Polymerase chain reaction for the laboratory diagnosis of aseptic meningitis and encephalitis

Abstract

-A protocol for testing cerebrospinal fluid specimens using a range of PCR assays for the diagnosis of central nervous system infection was developed and used to test prospectively 383 specimens. PCR assays were used for the detection of adenovirus, Borrelia burgdorferi, enteroviruses, Epstein Barr virus, cytomegalovirus, herpes simplex virus, human herpes virus type 6, JC virus, Leptospira interrogans, Listeria monocytogenes, lymphocytic choriomeningitis virus, measles virus, mumps virus, Mycobacterium sp., Mycoplasma pneumoniae, Toxoplasma gondii and varicella zoster virus. Of the 383 specimens tested in this study, 46 (12.0%) were found to be positive. The microorganisms detected were CMV, enterovirus, Epstein Barr virus, herpes simplex virus, human herpes virus type 6, JC virus, L. monocytogenes, Mycobacterium genus, Toxoplasma gondii and varicella zoster virus. The introduction of the PCR protocol described has improved the diagnosis of a range of central nervous system infections in our laboratory. We believe however that further evaluation of these assays in immunocompromised patients is necessary to better determine the predictive value of positive PCR results in these patient groups.KEY WORDS: polymerase chain reaction (PCR), cerebrospinal fluid (CSF), central nervous system (CNS), lymphocytic meningitis, encephalitis. Reação em cadeia da polimerase no diagnóstico laboratorial das meningites e encefalites assépticasRESUMO -Foi desenvolvido um protocolo de PCR para analisar os principais patógenos que infectam o sistema nervoso central (SNC). Foram testadas 383 amostras de líquido-cefalorraquidiano (LCR), para detecção de: adenovirus, Borrelia burgdorferi, enterovirus, vírus Epstein Barr , citomegalovírus, vírus herpes simplex, herpes humano tipo 6, vírus JC, Leptospira interrogans, Listeria monocytogenes, vírus da coriomeningite linfocitária, vírus do sarampo, vírus da caxumba, Mycobacterium sp, Mycoplasma pneumoniae, Toxoplasma gondii e vírus da varicela zoster. Das 383 amostras de LCR testadas a PCR foi positiva em 46 (12,0%). Os microrganismos detectados foram: citomegalovírus, enterovirus, vírus Epstein Barr , herpes simplex, herpes humanao tipo 6, vírus JC, Listeria monocytogenes, Mycobacterium sp, Toxoplasma gondii e varicela zoster. A introdução da técnica de PCR através de um protocolo para análise do LCR otimizou o diagnóstico etiológico das infecções do SNC e tem se revelado um instrumento de grande potencial diagnóstico. Estudos futuros necessitam ser realizados para melhor avaliar os resultados da PCR em pacientes imunocomprometidos e assim determinar o valor preditivo positivo deste ensaio neste grupo de pacientes. PALAVRAS-CHAVE: reação em cadeia da polimerase (PCR), líquido cefalorraquidiano (LCR), sistema nervoso central (SNC), meningite asséptica, encefalite.

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

“…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 .…”

Acute hemorrhagic leukoencephalitis mimicking herpes simplex encephalitis: case report

“…This low frequency of non-herpetic viral encephalitis in that series probably reflects a non systematic search for CNS viruses 22 . However, even in a larger Brazilian series of 383 patients with aseptic meningitis and encephalitis, the use of PCR protocols for the presence of 17 infectious agents, including enteroviruses, herpes simplex virus, varicella zoster virus, Epstein-Barr virus (EBV), cytomegalovirus, measles and mumps virus, yielded a positive result in just 12% of the patients 23 . Interestingly, as 32.6% of patients in this series were known to have HIV infection, a large number of CSF samples were positive for EBV, a virus whose role in pathogenesis of CNS disease still remains uncertain 23 .…”

Cerebelite aguda causada por vírus Epstein-Barr: relato de caso

“…Recentemente com a introdução da técnica de reação em cadeia da polimerase (PCR) tem-se aperfeiçoado o diagnóstico das infecções do sistema nervoso central, em particular a infeção pelo EBV [15][16][17] .…”