1
|
Lu Y, Li S, Su Z, Luo C, Gu M, Yuan D, Qin BE, Dai K, Xia H, Chen Y, Peng F, Jiang Y. Presence of Epstein-Barr virus in cerebrospinal fluid is associated with increased mortality in HIV-negative cryptococcal meningitis. Med Mycol 2024; 62:myae052. [PMID: 38710585 DOI: 10.1093/mmy/myae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/15/2024] [Accepted: 05/05/2024] [Indexed: 05/08/2024] Open
Abstract
Cryptococcus neoformans is the most common cause of fungal meningitis and is associated with a high mortality. The clinical significance of concurrent Epstein-Barr virus (EBV) in the cerebrospinal fluid (CSF) of human immunodeficiency virus (HIV)-negative patients with cryptococcal meningitis (CM) remains unclear. A retrospective cohort study was performed by analyzing CSF samples from 79 HIV-negative Chinese Han patients with confirmed CM. We identified CSF viral DNA in these patients by metagenomic next-generation sequencing (mNGS) and compared 10-week survival rates among those with and without EBV DNA in CSF. Of the 79 CSF samples tested, 44.3% (35/79) had detectable viral DNA in CSF, while 55.7% (44/79) were virus-negative. The most frequent viral pathogen was EBV, which was detected in 22.8% (18/79) patients. The median number of CSF-EBV DNA reads was 4 reads with a range from 1 to 149 reads. The 10-week mortality rates were 22.2% (4/18) in those with positive CSF-EBV and 2.3% (1/44) in those with negative CSF-virus (hazard ratio 8.20, 95% confidence interval [CI] 1.52-81.80; P = 0.014), which remained significant after a multivariate adjustment for the known risk factors of mortality (adjusted hazard ratio 8.15, 95% CI 1.14-92.87; P = 0.037). mNGS can identify viruses that coexist in CSF of HIV-negative patients with CM. EBV DNA is most commonly found together with C. neoformans in CSF and its presence is associated with increased mortality in HIV-negative CM patients.
Collapse
Affiliation(s)
- Yi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, PR China
- Department of Neurology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, PR China
| | - Shubo Li
- Department of Statistics, The Pennsylvania State University, State College, Pennsylvania, USA
| | - Zhihui Su
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Chongliang Luo
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Meifeng Gu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Dasen Yuan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Bang-E Qin
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Kai Dai
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Han Xia
- Department of Scientific Affairs, Hugobiotech Co, Beijing, PR China
| | - Yong Chen
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fuhua Peng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Ying Jiang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, PR China
| |
Collapse
|
2
|
Abdelrahim NA, Mohamed N, Evander M, Ahlm C, Fadl-Elmula IM. Human herpes virus type-6 is associated with central nervous system infections in children in Sudan. Afr J Lab Med 2022; 11:1718. [PMID: 36263389 PMCID: PMC9575351 DOI: 10.4102/ajlm.v11i1.1718] [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] [Received: 08/29/2021] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Human herpes virus type-6 (HHV-6) is increasingly recognised as a febrile agent in children. However, less is known in sub-Saharan African countries, including Sudan. Objective We investigated the involvement of HHV-6 in paediatric central nervous system (CNS) infections in Khartoum, Sudan. Methods Febrile patients aged up to 15 years with suspected CNS infections at Omdurman Hospital for Children from 01 December 2009 to 01 August 2010 were included. Viral DNA was extracted from leftover cerebrospinal fluid (CSF) specimens and quantitatively amplified by real-time polymerase chain reaction (PCR) at Umeå University in Sweden. Results Of 503 CSF specimens, 13 (2.6%) were positive for HHV-6 (33.0% [13/40 of cases with proven infectious meningitis]). The median thermal cycle threshold for all HHV-6-positive specimens was 38 (range: 31.9–40.8). The median number of virus copies was 281.3/PCR run (1 × 105 copies/mL CSF; range: 30–44 × 103 copies/PCR run [12 × 103 – 18 × 106 copies/mL CSF]). All positive patients presented with fever and vomiting; 86.0% had seizures. The male-to-female ratio was 1:1; 50.0% were toddlers, 42.0% infants and 8.0% teenagers. Most (83.0%) were admitted in the dry season and 17.0% in the rainy season. Cerebrospinal fluid leukocytosis was seen in 33.0%, CSF glucose levels were normal in 86.0% and low in 14.0%, and CSF protein levels were low in 14.0% and high in 43.0%. Conclusion Among children in Sudan with CNS infections, HHV-6 is common. Studies on the existence and spread of HHV-6 chromosomal integration in this population are needed.
Collapse
Affiliation(s)
- Nada A Abdelrahim
- Department of Medical Microbiology, Faculty of Medical Laboratory Sciences, Nile University, Khartoum, Sudan
| | - Nahla Mohamed
- Department of Virology, Faculty of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Magnus Evander
- Department of Virology, Faculty of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Clas Ahlm
- Department of Infection and Immunology, Faculty of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Imad M Fadl-Elmula
- Department of Pathology and Clinical Genetics, Faculty of Medicine, Al-Neelain University, Khartoum, Sudan
- Assafa Academy, Kartoum, Sudan
| |
Collapse
|
3
|
Li Y, Wan Z, Zuo L, Li S, Liu H, Ma Y, Zhou L, Jin X, Li Y, Zhang C. A Novel 2-dimensional Multiplex qPCR Assay for Single-Tube Detection of Nine Human Herpesviruses. Virol Sin 2021; 36:746-754. [PMID: 33635517 DOI: 10.1007/s12250-021-00354-2] [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: 09/26/2020] [Accepted: 12/28/2020] [Indexed: 11/28/2022] Open
Abstract
Human herpesviruses are double-stranded DNA viruses that are classified into nine species. More than 90% of adults are ever infected with one or more herpesviruses. The symptoms of infection with different herpesviruses are diverse ranging from mild or asymptomatic infections to deadly diseases such as aggressive lymphomas and sarcomas. Timely and accurate detection of herpesvirus infection is critical for clinical management and treatment. In this study, we established a single-tube nonuple qPCR assay for detection of all nine herpesviruses using a 2-D multiplex qPCR method with a house-keeping gene as the internal control. The novel assay can detect and distinguish different herpesviruses with 30 to 300 copies per 25 µL single-tube reaction, and does not cross-react with 20 other human viruses, including DNA and RNA viruses. The robustness of the novel assay was evaluated using 170 clinical samples. The novel assay showed a high consistency (100%) with the single qPCR assay for HHVs detection. The features of simple, rapid, high sensitivity, specificity, and low cost make this assay a high potential to be widely used in clinical diagnosis and patient treatment.
Collapse
Affiliation(s)
- Yingxue Li
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China.,CAS Key Laboratory of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China.,School of Biomedical Engineering, University of Science and Technology of China, Hefei, 260026, China
| | - Zhenzhou Wan
- Medical Laboratory of Taizhou Fourth People's Hospital, Taizhou, 225300, China
| | - Lulu Zuo
- Viral Hemorrhagic Fevers Research Unit, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Shenwei Li
- Shanghai International Travel Healthcare Center, Shanghai, 200335, China
| | - Honglian Liu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Yingying Ma
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Lianqun Zhou
- CAS Key Laboratory of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China.,School of Biomedical Engineering, University of Science and Technology of China, Hefei, 260026, China
| | - Xia Jin
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Yuye Li
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China.
| | - Chiyu Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China.
| |
Collapse
|
4
|
Lee GH, Kim J, Kim HW, Cho JW. Clinical significance of Epstein-Barr virus in the cerebrospinal fluid of immunocompetent patients. Clin Neurol Neurosurg 2021; 202:106507. [PMID: 33493883 DOI: 10.1016/j.clineuro.2021.106507] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Polymerase chain reaction (PCR)-based testing of cerebrospinal fluid (CSF) samples has greatly facilitated the diagnosis of central nervous system (CNS) infections. However, the clinical significance of Epstein-Barr virus (EBV) DNA in CSF of individuals with suspected CNS infection remains unclear. We wanted to gain a better understanding of EBV as an infectious agent in immunocompetent patients with CNS disorders. METHODS We identified cases of EBV-associated CNS infections and reviewed their clinical and laboratory characteristics. The study population was drawn from patients with EBV PCR positivity in CSF who visited Pusan National University Hospital between 2010 and 2019. RESULTS Of the 780 CSF samples examined during the 10-year study period, 42 (5.4 %) were positive for EBV DNA; 9 of the patients (21.4 %) were diagnosed with non-CNS infectious diseases, such as optic neuritis, Guillain-Barré syndrome, and idiopathic intracranial hypotension, and the other 33 cases were classified as CNS infections (22 as encephalitis and 11 as meningitis). Intensive care unit admission (13/33 patients, 39.3 %) and presence of severe neurological sequelae at discharge (8/33 patients, 24.2 %) were relatively frequent. In 10 patients (30.3 %), the following pathogens were detected in CSF in addition to EBV: varicella-zoster virus (n = 3), cytomegalovirus (n = 2), herpes simplex virus 1 (n = 1), herpes simplex virus 2 (n = 1), Streptococcus pneumomiae (n = 2), and Enterococcus faecalis (n = 1). The EBV-only group (n = 23) and the co-infection group (n = 10) did not differ in age, gender, laboratory data, results of brain imaging studies, clinical manifestations, or prognosis; however, the co-infected patients had higher CSF protein levels. CONCLUSION EBV DNA in CSF is occasionally found in the immunocompetent population; the virus was commonly associated with encephalitis and poor prognosis, and frequently found together with other microbes in CSF.
