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Silwal S, Hassan E, Jain S, Rauf I, Obulareddy SJ, Suleman S, Yousuf FA, O Gomez Urena E, Corsini Campioli C, Jain NK. A Case of Herpes Simplex Virus Meningitis in an Immunocompromised Individual: Avoiding Common Diagnostic Pitfalls. Cureus 2023; 15:e42242. [PMID: 37605663 PMCID: PMC10440017 DOI: 10.7759/cureus.42242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/23/2023] Open
Abstract
Herpes simplex virus meningoencephalitis (HSV ME) is a severe viral infection that affects the brain and surrounding tissues. It is caused primarily by HSV type 1 (HSV-1) virus. This condition requires prompt recognition and treatment due to its potential for significant morbidity and mortality. We aim to highlight the importance of avoiding common diagnostic pitfalls in identifying HSV meningoencephalitis, especially in immunocompromised individuals. We present a case of a 34-year-old immunocompromised patient with HSV meningoencephalitis, emphasizing key clinical features and diagnostic strategies that helped us reach an accurate diagnosis. By sharing this case, we aim to enhance awareness and improve the management of HSV meningoencephalitis in similar patient populations, leading to better outcomes.
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Affiliation(s)
- Swechchha Silwal
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, USA
| | - Esraa Hassan
- Department of Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
| | - Shikha Jain
- Department of Medicine, MV Jayaraman (MVJ) Medical College and Research Hospital, Bengaluru, IND
| | - Ibtisam Rauf
- Department of Medicine, St. George's School of Medicine, University Centre Grenada, West Indies, GRD
| | - Sri J Obulareddy
- Department of Oncology/Hematology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Sara Suleman
- Department of Palliative Care Medicine, Mayo Clinic Health System, Mankato, USA
| | | | - Eric O Gomez Urena
- Department of Infectious Disease, Mayo Clinic Health System, Mankato, USA
| | | | - Nitesh K Jain
- Department of Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
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Wan N, Weerakkody S. Herpes simplex virus encephalitis: An atypical presentation of delirium. Clin Case Rep 2023; 11:e7123. [PMID: 36992671 PMCID: PMC10040492 DOI: 10.1002/ccr3.7123] [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: 01/06/2023] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 03/28/2023] Open
Abstract
Herpes simplex encephalitis (HSE) is the most common cause of infectious encephalitis. Our case is of a 75‐year‐old woman who presented with dysuria and altered mental status. Our case addresses the difficulties in diagnosis and highlights the importance of early recognition of HSE and its associated neurological sequelae.
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Affiliation(s)
- Nicholas Wan
- Department of General Medicine, Flinders Medical CentreBedford ParkSouth AustraliaAustralia
- Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Sanath Weerakkody
- Department of General Medicine, Flinders Medical CentreBedford ParkSouth AustraliaAustralia
- College of Medicine and Public Health, Flinders UniversityBedford ParkSouth AustraliaAustralia
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3
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Le Bars H, Madany N, Lamoureux C, Beauruelle C, Vallet S, Payan C, Pilorgé L. Evaluation of the Performance Characteristics of a New POC Multiplex PCR Assay for the Diagnosis of Viral and Bacterial Neuromeningeal Infections. Diagnostics (Basel) 2023; 13:diagnostics13061110. [PMID: 36980418 PMCID: PMC10047878 DOI: 10.3390/diagnostics13061110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
Point-of-care syndromic PCR (POC SPCR) assays are useful tools for the rapid detection of the most common causative agents of community-acquired infections responsible for meningitis and encephalitis infections. We evaluated the performance characteristics of the new QIAstat-Dx® Meningitis/Encephalitis panel (QS) compared to the laboratory reference methods and the POC SPCR Biofire® FilmArray® Meningitis Encephalitis Panel (FA). Viral (Enterovirus, Parechovirus, HSV-1, HSV-2, HHV-6, VZV) and bacterial (E. coli K1, H. influenzae, L. monocytogenes, encapsulated N. meningitidis, M. pneumoniae, S. agalactiae, S. pneumoniae, S. pyogenes) pathogens were suspended at low concentrations and tested with the POC SPCR systems. The reproducibility, analytical specificity, carryover contamination, interferences and clinical samples were evaluated. All samples tested positive with both QS and FA except for those containing the lowest concentrations of Enterovirus-D68-B3, Echovirus-30 and S. agalactiae which were only detected by FA. In terms of analytical specificity, we observed 3 false positive results out of 48 QS tests versus 1 out of 37 FA tests. For the other studied criteria, both QS and FA performed as expected. Our results suggest that the performance characteristics of QS are close to those of FA. A prospective multicenter study would be useful to complete the performances evaluation of QS.
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Affiliation(s)
- Hervé Le Bars
- Unity of Bacteriology, Department of Bacteriology-Virology-Parasitology-Mycology-Hygiene, Pole of Biology-Pathology, University Hospital of Brest, F-29200 Brest, France
| | - Neil Madany
- Unity of Virology, Department of Bacteriology-Virology-Parasitology-Mycology-Hygiene, Pole of Biology-Pathology, University Hospital of Brest, F-29200 Brest, France
| | - Claudie Lamoureux
- Unity of Bacteriology, Department of Bacteriology-Virology-Parasitology-Mycology-Hygiene, Pole of Biology-Pathology, University Hospital of Brest, F-29200 Brest, France
- Univ Brest, Inserm, EFS, UMR 1078, GGB CEDEX, F-29200 Brest, France
| | - Clémence Beauruelle
- Unity of Bacteriology, Department of Bacteriology-Virology-Parasitology-Mycology-Hygiene, Pole of Biology-Pathology, University Hospital of Brest, F-29200 Brest, France
- Univ Brest, Inserm, EFS, UMR 1078, GGB CEDEX, F-29200 Brest, France
| | - Sophie Vallet
- Unity of Virology, Department of Bacteriology-Virology-Parasitology-Mycology-Hygiene, Pole of Biology-Pathology, University Hospital of Brest, F-29200 Brest, France
- Univ Brest, Inserm, EFS, UMR 1078, GGB CEDEX, F-29200 Brest, France
| | - Christopher Payan
- Unity of Virology, Department of Bacteriology-Virology-Parasitology-Mycology-Hygiene, Pole of Biology-Pathology, University Hospital of Brest, F-29200 Brest, France
- Univ Brest, Inserm, EFS, UMR 1078, GGB CEDEX, F-29200 Brest, France
| | - Léa Pilorgé
- Unity of Virology, Department of Bacteriology-Virology-Parasitology-Mycology-Hygiene, Pole of Biology-Pathology, University Hospital of Brest, F-29200 Brest, France
- Correspondence: ; Tel.: +33-298-347-191; Fax: +33-298-347-193
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Pizzi MA, Busl KM. Catch Me If You Can-How Herpes Simplex Virus Tries to Evade Diagnosis in Viral Encephalitis. Crit Care Med 2022; 50:1170-1173. [PMID: 35726985 DOI: 10.1097/ccm.0000000000005501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Michael A Pizzi
