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Schattner A. The Wide Spectrum of Presentations of Cytomegalovirus Infection in Immunocompetent Hosts: An Exhaustive Narrative Review. Pathogens 2024; 13:667. [PMID: 39204267 PMCID: PMC11357360 DOI: 10.3390/pathogens13080667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/09/2024] [Accepted: 07/26/2024] [Indexed: 09/03/2024] Open
Abstract
CMV is a ubiquitous DNA virus that establishes infection and results in 40-100% seropositivity. Viral replication occurs following an acquired primary infection (or reinfection) or by the reactivation of life-long latency. In immunocompetent patients, CMV infection is mostly asymptomatic or mild and self-limited. However, an extensive review of the literature published up to April 2024 reveals that despite immunocompetence, CMV can cause a very large variety of clinical syndromes in any part of the gastrointestinal tract (the most common pattern), the central or peripheral nervous system, and the eyes, as well as hematological, pulmonary, cardiac, and cutaneous disease. Not uncommonly, more than one system is involved, and though the disease is often self-limited, treatment with intravenous ganciclovir or oral valganciclovir may be required, and in isolated cases, fatalities may occur. Thus, a potential CMV infection should be considered in the differential of myriad syndromes in non-immunocompromised patients. Associated systemic symptoms (fever, sweats, and weight loss), lymphocytosis, and hepatitis are not uncommon and can be a useful clue. Some populations, such as critically ill patients in intensive care, pregnant women, elderly patients, and those with inflammatory bowel disease, may be more susceptible. Moreover, the potential of past, latent CMV infection (i.e., CMV seropositivity) to be associated with significant cardiovascular morbidity and all-cause mortality years later is intriguing and requires further study. All these data indicate the outstanding importance of developing a vaccine against CMV, which hopefully will become available in the foreseeable future. Meanwhile, a solid diagnosis of active CMV infection can be quickly established (or ruled out) by widely available serology tests and PCR amplification, and clinicians in all disciplines need to be more aware of the diverse guises of CMV infection and remember to consider it in any host, including an immunocompetent one.
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Affiliation(s)
- Ami Schattner
- The Faculty of Medicine, Hebrew University Hadassah Medical School, Ein Kerem, Jerusalem 91120, Israel
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Ahmed WA, Alghamdi AA, Almuhanna RA, Alazwari AA, Muddassir R, Elshony HS. Herpes simplex encephalitis with normal brain magnetic resonance imaging and normocellular initial cerebrospinal fluid. Int J Neurosci 2023:1-5. [PMID: 37929576 DOI: 10.1080/00207454.2023.2279501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
Introduction: Herpes simplex virus (HSV) is associated with one of the lethal diseases, Herpes simplex encephalitis (HSE). Diagnosis is confirmed using MRI and CT scan imaging techniques and more sensitive DNA PCR from cerebrospinal fluid analysis and brain biopsy.Case presentation: However, after four days, the patient's HSE diagnosis was confirmed by the detection of herpes simplex virus type 1 (HSV1) via polymerase chain reaction (PCR) testing. This case highlights the importance of utilizing multiple diagnostic aids and not solely relying on initial test results, as infections may not appear in CSF analysis or MRI scans initially. Furthermore, this case also emphasizes the necessity of initiating empirical treatment based on clinical signs and symptoms, even in cases where diagnostic tests initially appear negative. Prompt and efficient diagnosis and treatment are crucial in managing HSE and preventing long-term neurological damage.Conclusion: This case of HSE underscores the significance of a multifaceted diagnostic approach and timely intervention in managing this potentially severe and life-threatening condition. As mentioned, sometimes the infection does not appear in CSF analysis initially, nor does its effects appear in MRI. HSV PCR remains the golden test to confirm the diagnosis of HSE.
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Affiliation(s)
| | | | | | | | - Rabia Muddassir
- Department of Medicine, Security Forces Hospital, Makkah, Saudi Arabia
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3
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Humisto A, Antikainen J, Holma T, Jarva H, Toivonen A, Loginov R, Mannonen L. Evaluation of the Novel CE-IVD-Marked Multiplex PCR QIAstat-Dx Meningitis/Encephalitis Panel. Microbiol Spectr 2023; 11:e0514422. [PMID: 37042772 PMCID: PMC10269741 DOI: 10.1128/spectrum.05144-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/23/2023] [Indexed: 04/13/2023] Open
Abstract
Central nervous system (CNS) infections such as meningitis and encephalitis are life-threatening conditions that demand hospital care and prompt identification of the causative agent. Since 2015, there has been only one CE-IVD-marked rapid multiplexed diagnostic assay in cassette format for bacterial and viral detection from cerebrospinal fluid (CSF): the BioFire FilmArray meningitis/encephalitis (ME) panel. In the beginning of 2022, Qiagen introduced the QIAstat-Dx meningitis/encephalitis panel. It is a CE-IVD-marked multiplex PCR cassette test intended for the identification of suspected infectious meningitis, encephalitis, or meningoencephalitis caused by bacterial, viral, or fungal pathogens. In this study, we evaluated patient and quality control samples using the QIAstat-Dx meningitis/encephalitis panel and compared the results to those of the BioFire FilmArray meningitis/encephalitis panel and reference methods (current routine analysis methods in our laboratory, PCR, or cultivation). The combined positive percent agreement between the two panel assays was 100%, and the negative percent agreement was 94%. We further compared specifically herpes simplex virus 1 (HSV-1), HSV-2, and varicella-zoster virus (VZV) dilution series using six commercial herpesvirus assays, including the two cassette tests. The results suggested that real-time PCR methods (with separate extraction) were the most sensitive methods. When comparing the cassette tests, the BioFire FilmArray meningitis/encephalitis panel produced more positive results than the QIAstat-Dx meningitis/encephalitis panel in the herpesvirus analyses. IMPORTANCE The diagnosis of infectious meningitis and encephalitis relies mostly on specific PCR and culturing methods, but commercial syndromic panel assays are bringing a change in diagnostics. With multiplexed analysis, the identification of the pathogen is potentially faster, and less sample material is needed. The novel QIAstat-Dx meningitis/encephalitis panel assay is intended for the rapid identification of pathogens from cerebrospinal fluid for suspected central nervous system (CNS) infection, which is a life-threatening condition and difficult to diagnose. We studied the performance of this panel assay using patient samples and dilution series of selected viruses. The evaluation data for this novel meningitis/encephalitis panel assay are useful for other clinical laboratories and organizations using or considering using this test.
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Affiliation(s)
- Anu Humisto
- Department of Clinical Microbiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jenni Antikainen
- Department of Clinical Microbiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tanja Holma
- Department of Clinical Microbiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanna Jarva
- Department of Clinical Microbiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anne Toivonen
- Department of Clinical Microbiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Raisa Loginov
- Department of Clinical Microbiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Laura Mannonen
- Department of Clinical Microbiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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4
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Yong HYF, Pastula DM, Kapadia RK. Diagnosing viral encephalitis and emerging concepts. Curr Opin Neurol 2023; 36:175-184. [PMID: 37078655 DOI: 10.1097/wco.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
PURPOSE OF REVIEW This review offers a contemporary clinical approach to the diagnosis of viral encephalitis and discusses recent advances in the field. The neurologic effects of coronaviruses, including COVID-19, as well as management of encephalitis are not covered in this review. RECENT FINDINGS The diagnostic tools for evaluating patients with viral encephalitis are evolving quickly. Multiplex PCR panels are now in widespread use and allow for rapid pathogen detection and potentially reduce empiric antimicrobial exposure in certain patients, while metagenomic next-generation sequencing holds great promise in diagnosing challenging and rarer causes of viral encephalitis. We also review topical and emerging infections pertinent to neuroinfectious disease practice, including emerging arboviruses, monkeypox virus (mpox), and measles. SUMMARY Although etiological diagnosis remains challenging in viral encephalitis, recent advances may soon provide the clinician with additional tools. Environmental changes, host factors (such as ubiquitous use of immunosuppression), and societal trends (re-emergence of vaccine preventable diseases) are likely to change the landscape of neurologic infections that are considered and treated in clinical practice.
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Affiliation(s)
- Heather Y F Yong
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, Alberta, Canada
| | - Daniel M Pastula
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Ronak K Kapadia
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, Alberta, Canada
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5
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Inborn Errors of Immunity Predisposing to Herpes Simplex Virus Infections of the Central Nervous System. Pathogens 2023; 12:pathogens12020310. [PMID: 36839582 PMCID: PMC9961685 DOI: 10.3390/pathogens12020310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
Herpesvirus infections can lead to a number of severe clinical manifestations, particularly when involving the central nervous system (CNS), causing encephalitis and meningitis. However, understanding of the host factors conferring increased susceptibility to these diseases and their complications remains incomplete. Previous studies have uncovered defects in the innate Toll-like receptor 3 pathway and production of type I interferon (IFN-I) in children and adults that predispose them to herpes simplex encephalitis. More recently, there is accumulating evidence for an important role of IFN-independent cell-autonomous intrinsic mechanisms, including small nucleolar RNAs, RNA lariat metabolism, and autophagy, in restricting herpesvirus replication and conferring protection against CNS infection. The present review first describes clinical manifestations of HSV infection with a focus on neurological complications and then summarizes the host-pathogen interactions and innate immune pathways responsible for sensing herpesviruses and triggering antiviral responses and immunity. Next, we review the current landscape of inborn errors of immunity and the underlying genetic defects and disturbances of cellular immune pathways that confer increased susceptibility to HSV infection in CNS. Ultimately, we discuss some of the present outstanding unanswered questions relating to inborn errors of immunity and HSV CNS infection together with some perspectives and future directions for research in the pathogenesis of these severe diseases in humans.