Collapse
Affiliation(s)
- Gha-Hyun Lee
- Department of Neurology, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
| | - Jiyoung Kim
- Department of Neurology, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Hyun-Woo Kim
- Department of Neurology, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea; Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University, Yangsan, Republic of Korea
| | - Jae Wook Cho
- Department of Neurology, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea; Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University, Yangsan, Republic of Korea
| |
Collapse
|
5
|
Bauer KL, Steeil JC, Adkins EA, Childress AL, Wellehan JFX, Kerns KL, Sarro SJ, Holder KA. Management of Ocular Human herpesvirus 1 Infection in a White-faced Saki Monkey ( Pithecia pithecia). Comp Med 2018; 68:319-323. [PMID: 29907165 DOI: 10.30802/aalas-cm-17-000119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 20-y-old male intact white-faced saki monkey (Pithecia pithecia) presented with an acute ocular disease of the right eye. Clinical signs included periocular swelling, conjunctivitis, and anisocoria with a miotic right pupil. Conjunctival swabs were positive for Human herpesvirus 1 (HHV1) according to PCR amplification with sequencing. Initial clinical signs resolved with supportive treatment, and the animal was managed chronically by using acyclovir (5 mg/kg PO twice daily) during flare-ups. After more than 2 y, the progression of clinical disease led to enucleation of the right eye. At 2 mo after surgery, acute presentation of severe neurologic signs, including ataxia and blindness, resulted in euthanasia. Histopathology, PCR analysis, and sequencing results were consistent with viral encephalitis due to HHV1; coinfection with Pithecia pithecia lymphocryptovirus 1 was identified. This report describes the first case of managed HHV1 infection in a platyrrhine primate and the first case of HHV1 in a white-faced saki monkey that was not rapidly fatal.
Collapse
Affiliation(s)
- Kendra L Bauer
- Animal Care Sciences, Smithsonian Institution National Zoological Park, Smithsonian Conservation Biology Institute, Washington, DC, USA.
| | - James C Steeil
- Animal Care Sciences, Smithsonian Institution National Zoological Park, Smithsonian Conservation Biology Institute, Washington, DC, USA
| | | | - April L Childress
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - James F X Wellehan
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Kenton L Kerns
- Animal Care Sciences, Smithsonian Institution National Zoological Park, Smithsonian Conservation Biology Institute, Washington, DC, USA
| | - Steven J Sarro
- Animal Care Sciences, Smithsonian Institution National Zoological Park, Smithsonian Conservation Biology Institute, Washington, DC, USA
| | - Kali A Holder
- Animal Care Sciences, Smithsonian Institution National Zoological Park, Smithsonian Conservation Biology Institute, Washington, DC, USA
| |
Collapse
|
6
|
Lin CTM, Leibovitch EC, Almira-Suarez MI, Jacobson S. Human herpesvirus multiplex ddPCR detection in brain tissue from low- and high-grade astrocytoma cases and controls. Infect Agent Cancer 2016; 11:32. [PMID: 27462365 PMCID: PMC4960850 DOI: 10.1186/s13027-016-0081-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/25/2016] [Indexed: 11/19/2022] Open
Abstract
Background Glioblastoma (GBM) is a fatal CNS malignancy, representing 50 % of all gliomas with approximately 12–18 months survival time after initial diagnosis. Recently, the human herpesvirus cytomegalovirus (CMV) has been suggested to have an oncogenic role, yet this association remains controversial. In addition, human herpesvirus 6 (HHV-6) and Epstein-Barr virus (EBV) have also been associated with low-grade gliomas, but few studies have examined HHV-6 and EBV in glioblastomas. Droplet digital PCR (ddPCR) is a highly precise diagnostic tool that enables the absolute quantification of target DNA. This study examines the association between multiple human herpesviruses and astrocytomas. Methods This study analyzed 112 brain tissue specimens, including 45 glioblastoma, 12 astrocytoma grade III, 2 astrocytoma grade II, 4 astrocytoma grade I, and 49 controls. All brain tissue samples were de-identified and pathologically confirmed. Each tissue block was sectioned for DNA extraction and CMV, EBV, HHV-6A and HHV-6B, and a cellular housekeeping gene were amplified by ddPCR. Results Neither CMV nor HHV-6A were detected in any of the astrocytoma samples. However, HHV-6B (p = 0.147) and EBV (p = 0.049) had a higher positivity frequency in the GBM compared to the controls. Conclusion The undetectable CMV DNA in the astrocytoma cohort does not support the observation of an increased prevalence of CMV DNA in GBM, as reported in other studies. EBV has a significantly higher positivity in the GBM cohort compared to the controls, while HHV-6B has a higher but not statistically significant positivity in the case cohort. Whether these viruses play an oncogenic role in GBM remains to be further investigated.
Collapse
Affiliation(s)
- Cheng-Te Major Lin
- The National Institute of Neurological Disorders and Stroke, National Institutes of Health, BG 10 RM 5C103 10 Center Dr., Bethesda, MD 20892 USA ; School of Medicine and Health Sciences, The George Washington University, Ross Hall 2300 Eye Street, NW, Washington, DC 20037 USA
| | - Emily C Leibovitch
- The National Institute of Neurological Disorders and Stroke, National Institutes of Health, BG 10 RM 5C103 10 Center Dr., Bethesda, MD 20892 USA ; School of Medicine and Health Sciences, The George Washington University, Ross Hall 2300 Eye Street, NW, Washington, DC 20037 USA
| | - M Isabel Almira-Suarez
- School of Medicine and Health Sciences, The George Washington University, Ross Hall 2300 Eye Street, NW, Washington, DC 20037 USA
| | - Steven Jacobson
- The National Institute of Neurological Disorders and Stroke, National Institutes of Health, BG 10 RM 5C103 10 Center Dr., Bethesda, MD 20892 USA
| |
Collapse
|
7
|
Wootton SH, Aguilera E, Salazar L, Hemmert AC, Hasbun R. Enhancing pathogen identification in patients with meningitis and a negative Gram stain using the BioFire FilmArray(®) Meningitis/Encephalitis panel. Ann Clin Microbiol Antimicrob 2016; 15:26. [PMID: 27101869 PMCID: PMC4839114 DOI: 10.1186/s12941-016-0137-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 03/29/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Meningitis with a negative cerebrospinal (CSF) Gram stain represents a diagnostic and therapeutic challenge. The purpose of our study was to evaluate the performance of the BioFire FilmArray(®) Meningitis/Encephalitis (FA ME) panel in patients presenting with community-acquired meningitis with a negative Gram stain. METHODS CSF from 48 patients with community-acquired meningitis with a negative Gram stain admitted to four hospitals in Houston, TX underwent additional testing by the FA ME. FA ME results were compared to results obtained as part of routine evaluation. RESULTS The panel detected pathogens not previously identified in 11 (22.9 %) of 48, but did not detect pathogens identified by standard technique (West Nile virus, Histoplasma) in 5 (15.2 %) patients. CONCLUSIONS Rapid testing for the most common pathogens causing meningitis will aid in the diagnosis and treatment of patients with meningitis.
Collapse
Affiliation(s)
- Susan H Wootton
- Division of Infectious Diseases, Department of Pediatrics, University of Texas (UT) Health Science Center, Houston, TX, 77030, USA
| | - Elizabeth Aguilera
- Division of Infectious Diseases, Department of Pediatrics, University of Texas (UT) Health Science Center, Houston, TX, 77030, USA
| | - Lucrecia Salazar
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas (UT) Health Science Center, 6431 Fannin St. 2.112 MSB, Houston, TX, 77030, USA
| | | | - Rodrigo Hasbun
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas (UT) Health Science Center, 6431 Fannin St. 2.112 MSB, Houston, TX, 77030, USA.
| |
Collapse
|
8
|
Fatal elephant endotheliotropic herpesvirus-1 and -4 co-infection in a juvenile Asian elephant in Europe. JMM Case Rep 2016. [DOI: 10.1099/jmmcr.0.005005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
9
|
Joshi P. Multiple strokes associated with herpes simplex virus type-2 infection: case report. J Neurovirol 2015; 22:251-3. [PMID: 26443565 DOI: 10.1007/s13365-015-0385-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/12/2015] [Accepted: 09/17/2015] [Indexed: 11/26/2022]
Abstract
Herpes simplex virus (HSV) type-2 is known to cause meningitis and usually runs a benign course. Association of such infection with vasculitis of the central nervous system is not well known. Presented here is a case initially diagnosed as aseptic meningitis that subsequently evolved as stroke and exhibited angiographic evidence of widespread vasculitis of the intracranial vessels in association with a positive polymerase chain reaction (PCR) for HSV-2 in the cerebrospinal fluid (CSF).