- Both authors: Departments of Neurology and Neurosurgery, Division of Neurocritical Care, University of Florida College of Medicine, Gainesville, FL
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5
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Vaugon E, Mircescu A, Caya C, Yao M, Gore G, Dendukuri N, Papenburg J. Diagnostic accuracy of rapid one-step PCR assays for detection of herpes Simplex virus -1 and -2 in cerebrospinal fluid: A systematic Review and meta-analysis. Clin Microbiol Infect 2022; 28:1547-1557. [PMID: 35718347 DOI: 10.1016/j.cmi.2022.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/26/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Rapid and accurate diagnosis of HSV-1 and -2 (HSV1/2) in cerebrospinal fluid (CSF) is important for patient management. OBJECTIVES Summarize the diagnostic accuracy of commercial rapid sample-to-answer PCR assays (results in <90 minutes, without a separate nucleic acid extraction step) for HSV1/2 detection in CSF. DATA SOURCES Four databases (MEDLINE, EMBASE, Scopus and CENTRAL) and five conference abstract datasets from January 2012 to March 2022. STUDY ELIGIBILITY CRITERIA Diagnostic accuracy studies of FilmArray Meningitis-Encephalitis Panel™ and Simplexa™ HSV 1&2 Direct Kit compared to a PCR reference standard were included. Eligible studies provided sufficient data for the construction of a standard diagnostic accuracy two-by-two table. PARTICIPANTS Patients with suspected meningitis and/or encephalitis. ASSESSMENT OF RISK OF BIAS Two investigators independently extracted data, rated risk of bias and assessed quality using QUADAS-2. METHODS Accuracy estimates were pooled using Bayesian random effects models. RESULTS Thirty-one studies were included (27 FilmArray; 4 Simplexa), comprising 9,924 samples, with 95 HSV-1 and 247 HSV-2 infections. Pooled FilmArray sensitivities were 84.3% (95% credible interval 72.3%-93.0%) and 92.9% (95%CrI, 82.0%-98.5%) for HSV-1 and HSV-2, respectively; specificities were 99.8% (95%CrI, 99.6%-99.9%) and 99.9% (95%CrI, 99.9%-100%). Pooled Simplexa sensitivities were 97.1% (95%CrI, 88.1%-99.6%) and 97.9% (95%CrI, 89.6%-99.9%), respectively; specificities were 98.9% (95%CrI, 96.8%-99.7%) and 98.9% (95%CrI, 97.1%-99.7%). Pooled FilmArray sensitivities favored industry-sponsored studies by 10.0 and 13.0 percentage points for HSV-1 and HSV-2, respectively. Incomplete reporting frequently led to unclear risk of bias. Several FilmArray studies did not fully report true negative data leading to their exclusion. CONCLUSION Our results suggest Simplexa is accurate for HSV1/2 detection in CSF. Moderate FilmArray sensitivity for HSV-1 suggests additional testing and/or repeat CSF sampling is required for suspected HSV encephalitis when the HSV-1 result is negative. Low prevalence of HSV-1 infections limited summary estimates' precision. Underreporting of covariates limited exploration of heterogeneity.
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Affiliation(s)
- Esther Vaugon
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Chelsea Caya
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mandy Yao
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University Montreal, Quebec, Canada
| | - Nandini Dendukuri
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Jesse Papenburg
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
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Johnston C. Diagnosis and Management of Genital Herpes: Key Questions and Review of the Evidence for the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines. Clin Infect Dis 2022; 74:S134-S143. [PMID: 35416970 DOI: 10.1093/cid/ciab1056] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Genital herpes, caused by herpes simplex virus (HSV) type 1 or type 2, is a prevalent sexually transmitted infection (STI). Given that HSV is an incurable infection, there are important concerns about appropriate use of diagnostic tools, management of infection, prevention of transmission to sexual partners, and appropriate counseling. In preparation for updating the Centers for Disease Control and Prevention (CDC) STI treatment guidelines, key questions for management of genital herpes infection were developed with a panel of experts. To answer these questions, a systematic literature review was performed, with tables of evidence including articles that would change guidance assembled. These data were used to inform recommendations in the 2021 CDC STI treatment guidelines.
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Affiliation(s)
- Christine Johnston
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,University of Washington, Seattle, Washington, USA.,Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Trujillo-Gómez J, Tsokani S, Arango-Ferreira C, Atehortúa-Muñoz S, Jimenez-Villegas MJ, Serrano-Tabares C, Veroniki AA, Florez ID. Biofire FilmArray Meningitis/Encephalitis panel for the aetiological diagnosis of central nervous system infections: A systematic review and diagnostic test accuracy meta-analysis. EClinicalMedicine 2022; 44:101275. [PMID: 35198914 PMCID: PMC8851290 DOI: 10.1016/j.eclinm.2022.101275] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/30/2021] [Accepted: 01/07/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The FilmArray Meningitis/Encephalitis(FA/ME) panel brings benefits in clinical practice, but its diagnostic test accuracy (DTA) remains unclear. We aimed to determine the DTA of FA/ME for the aetiological diagnostic in patients with suspected central nervous system(CNS) infection. METHODS We performed a systematic review with DTA meta-analysis (PROSPERO: CRD42020139285). We searched Embase, Medline (Ovid), and Web of Science from inception until September 1st, 2021. We assessed the study-level risk of bias with the QUADAS-2 tool and applied the GRADE approach to assess the certainty of the synthesised evidence. We included studies that simultaneously measured the reference test (CSF/blood culture for bacteria, and specific polymerase chain reaction for viruses) and the FA/ME in patients with suspected CNS infection. We performed random-effects bivariate meta-analysis models of combined sensitivity and specificity using CSF/blood cultures(reference test 1) and a final diagnosis adjudication based on clinical/laboratory criteria (reference test 2). FINDINGS We included 19 studies (11,351 participants). For all bacteria with reference test 1 (16 studies/6183 patients) sensitivity was estimated at 89·5% (95%CI 81·1-94·4), and specificity at 97·4% (95%CI 94-98·9). With reference test 2 (15 studies/5,524 patients), sensitivity was estimated at 92·1%(95%CI 86·8-95·3) and specificity at 99.2(95%CI 98·3-99·6) For herpes simplex virus-2(HSV-2), enteroviruses, and Varicella-Zoster virus (VZV), we obtained sensitivities between 75·5 and 93·8%, and specificities above 99% (reference test 1). Certainty of the evidence was low. INTERPRETATION FA/ME may have acceptable-to-high sensitivities and high specificities for identifying bacteria, especially for S.pneumoniae, and viruses, especially for HSV-2, and enteroviruses. Sensitivities for L.monocytogenes, H.influenzae, E.coli, and HSV-1 were suboptimal. FUNDING None.
