Multiple-Year Experience in the Diagnosis of Viral Central Nervous System Infections with a Panel of Polymerase Chain Reaction Assays for Detection of 11 Viruses

Huang, Cinnia; Morse, Dale L.; Slater, Brett; Anand, Madhu; Tobin, Ellis; Smith, Perry F.; Dupuis, Michelle; Hull, Rene; Ferrera, Rocco; Rosen, B I; Grady, Leo J.

doi:10.1086/422650

Cited by 69 publications

(41 citation statements)

References 24 publications

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“…PCR testing of CSF has become the diagnostic method of choice for CNS viral infections because of the low yield from CSF cultures (15). When a causative agent is found, HSV and enterovirus are the most commonly identified viral pathogens (3,6,11), which is in agreement with our findings. Prompt diagnosis of herpes simplex virus encephalitis is especially important because treatment with intravenous acyclovir decreases morbidity and mortality (17).…”

Section: Discussionsupporting

confidence: 89%

Validation of Laboratory Screening Criteria for Herpes Simplex Virus Testing of Cerebrospinal Fluid

et al. 2007

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Most patients with herpes simplex virus (HSV) central nervous system (CNS) infection have abnormalcerebrospinal fluid (CSF) indices. Therefore, we implemented screening criteria based on CSF values and host immune status to guide testing. All CSF samples submitted for HSV PCR analysis from January 1999 through December 2004 were included in the study. Specimens from patients with human immunodeficiency virus, a history of transplants, an age of <2 years, a CSF white blood cell count of >5 cells/mm 3 , or a protein level of >50 mg/dl were tested upon request. All other samples were rejected and frozen. To validate our screening criteria, rejected specimens were pooled and tested retrospectively. Electronic medical records were also reviewed. A total of 1,659 HSV PCR requests from 1,458 patients were screened. Of the 1,296 specimens (78.1%) accepted for testing, 1,213 were negative, 7 were positive for HSV type 1 (HSV-1), 26 were positive for HSV-2, and 50 had unavailable results. Sixteen requests were rejected because an alternative microbiologic diagnosis had been established. Of the 347 samples rejected based on criteria, 222 (64.0%) remained available for pooled testing. No HSV-1-positive samples were identified in the rejected specimens. Two rejected specimens tested positive for HSV-2 DNA, but both met acceptance criteria which had not been communicated to the laboratory. Few patients (7.8%) with rejected specimens were treated with acyclovir, which suggests a low clinical concern for HSV encephalitis. Acceptance criteria based on CSF parameters and host immune status saved time and cost and did not miss patients with HSV CNS infection. Communication between the clinician and the laboratory is imperative for a successful screening program.Early recognition of herpes simplex virus (HSV) encephalitis is crucial because prompt initiation of antiviral therapy improves clinical outcomes (17, 18). The detection of HSV DNA directly in cerebrospinal fluid (CSF) by PCR has been well validated for the diagnosis of herpes central nervous system (CNS) infections, and given its high sensitivity and specificity, HSV PCR is now recognized as the reference standard (1,4,9,12). HSV PCR has become one of the most commonly requested tests of CSF in our clinical microbiology laboratory, and there has been a costly trend toward overusing molecular diagnostics to evaluate patients with nonspecific complaints.Most patients with CNS infections have an elevated CSF leukocyte count and/or protein level (5,7,16). Screening the CSF cell count and protein values prior to performing HSV PCR has been suggested as a way to save healthcare costs without reducing sensitivity (13, 16). In addition, laboratory acceptance criteria for HSV testing of CSF have been shown to increase the proportion of positive results (from 1.9% to 4.0% at one institution) (13). Based on these findings, we implemented criteria for HSV PCR testing that are founded on CSF profiles in addition to host characteristics but had not previously been validated with our pro...

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Section: Discussionsupporting

confidence: 89%

Validation of Laboratory Screening Criteria for Herpes Simplex Virus Testing of Cerebrospinal Fluid

et al. 2007

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“…At this time, the diagnosis of viral CNS infections is usually obtained through the combination of multiple PCR and RT-PCR assays, resulting in laboratory confirmation of approximately 45% of physician-diagnosed cases (4,27). This failure can be explained by the inconsistency between the small volume of CSF available and the large number of viruses potentially responsible for meningitis or encephalitis (15). In the first step, the use of a multiplex PCR approach allowed us to broaden the detection of neurotropic viruses (2,6,7,8,22,29,31,32,41,44).…”

Section: Discussionmentioning

confidence: 99%

Rapid Virological Diagnosis of Central Nervous System Infections by Use of a Multiplex Reverse Transcription-PCR DNA Microarray

Lévêque¹,

Haecke²,

Renois³

et al. 2011

J Clin Microbiol

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“…They are also the major etiologic agents of aseptic meningitis cases for which an etiologic agent was identified [17][18][19]. Since the introduction of the mumps vaccine, mumps meningitis has become far less common in those countries in which it is widely used.…”

Section: Discussionmentioning

confidence: 99%

Enteroviral meningitis in children in Turkey

Şensoy

Sel

Ozkaya³

et al. 2009

Open Medicine

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AbstractIn the indexed medical literature, there have been a very limited number of studies to investigate the epidemiologic and clinical features of enteroviral meningitis in Turkey. The aim of the present retrospective study is to update the actual situation to recognize the spectrum and magnitude of this important clinical entity. Between June 1999 and December 2004, 612 cases of aseptic meningitis were followed up at our hospital. Enteroviral meningitis was defined by isolation of enteroviruses from cerebrospinal fluid (CSF) and/or stool samples. Mumps virus was detected in 310 cases (50.7%) and enteroviruses were the etiologic agents in 104 (17%) of the patients with aseptic meningitis. Most of the enteroviral meningitis cases (36 cases, 34.6%) were diagnosed in August and 70 (67.3%) of them were male. The mean age was 5.6 ± 3.4 years. The most common initial symptoms were fever (81.7%), vomiting (77.9%) and headache (57.7%). In the physical examination, 46.2% of the cases had neck stiffness and 38.5% had pharyngitis. Echovirus 30 was the most frequently (38 cases, 36.5%) isolated enterovirus with peaks in 1999, 2002 and 2004. The other frequently isolated enteroviruses were Coxsackie virus type B (17 cases, 16.3%), echovirus 6 (11 cases, 10.6%), echovirus 11 (6 cases, 5.8%), and echovirus 13 (4 cases, 3.8 %). Mean hospitalization time was 6.2 ± 2.4 days. All patients recovered without any sequelae. Enteroviruses have an important role in childhood aseptic meningitis cases in Turkey too, and the predominant serotypes vary according to years.

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Multiple-Year Experience in the Diagnosis of Viral Central Nervous System Infections with a Panel of Polymerase Chain Reaction Assays for Detection of 11 Viruses

Cited by 69 publications

References 24 publications

Validation of Laboratory Screening Criteria for Herpes Simplex Virus Testing of Cerebrospinal Fluid

Validation of Laboratory Screening Criteria for Herpes Simplex Virus Testing of Cerebrospinal Fluid

Rapid Virological Diagnosis of Central Nervous System Infections by Use of a Multiplex Reverse Transcription-PCR DNA Microarray

Enteroviral meningitis in children in Turkey

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