Collapse
MESH Headings
- Brain/blood supply
- Brain/pathology
- Brain/virology
- DNA, Viral/genetics
- DNA, Viral/isolation & purification
- Diagnosis, Differential
- Female
- Herpesvirus 2, Human/genetics
- Herpesvirus 2, Human/isolation & purification
- Herpesvirus 2, Human/pathogenicity
- Humans
- Meningitis, Aseptic/cerebrospinal fluid
- Meningitis, Aseptic/diagnosis
- Meningitis, Aseptic/physiopathology
- Meningitis, Aseptic/virology
- Meningitis, Viral/cerebrospinal fluid
- Meningitis, Viral/diagnosis
- Meningitis, Viral/physiopathology
- Meningitis, Viral/virology
- Middle Aged
- Polymerase Chain Reaction
- Stroke/cerebrospinal fluid
- Stroke/diagnosis
- Stroke/physiopathology
- Stroke/virology
Collapse
|
10
|
Bhimrao SK, Maguire J, Garnis C, Tang P, Lea J, Akagami R, Westerberg BD. Lack of Association between Human Herpesvirus and Vestibular Schwannoma. Otolaryngol Head Neck Surg 2015; 152:513-7. [DOI: 10.1177/0194599814563517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To assess for the presence of human herpesvirus (HHV) using immunohistochemical and polymerase chain reaction (PCR) assay in surgically excised vestibular schwannoma (VS) samples. Study Design Cross-sectional study. Setting A retrospective laboratory-based study of tumors from patients with vestibular schwannoma. Subjects and Methods Tissue microarrays (TMAs) representing sporadic and NF2-associated VS from 121 patients, as well as appropriate positive and negative controls, were studied. TMA sections were immunostained using antibodies directed against HHV-1, HHV-2, HHV-3, HHV-4, HHV-5, and HHV-8. PCR was used for the detection of all 8 known human herpesviruses. Results There was no detectable HHV (HHV-1, HHV-2, HHV-3, HHV-4, HHV-5, HHV-8) by immunohistochemistry in any of the 121 cases of sporadic and NF2 cases analyzed. These data were further validated by DNA sequence analyses using PCR in a subset of the VS samples, all of which were found to be negative for all HHV. Conclusions The data offer no support for an association between HHV and the development of sporadic or NF2-associated VS in humans.
Collapse
Affiliation(s)
- Sanjiv K. Bhimrao
- Division of Otolaryngology–Head and Neck Surgery, University of British Columbia, Vancouver, Canada
| | - John Maguire
- Department of Pathology and Laboratory Medicine, Division of Neuropathology, University of British Columbia, Vancouver, Canada
| | - Cathie Garnis
- Division of Otolaryngology–Head and Neck Surgery, University of British Columbia, Vancouver, Canada
| | - Patrick Tang
- Department of Pathology and Laboratory Medicine, British Columbia Centre for Disease Control, University of British Columbia, Vancouver, Canada
| | - Jane Lea
- Division of Otolaryngology–Head and Neck Surgery, University of British Columbia, Vancouver, Canada
| | - Ryojo Akagami
- Division of Neurosurgery, University of British Columbia, Vancouver, Canada
| | - Brian D. Westerberg
- Division of Otolaryngology–Head and Neck Surgery, University of British Columbia, Vancouver, Canada
| |
Collapse
|
11
|
Clinical validation of the Lyra direct HSV 1+2/VZV assay for simultaneous detection and differentiation of three herpesviruses in cutaneous and mucocutaneous lesions. J Clin Microbiol 2014; 52:3799-801. [PMID: 25078915 DOI: 10.1128/jcm.02098-14] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
We evaluated the Lyra Direct HSV 1+2/VZV multiplex real-time PCR assay for the detection and differentiation of herpes simplex virus 1 (HSV-1), HSV-2, and varicella-zoster virus (VZV) on 695 consecutive cutaneous and mucocutaneous lesion specimens. The intra-assay and interassay coefficient of variation values for the Lyra assay were 0.29 to 1.30% and 2.33 to 2.61%, respectively. The sensitivities, specificities, and positive and negative predictive values were 93.4 to 95.0%, 96.1 to 96.8%, 78.0 to 80.3%, and 99.0 to 99.1%, respectively, in comparison to those of viral culture. The values were further improved when a resolution analysis was performed with a laboratory-developed PCR assay.
Collapse
|
12
|
Ho Dang Trung N, Le Thi Phuong T, Wolbers M, Nguyen Van Minh H, Nguyen Thanh V, Van MP, Thieu NTV, Le Van T, Song DT, Le Thi P, Thi Phuong TN, Van CB, Tang V, Ngoc Anh TH, Nguyen D, Trung TP, Thi Nam LN, Kiem HT, Thi Thanh TN, Campbell J, Caws M, Day J, de Jong MD, Van Vinh CN, Van Doorn HR, Tinh HT, Farrar J, Schultsz C. Aetiologies of central nervous system infection in Viet Nam: a prospective provincial hospital-based descriptive surveillance study. PLoS One 2012; 7:e37825. [PMID: 22662232 PMCID: PMC3360608 DOI: 10.1371/journal.pone.0037825] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 04/24/2012] [Indexed: 11/19/2022] Open
Abstract
Background Infectious diseases of the central nervous system (CNS) remain common and life-threatening, especially in developing countries. Knowledge of the aetiological agents responsible for these infections is essential to guide empiric therapy and develop a rational public health policy. To date most data has come from patients admitted to tertiary referral hospitals in Asia and there is limited aetiological data at the provincial hospital level where most patients are seen. Methods We conducted a prospective Provincial Hospital-based descriptive surveillance study in adults and children at thirteen hospitals in central and southern Viet Nam between August 2007– April 2010. The pathogens of CNS infection were confirmed in CSF and blood samples by using classical microbiology, molecular diagnostics and serology. Results We recruited 1241 patients with clinically suspected infection of the CNS. An aetiological agent was identified in 640/1241 (52%) of the patients. The most common pathogens were Streptococcus suis serotype 2 in patients older than 14 years of age (147/617, 24%) and Japanese encephalitis virus in patients less than 14 years old (142/624, 23%). Mycobacterium tuberculosis was confirmed in 34/617 (6%) adult patients and 11/624 (2%) paediatric patients. The acute case fatality rate (CFR) during hospital admission was 73/617 (12%) in adults and to 42/624 (7%) in children. Conclusions Zoonotic bacterial and viral pathogens are the most common causes of CNS infection in adults and children in Viet Nam.
Collapse
Affiliation(s)
- Nghia Ho Dang Trung
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
- Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
- * E-mail:
| | - Tu Le Thi Phuong
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Marcel Wolbers
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine, Oxford University, Oxford, United Kingdom
| | - Hoang Nguyen Van Minh
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Vinh Nguyen Thanh
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Minh Pham Van
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Nga Tran Vu Thieu
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Tan Le Van
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Diep To Song
- Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Phuong Le Thi
- Dong Thap Provincial Hospital, Dong Thap Province, Viet Nam
| | | | - Cong Bui Van
- Kien Giang Provincial Hospital, Kien Giang Province, Viet Nam
| | - Vu Tang
- Soc Trang Provincial Hospital, Soc Trang Province, Viet Nam
| | | | - Dong Nguyen
- Khanh Hoa Provincial Hospital, Khanh Hoa Province, Viet Nam
| | | | | | - Hao Tran Kiem
- Hue Central Hospital, Thua Thien – Hue Province, Viet Nam
| | | | - James Campbell
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine, Oxford University, Oxford, United Kingdom
| | - Maxine Caws
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine, Oxford University, Oxford, United Kingdom
| | - Jeremy Day
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine, Oxford University, Oxford, United Kingdom
| | - Menno D. de Jong
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine, Oxford University, Oxford, United Kingdom
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - H. Rogier Van Doorn
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine, Oxford University, Oxford, United Kingdom
| | - Hien Tran Tinh
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Jeremy Farrar
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine, Oxford University, Oxford, United Kingdom
| | - Constance Schultsz
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine, Oxford University, Oxford, United Kingdom
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
13
|
Evaluation of multiplex polymerase chain reaction and microarray-based assay for rapid herpesvirus diagnostics. Diagn Microbiol Infect Dis 2012; 73:74-9. [PMID: 22459558 DOI: 10.1016/j.diagmicrobio.2012.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 02/14/2012] [Accepted: 02/18/2012] [Indexed: 11/22/2022]
Abstract
Rapid diagnosis is critical to minimize morbidity and mortality associated with infections of the central nervous system (CNS). In this study, we evaluated the performance of a multiplex polymerase chain reaction (PCR) and microarray-based method, Prove-it™ Herpes, in a routine clinical laboratory setting for the diagnostics of 7 herpesviruses in viral CNS infections. Cerebrospinal fluid samples (n = 495), which had arrived for diagnostics in the 5 participating laboratories, were analyzed for herpesvirus DNA both by the current PCR-based method of the laboratory and by the microarray assay. The sensitivity and specificity for the microarray assay were 93% and 99%, respectively. The microarray assay was considered as a rapid and robust diagnostic platform that was easily implemented into the laboratory workflow. The broad herpesvirus coverage and the small sample volume required by the assay could benefit the diagnostics and thus the treatment of life-threatening infections of the CNS, especially among immunocompromised patients.