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Affiliation(s)
- Juliana Trujillo-Gómez
- Department of Paediatrics, Universidad de Antioquia, Calle 67 No. 53-108, Medellín, Antioquia 050001, Colombia
- Hospital San Vicente Fundacion, Calle 64 # 51D - 154, Medellín 050010, Colombia
- Hospital General de Medellín, Carrera 48 # 32-102, Medellín 0500515, Colombia
| | - Sofia Tsokani
- Department of Primary Education, School of Education, University of Ioannina, PO Box: 1186, Ioannina 45110, Greece
| | - Catalina Arango-Ferreira
- Department of Paediatrics, Universidad de Antioquia, Calle 67 No. 53-108, Medellín, Antioquia 050001, Colombia
- Hospital San Vicente Fundacion, Calle 64 # 51D - 154, Medellín 050010, Colombia
| | | | - Maria José Jimenez-Villegas
- Department of Paediatrics, Universidad de Antioquia, Calle 67 No. 53-108, Medellín, Antioquia 050001, Colombia
- Hospital San Vicente Fundacion, Calle 64 # 51D - 154, Medellín 050010, Colombia
| | - Carolina Serrano-Tabares
- Department of Paediatrics, Universidad de Antioquia, Calle 67 No. 53-108, Medellín, Antioquia 050001, Colombia
- Clínica Universitaria Bolivariana, Carrera 72A # 78b -50, Medellín 050015, Colombia
| | - Areti-Angeliki Veroniki
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, 8 Shuter St, Toronto, ON M5B 1A6, Canada
| | - Ivan D. Florez
- Department of Paediatrics, Universidad de Antioquia, Calle 67 No. 53-108, Medellín, Antioquia 050001, Colombia
- School of Rehabilitation Science, McMaster University, 1400 Main St. W. Hamilton, Hamilton, ON L8S 1C7, Canada
- Paediatric Intensive Care Unit, Clínica Las Americas AUNA, Dg. 75B ##2A-80/140, Medellin, Colombia
- Corresponding author at: Department of Paediatrics, Universidad de Antioquia, Calle 67 No. 53-108, Medellín, Antioquia 050001, Colombia.
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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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Quan DN, Shiloach J. rAAV Production and Titration at the Microscale for High-Throughput Screening. Hum Gene Ther 2022; 33:94-102. [PMID: 34328798 PMCID: PMC8819507 DOI: 10.1089/hum.2021.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
In the literature, there are few high-throughput screens or even methods for high-throughput screens of recombinant adeno-associated virus (rAAV) production despite potential benefits to research and production. In this study, a generalizable high-throughput relative rAAV titration method is examined within the context of an siRNA screen as siRNA knockdown is a common means of pathway engineering in bioproduction. Crude samples generated from transfected HEK293T/17 cultures were subjected to quantitative PCR (qPCR) and used to transduce COS7 cells to assess relative differences in genomic and infectious rAAV titer, respectively, at the 384-well scale, evaluating both supernatant and lysed samples. To evaluate relevant differences in titer for conditions that could be used in an actual screen, cultures subjected to an siRNA reverse transfection and subsequent rAAV forward transfection were also tested. The delayed forward rAAV triple-plasmid transfection was not seen to affect the siRNA activity of tested controls, while siRNA transfection was shown to measurably impact rAAV titer. Effective differentiation between infectious titer levels was dependent upon the choice of sample dilution, but trends between qPCR and infectious titer assays were consistent across sample sets.
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Affiliation(s)
- David Nathan Quan
- NIDDK Biotechnology Core, NIDDK, National Institutes of Health, Bethesda, Maryland, USA
| | - Joseph Shiloach
- NIDDK Biotechnology Core, NIDDK, National Institutes of Health, Bethesda, Maryland, USA.,Correspondence: Dr. Joseph Shiloach, NIDDK Biotechnology Core, National Institutes of Health, 14 Service Road W, Bethesda, MD 20894, USA.
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Vila J, Bosch J, Muñoz-Almagro C. Molecular diagnosis of the central nervous system (CNS) infections. ACTA ACUST UNITED AC 2021; 39:403-410. [PMID: 34620475 DOI: 10.1016/j.eimce.2020.03.008] [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: 01/07/2020] [Accepted: 03/09/2020] [Indexed: 11/17/2022]
Abstract
Central nervous system (CNS) infections such as meningitis and encephalitis are medical emergencies that require rapid diagnosis of the causative pathogen to guide early and adequate treatment since a delay in implementing an adequate antimicrobial therapy can lead to death. The current microbiological diagnostic methods based on culture or antigen detection have important limitations in their capacity to accurately identify the different potential pathogens causing CNS and, in the time, to obtaining results. Rapid syndromic molecular arrays have been developed. The main advantage of using a meningoencephalitis panel based in a multiplex test is that includes bacteria, viruses and fungi, covering the most prevalent microorganisms causing meningitis and encephalitis and the turn-around time is circa 1h. The use of these multiplex-PCR based tools is reviewed and the advantages and disadvantages of this technique are discussed.
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Affiliation(s)
- Jordi Vila
- Department of Clinical Microbiology, Hospital Clinic, University of Barcelona, Barcelona, Spain; Institute of Global Health of Barcelona (ISGlobal), Barcelona, Spain; Spanish Network for Research in Infectious Diseases, REIPI, Instituto de Salud Carlos III, Madrid, Spain.
| | - Jordi Bosch
- Department of Clinical Microbiology, Hospital Clinic, University of Barcelona, Barcelona, Spain; Institute of Global Health of Barcelona (ISGlobal), Barcelona, Spain; Spanish Network for Research in Infectious Diseases, REIPI, Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Muñoz-Almagro
- Department of Molecular Microbiology, Hospital Sant Joan de Deu, Barcelona, Spain; School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain; Spanish Network of Epidemiology and Public Health, CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
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11
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Vila J, Bosch J, Muñoz-Almagro C. Molecular diagnosis of the central nervous system (CNS) infections. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30168-3. [PMID: 32345489 DOI: 10.1016/j.eimc.2020.03.001] [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: 01/07/2020] [Revised: 02/27/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
Central nervous system (CNS) infections such as meningitis and encephalitis are medical emergencies that require rapid diagnosis of the causative pathogen to guide early and adequate treatment since a delay in implementing an adequate antimicrobial therapy can lead to death. The current microbiological diagnostic methods based on culture or antigen detection have important limitations in their capacity to accurately identify the different potential pathogens causing CNS and, in the time, to obtaining results. Rapid syndromic molecular arrays have been developed. The main advantage of using a meningoencephalitis panel based in a multiplex test is that includes bacteria, viruses and fungi, covering the most prevalent microorganisms causing meningitis and encephalitis and the turn-around time is circa 1h. The use of these multiplex-PCR based tools is reviewed and the advantages and disadvantages of this technique are discussed.