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6
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Phrathep DD, El-Husari A, Healey KD, Anthony S, Onyedimma N, Narvel R. Rapid-Onset Temporal Encephalitis With Negative Cerebrospinal Fluid Polymerase Chain Reaction Testing. Cureus 2023; 15:e34448. [PMID: 36874714 PMCID: PMC9980281 DOI: 10.7759/cureus.34448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Herpes simplex encephalitis is a rare disease presentation that is usually characterized by its temporal involvement and positive cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for the herpes simplex virus (HSV). HSV PCR has a sensitivity of 96% and specificity of 99%. Even when the test is negative, if clinical suspicion is high, acyclovir therapy should be continued with a repeated PCR within a week. In this case, we report a 75-year-old female patient who presented with signs of hypertensive emergency with rapid deterioration to seizure-like activity on electroencephalogram (EEG) and signs of temporal encephalitis on magnetic resonance imaging (MRI). The patient did not respond to the initial regimen of antibiotics but did show significant clinical response to acyclovir though she had a negative CSF PCR for HSV ten days after the start of her neurological symptoms. In this case, we argue that alternative methods of diagnosis should be considered in cases of acute encephalitis. Our patient had negative PCR but her computerized tomography (CT), EEG, and MRI results pointed to temporal encephalitis caused by HSV.
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Affiliation(s)
- Davong D Phrathep
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Ali El-Husari
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Kevin D Healey
- Urology, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Stefan Anthony
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Nneoma Onyedimma
- Family Medicine, Ascension St. Vincent's Medical Center, Jacksonville, USA
| | - Ravish Narvel
- Internal Medicine, Ascension St.Vincent's-Riverside, Jacksonville, USA
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7
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Krett JD, Beckham JD, Tyler KL, Piquet AL, Chauhan L, Wallace CJ, Pastula DM, Kapadia RK. Neurology of Acute Viral Infections. Neurohospitalist 2022; 12:632-646. [PMID: 36147750 PMCID: PMC9485684 DOI: 10.1177/19418744221104778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
As specialists in acute neurology, neurohospitalists are often called upon to diagnose and manage acute viral infections affecting the nervous system. In this broad review covering the neurology of several acute viral infections, our aim is to provide key diagnostic and therapeutic pearls of practical use to the busy neurohospitalist. We will review acute presentations, diagnosis, and treatment of human herpesviruses, arboviruses, enteroviruses, and some vaccine-preventable viruses. The neurological effects of coronaviruses, including COVID-19, are not covered in this review.
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Affiliation(s)
- Jonathan D Krett
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - J David Beckham
- Department of Neurology and Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado Neurosciences Center, Aurora, CO, USA
- Departments of Immunology & Microbiology, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Kenneth L Tyler
- Department of Neurology and Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado Neurosciences Center, Aurora, CO, USA
- Departments of Immunology & Microbiology, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Amanda L Piquet
- Department of Neurology and Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado Neurosciences Center, Aurora, CO, USA
| | - Lakshmi Chauhan
- Department of Neurology and Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado Neurosciences Center, Aurora, CO, USA
| | - Carla J Wallace
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Daniel M Pastula
- Department of Neurology and Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado Neurosciences Center, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Ronak K Kapadia
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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Rajmohan R, Khoury D, Perez-Rosendahl M, Mnatsakanyan L, Groysman L. Polymerase Chain Reaction (PCR)-Negative Herpes Simplex Virus (HSV) Encephalitis in a 62-Year-Old Woman With p-ANCA Vasculitis. Cureus 2022; 14:e21480. [PMID: 35223260 PMCID: PMC8858625 DOI: 10.7759/cureus.21480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/05/2022] Open
Abstract
We present the case of a 62-year-old woman with a past medical history significant for p-ANCA vasculitis (on immunosuppression) who was found to have polymerase chain reaction (PCR)-negative herpes simplex virus (HSV) encephalitis. We also present a review of all identifiable reports of PCR-negative HSV encephalitis in the past 20 years. To our knowledge, this is the first case of PCR-negative HSV encephalitis in a patient with p-ANCA vasculitis and the thirteenth overall in this timeframe. The patient presented with new-onset fever, encephalopathy, and a first-in-lifetime focal motor seizure progressing to status epilepticus. Cerebrospinal fluid (CSF) PCR was negative for HSV on three separate instances between the first and thirteenth days since symptom onset, and the CSF profile was not typical for HSV encephalitis. The patient underwent a brain biopsy, which confirmed the presence of HSV. She continued to worsen despite aggressive seizure control and six days of empiric acyclovir. Unfortunately, she expired despite the reinitiation of acyclovir. When faced with the classical features of encephalitis in the immunocompromised, the suspicion of HSV should remain high despite negative PCR results. The completion of a full course of acyclovir in the absence of clinical improvement should be considered.
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9
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Fujisato S, Urushibara T, Kasai H, Ishi D, Inafuku K, Fujinuma Y, Shinozaki T. A Fatal Case of Atypical Disseminated Herpes Zoster in a Patient with Meningoencephalitis and Seizures Associated with Steroid Immunosuppression. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1162-1167. [PMID: 30270342 PMCID: PMC6180941 DOI: 10.12659/ajcr.910521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Patient: Male, 69 Final Diagnosis: Disseminated herpes zoster Symptoms: Rash • seizures Medication: — Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
- Shushi Fujisato
- Department of Respiratory Medicine, Kimitsu Chuo Hospital, Kisarazu, Chiba, Japan
| | - Takashi Urushibara
- Department of Respiratory Medicine, Kimitsu Chuo Hospital, Kisarazu, Chiba, Japan
| | - Hajime Kasai
- Department of Respiratory Medicine, Kimitsu Chuo Hospital, Kisarazu, Chiba, Japan.,Department of Respirology, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan.,Health Professional Development Center, Chiba University Hospital, Chiba City, Chiba, Japan
| | - Daisuke Ishi
- Department of Respiratory Medicine, Kimitsu Chuo Hospital, Kisarazu, Chiba, Japan
| | - Kazuhiro Inafuku
- Department of Dermatology, Kimitsu Chuo Hospital, Kisarazu, Chiba, Japan
| | | | - Toshihide Shinozaki
- Department of Respiratory Medicine, Kimitsu Chuo Hospital, Kisarazu, Chiba, Japan
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Tauziède-Espariat A, Chrétien F, Jouvion G, Alde-Biassette H, Hofman P. [Practices in infectious pathology in France in 2015. Results of the national survey]. Ann Pathol 2018; 38:55-63. [PMID: 29317100 DOI: 10.1016/j.annpat.2017.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 12/20/2022]
Abstract
Pathologists have been, are and will be always implicated in the diagnosis of infectious and tropical diseases. The resurgence of opportunistic infections due to the development of immunosuppressive drugs, the increase of migratory involvements draining tropical infections and the last epidemics spotlight the importance of pathologists in the field of infectious diseases. However, cancer is nowadays the first preoccupation of pathologists, which is constantly subject to evaluate diagnostic and prognostic markers and factors predictive to targeted therapy response or immunotherapy. As tumor pathology, infectious diseases require more sophisticated and rapidly changing complementary techniques, appraisals and perhaps a national network of diagnosis. The infectious pathology club committee carries out here a census of methods used in the diagnosis of infectious diseases in France in 2015 and particularly the different techniques used by laboratories to perform infectious diseases diagnosis. This will lay down the foundation of a future national organization of the infectious pathology in providing efficient services (diagnostic support, complementary tools) for the community of French pathologists in this specific domain of competence.
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Affiliation(s)
- Arnault Tauziède-Espariat
- Laboratoire de neuropathologie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
| | - Fabrice Chrétien
- Laboratoire de neuropathologie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Unité d'histopathologie humaine et modèles animaux, Institut Pasteur, 25-28, rue du Docteur-Roux, 75015 Paris, France
| | - Grégory Jouvion
- Unité d'histopathologie humaine et modèles animaux, Institut Pasteur, 25-28, rue du Docteur-Roux, 75015 Paris, France
| | - Homa Alde-Biassette
- Service d'anatomie et cytologie pathologiques, hôpital Lariboisière, 1, rue Ambroise-Paré, 75475 Paris, France
| | - Paul Hofman
- Laboratoire de pathologie clinique et expérimentale et biobanque hospitalière (BB-0033-00025), hôpital Pasteur, CHU de Nice, 30, voie Romaine, 06001 Nice cedex 01, France
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11
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Simultaneous Detection and Genotype Determination of HSV 1 and 2 by Real-time PCR Using Melting Curve Analysis and a Unique Pair of Primers. Appl Immunohistochem Mol Morphol 2017; 25:139-143. [PMID: 26709736 DOI: 10.1097/pai.0000000000000282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Herpes simplex virus (HSV) is a human pathogen that causes different pathologic manifestations. Rapid and feasible detection and discrimination methods for HSV genotyping is a challenge in clinical laboratories, especially in children suffering from herpetic encephalitis. A quantitative real-time polymerase chain reaction (PCR)-based genotyping assay using SYBR Green I was established. We designed only 1 pair of primer for HSV 1 and 2, targeting thymidine kinase gene conserved region. HSV genotypes were determined by PCR using melting curve analysis with LightCycler. Different HSV genotypes were successfully detected in all clinical samples. The melting temperature for HSV 1 and 2 was 85.5±0.78°C and 89±0.53°C, respectively. These 2 genotypes were completely distinguished by means of the accurate melting assay. Importantly, detection was reliably performed within only 1 hour. The assay had no cross-reactivity across species, an excellent dynamic range from 10 to 10 copies per reaction, a good intra-assay and interassay reproducibility, and a detection limit of a single copy per reaction. Our homebrew designed and validated quantitative real-time PCR followed by a melting curve analysis provided a rapid and convenient screening test for differential identification of HSV genotypes 1 and 2. We recommend the large-scale application of this method for HSV 1 and 2 detection.