Collapse
|
14
|
Kelly MJ, Benjamin LA, Cartwright K, Ajdukiewicz KMB, Cohen DB, Menyere M, Galbraith S, Guiver M, Neuhann F, Solomon T, Lalloo DG, Heyderman RS. Epstein-barr virus coinfection in cerebrospinal fluid is associated with increased mortality in Malawian adults with bacterial meningitis. J Infect Dis 2012; 205:106-10. [PMID: 22075766 PMCID: PMC3242746 DOI: 10.1093/infdis/jir707] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 08/30/2011] [Indexed: 02/04/2023] Open
Abstract
Mortality from adult bacterial meningitis exceeds 50% in sub-Saharan Africa. We postulated that-particularly in individuals infected with human immunodeficiency virus (HIV)-herpes simplex virus, varicella zoster virus, Epstein-Barr virus (EBV), and cytomegalovirus (CMV) in the cerebrospinal fluid (CSF) contribute to poor outcome. CSF from 149 Malawian adults with bacterial meningitis and 39 controls were analyzed using polymerase chain reaction. EBV was detected in 79 of 149 bacterial meningitis patients. Mortality (54%) was associated with higher CSF EBV load when adjusted for HIV (P = .01). CMV was detected in 11 of 115 HIV-infected patients, 8 of whom died. The mechanisms by which EBV and CMV contribute to poor outcome require further investigation.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Case-Control Studies
- Coinfection/cerebrospinal fluid
- Coinfection/complications
- Coinfection/epidemiology
- Coinfection/mortality
- Cytomegalovirus/genetics
- Cytomegalovirus/isolation & purification
- Cytomegalovirus Infections/cerebrospinal fluid
- Cytomegalovirus Infections/complications
- DNA, Viral/cerebrospinal fluid
- Epstein-Barr Virus Infections/cerebrospinal fluid
- Epstein-Barr Virus Infections/complications
- Female
- HIV Infections/cerebrospinal fluid
- HIV Infections/complications
- HIV Infections/epidemiology
- Herpesvirus 1, Human/genetics
- Herpesvirus 1, Human/isolation & purification
- Herpesvirus 2, Human/genetics
- Herpesvirus 2, Human/isolation & purification
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/isolation & purification
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Humans
- Logistic Models
- Malawi
- Male
- Meningitis, Bacterial/cerebrospinal fluid
- Meningitis, Bacterial/complications
- Meningitis, Bacterial/mortality
- Middle Aged
- Polymerase Chain Reaction
- Prevalence
- Prospective Studies
- Young Adult
Collapse
Affiliation(s)
- Matthew J Kelly
- Wellcome Trust Tropical Centre, University of Liverpool, Liverpool, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Canniff J, Donson AM, Foreman NK, Weinberg A. Cytotoxicity of glioblastoma cells mediated ex vivo by varicella-zoster virus-specific T cells. J Neurovirol 2011; 17:448-54. [PMID: 21792750 PMCID: PMC4692468 DOI: 10.1007/s13365-011-0048-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 04/30/2011] [Accepted: 07/12/2011] [Indexed: 01/15/2023]
Abstract
Clinical or laboratory evidence of varicella-zoster virus (VZV) infection has been consistently associated with lower glioma risk in case-control studies, suggesting a protective effect of VZV against glioma. We formulated the following explanatory hypotheses: reactivated VZV preferentially infects and kills gliomas compared to normal parenchyma; and VZV-specific cytotoxic T lymphocytes (CTL) cross-react with gliomas. We established an ex vivo model of VZV infection, which showed that glioma cell lines and primary astrocytes were equally permissive to VZV infection and had similar 15% average decrease in viability upon infection. In co-cultures, the relative growth of glioma cells and astrocytes was not affected by the VZV infection. However, VZV stimulated, but not mock stimulated, peripheral blood mononuclear cells from VZV-seropositive individuals recognized and killed HLA class I-matched glioma cells (mean±SE decrease in viability of 26 ± 12%, p = 0.04), but not matched astrocytes. VZV infection of the glioma cells did not affect the T cell-mediated killing. Taken together, these data suggest that ex vivo VZV infection has similar direct effects on glioma cells and astrocytes. The protective effect of prior VZV infection against the incidence of glioma may be mediated by CTL that recognizes epitopes shared by VZV and glioma cells.
Collapse
Affiliation(s)
- Jennifer Canniff
- Department of Pediatrics, University Colorado Denver School of Medicine, Denver, CO, USA
| | | | | | | |
Collapse
|
16
|
Expanding the spectrum of neurological disease associated with Epstein-Barr virus activity. Eur J Clin Microbiol Infect Dis 2011; 30:1561-9. [PMID: 21573818 DOI: 10.1007/s10096-011-1261-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 03/30/2011] [Indexed: 01/26/2023]
Abstract
The purpose of this study was to delineate the spectrum of neurological diseases attributed to Epstein-Barr virus (EBV) activity. The approach was a retrospective study on patients with EBV activity proven by a positive EBV antibody-specific index (AI) and/or cerebrospinal fluid (CSF) PCR. One hundred six children and adults (AI positive = 77, AI + PCR positive = 3, PCR positive = 26) were identified, most with reactivated infections. Twenty-eight showed typical EBV-related diseases (encephalitis, neuritis, meningitis), 19 further infections (HSV encephalitis, neuroborreliosis, HIV infection, bacterial meningitis), nine immune-mediated disorders (multiple sclerosis, optic neuritis), and 50 further diseases not typical for EBV. The highest AI values occurred in patients with encephalitis. No relationship between disease category or AI values and viral loads was found. Additional reanalysis of 1,500 consecutive CSF EBV PCR studies revealed the highest positive rates among patients with further infections (n = 18/227, 7.9%) but lower rates among patients with typical EBV-related disorders (5/395; 1.3%), immune-mediated disorders (n = 2/174; 1.1%) and other conditions (n = 4/704; 0.6%). Intrathecal EBV activity is not restricted to typical EBV-related disorders, unexpectedly frequent in further CNS infections and also present in non-inflammatory conditions. Prospective studies should assess the pathogenic role of EBV in these different diseases.
Collapse
|
17
|
Sankuntaw N, Sukprasert S, Engchanil C, Kaewkes W, Chantratita W, Pairoj V, Lulitanond V. Single tube multiplex real-time PCR for the rapid detection of herpesvirus infections of the central nervous system. Mol Cell Probes 2011; 25:114-20. [PMID: 21466846 DOI: 10.1016/j.mcp.2011.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 02/06/2010] [Accepted: 03/16/2011] [Indexed: 11/24/2022]
Abstract
Human herpesvirus infection of immunocompromised hosts may lead to central nervous system (CNS) infection and diseases. In this study, a single tube multiplex real-time PCR was developed for the detection of five herpesviruses (HSV-1, HSV-2, VZV, EBV and CMV) in clinical cerebrospinal fluid (CSF) specimens. Two primer pairs specific for the herpesvirus polymerase gene and five hybridization probe pairs for the specific identification of the herpesvirus types were used in a LightCycler multiplex real-time PCR. A singleplex real-time PCR was first optimized and then applied to the multiplex real-time PCR. The singleplex and multiplex real-time PCRs showed no cross-reactivity. The sensitivity of the singleplex real-time PCR was 1 copy per reaction for each herpesvirus, while that of the multiplex real-time PCR was 1 copy per reaction for HSV-1 and VZV and 10 copies per reaction for HSV-2, EBV and CMV. Intra and inter-assay variations of the single tube multiplex assay were in the range of 0.02%-3.67% and 0.79%-4.35%, respectively. The assay was evaluated by testing 62 clinical CSF samples and was found to have equivalent sensitivity, specificity and agreement as the routine real-time PCR, but reducing time, cost and amount of used sample.
Collapse
Affiliation(s)
- Nipaporn Sankuntaw
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | | | | | | | | | | | | |
Collapse
|
18
|
Soares CN, Cabral-Castro MJ, Peralta JM, de Freitas MRG, Zalis M, Puccioni-Sohler M. Review of the etiologies of viral meningitis and encephalitis in a dengue endemic region. J Neurol Sci 2011; 303:75-9. [PMID: 21292281 DOI: 10.1016/j.jns.2011.01.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 12/27/2010] [Accepted: 01/12/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the etiology of viral meningitis and encephalitis in adults and adolescents living in areas affected by dengue. METHODS Over two years, adults and adolescents with diagnoses of viral encephalitis or meningitis were selected for study in Brazil. PCRs for dengue, enterovirus, HSV1 and 2 and cytomegalovirus were performed in CSF samples. Serum and CSF samples were tested for the presence of anti-dengue IgM antibodies. RESULTS The etiologies of encephalitis and meningitis were determined in 70% of cases (30/47). Dengue was the leading cause of encephalitis (47%) with normal CSF cellularity in 75% of these patients. HSV1 was found in 17.6% of the cases, two of which had mild encephalitis. Enterovirus was the most common cause of meningitis (50%), followed by HSV1 (15%), cytomegalovirus and dengue (10%, each). CONCLUSIONS We identified the viral agents causing encephalitis and meningitis in a higher proportion of cases than has been reported in other studies. Dengue was the most frequent cause of encephalitis, which surpassed HSV. In endemic areas, dengue should be investigated as an important cause of encephalitis. Normal CSF cellularity should not exclude dengue encephalitis. Enterovirus is known to be the leading cause of meningitis in children, but here we found it was also the main cause of the disease in adults. HSV1 should be investigated in patients with mild forms of encephalitis and meningitis.
Collapse
Affiliation(s)
- Cristiane N Soares
- Neurology Service, Antônio Pedro Hospital/Federal Fluminense University, Brazil.
| | | | | | | | | | | |
Collapse
|
19
|
Mihály I, Kolozsi T, Liptai Z, Lukács A, Molnár P, Budai J, Prinz G, Abrahám A, Palánszky M, Dóczy J. [Experience with multiplex nested PCR and fluorescent antibody tests in the diagnosis of acute central nervous system infections with herpes simplex virus type 1 and 2]. Orv Hetil 2010; 151:1896-903. [PMID: 21044940 DOI: 10.1556/oh.2010.28921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED The specific diagnosis of herpes simplex virus type 1 and 2 infections has an extreme importance in acute infections of central nervous system due to both availability of specific antiviral therapy and the possible serious consequences of the disease. AIMS Evaluation of the relevance and interpretation of the results of PCR and the specific antibody testing. METHODS Home made multiplex nested herpes simplex virus PCR and immunofluorescent IgM, IgA, IgG antibody tests were carried out in a total of 474 cerebrospinal fluid and 555 serum samples of 396 patients with acute infection of the central nervous system between 1. January, 2003 and 31. December, 2009. RESULTS The herpes simplex virus etiology was verified in 21% of 396 patients (82 patients, mean 12 cases per year): 26 were diagnosed by both methods (32%), 41 by PCR only (50%), 15 by the detection of intrathecal antibody production only (18%) (p<0.0001). HSV type1 or 2 DNA remained detectable in 35% of the samples drawn after the 30th day of the disease. These patients were all younger than two years of age. CONCLUSIONS 1. PCR increased the ratio of verified herpes simplex virus etiology in acute central nervous infections. 2. Testing the specific antibody response cannot be ceased even in the availability of PCR. 3. Herpes simplex virus type 1 or 2 DNA might persist in central nervous system in spite of the specific antiviral therapy especially in the infants. 4. Herpes simplex virus PCR can be repeated if an early sample is negative or if it is suspected false positive. 5. There is a need for cooperation between clinicians and virologists in the appropriate interpretation of the results and in finding etiology.