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Affiliation(s)
- Jordi Vila
- Department of Clinical Microbiology, Hospital Clinic, University of Barcelona, Barcelona, Spain; Institute of Global Health of Barcelona (ISGlobal), Barcelona, Spain; Spanish Network for Research in Infectious Diseases, REIPI, Instituto de Salud Carlos III, Madrid, Spain.
| | - Jordi Bosch
- Department of Clinical Microbiology, Hospital Clinic, University of Barcelona, Barcelona, Spain; Institute of Global Health of Barcelona (ISGlobal), Barcelona, Spain; Spanish Network for Research in Infectious Diseases, REIPI, Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Muñoz-Almagro
- Department of Molecular Microbiology, Hospital Sant Joan de Deu, Barcelona, Spain; School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain; Spanish Network of Epidemiology and Public Health, CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
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12
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Vetter P, Schibler M, Herrmann JL, Boutolleau D. Diagnostic challenges of central nervous system infection: extensive multiplex panels versus stepwise guided approach. Clin Microbiol Infect 2019; 26:706-712. [PMID: 31899336 DOI: 10.1016/j.cmi.2019.12.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) testing is a key component for the diagnosis of central nervous system (CNS) infections. Current meningitis and encephalitis management guidelines agree on the need for CSF molecular testing in combination with other direct and indirect biological testing, both in CSF and blood. Multiplex molecular tests have been developed to reduce turnaround times and facilitate the diagnostic approach. OBJECTIVES We aim to discuss the role of multiplex molecular panels in the management of CNS infections. SOURCES The MEDLINE database and the grey literature have been searched for relevant articles. CONTENT New molecular multiplex panels are being developed to simultaneously detect a large array of neuropathogens in CSF. Although one of these assays has been US Food and Drug Administration-approved, extensive analytical and clinical validation is still missing, and suboptimal performance related issues have been raised. Its use has been associated with decreased costs, reduced length of hospital stay and reduced antiviral therapy administration in retrospective, industry-sponsored studies. The pros and cons of this multiplex syndromic approach are discussed in this narrative review. IMPLICATIONS Molecular multiplex CNS infection diagnosis panels have been developed and present several attractive features, including ease of use and low turnaround time. However, suboptimal analytical performances render these tests difficult to use without additional confirmatory tests. Such panels are not comprehensive nor adapted to all situations, depending on the epidemiological or clinical context. Overall, available data in the literature currently do not support the use of a multiplex PCR panel in clinical routine as a 'stand-alone' molecular assay. Except in restricted laboratory capacity settings where such easy-to-use multiplex panels offer the diagnostic means that would otherwise not be available, the stepwise testing approach remains a more rational option. Serological testing both in blood and CSF should not be neglected, but it represents essential complementary tools regarding some neuropathogens.
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Affiliation(s)
- P Vetter
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; Infectious Diseases Division, Geneva University Hospitals, Geneva, Switzerland.
| | - M Schibler
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; Infectious Diseases Division, Geneva University Hospitals, Geneva, Switzerland
| | - J L Herrmann
- 2I, UVSQ, INSERM, Université Paris Saclay, Versailles France; AP-HP, GHU Paris Saclay, Hôpital Raymond Poincaré, Garches, France
| | - D Boutolleau
- Sorbonne Université, INSERM, Institut Pierre Louis D'Epidémiologie et de Santé Publique (iPLESP), Paris, France; AP-HP, GHU AP-HP. Sorbonne Université, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Virology Department, National Reference Center for Herpesviruses (associate Laboratory), Paris, France
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Advances in Magnetoresistive Biosensors. MICROMACHINES 2019; 11:mi11010034. [PMID: 31888076 PMCID: PMC7019276 DOI: 10.3390/mi11010034] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/22/2019] [Accepted: 12/24/2019] [Indexed: 01/05/2023]
Abstract
Magnetoresistance (MR) based biosensors are considered promising candidates for the detection of magnetic nanoparticles (MNPs) as biomarkers and the biomagnetic fields. MR biosensors have been widely used in the detection of proteins, DNAs, as well as the mapping of cardiovascular and brain signals. In this review, we firstly introduce three different MR devices from the fundamental perspectives, followed by the fabrication and surface modification of the MR sensors. The sensitivity of the MR sensors can be improved by optimizing the sensing geometry, engineering the magnetic bioassays on the sensor surface, and integrating the sensors with magnetic flux concentrators and microfluidic channels. Different kinds of MR-based bioassays are also introduced. Subsequently, the research on MR biosensors for the detection of protein biomarkers and genotyping is reviewed. As a more recent application, brain mapping based on MR sensors is summarized in a separate section with the discussion of both the potential benefits and challenges in this new field. Finally, the integration of MR biosensors with flexible substrates is reviewed, with the emphasis on the fabrication techniques to obtain highly shapeable devices while maintaining comparable performance to their rigid counterparts.
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Cooper CL. Now Is the Time to Quickly Eliminate Barriers Along the Hepatitis C Cascade of Care. J Infect Dis 2019. [PMID: 29534217 DOI: 10.1093/infdis/jiy117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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15
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Arshad Z, Alturkistani A, Brindley D, Lam C, Foley K, Meinert E. Tools for the Diagnosis of Herpes Simplex Virus 1/2: Systematic Review of Studies Published Between 2012 and 2018. JMIR Public Health Surveill 2019; 5:e14216. [PMID: 31124465 PMCID: PMC6552407 DOI: 10.2196/14216] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 12/31/2022] Open
Abstract
Background Herpes simplex virus (HSV)-1 and HSV-2 are common infections affecting the global population, with HSV-1 estimated to affect 67% of the global population. HSV can have rare but severe manifestations, such as encephalitis and neonatal herpes, necessitating the use of reliable and accurate diagnostic tools for the detection of the viruses. Currently used HSV diagnostic tools require highly specialized skills and availability of a laboratory setting but may lack sensitivity. The numerous recently developed HSV diagnostic tools need to be identified and compared in a systematic way to make the best decision about which diagnostic tool to use. The diagnosis of HSV is essential for prompt treatment with antivirals. To select the best test for a patient, knowledge of the performance and limitations of each test is critical. Objective This systematic review has summarized recent studies evaluating HSV-1 and HSV-2 diagnostic tools. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, selection criteria, data extraction, and data analysis were determined before the commencement of the study. Studies assessing the specificity/sensitivity of HSV-1 or HSV-2 diagnostic tools published between 2012 and 2018 were included. Quality assessment of included studies was performed using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Results Searches of the PubMed database yielded 264 studies; 11 studies included 11 molecular assays, and 8 studies included 19 different serological assays for the detection of HSV-1, HSV-2, or both. A greater proportion of molecular assay–based tools are being developed by commercial entities. Studies that tested molecular assays mostly focused on cutaneous and mucosal HSV infections (n=13); 2 studies focused on ocular disease, whereas only 1 study focused on the central nervous system manifestations. The Simplexa HSV 1 & 2 Direct is currently the only Food and Drug Administration–approved device for use on cerebrospinal fluid. No tools focused on prenatal screening. We also present performance metrics of tests for benchmarking of future technology. Most of the included studies had a high risk of bias rating in half of the QUADAS-2 tool risk of bias domains. Conclusions The use of serologic tests to diagnose genital lesions is inappropriate because positive results may be due to chronic infection, whereas negative results may overlook recent infection. The incidence of acute infections is rising. As these infections present the greatest risk to fetuses, work needs to be done to prevent vertical transfer. Prenatal screening for primary infection and subsequent medical intervention will assist in lowering the rate of neonatal herpes. In conclusion, HSV diagnosis is moving away from culture-based methods to serology-based or polymerase chain reaction–based methods. Sensitive, rapid, and efficient HSV diagnostic tools should be adopted for the prevention of acute infections and neonatal herpes.