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12
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Abstract
This chapter provides an overview of infectious syndromes, pathogens, and diagnostic testing modalities for central nervous system infections in the immunocompromised host.
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Piewbang C, Rungsipipat A, Poovorawan Y, Techangamsuwan S. Viral molecular and pathological investigations of Canid herpesvirus 1 infection associated respiratory disease and acute death in dogs. ACTA VET-BEOGRAD 2017. [DOI: 10.1515/acve-2017-0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Canid herpesvirus 1 (CaHV-1) is a member of the canine infectious respiratory disease complex (CIRDC). The outcome of CaHV-1 infection can be occasionally fatal. So far, no information on CaHV-1 circulation in Thailand has been reported resulting in a lack of preventive strategies. In this study, nasal (NS) and oropharyngeal (OS) swabs were collected from 100 live dogs with respiratory distress. Among them, 23 pleural effusions were aspirated. A panel of CIRDC-associated viruses was screened by (RT)-PCR, including CaHV-1, CIV, CPIV, CDV, CRCoV and CAdV-2, for all collected samples. The CaHV-1 was detected in 32 dogs. Additionally, CaHV-1 was consistently detected in six pleural effusions. Most CaHV-1 infected dogs were over 5 years of age (43.8%) and expressed a mild nasal discharge. Pathological results of four three-month-old puppies, naturally moribund from respiratory disease, revealed a severe multifocal necrotic-hemorrhagic disease in several organs without pathognomonic inclusion bodies. They were only found to be CaHV-1 positive by PCR. Phylogenetic analysis demonstrated concordant results of CaHV-1 circulation in Thailand. Although mostly found as a co-infection with other CIRDC viruses (68.8%) it also occurred alone. Therefore, rapid ante-mortem diagnosis might facilitate the investigation of unclassical CaHV-1 infection, which is fatal in neonates and causes illness in annually core-vaccinated adults.
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Affiliation(s)
- Chutchai Piewbang
- Department of Pathology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330 Thailand
- Center of Excellence for Emerging and Re-emerging Infectious Diseases in Animals, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330 Thailand
| | - Anudep Rungsipipat
- Department of Pathology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330 Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330 Thailand
| | - Somporn Techangamsuwan
- Department of Pathology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330 Thailand
- Center of Excellence for Emerging and Re-emerging Infectious Diseases in Animals, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330 Thailand
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14
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Garcia M, Chessa C, Bourgoin A, Giraudeau G, Plouzeau C, Agius G, Lévêque N, Beby-Defaux A. Comparison of eMAG™ versus NucliSENS ® EasyMAG ® performance on clinical specimens. J Clin Virol 2017; 88:52-57. [PMID: 28160729 PMCID: PMC7185493 DOI: 10.1016/j.jcv.2017.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/27/2016] [Accepted: 01/14/2017] [Indexed: 11/28/2022]
Abstract
eMAG™ is a new nucleic acid extraction platform based on magnetic silica technology. Performance of eMAG™ and easyMAG® were compared on various clinical specimens. Agreement for virus detection ranged from 84.6% to 95.9%. Correlation for virus quantitation displayed R2 from 0.802 to 0.995. The two platforms showed comparable performance on the clinical specimens tested.
Background eMAG™ (bioMerieux) is a new nucleic acid extraction platform based on magnetic silica technology, like its predecessor, NucliSENS® easyMAG® (bioMerieux). Using the same reagents and disposables, eMAG™ adds further automation, allowing simultaneous extraction of 48 samples directly from primary tubes, and distribution of nucleic acid extracts on PCR strips or in tubes at the end of the extraction process. Objective To compare the performance of eMAG™ and easyMAG® on various clinical specimens. Study design Respiratory (n = 199), whole blood (n = 50), plasma (n = 25) and urine (n = 25) specimens were extracted in parallel on both platforms. Both qualitative (respiratory virus, cell control, CMV, EBV, HHV6 and BKV detection) and quantitative (respiratory virus and cell control cycle thresolds, and CMV, EBV, HHV6 and BKV viral loads) results were compared. Results Detection of qualitative targets showed good agreement, ranging from 84.6% for whole blood to 95.9% for respiratory specimens. Correlations between quantitative results were good, with R2 ranging from 0.802 to 0.995. Quantitative results showed average overall differences below 0.10 log10 copies/mL between eMAG™ and easyMAG®. Conclusions The two platforms showed comparable performance on the types of clinical specimen tested. With higher automation and throughput than easyMAG®, the eMAG™ platform is likely to be advantageous for laboratories performing a large number of molecular analyses.
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Affiliation(s)
- Magali Garcia
- Laboratoire de Virologie et de Mycobactériologie, CHU de Poitiers, Poitiers, France; EA4331-LITEC, Université de Poitiers, Poitiers, France
| | - Céline Chessa
- Laboratoire de Virologie et de Mycobactériologie, CHU de Poitiers, Poitiers, France; EA4331-LITEC, Université de Poitiers, Poitiers, France
| | - Anne Bourgoin
- Laboratoire de Virologie et de Mycobactériologie, CHU de Poitiers, Poitiers, France
| | - Geneviève Giraudeau
- Laboratoire de Virologie et de Mycobactériologie, CHU de Poitiers, Poitiers, France
| | - Chloé Plouzeau
- Laboratoire de Bactériologie, CHU de Poitiers, Poitiers, France; Unité de Microbiologie Moléculaire et Séquençage, CHU de Poitiers, Poitiers, France
| | - Gérard Agius
- Laboratoire de Virologie et de Mycobactériologie, CHU de Poitiers, Poitiers, France
| | - Nicolas Lévêque
- Laboratoire de Virologie et de Mycobactériologie, CHU de Poitiers, Poitiers, France; EA4331-LITEC, Université de Poitiers, Poitiers, France.
| | - Agnès Beby-Defaux
- Laboratoire de Virologie et de Mycobactériologie, CHU de Poitiers, Poitiers, France; Unité de Microbiologie Moléculaire et Séquençage, CHU de Poitiers, Poitiers, France
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15
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Gomez CA, Pinsky BA, Liu A, Banaei N. Delayed Diagnosis of Tuberculous Meningitis Misdiagnosed as Herpes Simplex Virus-1 Encephalitis With the FilmArray Syndromic Polymerase Chain Reaction Panel. Open Forum Infect Dis 2016; 4:ofw245. [PMID: 28540320 PMCID: PMC5437853 DOI: 10.1093/ofid/ofw245] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/17/2016] [Indexed: 11/19/2022] Open
Abstract
The FilmArray meningitis/encephalitis (ME) panel is a novel syndromic, nucleic acid amplification test for diagnosis of acute meningitis and encephalitis. Emerging data on its performance are concerning for false-positive results. We present a case of tuberculous meningitis misdiagnosed as herpes simplex virus-1 encephalitis with the FilmArray ME panel. Strategies to mitigate erroneous results are discussed.
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Affiliation(s)
- Carlos A Gomez
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine.,Department of Pathology, and
| | - Benjamin A Pinsky
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine.,Department of Pathology, and
| | - Anne Liu
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine.,Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, California
| | - Niaz Banaei
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine.,Department of Pathology, and.,Clinical Microbiology Laboratory, Stanford University Medical Center, Palo Alto, California
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16
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Algahtani H, Shirah B, Hmoud M, Subahi A. Nosocomial herpes simplex encephalitis: A challenging diagnosis. J Infect Public Health 2016; 10:343-347. [PMID: 27686257 DOI: 10.1016/j.jiph.2016.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022] Open
Abstract
Herpes simplex encephalitis (HSE) is a rare disease, but it is the most common form of sporadic encephalitis. HSE is transmitted through direct contact and developing nosocomial HSE is rarely reported in the literature. Nosocomial HSE is difficult to diagnose due to its non-specific clinical features. In this article, we present a case of nosocomial HSE that was responsible for grave consequence. We also explore its causes, outcome, and give recommendations to avoid such fatal occurrence. We stress on strict adherence to the standard precautions and preventive control measures.