Collapse
Affiliation(s)
- Ilona Mihály
- Fővárosi Önkormányzat Egyesített Szent István és Szent László Kórház-Rendelőintézet, Mikrobiológiai Osztály, Virológiai Laboratórium, Budapest.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Zhongliang W, Rui C, Xiangling W, Ding L, Jinrong Z, Yanhai G, Ju Z. Detection of the four major human herpesviruses simultaneously in whole blood and cerebrospinal fluid samples by the fluorescence polarization assay. Int J Infect Dis 2010; 14:e893-7. [PMID: 20678952 DOI: 10.1016/j.ijid.2010.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 03/11/2010] [Accepted: 03/12/2010] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Herpes simplex virus type 1/2 (HSV-1/-2), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) correlate strongly with infections of the central nervous system. The objective of this study was to develop a method for the simultaneous detection of HSV-1/-2, CMV, and EBV DNA by the fluorescence polarization assay based on asymmetric polymerase chain reaction (PCR) and hybridization. METHODS DNA of HSV-1/-2, CMV, and EBV was amplified in an asymmetric PCR by a universal primer system. The amplicons were then detected by the fluorescence polarization assay. In this method, the probes for HSV-1/-2, CMV, and EBV hybridized with their respective target amplicons, and the hybridization resulted in an increase in the fluorescence polarization values. Infections of HSV-1/-2, CMV, and EBV were determined by the increased fluorescence polarization values. The DNA extracted from whole blood and cerebrospinal fluid samples was subjected to fluorescence polarization and a previously published multiplex PCR assay in parallel. RESULTS Compared to the multiplex PCR assay, no significant difference in the numbers of samples positive for the human herpesviruses was identified by the fluorescence polarization assay. CONCLUSIONS The fluorescence polarization assay presented in this study is a reliable, convenient, and cost-effective diagnostic tool that allows the detection of the four major human herpesviruses.
Collapse
Affiliation(s)
- Wu Zhongliang
- Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Xian, China
| | | | | | | | | | | | | |
Collapse
|
21
|
|
22
|
Li H, Meng S, Levine SM, Stratton CW, Tang YW. Sensitive, qualitative detection of human herpesvirus-6 and simultaneous differentiation of variants A and B. J Clin Virol 2009; 46:20-3. [PMID: 19540801 DOI: 10.1016/j.jcv.2009.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The current limitations of laboratory testing for the detection of human herpesvirus virus 6 (HHV-6) in clinical specimens with low HHV-6 viral loads make this area a priority for further research and development. OBJECTIVES To develop and validate a sensitive qualitative assay for simultaneous HHV-6 detection and variant differentiation. METHODS We developed a diagnostic procedure, which combines a magnetic bead-based nucleic acid extraction, PCR amplification, and colorimetric microtiter plate identification (MAG-PCR-EIA), for the sensitive detection of HHV-6 and the simultaneous differentiation of HHV-6A and HHV-6B. RESULTS Analytic sensitivities of the MAG-PCR-EIA assay were 10 copies per reaction for both HHV-6A and HHV-6B variants, which is equivalent to 20 copies/ml when 1ml of clinical specimen was processed. A proficiency panel containing 11 blinded specimens covering HHV-6A viral loads from 0 to 100,000 copies was tested, and the MAG-PCR-EIA was able to detect the lowest concentration at one copy in 200microl. A panel of 27 urine specimens, which were collected from patients with and without chronic fatigue syndrome, was tested by the MAG-PCR-EIA. HHV-6 was detected in two (HHV-6A) patients who have chromosomally integrated HHV-6A and in one (HHV-6B) patient who was a healthy control and diagnosed as cervical cancer later on. The HHV-6 results did not correlate with results previously determined by HHV-6 antigenemia in urine. CONCLUSION With large specimen volumes processed and an additional signal amplification incorporated, the MAG-PCR-EIA provides a sensitive and qualitative system for HHV-6 detection and simultaneous variant differentiation. Clinical relevance of the assay awaits further investigation.
Collapse
Affiliation(s)
- Haijing Li
- Department of Pathology, Vanderbilt University School of Medicine, Nashville, TN 37232, United States
| | | | | | | | | |
Collapse
|
23
|
Mendoza LP, Bronzoni RVDM, Takayanagui OM, Aquino VH, Moraes Figueiredo LT. Viral infections of the central nervous system in Brazil. J Infect 2007; 54:589-96. [DOI: 10.1016/j.jinf.2006.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Revised: 11/14/2006] [Accepted: 11/15/2006] [Indexed: 10/23/2022]
|
24
|
Espy MJ, Uhl JR, Sloan LM, Buckwalter SP, Jones MF, Vetter EA, Yao JDC, Wengenack NL, Rosenblatt JE, Cockerill FR, Smith TF. Real-time PCR in clinical microbiology: applications for routine laboratory testing. Clin Microbiol Rev 2006; 19:165-256. [PMID: 16418529 PMCID: PMC1360278 DOI: 10.1128/cmr.19.1.165-256.2006] [Citation(s) in RCA: 800] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Real-time PCR has revolutionized the way clinical microbiology laboratories diagnose many human microbial infections. This testing method combines PCR chemistry with fluorescent probe detection of amplified product in the same reaction vessel. In general, both PCR and amplified product detection are completed in an hour or less, which is considerably faster than conventional PCR detection methods. Real-time PCR assays provide sensitivity and specificity equivalent to that of conventional PCR combined with Southern blot analysis, and since amplification and detection steps are performed in the same closed vessel, the risk of releasing amplified nucleic acids into the environment is negligible. The combination of excellent sensitivity and specificity, low contamination risk, and speed has made real-time PCR technology an appealing alternative to culture- or immunoassay-based testing methods for diagnosing many infectious diseases. This review focuses on the application of real-time PCR in the clinical microbiology laboratory.
Collapse
Affiliation(s)
- M J Espy
- Mayo Clinic, 200 First St. SW, Hilton 470, Rochester, MN 55905, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Guerra A, Cisneros JL, Eiros JM, Herrera E, Jaén P, Pérez-Macías JM. Profilaxis antiherpética en intervenciones de dermoexfoliación facial. ACTAS DERMO-SIFILIOGRAFICAS 2005; 96:479-97. [PMID: 16476283 DOI: 10.1016/s0001-7310(05)73120-3] [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: 11/19/2022] Open
Abstract
In recent years, a spectacular increase has taken place in the demand for techniques to improve the appearance of the skin, both for cosmetic and reparative purposes. The techniques used may have complications that interfere with the healing process, and therefore may affect the results from an aesthetic standpoint. The most significant complication is herpes simplex infection. Furthermore, accurate, early diagnosis of herpes infection makes greater individual and community control possible, thanks to the current availability of effective antiviral agents. The scientific literature relating to herpes simplex prophylaxis was reviewed, and this information was pooled with the knowledge and experience of a multidisciplinary group of experts. After all of this data was analyzed, the consensus was reached that all patients should be treated with specific oral medications for herpes simplex as a preventive measure.
Collapse
Affiliation(s)
- Aurora Guerra
- Hospital Universitario 12 de Octubre de Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
26
|
Ward KN. The natural history and laboratory diagnosis of human herpesviruses-6 and -7 infections in the immunocompetent. J Clin Virol 2005; 32:183-93. [PMID: 15722023 DOI: 10.1016/j.jcv.2004.11.008] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Accepted: 11/11/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Human herpesviruses-6 and -7 (HHV-6/7) are widespread in all populations. In some individuals HHV-6 is found integrated into human chromosomes, which results in a high viral load in blood. HHV-6 variant B (HHV-6B) and HHV-7 primary infections, although usually silent, not infrequently cause the childhood exanthem roseola infantum and are sometimes accompanied by neurological illness. HHV-6 variant A (HHV-6A) is not associated with any disease. OBJECTIVES The present review focuses on the immunocompetent individual and considers the epidemiology of the two viruses and their role as human pathogens. It discusses the importance of satisfactory diagnostic tests to distinguish them, compares those currently available, and recommends how best to differentiate primary from persistent infection in each case. RESULTS It is explained that at the present time antibody avidity immunofluorescence tests are the most reliable discriminators of the two types of infection. In primary infection these tests can be supplemented by PCR for viral DNA in blood but careful interpretation is required for HHV-6 in view of the high persistent viral DNA load seen with chromosomal integration. Since the contribution of primary HHV-6 and -7 infections to the burden of severe neurological illness in young children is only now emerging as significant, the need to test for these viruses in such cases is stressed. CONCLUSIONS 1. Primary HHV-6/7 infections must be distinguished from persistent infections. 2. Chromosomal integration of HHV-6 requires urgent study. 3. HHV-6A/B must be distinguished in clinical situations. 4. Where serious neurological disease/encephalitis is temporally related to immunisation it is particularly important to test for HHV-6/7 primary infection since otherwise the condition might wrongly be diagnosed as a vaccine reaction. 5. Because less is currently known about HHV-7 and HHV-6A than HHV-6B, future studies should concentrate on the former two. 6. Improvements in diagnostic tests are required for each virus.