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Affiliation(s)
- Zeeshaan Arshad
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Abrar Alturkistani
- Global Digital Health Unit, Imperial College London, London, United Kingdom
| | - David Brindley
- Healthcare Translation Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Ching Lam
- Healthcare Translation Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Kimberley Foley
- Global Digital Health Unit, Imperial College London, London, United Kingdom
| | - Edward Meinert
- Healthcare Translation Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
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Slinger R, Amrud K, Sant N, Ramotar K, Desjardins M. A comparison of the Quidel Solana HSV 1 + 2/VZV Assay, the Focus Diagnostics Simplexa HSV 1 & 2 Direct Assay and the Luminex Aries HSV 1&2 Assay for detection of herpes simplex virus 1 and 2 from swab specimens. J Clin Virol 2019; 113:35-38. [PMID: 30856386 DOI: 10.1016/j.jcv.2019.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/07/2019] [Accepted: 03/01/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Molecular methods enable more rapid and sensitive detection of herpes simplex virus (HSV) than viral culture. OBJECTIVE Three commercial molecular methods, all of which detect both HSV-1 and HSV-2, were compared to viral culture for the detection of HSV from swab specimens. STUDY DESIGN Pediatric and adult patient viral swab specimens were cultured for HSV. Residual swab fluid was frozen at -80 °C until tested with the 3 molecular methods: the Quidel Solana HSV 1 + 2/VZV Assay, the Focus Diagnostics Simplexa HSV 1 & 2 Direct Assay and the Luminex Aries HSV 1&2 Assay. A true positive was defined as positive by culture or positive by ≥ 2/3 molecular methods. RESULTS 177 specimens were studied. The sensitivity of culture was 81.3% (61/75, 95% CI 70.7-89.4%) and specificity was 100% (102/102, 95% CI 96.4-100%). The sensitivities of both the Solana and Simplexa were 100% (75/75, 95% CI 95.2-100%) and specificities were also both 100% (102/102, 95% CI 96.4-100%). The Aries had a sensitivity of 98.7% (74/75, 95% CI 92.8-99.97%) and specificity 99.0% (101/102, 95% CI 94.7-99.98%). All three molecular methods were significantly more sensitive than culture (p ≤ 0.0005 for Solana and Simplexa and p ≤ 0.0012 for Aries). CONCLUSION All the molecular methods studied provided a significantly higher sensitivity than culture. In addition, the molecular methods took 1-2 hours to perform compared to a mean of 2.1 days for culture results. Use of any of the three molecular methods could lead to improved patient care.
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Affiliation(s)
- Robert Slinger
- Eastern Ontario Regional Laboratory Association, Canada; Children's Hospital of Eastern Ontario, Canada.
| | - Kelly Amrud
- The Ottawa Hospital/The Ottawa Hospital Research Institute, Canada.
| | - Nadia Sant
- Eastern Ontario Regional Laboratory Association, Canada; The Ottawa Hospital/The Ottawa Hospital Research Institute, Canada.
| | - Karam Ramotar
- Eastern Ontario Regional Laboratory Association, Canada; The Ottawa Hospital/The Ottawa Hospital Research Institute, Canada.
| | - Marc Desjardins
- Eastern Ontario Regional Laboratory Association, Canada; The Ottawa Hospital/The Ottawa Hospital Research Institute, Canada.
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Schibler M, Eperon G, Kenfak A, Lascano A, Vargas MI, Stahl JP. Diagnostic tools to tackle infectious causes of encephalitis and meningoencephalitis in immunocompetent adults in Europe. Clin Microbiol Infect 2019; 25:408-414. [PMID: 30654044 DOI: 10.1016/j.cmi.2018.12.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/19/2018] [Accepted: 12/23/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Encephalitis and meningoencephalitis imply inflammation of the brain parenchyma, and comprise many diagnostic entities, such as various infections and causes of dysimmunity. The cause remains unknown in around 50% of cases. OBJECTIVES To summarize the main infectious causes of encephalitis and meningoencephalitis acquired in Europe, and the diagnostic means to identify them. SOURCES PubMed, ECDC and WHO websites, personal experience. CONTENT The principal infectious causes of encephalitis and meningoencephalitis acquired in Europe in adults are discussed in this review, with special emphasis on the microbiological and imaging diagnostic approaches. The role of electroencephalography in diagnosing encephalitis is also mentioned. Among infections, viruses are more frequent than other pathogen types, and their epidemiology varies according to geographic area. A few bacteria, such as Listeria monocytogenes and Mycobacterium tuberculosis, are also to be considered. In contrast, parasites and fungi are rare encephalitis causes in Europe. IMPLICATIONS Identifying the causative pathogen of infectious encephalitis and meningoencephalitis is complex because of the variety of pathogens, the epidemiology of which is determined by geography and environmental factors. Furthermore, despite extensive microbiological testing, many cases of encephalitis remain of unknown origin. Brain magnetic resonance imaging and electroencephalography are useful complementary diagnostic tools, and newer unbiased sequencing technologies might help to fill in the diagnostic gap.
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Affiliation(s)
- M Schibler
- Infectious Diseases Division and Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland.
| | - G Eperon
- Tropical and Humanitarian Medicine Division, Geneva University Hospitals, Geneva, Switzerland
| | - A Kenfak
- Internal Medicine Service, Jura Bernois Hospital, Moutier, Switzerland
| | - A Lascano
- Neurology Division, Geneva University Hospitals, Geneva, Switzerland
| | - M I Vargas
- Diagnostic and Interventional Neuroradiology Division, Geneva University, Geneva, Switzerland
| | - J P Stahl
- Infectious Diseases and Tropical Medicine, University Hospital, Grenoble, France
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Buchan BW. Avoiding the Headache: Laboratory Considerations for Implementation, Utilization, and Interpretation of Multiplex Molecular Panels for the Diagnosis of Meningitis and Encephalitis, Part I. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.clinmicnews.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maillet M, De Broucker T, Mailles A, Bouzat P, Stahl JP. Cerebrospinal fluid lactate concentration and bacterial encephalitis diagnosis. Med Mal Infect 2018; 48:396-402. [PMID: 29914776 DOI: 10.1016/j.medmal.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 04/22/2018] [Accepted: 05/23/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES A French national study on infectious encephalitis enrolled 253 patients in 2007. Fifty-two per cent of patients had a proven etiological diagnosis; 16% had bacterial encephalitis. We aimed to assess the predictive value of CSF lactate concentration to diagnose bacterial encephalitis. PATIENTS AND METHODS Patients from the 2007 cohort whose CSF lactate concentration was available were included. Clinical and biological features associated with a bacterial etiology were assessed using univariate analysis and multivariate logistic regression. The ROC curve of CSF lactate concentration was used to define the most appropriate cut-off associated with bacterial etiology. RESULTS Fifty-seven patients (37 men, 20 women) were included. Ten patients had bacterial encephalitis, 20 patients had viral encephalitis. The mean CSF white blood cells (WBC), protein, glucose, and lactate levels were respectively 92 cells/mm3 (range: 0-450), 1.2g/L (range: 0.2-8.2), 3.9mmol/L (range: 0.8-8.8), and 2.8mmol/L (range: 0-9.4). In univariate analysis, CSF protein level (P<0.01), WBC count (P=0.02), and lactate concentration (P<0.01) were significantly associated with bacterial etiology. The only factor independently associated with bacterial etiology in the multivariate analysis was CSF lactate concentration. The area under the ROC curve of CSF lactate for the diagnosis of bacterial encephalitis was 0.86. The cut-off value of 3.4 mmol/L correctly classified 87.8% of patients with 70% sensitivity, 91.5% specificity, 64% positive predictive value, and 93% negative predictive value. CONCLUSION A high CSF lactate level seems to be a better predictor than WBC or proteins to differentiate bacterial encephalitis from other etiologies.