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Affiliation(s)
- Hussein Algahtani
- King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, P.O. Box: 12723, Jeddah 21483, Saudi Arabia.
| | - Bader Shirah
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammed Hmoud
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ahmad Subahi
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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17
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Wong AA, Pabbaraju K, Wong S, Tellier R. Development of a multiplex real-time PCR for the simultaneous detection of herpes simplex and varicella zoster viruses in cerebrospinal fluid and lesion swab specimens. J Virol Methods 2015; 229:16-23. [PMID: 26711555 DOI: 10.1016/j.jviromet.2015.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/17/2015] [Accepted: 12/17/2015] [Indexed: 12/19/2022]
Abstract
Herpes simplex viruses (HSV) and varicella zoster virus (VZV) can have very similar and wide-ranging clinical presentations. Rapid identification is necessary for timely antiviral therapy, especially with infections involving the central nervous system, neonates, and immunocompromised individuals. Detection of HSV-1, HSV-2 and VZV was combined into one real-time PCR reaction utilizing hydrolysis probes. The assay was validated on the LightCycler(®) (Roche) and Applied Biosystems 7500 Real-Time PCR System (Thermo Fisher Scientific Inc.) to detect alphaherpesviruses in cerebral spinal fluid (CSF) and lesion swab specimens, respectively. Validation data on blood and tissue samples are also presented. The multiplex assay showed excellent sensitivity, specificity and reproducibility when compared to two singleplex real-time PCR assays for CSF samples and direct fluorescent antigen/culture for lesion swab samples. Implementation of the multiplex assay has facilitated improved sensitivity and accuracy as well as reduced turn-around-times and costs. The results from a large data set of 16,622 prospective samples tested between August 16, 2012 to February 1, 2014 at the Provincial Laboratory for Public Health (Alberta, Canada) are presented here.
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Affiliation(s)
- Anita A Wong
- Provincial Laboratory for Public Health (Microbiology), 3030 Hospital Drive NW, Calgary, Alberta, Canada T2N 4W4
| | - Kanti Pabbaraju
- Provincial Laboratory for Public Health (Microbiology), 3030 Hospital Drive NW, Calgary, Alberta, Canada T2N 4W4.
| | - Sallene Wong
- Provincial Laboratory for Public Health (Microbiology), 3030 Hospital Drive NW, Calgary, Alberta, Canada T2N 4W4
| | - Raymond Tellier
- Provincial Laboratory for Public Health (Microbiology), 3030 Hospital Drive NW, Calgary, Alberta, Canada T2N 4W4; Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
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18
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Kapil S. Canid herpesvirus 1 (CHV-1)–related disease in older puppies and CHV-1 shedding in the vagina of adult pregnant dogs. J Vet Diagn Invest 2015; 27:758-61. [DOI: 10.1177/1040638715610377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A large breeding kennel of Bulldogs ( n = 57) experienced several Canid herpesvirus 1 (CHV-1)–related diseases in older puppies (9 weeks of age) in Arkansas. CHV-1 has been repeatedly confirmed in the kennel in several animals for 3 years (January 2012–February 2015) using various virology tests. I was able to detect a partial sequence of CHV DNA (~120 bp) in archived formalin-fixed, paraffin-embedded tissue blocks after 3 years of storage. CHV-1 is persistently circulating in this kennel in spite of high serum antibody titers in the adult dogs. The dogs were negative for canine brucellosis antibodies based on Brucella canis rapid card test.
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Affiliation(s)
- Sanjay Kapil
- Oklahoma Animal Disease Diagnostic Laboratory, Center for Veterinary Health Sciences, Stillwater, OK
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19
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Levy M, Hentgen V, Marque-Juillet S, Fiot E, Fagherazzi G, Nathanson S, Foucaud P. Manifestations neurologiques associées à la varicelle : apport de l’amplification génique dans le liquide céphalo-rachidien. Arch Pediatr 2015; 22:491-7. [DOI: 10.1016/j.arcped.2015.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/16/2014] [Accepted: 02/10/2015] [Indexed: 12/27/2022]
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20
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Barberi W, Perrone S, Iori AP, Torelli GF, Testi AM, Moleti ML, Ceglie T, Papoff P, Caresta E, Antonelli M, Gianno F, Melone A, Badiali M, Giangaspero F, Foà R, Gentile G. Proven Epstein-Barr encephalitis with negative EBV-DNA load in cerebrospinal fluid after allogeneic hematopoietic stem cell transplantation in a child with acute lymphoblastic leukemia. Pediatr Transplant 2015; 19:E19-24. [PMID: 25388950 PMCID: PMC7167730 DOI: 10.1111/petr.12386] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 12/19/2022]
Abstract
We report a case of EBV encephalitis in a seven-yr-old child with Ph+ ALL. Two months after an allogeneic HSCT from his HLA mismatched mother, the patient showed an altered sensorium, generalized seizures, and a left hemiparesis. Brain MRI demonstrated multiple lesions highly suggestive for viral encephalitis. Blood and CSF PCR analyses were negative for the most common viruses involved in immunocompromised patients including EBV. A cerebral biopsy was performed, which showed intense gliosis and perivascular lymphocytic cuffing. PCR analysis performed on brain tissue was positive only for the EBV genome, while extensive investigations for other viral infections were negative. The patient's neurological symptoms rapidly worsened and he died two months later. This case report suggests that in patients presenting neurological and radiological signs of encephalitis after an HSCT, an EBV involvement should be considered, even in the absence of CSF and blood PCR virus detection.
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Affiliation(s)
- Walter Barberi
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Salvatore Perrone
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Anna Paola Iori
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Giovanni Fernando Torelli
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Anna Maria Testi
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Maria Luisa Moleti
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Teresa Ceglie
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Paola Papoff
- Department of Pediatrics, Pediatric Emergency and Intensive Care“Sapienza” UniversityRomeItaly
| | - Elena Caresta
- Department of Pediatrics, Pediatric Emergency and Intensive Care“Sapienza” UniversityRomeItaly
| | - Manila Antonelli
- Department of Radiological, Oncological and Anatomo‐Pathological Sciences“Sapienza” UniversityRomeItaly
| | - Francesca Gianno
- Department of Radiological, Oncological and Anatomo‐Pathological Sciences“Sapienza” UniversityRomeItaly
| | - Antonio Melone
- Division of RadiologyEmergency Department“Sapienza” UniversityRomeItaly
| | - Manuela Badiali
- Bone Marrow Transplantion UnitDepartment Public Health, Clinical and Molecular MedicineOspedale Pediatrico MicrocitemicoCagliariItaly
| | - Felice Giangaspero
- Department of Radiological, Oncological and Anatomo‐Pathological Sciences“Sapienza” UniversityRomeItaly,Neuromed InstituteIRCCSPozzilliItaly
| | - Robin Foà
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Giuseppe Gentile
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
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21
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Rimério CAT, De Oliveira RS, de Almeida Bonatelli MQ, Nucci A, Costa SCB, Bonon SHA. Human herpesvirus infections of the central nervous system: laboratory diagnosis based on DNA detection by nested PCR in plasma and cerebrospinal fluid samples. J Med Virol 2015; 87:648-55. [PMID: 25611195 DOI: 10.1002/jmv.24134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2014] [Indexed: 11/10/2022]
Abstract
Infections of the central nervous systems (CNS) present a diagnostic problem for which an accurate laboratory diagnosis is essential. Invasive practices, such as cerebral biopsy, have been replaced by obtaining a polymerase chain reaction (PCR) diagnosis using cerebral spinal fluid (CSF) as a reference method. Tests on DNA extracted from plasma are noninvasive, thus avoiding all of the collateral effects and patient risks associated with CSF collection. This study aimed to determine whether plasma can replace CSF in nested PCR analysis for the detection of CNS human herpesvirus (HHV) diseases by analysing the proportion of patients whose CSF nested PCR results were positive for CNS HHV who also had the same organism identified by plasma nested PCR. In this study, CSF DNA was used as the "gold standard," and nested PCR was performed on both types of samples. Fifty-two patients with symptoms of nervous system infection were submitted to CSF and blood collection. For the eight HHV, one positive DNA result-in plasma and/or CSF nested PCR-was considered an active HHV infection, whereas the occurrence of two or more HHVs in the same sample was considered a coinfection. HHV infections were positively detected in 27/52 (51.9%) of the CSF and in 32/52 (61.5%) of the plasma, difference not significant, thus nested PCR can be performed on plasma instead of CSF. In conclusion, this findings suggest that plasma as a useful material for the diagnosis of cases where there is any difficulty to perform a CSF puncture.
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22
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Epstein-barr virus encephalitis in infancy. W INDIAN MED J 2014; 63:206-7. [PMID: 25303265 DOI: 10.7727/wimj.2014.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/13/2014] [Indexed: 11/18/2022]
Abstract
Epstein-Barr virus (EBV) infection causes a wide spectrum of illness in humans including subclinical infection, infectious mononucleosis, and is associated with some malignancies. This report presents the clinical findings of an unusual case of EBV encephalitis in a 10-month old infant who presented with a febrile infection and seizures. The clinical manifestations, serologic study and a dynamic change of EBV DNA in cerebrospinal fluid with spontaneous recovery confirmed the diagnosis of EBV infection of the nervous system.
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23
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Rapid and direct detection of herpes simplex virus in cerebrospinal fluid by use of a commercial real-time PCR assay. J Clin Microbiol 2014; 52:4361-2. [PMID: 25274992 DOI: 10.1128/jcm.02623-14] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Central nervous system infection due to herpes simplex virus (HSV) is a medical emergency and requires rapid diagnosis and initiation of therapy. In this study, we compared a routine real-time PCR assay for HSV types 1 (HSV-1) and 2 (HSV-2) to a recently FDA-approved direct PCR assay (Simplexa HSV-1/2 Direct; Focus Diagnostics, Cypress, CA) using cerebrospinal fluid samples (n = 100). The Simplexa HSV-1/2 assays demonstrated a combined sensitivity and specificity of 96.2% (50/52) and 97.9% (47/48), respectively. In addition, the Simplexa assay does not require nucleic acid extraction, and the results are available in 60 min.