Collapse
Affiliation(s)
- K N Ward
- Centre for Virology, Department of Infection, Royal Free and University College Medical School (UCL campus), Windeyer Institute of Medical Sciences, 46 Cleveland Street, London W1T 4JF, UK.
| |
Collapse
|
27
|
Sefers SE, Rickmyre J, Blackman A, Li H, Edwards K, Tang YW. QIAamp MinElute virus kit effectively extracts viral nucleic acids from cerebrospinal fluids and nasopharyngeal swabs. J Clin Virol 2005; 35:141-6. [PMID: 16039902 PMCID: PMC7108269 DOI: 10.1016/j.jcv.2005.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Revised: 05/23/2005] [Accepted: 05/25/2005] [Indexed: 02/04/2023]
Abstract
Background Nucleic acid preparation from a variety of clinical specimens requires efficient target recovery and amplification inhibitor removal and is critical for successful molecular diagnosis. The QIAamp MinElute Virus kit (Qiagen Inc., Valencia, CA) was compared to the two existing methods currently used in our laboratory, IsoQuick (Orca Research Inc., Bothell, WA) for DNA extraction and RNAzol B (Leedo Laboratories Inc., Houston, TX) for RNA extraction, of viral nucleic acids. Study design A total of 150 clinical specimens, including cerebrospinal fluid (CSF) and nasopharyngeal swabs (NPS), were used to determine the extraction efficiency of the MinElute compared to the other two methods. Nucleic acid recovery, hands-on time, turn-around-time and cost were compared across all kits. Results There was complete concordance between the MinElute and IsoQuick/RNAzol kits when herpes simplex virus (HSV), Epstein–Barr virus (EBV), varicella-zoster virus (VZV), influenza A virus or enteroviruses were detected using a colorimetric microtiter plate PCR system. The kits were equivalent in their ability to detect either DNA or RNA with superior ability to recover a high quality and quantity of RNA. With the potential to process larger specimen volumes, the MinElute kit can significantly shorten processing time from 2 h to 50–55 min. Conclusions Although relatively high test kit costs were noted, the MinElute kit provides another rapid and user-friendly specimen processing tool in the diagnostic molecular microbiology laboratory.
Collapse
Affiliation(s)
- Susan E. Sefers
- Department of Pathology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Jamie Rickmyre
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Amondrea Blackman
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Haijing Li
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Kathryn Edwards
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Yi-Wei Tang
- Department of Pathology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
- Corresponding author at: Molecular Infectious Disease Laboratory, Vanderbilt University Hospital, 4605 TVC, Nashville, TN 37232-5310, USA. Tel.: +1 615 322 2035; fax: +1 615 343 8420.
| |
Collapse
|
28
|
Dong G, Shang S, Liang L, Yu X. Determination of the six major human herpesviruses in cerebrospinal fluid and blood specimens of children. Acta Paediatr 2005; 94:38-43. [PMID: 15858958 DOI: 10.1111/j.1651-2227.2005.tb01785.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To detect and differentiate six major human herpesviruses in the cerebrospinal fluid (CSF) and blood of children by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). METHODS We synthesized two pairs of primers in the well-conserved regions of the DNA polymerase gene in human herpesviruses. One pair was designed to amplify cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), and the other pair to amplify varicella-zoster virus (VZV) and human herpesvirus 6 (HHV-6) by PCR. Virus species identification was achieved by restriction enzyme digestion with BamHI and BstUI. Ninety-eight CSF and 75 blood specimens were analysed by this technique. At the same time, all blood specimens were also examined by enzyme-linked immunosorbent assay (ELISA). RESULTS Thirteen (13.3%) of 98 CSF specimens and 26 (34.7%) of 75 blood specimens were positive for herpesvirus DNA in this PCR assay. Only 10 (13.3%) of the blood specimens were positive in ELISA for virus-IgM antibody. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PCR in detecting herpesvirus infections compared with ELISA were 100% (10/10), 75.4% (49/65), 38.5% (10/26) and 100% (49/49), respectively. These results indicate that the positive rate of PCR was significantly higher than that of ELISA (p < 0.05). The herpesvirus type of these positive specimens was rapidly detected using restriction enzyme digestion with BamHI and BstUI. CONCLUSIONS PCR-RFLP is a specific, sensitive and accurate technique for the identification of herpesvirus infections in the CSF and blood of children.
Collapse
Affiliation(s)
- G Dong
- Department of Infectious Medicine, Children's Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
| | | | | | | |
Collapse
|
29
|
Abstract
Facial nerve palsy has long been considered to have an infectious etiology, either viruses, mainly herpesviruses, or bacteria, such as Borrelia burgdorferi. We report for the first time the association of human herpesvirus 6 and facial palsy in a previously healthy 1-year 9-month-old boy who developed left facial nerve palsy 7 days after exanthema subitum caused by human herpesvirus 6.
Collapse
Affiliation(s)
- Anne Pitkäranta
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland.
| | | | | |
Collapse
|
30
|
Saygun I, Yapar M, Ozdemir A, Kubar A, Slots J. Human cytomegalovirus and Epstein-Barr virus type 1 in periodontal abscesses. ACTA ACUST UNITED AC 2004; 19:83-7. [PMID: 14871346 DOI: 10.1046/j.0902-0055.2002.00118.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Recent studies have linked herpesviruses to severe types of periodontal disease, but no information exists on their relationship to periodontal abscesses. The present study determined the presence of human cytomegalovirus (HCMV) and Epstein-Barr virus type 1 (EBV-1) in periodontal abscesses and the effect of treatment on the subgingival occurrence of these viruses. MATERIAL AND METHODS Eighteen adults with periodontal abscesses participated in the study. Subgingival samples were collected from each patient with sterile curettes from an abscess-affected site and a healthy control site. HCMV and EBV-1 were identified by polymerase chain reaction at the time of the abscess and at 4 months after surgical and systemic doxycycline therapy. RESULTS HCMV was detected in 66.7% of periodontal abscess sites and in 5.6% of healthy sites (P=0.002). EBV-1 occurred in 72.2% of abscess sites but not in any healthy site (P<0.001). HCMV and EBV-1 co-infection was identified in 55.6% of the abscess sites. Posttreatment, HCMV and EBV-1 were not found in any study site. CONCLUSIONS HCMV and EBV-1 genomes are commonly found in periodontal abscesses. These data favor a model in which a herpesvirus infection of the periodontium impairs the host defense and serves as a platform for the entrance of bacterial pathogens into gingival tissue with subsequent risk of abscess development.
Collapse
Affiliation(s)
- I Saygun
- Department of Periodontology, Gülhane Military Medical Academy, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
31
|
Mackay IM, Gardam T, Arden KE, McHardy S, Whiley DM, Crisante E, Sloots TP. Co-detection and discrimination of six human herpesviruses by multiplex PCR-ELAHA. J Clin Virol 2004; 28:291-302. [PMID: 14522068 DOI: 10.1016/s1386-6532(03)00072-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Herpesviruses are a significant cause of human morbidity. Traditional approaches to the identification of these viruses require infectious or at least antigenic virus. Multiplex PCR (mPCR) is capable of simultaneously amplifying a range of targets from a single preparation of nucleic acids and when combined with a suitable detection assay, it is capable of discriminating each of the amplicons. OBJECTIVES Several methods have been described in the literature, however, they lack one or more significant design features required to suitably control a routinely applied nucleic acid amplification assay. We aimed to design a multiplex herpesvirus PCR that could co-amplify eight human herpesvirus targets plus an internal control (IC) molecule in a single tube. STUDY DESIGN Primers were designed to target the DNA polymerase genes of each of the human herpesviruses. Synthetic controls were developed to act as templates for the evaluation of assay sensitivity and specificity and for development of an in-house competitive quantitative PCR. Amplicon was discriminated using a simplified enzyme linked amplicon hybridisation assay (ELAHA). RESULTS AND CONCLUSIONS For routine diagnostic use we reduced the number of herpesviral targets from 8 to 6 in order to maintain adequate clinical sensitivity. The ELAHA proved more sensitive than agarose gel electrophoresis. Additionally, 36 cytomegalovirus positive patients were examined with an in-house quantitative PCR-ELAHA which was developed to confirm that that the mPCR's co-detection limit of 10(2) copy of synthetic template per millilitre was relevant for use in detecting virus from clinical samples. The mPCR-ELAHA was then applied to the screening of 174 patient specimens resulting in a specificity of 98% and a sensitivity of 93%. This preliminary study demonstrated that the mPCR-ELAHA was a complete approach to the detection of herpesviruses from a range of clinical samples and disease states.
Collapse
Affiliation(s)
- Ian M Mackay
- Clinical Virology Research Unit, Sir Albert Sakzewski Virus Research Centre, Royal Children's Hospital, Brisbane, Australia.
| | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
Human herpes virus-6 was first reported in 1986 and is the sixth member of the herpes virus family. HHV-6 consists of two closely related variants HHV-6A and HHV-6B. The majority of infections occur in healthy infants with most infections caused by HHV-6B. The virus preferentially infects CD4+T-lymphocytes and the surface marker CD46 acts as a co-receptor. Infection is followed by persistence and latency in different cells and organs including monocytes/macrophages, salivary glands, the brain and the kidneys. In this article we will discuss the clinical manifestations of HHV-6 infection in healthy children and the syndromes associated with HHV-6 reactivation in immunocompromised patients. Evidence of association between HHV-6 infection and different clinical entities such as multiple sclerosis, malignancy, infectious momononucleosis, drug hypersensitivity syndromes and skin eruptions is discussed. Published data on the use and efficacy of antiviral agents in complicated infections and infections in immunocompromised patients is presented.