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Affiliation(s)
- M Maillet
- Service de maladies infectieuses, centre hospitalier universitaire de Grenoble, BP 218, 38043 Grenoble cedex 9, France.
| | - T De Broucker
- Service de neurologie, centre hospitalier de Saint-Denis, 2, rue du Dr-Delafontaine, 93200 Saint-Denis, France.
| | - A Mailles
- Santé publique France, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France; ESGIB, ESCMID Study Group for Infectious Diseases of the Brain.
| | - P Bouzat
- Pôle anesthésie et réanimation, centre hospitalier universitaire de Grenoble, Grenoble, France.
| | - J P Stahl
- Service de maladies infectieuses, centre hospitalier universitaire de Grenoble, BP 218, 38043 Grenoble cedex 9, France; ESGIB, ESCMID Study Group for Infectious Diseases of the Brain.
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Alsweed A, Alsuhibani M, Casanova JL, Al-Hajjar S. Approach to recurrent Herpes Simplex Encephalitis in children. Int J Pediatr Adolesc Med 2018; 5:35-38. [PMID: 30805531 PMCID: PMC6363264 DOI: 10.1016/j.ijpam.2018.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/05/2018] [Indexed: 06/09/2023]
Abstract
Herpes Simplex Encephalitis (HSE) is one of the commonest viral encephalitis and its recurrence is being increasingly reported were HSE relapse rate came up to 5%. Both herpes simplex virus (HSV) types can lead to encephalitis and it was established that HSV-1 is capable of nervous system invasion, latency, and recurrence. The recurrence of HSE used to be attributed to immunological compromise, but reports show many cases have no obvious immune system impairment. Further investigations revealed genetic predispositions to HSV infection that would explain the host vulnerability to its recurrence. In this review, we discuss the gene mutations that may predispose to recurrent HSE and the importance of early diagnosis and treatment.
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Affiliation(s)
- Abdulrahman Alsweed
- Department of Pediatrics, Section of Infectious Disease, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Al-Imam Muhammad ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Mohammed Alsuhibani
- Department of Pediatrics, Section of Infectious Disease, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- Paris Descartes University, Imagine Institute, Paris, France
- Pediatric Hematology-Immunology Unit, Necker Hospital for Sick Children, AP-HP, Paris, France
- Howard Hughes Medical Institute, New York, USA
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Sami Al-Hajjar
- Department of Pediatrics, Section of Infectious Disease, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Affiliation(s)
- Mark D Gonzalez
- Department of Pathology, Children's Healthcare of Atlanta, 1405 Clifton Road, Northeast, Atlanta, GA 30322, USA
| | - Erin McElvania
- Department of Pathology, NorthShore University Health System, 2650 Ridge Avenue, Evanston, IL 60201, USA.
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Sam SS, Caliendo AM, Ingersoll J, Abdul-Ali D, Kraft CS. Performance evaluation of the Aptima HSV-1 and 2 assay for the detection of HSV in cutaneous and mucocutaneous lesion specimens. J Clin Virol 2017; 99-100:1-4. [PMID: 29253834 DOI: 10.1016/j.jcv.2017.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/04/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Timely and precise laboratory diagnosis of Herpes simplex viruses (HSV) is required to guide clinical management. OBJECTIVES The study evaluated limit of detection (LOD) and performance characteristics of the Aptima HSV 1 & 2 assay in comparison to four assays. STUDY DESIGN The multi-center study compared qualitative detection of HSV-1 and 2 by the Aptima HSV-1 and 2 assay (Hologic) to ELVIS culture, Lyra Direct (Quidel), AmpliVue (Quidel) and a laboratory developed test (LDT). LOD was performed using VTM and STM diluted viral concentrations and clinical performance was evaluated using 505 swab specimens. RESULTS The Aptima LOD studies performed showed a lower detection limit for STM specimens as 1450 copies/mL and 430 copies/mL for HSV1 and HSV-2 respectively; the LOD for VTM specimens was 9370 copies/mL and 8045 copies/mL for HSV-1 and HSV-2 respectively. When the assays were analyzed based on the positive consensus result established the Aptima had 95% of percent positive agreement (PPA) and 100% negative percent agreement (NPA) for the HSV-1. For the HSV-2, the PPA and NPA for Aptima were 96% and 100% respectively. AmpliVue had 1.8% invalid rate, while Lyra had no invalid results but an inhibition rate of 0.8%. Aptima and LDT did not have any invalid or inhibited results. CONCLUSION The results indicate that the Aptima HSV-1 & 2 assay is sensitive and the performance characteristics of the Aptima assay is comparable to the assays analyzed for the detection and differentiation of HSV-1 and 2 from cutaneous and mucocutaneous lesions.
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Affiliation(s)
- Soya S Sam
- Division of Infectious Diseases, The Miriam Hospital, Providence, RI, United States.
| | - Angela M Caliendo
- Department of Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, United States
| | - Jessica Ingersoll
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Deborah Abdul-Ali
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Colleen S Kraft
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
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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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Impact of a Rapid Herpes Simplex Virus PCR Assay on Duration of Acyclovir Therapy. J Clin Microbiol 2017; 55:1557-1565. [PMID: 28275080 DOI: 10.1128/jcm.02559-16] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/06/2017] [Indexed: 02/07/2023] Open
Abstract
Herpes simplex virus (HSV) infections of the central nervous system (CNS) are associated with significant morbidity and mortality rates in children. This study assessed the impact of a direct HSV (dHSV) PCR assay on the time to result reporting and the duration of acyclovir therapy for children with signs and symptoms of meningitis and encephalitis. A total of 363 patients with HSV PCR results from cerebrospinal fluid (CSF) samples were included in this retrospective analysis, divided into preimplementation and postimplementation groups. For the preimplementation group, CSF testing was performed using a laboratory-developed real-time PCR assay; for the postimplementation group, CSF samples were tested using a direct sample-to-answer assay. All CSF samples were negative for HSV. Over 60% of patients from both groups were prescribed acyclovir. The average HSV PCR test turnaround time for the postimplementation group was reduced by 14.5 h (23.6 h versus 9.1 h; P < 0.001). Furthermore, 79 patients (43.6%) in the postimplementation group had dHSV PCR results reported <4 h after specimen collection. The mean time from specimen collection to acyclovir discontinuation was 17.1 h shorter in the postimplementation group (31.1 h versus 14 h; P < 0.001). The median duration of acyclovir therapy was also significantly reduced in the postimplementation group (29.2 h versus 14.3 h; P = 0.01). Our investigation suggests that implementation of rapid HSV PCR testing can decrease turnaround times and the duration of unnecessary acyclovir therapy.