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24
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Kleines M, Scheithauer S, Schiefer J, Häusler M. Clinical application of viral cerebrospinal fluid PCR testing for diagnosis of central nervous system disorders: a retrospective 11-year experience. Diagn Microbiol Infect Dis 2014; 80:207-15. [PMID: 25178670 DOI: 10.1016/j.diagmicrobio.2014.07.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 07/27/2014] [Accepted: 07/28/2014] [Indexed: 11/17/2022]
Abstract
The cerebrospinal fluid (CSF) polymerase chain reaction (PCR) is the gold standard to detect cerebral viral activity. As positive findings do not prove an impact on the neurological disorder, data interpretation is difficult. To better assess the impact of positive CSF PCR findings in different neurological diseases and to identify coherences facilitating CSF PCR data interpretation, we performed this retrospective analysis of CSF PCR data of 481 pediatric and 2604 adult patients, including herpes simplex virus (HSV), varicella zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus 6 (HHV-6), and enteroviruses (EV). Nucleic acid of EBV was detected in 1.6% (39/2449), of VZV in 1.3% (34/2624), of HSV in 1.24% (37/2994), of EV in 0.4% (10/2364), of HHV-6 in 0.17% (4/2417), and of CMV in 0.2% (5/2514) of the patients. Newborns and elderly people showed highest infection rates. HSV, VZV, and EV prevailed in typical infectious central nervous system (CNS) diseases; EBV, in further inflammatory neurological diseases; HSV and EBV, in immunocompromised patients; and EBV, HSV, and HHV-6, in further non-inflammatory neurological diseases. Analysis of successive PCR studies revealed delayed viral detection for EBV (6/147) and HSV (1/217), respectively. Rapid viral clearance was typical for HSV, VZV, CMV, and EV infections, although the maximum duration of viral detection was 15days for HSV and 12days for VZV, respectively. This suggests that the detection of HSV, VZV, CMV, and EV strongly indicates symptomatic viral CNS disease. Secondary viral reactivation mostly underlies positive EBV and HHV-6 findings. Their detection does not rule out clinical impact but recommends searching for additional underlying conditions.
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Affiliation(s)
- Michael Kleines
- Division of Virology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Simone Scheithauer
- Department of Infection Control and Infectious Diseases, RWTH Aachen University Hospital, Aachen, Germany.
| | - Johannes Schiefer
- Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany.
| | - Martin Häusler
- Department of Pediatrics, Division of Pediatric Neurology and Social Pediatrics, RWTH Aachen University Hospital, Aachen, Germany.
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25
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26
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Acute parkinsonism as first manifestation of systemic lupus erythematosus unmasked by CMV infection. Neurol Sci 2014; 35:2019-21. [DOI: 10.1007/s10072-014-1844-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
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27
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Concomitant Viral and Bacterial Encephalitis after Temozolomide for Glioblastoma. Can J Neurol Sci 2014; 41:84-5. [DOI: 10.1017/s0317167100016310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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28
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Virological diagnosis of central nervous system infections by use of PCR coupled with mass spectrometry analysis of cerebrospinal fluid samples. J Clin Microbiol 2013; 52:212-7. [PMID: 24197874 DOI: 10.1128/jcm.02270-13] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Viruses are the leading cause of central nervous system (CNS) infections, ahead of bacteria, parasites, and fungal agents. A rapid and comprehensive virologic diagnostic testing method is needed to improve the therapeutic management of hospitalized pediatric or adult patients. In this study, we assessed the clinical performance of PCR amplification coupled with electrospray ionization-time of flight mass spectrometry analysis (PCR-MS) for the diagnosis of viral CNS infections. Three hundred twenty-seven cerebrospinal fluid (CSF) samples prospectively tested by routine PCR assays between 2004 and 2012 in two university hospital centers (Toulouse and Reims, France) were retrospectively analyzed by PCR-MS analysis using primers targeted to adenovirus, human herpesviruses 1 to 8 (HHV-1 to -8), polyomaviruses BK and JC, parvovirus B19, and enteroviruses (EV). PCR-MS detected single or multiple virus infections in 190 (83%) of the 229 samples that tested positive by routine PCR analysis and in 10 (10.2%) of the 98 samples that tested negative. The PCR-MS results correlated well with herpes simplex virus 1 (HSV-1), varicella-zoster virus (VZV), and EV detection by routine PCR assays (kappa values [95% confidence intervals], 0.80 [0.69 to 0.92], 0.85 [0.71 to 0.98], and 0.84 [0.78 to 0.90], respectively), whereas a weak correlation was observed with Epstein-Barr virus (EBV) (0.34 [0.10 to 0.58]). Twenty-six coinfections and 16 instances of uncommon neurotropic viruses (HHV-7 [n = 13], parvovirus B19 [n = 2], and adenovirus [n = 1]) were identified by the PCR-MS analysis, whereas only 4 coinfections had been prospectively evidenced using routine PCR assays (P < 0.01). In conclusion, our results demonstrated that PCR-MS analysis is a valuable tool to identify common neurotropic viruses in CSF (with, however, limitations that were identified regarding EBV and EV detection) and may be of major interest in better understanding the clinical impact of multiple or neglected viral neurological infections.
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29
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Rodrigues D, de-Paris F, Paiva RM. Minimum detection limit of an in-house nested-PCR assay for herpes simplex virus and varicella zoster virus. Rev Soc Bras Med Trop 2013; 46:625-8. [DOI: 10.1590/0037-8682-1520-2013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 06/06/2012] [Indexed: 11/21/2022] Open
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30
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Pelkonen T, Roine I, Anjos E, Mäki M, Peltola H, Pitkäranta A. Herpesviruses in cerebrospinal fluid of children with meningitis in Luanda, Angola. Acta Paediatr 2013; 102:e281-3. [PMID: 23458446 DOI: 10.1111/apa.12222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 02/24/2013] [Accepted: 02/25/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Tuula Pelkonen
- Hospital Pediátrico David Bernardino; Luanda Angola
- Helsinki University Central Hospital; Hospital for Children and Adolescents; Helsinki Finland
- University of Helsinki; Helsinki Finland
| | - Irmeli Roine
- Faculty of Medicine; Universidad Diego Portales; Santiago Chile
| | | | - Minna Mäki
- Mobidiag ltd, Biomedicum; Helsinki Finland
| | - Heikki Peltola
- Helsinki University Central Hospital; Hospital for Children and Adolescents; Helsinki Finland
- University of Helsinki; Helsinki Finland
| | - Anne Pitkäranta
- University of Helsinki; Helsinki Finland
- Department of Otorhinolaryngology; Helsinki University Central Hospital; Helsinki Finland
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31
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Liu QF, Ling YW, Fan ZP, Jiang QL, Sun J, Wu XL, Zhao J, Wei Q, Zhang Y, Yu GP, Wu MQ, Feng R. Epstein-Barr virus (EBV) load in cerebrospinal fluid and peripheral blood of patients with EBV-associated central nervous system diseases after allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2013; 15:379-92. [PMID: 23692640 DOI: 10.1111/tid.12090] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 11/29/2012] [Accepted: 12/08/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Q.-F. Liu
- Department of Hematology; Nanfang Hospital, Southern Medical University; Guangzhou; Guangdong; China
| | - Y.-W. Ling
- Department of Hematology; Nanfang Hospital, Southern Medical University; Guangzhou; Guangdong; China
| | - Z.-P. Fan
- Department of Hematology; Nanfang Hospital, Southern Medical University; Guangzhou; Guangdong; China
| | - Q.-L. Jiang
- Department of Hematology; Nanfang Hospital, Southern Medical University; Guangzhou; Guangdong; China
| | - J. Sun
- Department of Hematology; Nanfang Hospital, Southern Medical University; Guangzhou; Guangdong; China
| | - X.-L. Wu
- Department of Hematology; Nanfang Hospital, Southern Medical University; Guangzhou; Guangdong; China
| | - J. Zhao
- Department of Hematology; Nanfang Hospital, Southern Medical University; Guangzhou; Guangdong; China
| | - Q. Wei
- Department of Hematology; Nanfang Hospital, Southern Medical University; Guangzhou; Guangdong; China
| | - Y. Zhang
- Department of Hematology; Nanfang Hospital, Southern Medical University; Guangzhou; Guangdong; China
| | - G.-P. Yu
- Department of Hematology; Nanfang Hospital, Southern Medical University; Guangzhou; Guangdong; China
| | - M.-Q. Wu
- Department of Hematology; Nanfang Hospital, Southern Medical University; Guangzhou; Guangdong; China
| | - R. Feng
- Department of Hematology; Nanfang Hospital, Southern Medical University; Guangzhou; Guangdong; China
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32
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Meyding-Lamadé U, Strank C. Herpesvirus infections of the central nervous system in immunocompromised patients. Ther Adv Neurol Disord 2012; 5:279-96. [PMID: 22973424 DOI: 10.1177/1756285612456234] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Human herpesviruses may cause infections of the central nervous system during primary infection or following reactivation from a latent state. Especially in immunosuppressed patients the infection can take a life-threatening course, and therefore early diagnosis of herpesvirus-associated neurological diseases should have high priority. Clinical presentation in these patients is usually without typical features, making diagnosis even more challenging. Therefore general broad testing for different herpesviruses in cerebrospinal fluid samples is highly recommended. In addition, determination of the virus DNA level in the cerebrospinal fluid by quantitative assays seems to be of high importance to determine prognosis. Moreover, it might help to differentiate between specific virus-associated disease and unspecific presence of virus in the cerebrospinal fluid, especially in immunocompromised patients. Polymerase chain reaction analysis of cerebrospinal fluid has revolutionized the diagnosis of nervous system viral infections, particularly those caused by human herpesviruses. This review summarizes the role human herpesviruses play in central nervous system infections in immunocompromised patients, with a focus on the clinical manifestation of encephalitis.