Collapse
Affiliation(s)
- Nahed M Abdel-Haq
- Division of Infectious Diseases, Children's Hospital of Michigan, Detroit Medical Center, Department of Pediatrics, School of Medicine, Wayne State University, Detroit, Michigan 48201, USA.
| | | |
Collapse
|
33
|
Tang YW, Johnson JE, Browning PJ, Cruz-Gervis RA, Davis A, Graham BS, Brigham KL, Oates JA, Loyd JE, Stecenko AA. Herpesvirus DNA is consistently detected in lungs of patients with idiopathic pulmonary fibrosis. J Clin Microbiol 2003; 41:2633-40. [PMID: 12791891 PMCID: PMC156536 DOI: 10.1128/jcm.41.6.2633-2640.2003] [Citation(s) in RCA: 208] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2002] [Revised: 01/08/2003] [Accepted: 01/29/2003] [Indexed: 11/20/2022] Open
Abstract
On the basis of earlier reports associating Epstein-Barr Virus (EBV) with half of the cases of idiopathic pulmonary fibrosis (IPF), we hypothesized that chronic infection with EBV or a closely related herpesvirus would be detected in all cases of IPF. We tested lung specimens from 33 IPF patients (8 patients with familial IPF and 25 patients with sporadic IPF) and 25 patients with other diseases as controls for the presence of eight herpesviruses using PCR-based techniques. One or more of four herpesviruses (cytomegalovirus [CMV], EBV, human herpesvirus 7 [HHV-7], and HHV-8) were detected in 32 of 33 (97%) subjects with IPF and in 9 of 25 (36%) controls (P < 0.0001). CMV, EBV, and HHV-8 were found more frequently in IPF patients than in controls (P < 0.05, P < 0.001, and P < 0.01 respectively). Two or more herpesviruses were detected in 19 of 33 (57%) IPF patients and in 2 of 25 (8%) controls (P < 0.001). Two or more herpesviruses and HHV-8 were found more frequently in patients with sporadic IPF than in patients with familial IPF (P < 0.05 for both comparisons), and CMV was found less frequently in patients with sporadic IPF than in patients with familial IPF (P < 0.05). Immunohistochemistry for EBV or HHV-8 antigen showed viral antigen primarily in airway epithelial cells. These data support the concept that a herpesvirus could be a source of chronic antigenic stimulation in IPF.
Collapse
Affiliation(s)
- Yi-Wei Tang
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Li H, Dummer JS, Estes WR, Meng S, Wright PF, Tang YW. Measurement of human cytomegalovirus loads by quantitative real-time PCR for monitoring clinical intervention in transplant recipients. J Clin Microbiol 2003; 41:187-91. [PMID: 12517846 PMCID: PMC149564 DOI: 10.1128/jcm.41.1.187-191.2003] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Quantitative monitoring of human cytomegalovirus (HCMV) infection is helpful in determining appropriate antiviral management of transplant recipients. Quantitative PCR technologies have demonstrated accuracy in measuring systemic HCMV loads. A total of 298 consecutive whole-blood specimens submitted to the Clinical Virology Laboratory at Vanderbilt University Medical Center from 15 February to 31 October 1999 were included in the study. In addition to a qualitative colorimetric microtiter plate PCR assay (MTP-PCR) and a semiquantitative pp65 antigenemia assay, each specimen was measured for HCMV loads by a quantitative PCR assay performed on an ABI PRISM 7700 Sequence Detection System (TaqMan). Compared to results of the MTP-PCR, the sensitivity, specificity, positive predictive value, and negative predictive value were 70.5, 97.5, 87.8, and 92.8% for the antigenemia assay and were 96.7, 92.0, 75.6, and 99.1% for the TaqMan assay, respectively. There was a high correlation between antigenemia values and HCMV loads as determined by the TaqMan (r = 0.989; P < 0.001). Antigenemia values of 0, 1 to 10, 11 to 100, 101 to 1,000, and over 1,000 positive cells per 2 x 10(5) leukocytes corresponded to median HCMV loads measured by TaqMan of 125, 1,593, 5,713, 16,825, and 5,425,000 copies/ml, respectively. Corresponding to antigenemia values of 1 to 2, 10, and 50 positive cells per 2 x 10(5) leukocytes, HCMV viral loads of 1,000, 4,000, and 10,000 copies/ml are proposed as cutoff points for initiating antiviral therapy in patient groups with high, intermediate, and low risk of CMV diseases.
Collapse
Affiliation(s)
- Haijing Li
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA
| | | | | | | | | | | |
Collapse
|
35
|
Cinque P, Bossolasco S, Lundkvist A. Molecular analysis of cerebrospinal fluid in viral diseases of the central nervous system. J Clin Virol 2003; 26:1-28. [PMID: 12589831 PMCID: PMC7128469 DOI: 10.1016/s1386-6532(02)00173-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of nucleic acid (NA) amplification techniques has transformed the diagnosis of viral infections of the central nervous system (CNS). Because of their enhanced sensitivity, these methods enable detection of even low amounts of viral genomes in cerebrospinal fluid. Following more than 10 years of experience, the polymerase chain reaction or other NA-based amplification techniques are nowadays performed in most diagnostic laboratories and have become the test of choice for the diagnosis of several viral CNS infections, such as herpes encephalitis, enterovirus meningitis and other viral infections occurring in human immunodeficiency virus-infected persons. Furthermore, they have been useful to establish a viral etiology in neurological syndromes of dubious origin and to recognise unusual or poorly characterised CNS diseases. Quantitative methods have provided a valuable additional tool for clinical management of these diseases, whereas post-amplification techniques have enabled precise genome characterisation. Current efforts are aiming at further improvement of the diagnostic efficiency of molecular techniques, their speed and standardisation, and to reduce the costs. The most relevant NA amplification strategies and clinical applications of to date will be the object of this review.
Collapse
Affiliation(s)
- Paola Cinque
- Clinic of Infectious Diseases, San Raffaele Hospital, Via Stamira d'Ancona, 20, 20127, Milan, Italy.
| | | | | |
Collapse
|
36
|
Spilki FR, Franco AC, Teixeira MB, Esteves PA, Schaefer R, Schmidt E, Lemos RA, Roehe PM. Bovine herpesvirus type 5 (BHV-5) in a calf with rabies. PESQUISA VETERINARIA BRASILEIRA 2003. [DOI: 10.1590/s0100-736x2003000100001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The brain of an one year old male calf which died with signs of neurological disease was submitted to the laboratory for rabies diagnosis. Microscopical findings included moderate mielitis, mild meningoencephalitis with perivascular cell cuffing and Negri inclusion bodies in Purkinje cells of the cerebellum. Rabies virus infection was further confirmed by the direct fluorescent antibody test as well as by mouse inoculation. In addition, a herpesvirus was isolated from brain tissues. The isolate was antigenic and genetically characterized as bovine herpesvirus type 5 (BHV-5). It was not possible to determine whether BHV-5 played an active role in the outcome of the infection, since, the virus might have been present in a latent form in neural tissues. This is the first report of a mixed rabies/ BHV-5 infection in calves.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Paulo M. Roehe
- Universidade Federal do Rio Grande do Sul, Brasil; Centro de Pesquisas Veterinárias Desidério Finamor
| |
Collapse
|
37
|
Lu HZ, Bloch KC, Tang YW. Molecular Techniques in the Diagnosis of Central Nervous System Infections. Curr Infect Dis Rep 2002; 4:339-350. [PMID: 12126611 DOI: 10.1007/s11908-002-0027-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Development of polymerase chain reaction (PCR)-based molecular techniques has initiated a revolution in the field of diagnostic microbiology. These techniques have not only provided rapid, noninvasive detection of microorganisms that cause central nervous system (CNS) infections, but have also demonstrated that several neurologic disorders are linked to infectious agents. While PCR-based techniques are predicted to be widely used in diagnosing and monitoring CNS infections, the limitations, as well as strengths, of these techniques must be clearly understood by both clinicians and laboratory personnel to ensure proper utilization.