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Abstract
PURPOSE OF REVIEW The goal of this review is to provide an update on current thinking regarding herpes simplex encephalitis (HSE), emphasizing new information about pathogenesis, diagnosis, and immune responses. Specific questions to be addressed are the following: (1) Is there a genetic predisposition to HSE? (2) What clinical approaches have the greatest impact on improving the long-term outcomes in patients with HSE? And (3) are there immune-mediated mechanisms that may account for relapsing HSE? RECENT FINDINGS Toll-like receptor 3 (TLR 3) plays an important role in innate immune responses, including generation of interferons. Multiple single-gene errors in TLR 3 interferon pathways have recently been described in children that result in increased susceptibility to HSE. Conversely, studies in both animal models and humans indicate that both cytolytic viral replication and immune-mediated responses (including cytotoxic T lymphocytes and immune mechanisms mediated by TLR 2) contribute to the pathology of HSV, suggesting possible new therapeutic approaches. In terms of treatment, data clearly indicate that a longer duration between onset of symptoms and initiation of effective antiviral therapy correlates directly with less favorable clinical outcome. Recurrent or relapsing HSE may occasionally occur, but recent observations indicate that many instances of "relapsing HSE", especially in children, are more often anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis triggered by the antecedent HSV infection. Innate immune responses are critical for defense against HSV; genetic defects in this system may predispose patients to HSE. During acute HSE, exuberant immune responses may contribute to the CNS pathology, suggesting that selective immunosuppressive therapy, coupled with potent antiviral drugs, may eventually play a role in the therapeutic management of HSV. While overall clinical outcomes of HSE remain suboptimal, the initiation of high-dose acyclovir therapy as early as possible in the course of the illness provides the best chance for a patient to survive with minimal neurologic damage. Distinguishing relapsing HSE from autoimmune anti-NMDAR antibody encephalitis is critically important because therapeutic approaches will be very different.
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Affiliation(s)
- John W Gnann
- Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina, 135 Rutledge Avenue, MSC 752, Charleston, SC, 29425, USA.
| | - Richard J Whitley
- University of Alabama at Birmingham, 303 CHB, 1600 7th Ave. S, Birmingham, AL, 35233-1711, USA
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Binnicker MJ, Espy MJ, Duresko B, Irish C, Mandrekar J. Automated processing, extraction and detection of herpes simplex virus types 1 and 2: A comparative evaluation of three commercial platforms using clinical specimens. J Clin Virol 2017; 89:30-33. [PMID: 28226272 DOI: 10.1016/j.jcv.2017.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/08/2017] [Accepted: 02/12/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Recently, automated platforms have been developed that can perform processing, extraction and testing for herpes simplex virus (HSV) nucleic acid on a single instrument. OBJECTIVES In this study, we compared three commercially-available systems; Aptima®/Panther (Hologic, San Diego, CA), ARIES® (Luminex Corporation, Austin, TX), and cobas® 4800 (Roche Molecular Systems Inc, Pleasanton, CA) for the qualitative detection of HSV-1/2 in clinical samples. STUDY DESIGN Two-hundred seventy-seven specimens (genital [n=193], dermal [n=84]) were submitted for routine HSV-1/2 real-time PCR by a laboratory developed test. Following routine testing, samples were also tested by the Aptima, ARIES, and cobas HSV-1/2 assays per the manufacturer's recommendations. Results were compared to a "consensus standard" defined as the result obtained from ≥3 of the 4 assays. RESULTS Following testing of 277 specimens, the cobas and ARIES assays demonstrated a sensitivity of 100% for HSV-1 (61/61) and HSV-2 (55/55). The Aptima assays showed a sensitivity of 91.8% (56/61) for HSV-1 and 90.9% (50/55) for HSV-2. Percent specificities for HSV-1 were 96.2% (202/210) by cobas, 99.5% (209/210) by ARIES and 100% (236/236) by Aptima. For HSV-2, the specificities were 98.1% (211/215) by cobas, 99.5% (215/216) by ARIES and 100% (216/216) by Aptima. The turnaround time for testing 24 samples was 2.5h by the cobas 4800, 3.1h by Aptima/Panther, and 3.9h by ARIES. CONCLUSIONS The three commercial systems can perform all current functions on a single platform, thereby improving workflow and potentially reducing errors associated with manual processing of samples.
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Affiliation(s)
- Matthew J Binnicker
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, United States.
| | - Mark J Espy
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, United States
| | - Brian Duresko
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, United States
| | - Cole Irish
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, United States
| | - Jay Mandrekar
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, United States; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, United States
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Virók DP, Eszik I, Mosolygó T, Önder K, Endrész V, Burián K. A direct quantitative PCR-based measurement of herpes simplex virus susceptibility to antiviral drugs and neutralizing antibodies. J Virol Methods 2017; 242:46-52. [PMID: 28093274 DOI: 10.1016/j.jviromet.2017.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 12/15/2022]
Abstract
Herpes simplex viruses (HSV) are common human pathogens that can cause painful but benign manifestations and recurrent complaints, but can also cause significant morbidity and mortality on infection of the eye or brain and with disseminated infection of an immunosuppressed patient or a neonate. HSV growth inhibition measurement by plaque or yield reduction is a key task in the development of novel antiviral compounds but the manual methods are very labour intensive. The sensitive and specific PCR technology could be an effective method for quantitation of HSV DNA related to virus replication; however the currently described PCR approaches have a major limitation, namely the requirement of purification of DNA from the infected cells. This limitation makes this approach unfeasible for high-throughput screenings. The monitoring of HSV specific antibody titre is essential in vaccination trials and in the improvement of HSV-based oncolytic virotherapy. Usually, conventional cytopathic effect-based and plaque reduction neutralization tests are applied to measure the neutralization titre, but these methods are also time-consuming. To overcome this, we developed a quantitative PCR (qPCR) method for the detection of HSV-2 DNA directly from the infected cells (direct qPCR) and the method was further adapted to measure the titre of HSV specific neutralizing antibody in human sera. The conditions of direct qPCR assay were optimized to measure the antiviral activity of known and novel antiviral substances. Using HSV-2 seronegative and seropositive patients' sera, the validity of the direct qPCR neutralization test was compared to traditional cytopathic effect-based assay. The direct qPCR method was able to detect the HSV-2 DNA quantitatively between multiplicity of infection 1/64 and 1/4194304, indicating that the dynamic range of the detection was approximately 65,500 fold with high correlation between the biological and technical replicates. As a proof of the adaptability of the method, we applied the direct qPCR for antiviral inhibitory concentration 50 (IC50) measurements of known and novel antiviral compounds. The measured IC50 of acyclovir was ∼0.28μg/ml, similar to the previously published IC50 value. The IC50 of novel antiviral candidates was between 1.6-3.1μg/ml. The direct qPCR-based neutralization titres of HSV positive sera were 1:32-1:64, identical to the neutralization titres determined using a traditional neutralization assay. The negative sera did not inhibit the HSV-2 replication in either of the tests. Our direct qPCR method for the HSV-2 growth determination of antiviral IC50 and neutralization titre is less time-consuming, less subjective and a more accurate alternative to the traditional plaque titration and growth reduction assays.