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Affiliation(s)
- Uta Meyding-Lamadé
- Head, Department of Neurology Krankenhaus Nordwest, Frankfurt/M. Germany
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33
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Abstract
Acute encephalitis can be due to many causes, although most are viral, and is a medical emergency. A significant percentage remains without a definitive diagnosis due to the large number of etiologic agents. The single most frequent cause of sporadic encephalitis around the world is herpes simplex virus type 1, although in certain locations diverse local agents should be considered such as West Nile virus or tick-borne encephalitis, among others. Patients with encephalitis require intense care measures with special emphasis on respiratory problems secondary to a depressed level of consciousness, seizures, and intracranial hypertension due to cerebral edema. Herpes encephalitis has an incidence of 4 cases per million inhabitants. Clinical presentation, together with electroencephalography, magnetic resonance imaging and cerebrospinal fluid (CSF) findings are critical to establish a diagnosis. Polymerase chain reaction (PCR) in CSF is highly sensitive and specific (> 95%), but the results can be negative during the first 3 days of the disease. The treatment of choice is currently acyclovir 10 mg/kg/8 h for 10-21 days. Whenever resistance is suspected, foscarnet is an alternative. The family of arboviruses represents another important etiologic group of encephalities. These are zoonotic diseases transmitted by mosquitoes or ticks and include alphaviruses, bunyaviruses (Toscana virus and others) and flaviviruses. The West Nile virus belongs to the latter group. There is no specific therapy and diagnosis is based on serology and PCR depending on the suspected virus.
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Affiliation(s)
- J C García-Moncó
- Servicio de Neurología, Hospital de Galdakao-Usansolo, País Vasco, España.
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34
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Pollak L, Dovrat S, Book M, Mendelson E, Weinberger M. Varicella zoster vs. herpes simplex meningoencephalitis in the PCR era. A single center study. J Neurol Sci 2011; 314:29-36. [PMID: 22138027 DOI: 10.1016/j.jns.2011.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 10/29/2011] [Accepted: 11/02/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND The introduction of polymerase chain reaction (PCR) for the diagnosis of herpesvirus central nervous system infections is reshaping our understanding of these illnesses. Varicella-zoster virus (VZV) is increasingly recognized as an important etiology of sporadic viral meningoencephalitis (ME). Furthermore, mild cases of herpes simplex virus (HSV) ME, traditionally considered a devastating infection, are frequently reported. METHODS We compared the demographic and clinical features of patients with VZV (20) and HSV (17) ME diagnosed by Real-Time PCR of cerebrospinal samples in a single center during the years 2002-2010. RESULTS VZV and HSV patients were comparable with respect to age, sex, underlying diseases, immune suppression, and the rates of fever, headache and altered mental status on presentation. Seizures, focal neurological signs, systemic complications and in-hospital death were noted only in the HSV group. CONCLUSIONS Our study confirms the prevalence of VZV as a cause of sporadic ME over the last decade. While patients with HSV ME had more manifestations of severe disease, there also was a significant overlap with clinical and laboratory parameters of VZV ME. In the absence of dermatomal rash, differentiation between VZV and HSV ME on clinical grounds alone may represent a true challenge.
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Affiliation(s)
- Lea Pollak
- Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel.
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Rapid virological diagnosis of central nervous system infections by use of a multiplex reverse transcription-PCR DNA microarray. J Clin Microbiol 2011; 49:3874-9. [PMID: 21918017 DOI: 10.1128/jcm.01214-11] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Viruses are the main etiological cause of central nervous system (CNS) infections. A rapid molecular diagnosis is recommended to improve the therapeutic management of patients. The aim of this study was to evaluate the performances of a DNA microarray, the Clart Entherpex kit (Genomica, Coslada, Spain), allowing the rapid and simultaneous detection of 9 DNA and RNA neurotropic viruses: herpes simplex virus 1 (HSV-1), HSV-2, varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), HHV-7, HHV-8, and the human enteroviruses (HEVs). This evaluation was performed with 28 samples from the European proficiency panels (Quality Control for Molecular Diagnostics [QCMD]; Glasgow, Scotland) and then with 78 cerebrospinal fluid (CSF) specimens. The majority of the QCMD results obtained by the DNA microarray were similar to those recorded by the overall QCMD participants. The main discrepant results were observed for low concentrations of HSV-2 and HEVs. From the clinical samples, the kit detected 27 of the 28 herpesvirus CNS infections and all of the 30 HEV-positive CSF samples. No false-positive result was observed among the 20 virus-negative CSF samples. The clinical sensitivity, specificity, and negative and positive predictive values of the assay were 98.3, 100, 95.2, and 100%, respectively, when the results were compared to those of commercially available PCR assays. Interestingly, HHV-7 was detected in 11 (37%) of the 30 HEV-positive CSF samples from children suffering from aseptic meningitis causing significantly longer lengths of stay at the hospital than infection with HEVs alone (2.4 versus 1.4 days; P = 0.038). In conclusion, this preliminary study showed that this DNA microarray could be a valuable molecular diagnostic tool for single and mixed DNA and RNA virus infections of the CNS.
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Sundén B, Larsson M, Falkeborn T, Paues J, Forsum U, Lindh M, Ydrenius L, Akerlind B, Serrander L. Real-time PCR detection of human herpesvirus 1-5 in patients lacking clinical signs of a viral CNS infection. BMC Infect Dis 2011; 11:220. [PMID: 21849074 PMCID: PMC3176207 DOI: 10.1186/1471-2334-11-220] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 08/17/2011] [Indexed: 11/13/2022] Open
Abstract
Background Infections of the central nervous system (CNS) with herpes- or enterovirus can be self-limiting and benign, but occasionally result in severe and fatal disease. The polymerase chain reaction (PCR) has revolutionized the diagnostics of viral pathogens, and by multiple displacement amplification (MDA) prior to real-time PCR the sensitivity might be further enhanced. The aim of this study was to investigate if herpes- or enterovirus can be detected in cerebrospinal fluid (CSF) from patients without symptoms. Methods Cerebrospinal fluid (CSF) samples from 373 patients lacking typical symptoms of viral CNS infection were analysed by real-time PCR targeting herpesviruses or enteroviruses with or without prior MDA. Results In total, virus was detected in 17 patients (4%). Epstein-Barr virus (EBV) was most commonly detected, in general from patients with other conditions (e.g. infections, cerebral hemorrhage). MDA satisfactorily amplified viral DNA in the absence of human nucleic acids, but showed poor amplification capacity for viral DNA in CSF samples, and did not increase the sensitivity for herpes virus-detection with our methodology. Conclusions Viral pathogens are rarely detected in CSF from patients without signs of CNS infection, supporting the view that real-time PCR is a highly specific method to detect symptomatic CNS-infection caused by these viruses. However, EBV may be subclinically reactivated due to other pathological conditions in the CNS.
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Affiliation(s)
- Birgitta Sundén
- Div Clinical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Sweden
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Adler AC, Kadimi S, Apaloo C, Marcu C. Herpes simplex encephalitis with two false-negative cerebrospinal fluid PCR tests and review of negative PCR results in the clinical setting. Case Rep Neurol 2011; 3:172-8. [PMID: 21941494 PMCID: PMC3177787 DOI: 10.1159/000330298] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Herpes simplex virus encephalitis (HSE) is an acute infection accompanied by significant morbidity and mortality with the diagnosis often made by cerebrospinal fluid (CSF) polymerase chain reaction (PCR) testing. CASE PRESENTATION We report a case of a healthy 35-year-old woman presenting with altered mental status. Due to suspicion of herpes encephalitis, a CSF PCR for herpes virus was sent for examination and acyclovir was started. The patient had an immediate response to acyclovir; however, when the PCR returned negative she was discharged without therapy. The altered mental status returned and she was started on acyclovir therapy and a second CSF PCR sample was sent and was again negative. MRI performed at initial hospitalization was negative, but a repeat MRI demonstrated bilateral temporal lobe involvement suggestive of herpes encephalitis. The patient was successfully treated for 21 days with acyclovir. CONCLUSION CSF PCR for herpes virus is highly sensitive and specific and remains the standard for diagnosing herpes encephalitis. Clinicians should be aware of the pitfalls of CSF PCR testing, specifically false-negative results. Although rare, these false negatives can result in premature termination of treatment.
