagnostic laboratories and have become the test of choice for the diagnosis of several viral CNS infections, such as herpes encephalitis, enterovirus meningitis and other viral infections occurring in human immunodeficiency virus-infected persons. Furthermore, they have been useful to establish a viral etiology in neurological syndromes of dubious origin and to recognise unusual or poorly characterised CNS diseases. Quantitative methods have provided a valuable additional tool for clinical management of these diseases, whereas post-amplification techniques have enabled precise genome characterisation. Current efforts are aiming at further improvement of the diagnostic efficiency of molecular techniques, their speed and standardisation, and to reduce the costs. The most relevant NA amplification strategies and clinical applications of to date will be the object of this review.

Enterovirus and herpesviridae family as etiologic agents of lymphomonocytary meningitis, Southern Brazil

“…Some authors report the difficulty to distinguish aseptic from bacterial meningitis due to the overlap of clinical symptoms and laboratory findings 26,27 . In this context, CSF examination is an essential part of the diagnostic analysis of patients with suspected CNS viral infection 28 . The classical pattern of viral meningitis is an increase of CSF WBCs, lymphomonocytary with normal glucose and elevated lactic acid.…”

“…These patients also have benefic with the virus PCR analysis of CSF, as if the reaction is positive the patient is not submitted to antibiotic therapy and has prompt hospital discharge 19 . PCR has been proved to be a key method to detect viral infections of the CNS 28 . Molecular biology analysis offers advantages over cellular culture, because several days are taken for viral growth and identification using the latter method 30 .…”

“…the use of antibiotics or the benefits of hospitalization 31 . Herpesviruses analysis by PCR has been found to present high sensitivity and sensibility and has definitely revolutionized virological diagnostic 28,[31][32][33] . Prior to PCR, the viral diagnosis of CNS infection was based on cellular culture of the CSF, brain biopsy or the demonstration of intrathecal antibody response, so that, in many instances the positive diagnostic was retrospective 34 .…”

Analysis of correlation between cerebrospinal fluid and plasma HIV-1 RNA levels in patients with neurological opportunistic diseases

“…Quantitative studies generally show higher mean and median HIV-1 RNA levels in plasma than in CSF, but higher CSF levels have been reported in certain cases (CINQUE et al 2000, DE LUCA et al 2002, LAFEUILLADE et al 1996, BURGER et al 1997. Some investigators found no correlation between CSF and plasma viral load (BREW et al 1997, ELLIS et al 1997, CINQUE et al 1998, MARTIN et al 1998, FOUDRAINE et al 1998, SCHRAGER et al 1998, ANTINORI et al 2002, while others did (McARTHUR et al 1997, BOSSI et al 1998, ROBERTSON et al 1998, GARCIA et al 1999.…”

“…This is important because it involves the validity of the measurement of HIV RNA levels in CSF as a replacement of brain viral load (CINQUE et al 2000). The objective of the present study was to evaluate the correlation between plasma and CSF HIV-1 RNA levels in individuals with a suspicion of opportunistic neurological disease and to identify situations in which there is no correlation between the two compartments.…”