Prevalence of viral infection markers by polymerase chain reaction amplification and interferon‐alpha measurements among patients undergoing lumbar puncture in an emergency department

Abstract

Aseptic meningitis is a frequent diagnosis in emergency departments. Nevertheless, viral investigations are not carried out currently and the viral etiology in adult population has not been studied extensively. We conducted a prospective study including all consecutive patients undergoing lumbar puncture during a 15 months period in an adult emergency department. Bloody and purulent cerebrospinal fluid (CSF) were excluded. The main tests undertaken were: CSF genomic amplification by the polymerase chain reaction (PCR) for neurotropic viruses and serum and CSF interferon-alpha (IFN-alpha) measurements. Among 194 patients included, 45 had and 149 did not have aseptic meningitis. Of 45 patients with aseptic meningitis, 10 had alternative non-virological final diagnosis, and 35/45 were presumed to have neurological disorders of viral origin. Patients (27/35) completed virological analysis: 21/27 (78%) had either positive viral PCR (enterovirus: 8 patients, Varicella zoster virus (VZV): 5, Epstein-Barr virus (EBV): 2, herpes simplex virus (HSV): 1, human herpes virus 6: 1) or only raised serum or CSF IFN-alpha (4 patients). Overall, 59% of patients with a positive viral PCR had either CSF or serum raised IFN-alpha. Twentyone patients without meningitis had either positive viral PCR (enterovirus: 3 patients) or only high serum IFN-alpha level (18 patients). In the setting of aseptic meningitis diagnosed in an adult emergency department, viruses are the most common agents encountered, with enterovirus and VZV as the two main etiological agents. Current CSF viral genome amplification and IFN-alpha measurement are informative and could be useful to confirm the viral origin of various neurological disorders, although the sensitivity and specificity of IFN-alpha measurement for the diagnosis of viral infection need further confirmation.

Atypical symptoms in patients with herpesvirus DNA detected by PCR in cerebrospinal fluid

“…Elsewhere, as previously published (Aurelius et al, 1993), no relation was observed for the cell count in the CSF or the CSF protein content and the clinical outcome: in our study, five of PCR-positive patients showing normal cytological and biochemical values in CSF presented with neurological sequelae. Interferon-alpha was detected in only 21 (50%) of the 42 CSFs analysed (not shown) which were PCR-positive for one herpesvirus (Aurelius et al, 1993;Hausfater et al, 2004).…”

Varicella-zoster virus infections of the central nervous system – Prognosis, diagnostics and treatment

“…Of patients with suspected viral meningitis 4.4% to 11% (all ages) are VZV DNA positive by PCR [42,43,17], and VZV is reported to be the second most frequent infectious agent that causes viral meningitis, after enterovirus [17]. In general, patients with meningitis tend to be younger than patients with encephalitis [44,40,17,4].…”

Meningitis in elderly patients

“…Several epidemiological studies indicate that a greater variety of organisms may be responsible for bacterial meningitis (BM) in the older adults, quite different from younger patients [6]. Conversely, viral etiologies are classically uncommon in older adults and less described [7][8][9][10]. The objective of this study was to describe the characteristics of BM and nonbacterial meningitis (NBM) occurring in elderly patients.…”