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Affiliation(s)
- Adam C Adler
- Department of Internal Medicine, St. Vincent's Medical Center, Bridgeport, Conn., USA
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Kittan N, Beier F, Kurz K, Niller H, Egger L, Jilg W, Andreesen R, Holler E, Hildebrandt G. Isolated cerebral manifestation of Epstein-Barr virus-associated post-transplant lymphoproliferative disorder after allogeneic hematopoietic stem cell transplantation: a case of clinical and diagnostic challenges. Transpl Infect Dis 2011; 13:524-30. [DOI: 10.1111/j.1399-3062.2011.00621.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Singhal RL, Corman LC. Subacute herpes simplex virus type 1 encephalitis as an initial presentation of chronic lymphocytic leukemia and multiple sclerosis: a case report. J Med Case Rep 2011; 5:59. [PMID: 21314934 PMCID: PMC3062610 DOI: 10.1186/1752-1947-5-59] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 02/11/2011] [Indexed: 12/01/2022] Open
Abstract
Introduction Herpes simplex virus type 1 encephalitis presents acutely in patients who are immunocompetent. We report what we believe to be the first published case of a subacute course of herpes simplex virus type 1 encephalitis in a patient with asymptomatic chronic lymphocytic leukemia who subsequently developed multiple sclerosis. Case presentation A 49-year-old Caucasian woman with a history of fever blisters presented to the emergency department with a history of left temporal headache for four weeks, and numbness of the left face and leg for two weeks. A complete blood count revealed white blood cell count of 11,820 cells/mL, with an absolute lymphocyte count of 7304 cells/mL. The cerebrospinal fluid contained 6 white blood cells/μL, 63 red blood cells/μL, 54 mg glucose/dL, and 49 mg total protein/dL. Magnetic resonance imaging of the brain revealed meningoencephalitis and bilateral ventriculitis. Cerebrospinal fluid polymerase chain reaction for herpes simplex virus type 1 was positive, and the patient's symptoms resolved after ten days of treatment with parenteral aciclovir. Incidental findings on peripheral blood smear and flow cytometry testing confirmed chronic lymphocytic leukemia. One month later, she developed bilateral numbness of the hands and feet; a repeat cerebrospinal fluid polymerase chain reaction for herpes simplex virus type 1 at this time was negative. A repeat magnetic resonance imaging scan showed an expansion of the peri-ventricular lesions, and the cerebrospinal fluid contained elevated oligoclonal bands and myelin basic protein. A brain biopsy revealed gliosis consistent with multiple sclerosis, and the patient responded to treatment with high-dose parenteral steroids. Conclusion Herpes simplex virus type 1 encephalitis is a rare presentation of chronic lymphocytic leukemia. Our patient had an atypical, subacute course, presumably due to immunosuppression from chronic lymphocytic leukemia. This unusual case of herpes simplex virus type 1 encephalitis emphasizes the importance of T cell function in diseases of immune dysregulation and autoimmunity such as chronic lymphocytic leukemia and multiple sclerosis. It raises the question of whether atypical presentations of herpes simplex virus encephalitis warrant deliberations on immunocompetence. The development of multiple sclerosis in our patient so soon after she received treatment for herpes simplex virus type 1 encephalitis raises the possibility that herpes simplex virus type 1 encephalitis in an immunosuppressed patient may trigger multiple sclerosis.
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Affiliation(s)
- Rashi L Singhal
- The University of Alabama at Birmingham, Huntsville, Alabama, USA.
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40
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Carvalho KSS, Silvestre EDA, Maciel SDS, Lira HIG, Galvão RADS, Soares MJDS, Costa CHN, Malaquias LCC, Coelho LFL. PCR detection of multiple human herpesvirus DNA in saliva from HIV-infected individuals in Teresina, State of Piauí, Brazil. Rev Soc Bras Med Trop 2010; 43:620-3. [DOI: 10.1590/s0037-86822010000600003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Accepted: 09/16/2010] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: Human herpesviruses are frequently associated with orofacial diseases in humans (HSV-1, EBV, CMV and HHV-8), some can also cause systemic disease (CMV and HHV-8). The transmission of these viruses occurs by contact with infected secretions, especially saliva. Human immunodeficiency virus infection is associated with an increased risk of HHVs and related diseases. METHODS: This work aimed to detect HSV-1, EBV, CMV and HHV-8 DNA in saliva of HIV-infected patients from Teresina, northeast Brazil, by PCR and compare these findings with age and sex matched HIV-seronegative individuals. RESULTS: No difference in prevalence was verified between HHV detection in the saliva of HIV-seropositive individuals and controls. The individual frequencies of these viruses in these two populations were different. HIV seropositivity correlated positively with the presence of CMV (OR: 18.2, p= 0.00032) and EBV (OR: 3.44, p= 0.0081). No association between CD4 counts and the prevalence of HHVs in the saliva was observed; however, a strong association was determined between seropositivity and the presence of multiple HHV DNAs in saliva (OR: 4.83, p = 0.0028). CONCLUSIONS: These findings suggest the asymptomatic salivary shedding of HHVs is a common event between HIV-seropositive and seronegative individuals from Teresina, Piauí, Brazil, and, especially for HIV-seropositive patients, saliva is a risk factor for the acquisition/transmission of multiple HHVs.
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Khalil M, Enzinger C, Wallner-Blazek M, Scarpatetti M, Barth A, Horn S, Reiter G. Epstein-Barr virus encephalitis presenting with a tumor-like lesion in an immunosuppressed transplant recipient. J Neurovirol 2010; 14:574-8. [PMID: 18991070 DOI: 10.1080/13550280802345715] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Epstein-Barr virus (EBV) associated central nervous system (CNS) infection is a rare disease. We report an atypical manifestation of EBV encephalitis initially presenting with a tumor-like lesion of the optic tract in an immunocompromised patient 8 years after a combined kidney and pancreas transplantation had been performed. Polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF) and antibody testing confirmed the diagnosis of EBV encephalitis, most likely as a consequence of a reactivated persistent EBV infection. After cessation of the immunosuppressive therapy and induction of treatment with ganciclovir, clinical and magnetic resonance imaging (MRI) findings rapidly improved.
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Affiliation(s)
- Michael Khalil
- Department of Neurology, Medical University Graz, Graz, Austria. Medical University Graz, Graz, Austria
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Patients with an acute zonal occult outer retinopathy-like illness rapidly improve with valacyclovir treatment. Am J Ophthalmol 2010; 150:511-8. [PMID: 20691421 DOI: 10.1016/j.ajo.2010.05.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 05/18/2010] [Accepted: 05/19/2010] [Indexed: 11/22/2022]
Abstract
PURPOSE To describe 3 cases of an acute zonal occult outer retinopathy-like illness responsive to valacyclovir hydrochloride. DESIGN Retrospective, interventional case series. METHODS Three patients were treated with valacyclovir and monitored by clinical examination, Goldmann visual field testing, and electroretinography. RESULTS Patients with an acute zonal occult outer retinopathy-like illness presented following progressive vision loss. This course was immediately reversed by treatment with oral valacyclovir, and visual acuity and visual field improved significantly at 1 week and 1 month. Patients remained stable without treatment during a follow-up period ranging from 1 to 3 years. CONCLUSIONS Some conditions with features of acute zonal occult outer retinopathy may be attributable to a subacute herpetic viral infection that is responsive to oral antiviral medication.
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[Postoperative herpetic meningoencephalitis after lumbar surgery: a case report]. ACTA ACUST UNITED AC 2010; 29:732-5. [PMID: 20797834 DOI: 10.1016/j.annfar.2010.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 07/05/2010] [Indexed: 11/20/2022]
Abstract
We report a case of a patient with an herpetic meningoencephalitis complicating lumbar surgery. A combination of factors like a postoperative sepsis, an abnormal MRI, and a positive viral PCR and culture made the diagnosis. A prolonged acyclovir treatment was employed with satisfactory results. This case remembers us the possibility of herpes reactivation in a stressful situation (including surgical stress).
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Nguyen ML, Blaho JA. Cellular players in the herpes simplex virus dependent apoptosis balancing act. Viruses 2009; 1:965-78. [PMID: 21994577 PMCID: PMC3185536 DOI: 10.3390/v1030965] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 11/16/2009] [Accepted: 11/17/2009] [Indexed: 01/01/2023] Open
Abstract
Apoptosis is triggered as an intrinsic defense against numerous viral infections. Almost every virus encodes apoptotic modulators, and the herpes simplex viruses (HSV) are no exception. During HSV infection, there is an intricate balance between pro- and anti-apoptotic factors that delays apoptotic death until the virus has replicated. Perturbations in the apoptotic balance can cause premature cell death and have the potential to dramatically alter the outcome of infection. Recently, certain cellular genes have been shown to regulate sensitivity to HSV-dependent apoptosis. This review summarizes current knowledge of the cellular genes that impact the apoptotic balance during HSV infection.