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Affiliation(s)
- Dezső P Virók
- Department of Medical Microbiology and Immunobiology, University of Szeged, Dóm tér 10, 6720 Szeged, Hungary.
| | - Ildikó Eszik
- Department of Medical Microbiology and Immunobiology, University of Szeged, Dóm tér 10, 6720 Szeged, Hungary.
| | - Tímea Mosolygó
- Department of Medical Microbiology and Immunobiology, University of Szeged, Dóm tér 10, 6720 Szeged, Hungary.
| | - Kamil Önder
- Research Program for Rational Drug Design in Dermatology and Rheumatology, Department of Dermatology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; ProComCure Biotech, 5020 Salzburg, Austria.
| | - Valéria Endrész
- Department of Medical Microbiology and Immunobiology, University of Szeged, Dóm tér 10, 6720 Szeged, Hungary.
| | - Katalin Burián
- Department of Medical Microbiology and Immunobiology, University of Szeged, Dóm tér 10, 6720 Szeged, Hungary.
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Laboratory Diagnosis of Infections in Cancer Patients: Challenges and Opportunities. J Clin Microbiol 2016; 54:2635-2646. [PMID: 27280421 DOI: 10.1128/jcm.00604-16] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Infections remain a significant cause of morbidity and mortality in cancer patients. The differential diagnosis for these patients is often wide, and the timely selection of the right clinical tests can have a significant impact on their survival. However, laboratory findings with current methodologies are often negative, challenging clinicians and laboratorians to continue the search for the responsible pathogen. Novel methodologies are providing increased sensitivity and rapid turnaround time to results but also challenging our interpretation of what is a clinically significant pathogen in cancer patients. This minireview provides an overview of the most common infections in cancer patients and discusses some of the challenges and opportunities for the clinical microbiologist supporting the care of cancer patients.
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Köller T, Kurze D, Lange M, Scherdin M, Podbielski A, Warnke P. Implementation and Evaluation of a Fully Automated Multiplex Real-Time PCR Assay on the BD Max Platform to Detect and Differentiate Herpesviridae from Cerebrospinal Fluids. PLoS One 2016; 11:e0153991. [PMID: 27092772 PMCID: PMC4836685 DOI: 10.1371/journal.pone.0153991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/06/2016] [Indexed: 02/04/2023] Open
Abstract
A fully automated multiplex real-time PCR assay--including a sample process control and a plasmid based positive control--for the detection and differentiation of herpes simplex virus 1 (HSV1), herpes simplex virus 2 (HSV2) and varicella-zoster virus (VZV) from cerebrospinal fluids (CSF) was developed on the BD Max platform. Performance was compared to an established accredited multiplex real time PCR protocol utilizing the easyMAG and the LightCycler 480/II, both very common devices in viral molecular diagnostics. For clinical validation, 123 CSF specimens and 40 reference samples from national interlaboratory comparisons were examined with both methods, resulting in 97.6% and 100% concordance for CSF and reference samples, respectively. Utilizing the BD Max platform revealed sensitivities of 173 (CI 95%, 88-258) copies/ml for HSV1, 171 (CI 95%, 148-194) copies/ml for HSV2 and 84 (CI 95%, 5-163) copies/ml for VZV. Cross reactivity could be excluded by checking 25 common viral, bacterial and fungal human pathogens. Workflow analyses displayed shorter test duration as well as remarkable fewer and easier preparation steps with the potential to reduce error rates occurring when manually assessing patient samples. This protocol allows for a fully automated PCR assay on the BD Max platform for the simultaneously detection of herpesviridae from CSF specimens. Singular or multiple infections due to HSV1, HSV2 and VZV can reliably be differentiated with good sensitivities. Control parameters are included within the assay, thereby rendering its suitability for current quality management requirements.
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Affiliation(s)
- Thomas Köller
- Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Hospital, Rostock, Germany
| | - Daniel Kurze
- Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Hospital, Rostock, Germany
| | - Mirjam Lange
- Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Hospital, Rostock, Germany
| | - Martin Scherdin
- Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Hospital, Rostock, Germany
| | - Andreas Podbielski
- Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Hospital, Rostock, Germany
| | - Philipp Warnke
- Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Hospital, Rostock, Germany
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Testing for Herpes Simplex Virus in Low-Volume Cerebrospinal Fluid Samples: Comparison of Three Protocols To Optimize Detection. J Clin Microbiol 2015; 53:3897-9. [PMID: 26400783 DOI: 10.1128/jcm.02386-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Detection of herpes simplex virus 1 and 2 (HSV-1 and HSV-2) in cerebrospinal fluid (CSF) is a medical emergency and requires rapid, sensitive testing. However, the volume of CSF received for microbiological studies may be limited, especially from young children. In this study, we compared three testing protocols to our routine real-time PCR method to determine the most sensitive approach for detecting HSV-1 and HSV-2 in low-volume (≤100 μl) CSF.
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Development and Validation of a Laboratory-Developed Multiplex Real-Time PCR Assay on the BD Max System for Detection of Herpes Simplex Virus and Varicella-Zoster Virus DNA in Various Clinical Specimens. J Clin Microbiol 2015; 53:1921-6. [PMID: 25878344 DOI: 10.1128/jcm.03692-14] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/07/2015] [Indexed: 01/06/2023] Open
Abstract
A multiplex real-time PCR (quantitative PCR [qPCR]) assay detecting herpes simplex virus (HSV) and varicella-zoster virus (VZV) DNA together with an internal control was developed on the BD Max platform combining automated DNA extraction and an open amplification procedure. Its performance was compared to those of PCR assays routinely used in the laboratory, namely, a laboratory-developed test for HSV DNA on the LightCycler instrument and a test using a commercial master mix for VZV DNA on the ABI7500fast system. Using a pool of negative cerebrospinal fluid (CSF) samples spiked with either calibrated controls for HSV-1 and VZV or dilutions of a clinical strain that was previously quantified for HSV-2, the empirical limit of detection of the BD Max assay was 195.65, 91.80, and 414.07 copies/ml for HSV-1, HSV-2, and VZV, respectively. All the samples from HSV and VZV DNA quality control panels (Quality Control for Molecular Diagnostics [QCMD], 2013, Glasgow, United Kingdom) were correctly identified by the BD Max assay. From 180 clinical specimens of various origins, 2 CSF samples were found invalid by the BD Max assay due to the absence of detection of the internal control; a concordance of 100% was observed between the BD Max assay and the corresponding routine tests. The BD Max assay detected the PCR signal 3 to 4 cycles earlier than did the routine methods. With results available within 2 h on a wide range of specimens, this sensitive and fully automated PCR assay exhibited the qualities required for detecting simultaneously HSV and VZV DNA on a routine basis.
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