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Affiliation(s)
- Marie L. Nguyen
- Department of Microbiology and Immunology, Des Moines University, Des Moines, IA, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-515-271-1400; Fax: +1-515-271-1543
| | - John A. Blaho
- Department of Microbiology, Mount Sinai School of Medicine, New York, NY, USA; E-Mail:
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Murphy RF, Caliendo AM. Relative quantity of cerebrospinal fluid herpes simplex virus DNA in adult cases of encephalitis and meningitis. Am J Clin Pathol 2009; 132:687-90. [PMID: 19846808 DOI: 10.1309/ajcp0kn1pcheysik] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Herpes simplex virus (HSV) remains an important cause of meningitis and encephalitis in adults, and polymerase chain reaction (PCR)-based tests are the "gold standard" for diagnosis. The objective of this study was to assess differences in semiquantitative PCR values, based on the crossing threshold (Ct) value for cases of HSV meningitis and encephalitis. A retrospective chart review was performed for 29 patients with a documented diagnosis of HSV meningitis or encephalitis during the course of 5 years from a large urban academic hospital. Demographic information, cerebrospinal fluid (CSF) laboratory findings, and PCR data were obtained for each patient. There was no statistically significant difference in the Ct values in patients with meningitis or encephalitis. In addition, no differences were found in CSF chemistry and hematology parameters. There is a broad range in relative concentrations of HSV DNA in the CSF in cases of meningitis and encephalitis.
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Lara M, Cunha E, Villalobos E, Nassar A, Asano K, Fernandes W, Richtzenhain L, Brandão P, Mori E. FIRST ISOLATION OF EQUINE HERPESVIRUS TYPE 1 FROM A HORSE WITH NEUROLOGICAL DISEASE IN BRAZIL. ARQUIVOS DO INSTITUTO BIOLÓGICO 2008. [DOI: 10.1590/1808-1657v75p2212008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT This report describes the first Brazilian equine herpesvirus type 1 (EHV-1) isolation from a single fatal equine herpes myeloencephalopathy case in a mare. The isolation of EHV-1 was confirmed from the first passage of cerebrospinal fluid (CSF) sample in Vero cells by PCR and virus neutralization assay. As virus isolation from CSF is unlikely to be successful, as has been shown in several case reports, this circumstantial evidence suggests that the neurological disease was caused by particularly neurovirulent strain of EHV-1.
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Affiliation(s)
| | | | | | | | | | | | | | | | - E. Mori
- Universidade de São Paulo, Brasil
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Plentz A, Jilg W, Kochanowski B, Ibach B, Knöll A. Detection of herpesvirus DNA in cerebrospinal fluid and correlation with clinical symptoms. Infection 2008; 36:158-62. [PMID: 18379728 DOI: 10.1007/s15010-007-6354-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Accepted: 09/19/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Novel PCR techniques can detect minute quantities of herpesvirus DNA in cerebrospinal fluid (CSF). The clinical significance of such findings is not always clear. PATIENTS AND METHODS (a) Investigation of clinical characteristics of 76 patients with herpesvirus DNA detection in CSF. (b) Screening for herpesvirus DNA in CSF samples of 208 patients without clinical signs of herpesvirus infection. RESULTS (a) Eleven of 76 herpesvirus-DNA-positive patients did not show symptoms usually associated with the detected virus (HSV-1/2, n = 5; EBV, n = 6). (b) Two of 208 patients without hint for herpesvirus infection had HHV-6 DNA of low concentration in CSF. CONCLUSIONS The detection of low-level herpesvirus replication in CSF by highly sensitive PCR assays requires critical evaluation.
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Affiliation(s)
- A Plentz
- Institute of Medical Microbiology and Hygiene, University of Regensburg, F-J-Strauss-Allee 11, 93053, Regensburg, Germany.
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Karatas H, Gurer G, Pinar A, Soylemezoglu F, Tezel GG, Hascelik G, Akalan N, Tuncer S, Ciger A, Saygi S. Investigation of HSV-1, HSV-2, CMV, HHV-6 and HHV-8 DNA by real-time PCR in surgical resection materials of epilepsy patients with mesial temporal lobe sclerosis. J Neurol Sci 2008; 264:151-6. [PMID: 17804017 DOI: 10.1016/j.jns.2007.08.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2006] [Revised: 08/08/2007] [Accepted: 08/13/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study is to investigate the presence of viral DNAs of HSV-1, HSV-2, HHV-6, HHV-8, and CMV in hippocampus of the patients with mesial temporal lobe epilepsy (MTLE) syndrome. METHODS Pathological specimens were obtained from 33 patients with MTLE undergone temporal lobectomy with amygdalo-hippocampectomy due to intractable seizures. Autopsy materials from the hippocampus of 7 patients without neurological disease were used as controls. The data was also correlated with the clinical history of patients including febrile convulsions, age, and history of CNS infections. Real-time polymerase chain reaction method was performed for detection of DNAs of these viruses. RESULTS HHV-6, HSV-1 and HHV-8 were detected in the hippocampus of 3, 2 and 1 patients with MTLE respectively. None of the hippocampus of patients with MTLE was positive for DNA of HSV-2 and/or CMV. Three patients with positive HHV-6 DNAs had febrile convulsions and family history for epilepsy. None of our control specimens showed PCR positivity to any of the 5 tested viruses. CONCLUSIONS Our study is the first to report the presence of HHV-8 viral genome in the brain tissue of patient with MTLE. Viral DNAs were detected in a total of 18% of the patients in this study; we can conclude that activity of the latent virus in patients with hippocampal sclerosis should be more extensively studied to establish its role in active infection.
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MESH Headings
- Adolescent
- Adult
- Autopsy
- Cytomegalovirus/genetics
- DNA, Viral/analysis
- Encephalitis, Herpes Simplex/complications
- Encephalitis, Herpes Simplex/diagnosis
- Encephalitis, Herpes Simplex/genetics
- Epilepsy, Temporal Lobe/pathology
- Epilepsy, Temporal Lobe/physiopathology
- Epilepsy, Temporal Lobe/virology
- Female
- Herpes Simplex/complications
- Herpesviridae Infections/complications
- Herpesviridae Infections/diagnosis
- Herpesviridae Infections/genetics
- Herpesvirus 1, Human/genetics
- Herpesvirus 2, Human/genetics
- Herpesvirus 6, Human/genetics
- Herpesvirus 8, Human/genetics
- Hippocampus/pathology
- Hippocampus/physiopathology
- Hippocampus/virology
- Humans
- Male
- Reverse Transcriptase Polymerase Chain Reaction
- Virus Latency/genetics
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Affiliation(s)
- Hulya Karatas
- Hacettepe University, Faculty of Medicine, Department of Neurology, Sihhiye, Ankara, 06100, Turkey.
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Tan E, Erwin B, Dames S, Voelkerding K, Niemz A. Isothermal DNA Amplification with Gold Nanosphere-Based Visual Colorimetric Readout for Herpes Simplex Virus Detection. Clin Chem 2007; 53:2017-20. [DOI: 10.1373/clinchem.2007.091116] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Eric Tan
- ( Keck Graduate Institute of Applied Life Sciences, Claremont, CA
| | - Barbara Erwin
- ( Keck Graduate Institute of Applied Life Sciences, Claremont, CA
| | - Shale Dames
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | - Karl Voelkerding
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
- Department of Pathology, University of Utah, Salt Lake City, UT 84108
| | - Angelika Niemz
- ( Keck Graduate Institute of Applied Life Sciences, Claremont, CA
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Bergallo M, Costa C, Margio S, Sidoti F, Terlizzi M, Cavallo R. Development of a multiplex polymerase chain reaction for detection and typing of major human herpesviruses in cerebrospinal fluid. Can J Microbiol 2007; 53:1117-22. [DOI: 10.1139/w07-074] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Infections of the central nervous system (CNS) represent a difficult diagnostic problem for both clinicians and microbiologists. In particular, the Herpesviridae family plays a central etiological role in CNS viral infections. These diseases have acquired growing importance in the past few years owing to the increasing number of immunocompromised patients and the availability of new antiviral drugs. Prompt detection and diagnosis of CNS viral infections are critical because most infections are treatable, while a delayed recognition may lead to life-threatening conditions or severe sequelae. The traditional methods for detection of herpesviruses in CNS infections exhibit several drawbacks, whereas the polymerase chain reaction (PCR) on cerebrospinal fluid has revolutionized the neurovirology and is becoming an essential part of the diagnostic work-up of patients with suspected CNS viral infections. A sensitive multiplex PCR method was developed for the simultaneous detection of 6 human herpesviruses (human cytomegalovirus, herpes simplex virus 1, herpes simplex virus 2, Epstein–Barr virus, varicella-zoster virus, and human herpesvirus 6) with the aim of simplifying detection and reducing time and costs. The accuracy, reproducibility, specificity, and sensitivity of these assays were established.
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Affiliation(s)
- Massimiliano Bergallo
- University of Turin, Department of Public Health and Microbiology, Virology Unit, Via Santena 9 - 10126 Turin, Italy
| | - Cristina Costa
- University of Turin, Department of Public Health and Microbiology, Virology Unit, Via Santena 9 - 10126 Turin, Italy
| | - Samuela Margio
- University of Turin, Department of Public Health and Microbiology, Virology Unit, Via Santena 9 - 10126 Turin, Italy
| | - Francesca Sidoti
- University of Turin, Department of Public Health and Microbiology, Virology Unit, Via Santena 9 - 10126 Turin, Italy
| | - Maria Elena Terlizzi
- University of Turin, Department of Public Health and Microbiology, Virology Unit, Via Santena 9 - 10126 Turin, Italy
| | - Rossana Cavallo
- University of Turin, Department of Public Health and Microbiology, Virology Unit, Via Santena 9 - 10126 Turin, Italy
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