Collapse
Affiliation(s)
- Hong-Zhou Lu
- A3310 MCN, Division of Infectious Diseases, Departments of Medicine, Pathology, and Preventive Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-2605, USA.
| | | | | |
Collapse
|
38
|
Minjolle S, Arvieux C, Gautier AL, Jusselin I, Thomas R, Michelet C, Colimon R. Detection of herpesvirus genomes by polymerase chain reaction in cerebrospinal fluid and clinical findings. J Clin Virol 2002; 25 Suppl 1:S59-70. [PMID: 12091083 DOI: 10.1016/s1386-6532(02)00035-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The viruses of the Herpesviridae family, in particular herpes simplex virus types 1 (HSV-1) and 2 (HSV-2), cytomegalovirus (CMV), Epstein-Barr virus (EBV), varicella zoster virus (VZV), and human herpesvirus 6 (HHV-6), are responsible for numerous infections of the central nervous system (CNS). These infections manifest as diverse clinical signs, many of which are not specific. The diagnosis of these infections is necessary to make it possible to adapt treatment appropriately, as treatment is specific for the particular virus concerned. OBJECTIVES To apply a polymerase chain reaction (PCR) technique for the diagnosis in a single reaction of the six herpesviruses most frequently detected in the cerebrospinal fluid (CSF) and to analyse clinical events in patients presenting positive results in PCR for herpesviruses. STUDY DESIGN We studied 141 patients, from whom 180 CSF samples were collected. The clinical files of the patients were consulted retrospectively, and a list of clinical signs was recorded. After testing by targeted PCR, at the clinician's demand, we tested these samples by herpes consensus PCR, which detects six herpesviruses (HSV-1, HSV-2, CMV, EBV, VZV, HHV-6), in a single PCR. RESULTS Targeted PCR tests identified 25 CSF samples (13.9%), corresponding to 18 patients (12%), as positive. The herpes consensus PCR test detected 49 samples (27.2%) as positive, resulting in the identification of 54 individual viruses (four samples displayed co-infection) from 39 patients (27%). 130 CSF samples, from 101 patients, tested negative by both techniques. 23 HIV-positive patients (30.6%), three HIV-negative immunocompromised patients (27%), and 14 immunocompetent patients (25%) were CSF PCR-positive. In HIV-positive patients, CMV was the virus most frequently identified (13%), followed by EBV (10.6%), VZV (5.3%) and finally HSV-1 and HSV-2 (both 1.3%). We did not detect HHV-6 in any of these samples. We detected only HSV-2, EBV and VZV in the 11 HIV-negative immunocompromised patients. CSF samples of immunocompetent patients contained mostly VZV (9%) and HSV-1 (7.3%). CONCLUSIONS The herpes consensus PCR for a given virus was more sensitive than the standard, targeted PCR used in our laboratory. The clinical signs presented by patients infected with HSV-1, HSV-2 and CMV were similar to those reported in previous studies. For VZV, we report the possibility of mild, transient cerebral viral reactivation. Our data on the detection of EBV by PCR suggest that the PCR test is of predictive value for cerebral lymphoma in immunocompromised patients. The possible role of HHV-6 in a subacute neurological disorder merits further investigation.
Collapse
Affiliation(s)
- Sophie Minjolle
- Laboratoire de Bactériologie-Virologie, Université Rennes 1, 2 avenue, du Pr Léon Bernard, CS 34317, 35 043 Rennes cedex, France
| | | | | | | | | | | | | |
Collapse
|
39
|
Calvario A, Bozzi A, Scarasciulli M, Ventola C, Seccia R, Stomati D, Brancasi B. Herpes Consensus PCR test: a useful diagnostic approach to the screening of viral diseases of the central nervous system. J Clin Virol 2002; 25 Suppl 1:S71-8. [PMID: 12091084 DOI: 10.1016/s1386-6532(02)00036-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Infections of the central nervous system (CNS) are a difficult diagnostic problem for both clinicians and microbiologists. Various clinical signs, such as encephalitis, myelitis, meningitis, may be associated with herpesviruses. The use of multiplex 'Herpes Consensus' polymerase chain reaction (HC-PCR) in association with nested PCR (nPCR), in addition to classical techniques, made it possible to optimise the management of cerebrospinal fluid (CSF) and serum samples from patients affected by these viral diseases of the CNS. OBJECTIVES To test by HC-PCR by nPCR and cell culture the CSF and sera from patients with viral infections of the CNS. STUDY DESIGN We analysed 320 CFS, 154 serum samples and 11 various samples from 286 patients with clinically suspected encephalitis, meningitis or other diseases of the CNS by HC-PCR, nPCR and traditional investigations (cell culture and serological tests). RESULTS On molecular analysis with the HC-PCR test, 51 CFS samples (15.9%) were positive for at least one of the six target Herpes viruses: fourteen for Herpes simplex 1 (HSV-1), seven for HSV-2, 12 for Cytomegalovirus (CMV; one of which was from an HIV-positive patient), five for Epstein-Barr virus (EBV; four of which were from HIV-positive patients), three for Varicella-Zoster virus (VZV), five for Human Herpes virus type 6 (HHV-6), three for HSV-1 with HHV-6 co-infection (two cases) and HSV-2 co-infection (one case), and two for HHV-6 with CMV or EBV co-infection (both from patients with immune deficiency). A further 12 samples were positive in nPCR for HHV-7 (8), ADV (1), Enterovirus (1), HSV-1 (1), EBV (1). Of the 154 serum samples, 17 (11.0%) tested positive by HC-PCR for HSV-1 (4), HSV-2 (1), CMV(1), EBV(1), VZV(3) or HHV-6(6), 1 with co-HSV-2/VZV infection. A further five samples tested positive for HHV-7 in nPCR. Culture and tests for antibodies did not supply sufficiently sensitive and specific data. CONCLUSIONS Our laboratory experience shows that herpesviruses play a central aetiological role in viral infections of the CNS. PCR analysis, especially the HC-PCR test, have revolutionised the diagnostic approach to such infections, making possible rapid, specific and highly sensitive baseline screening. In this way, microbiological investigations can lead to prompt diagnosis, which was limited in the past to a very small number of cases.
Collapse
Affiliation(s)
- A Calvario
- Virology Laboratory, Hygiene, Epidemiology and Public Health Department, Policlinico, P.za G. Cesare, 11-70124 Bari, Italy.
| | | | | | | | | | | | | |
Collapse
|
40
|
Demkin VV, Kruglova AI, Nikolaeva NP, Yurchenko JV. Detection and species identification of four human herpesviruses using polymerase chain reaction coupled with restriction endonuclease analysis. J Virol Methods 2002; 103:121-8. [PMID: 12008006 DOI: 10.1016/s0166-0934(02)00011-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A polymerase chain reaction (PCR) based assay for detection and species identification of four human herpesviruses, including herpes simplex virus types 1 and 2, Epstein-Barr virus, and cytomegalovirus was developed. The detection of the herpesviruses was achieved by seminested PCR with three primers targeting well-conserved regions within the DNA-polymerase gene. Virus species were identified by simple restriction enzyme digestion of the amplified products with TaqI or RsaI. In comparison with mono-specific nested PCR assays the tetra-specific assay demonstrated similar specificity and sensitivity with reference and clinical samples. The tetra-specific assay is sensitive, cost effective, and can be used for examination of clinical samples of different origin.
Collapse
MESH Headings
- Animals
- Cell Line
- Cytomegalovirus/classification
- Cytomegalovirus/genetics
- Cytomegalovirus/isolation & purification
- DNA Primers
- DNA, Viral/analysis
- Deoxyribonucleases, Type II Site-Specific
- Herpes Simplex/diagnosis
- Herpesvirus 1, Human/classification
- Herpesvirus 1, Human/genetics
- Herpesvirus 1, Human/isolation & purification
- Herpesvirus 2, Human/classification
- Herpesvirus 2, Human/genetics
- Herpesvirus 2, Human/isolation & purification
- Herpesvirus 4, Human/classification
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Humans
- Polymerase Chain Reaction/methods
- Sensitivity and Specificity
Collapse
Affiliation(s)
- Vladimir V Demkin
- Institute of Molecular Genetics, Russian Academy of Sciences, Moscow, Russia.
| | | | | | | |
Collapse
|
41
|
Sakallah SA. Molecular diagnostics of infectious diseases: state of the technology. BIOTECHNOLOGY ANNUAL REVIEW 2001; 6:141-61. [PMID: 11193293 DOI: 10.1016/s1387-2656(00)06021-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this review, the basic technologies and procedures currently used in clinical laboratories performing molecular diagnostics are described. Special emphasis on specimen processing has been made since it is one of the most challenging steps involved in molecular testing. Representative examples are given for each type of technology, especially tests that are currently available in the market. The types of hybridization-based and amplification-based procedures are detailed. Finally, current problems and future developments are discussed.
Collapse
Affiliation(s)
- S A Sakallah
- Department of Health and Human Services, Public Health Laboratories, State of New Hampshire, 6 Hazen Drive, Concord, NH 03301, USA.
| |
Collapse
|
42
|
Portolani M, Pecorari M, Tamassia MG, Gennari W, Beretti F, Guaraldi G. Case of fatal encephalitis by HHV-6 variant A. J Med Virol 2001. [DOI: 10.1002/jmv.2012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
43
|
Bouquillon C, Dewilde A, Andreoletti L, Lambert V, Chieux V, Gerard Y, Lion G, Bocket L, Wattre P. Simultaneous detection of 6 human herpesviruses in cerebrospinal fluid and aqueous fluid by a single PCR using stair primers. J Med Virol 2000; 62:349-53. [PMID: 11055245 DOI: 10.1002/1096-9071(200011)62:3<349::aid-jmv7>3.0.co;2-l] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A Herpes Consensus allows the simultaneous detection of 6 human herpesviruses: herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), human cytomegalovirus (HCMV), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), and human herpes virus 6 (HHV-6). This technique was used first to examine retrospectively 100 DNA extracts from 95 CSF and 5 aqueous fluids, prepared by treatment by saturated NaCl followed by ethanol precipitation (n = 63) or by simple boiling (n = 37) and stored at -80 degrees C, and secondly to test prospectively 38 CSF samples for which two DNA extracts were prepared with commercially available DNA extraction kits. In all cases, the results were compared with those of an "in-house" PCR. Concordant results between both PCR and the Herpes Consensus techniques were obtained in 61 of 63 DNA extracts prepared by treatment by saturated NaCl (97%) and in only 31 of 37 boiled samples (84%). Both commercially available methods of DNA extraction examined appear to be suitable for Herpes Consensus PCR, although they cannot remove completely PCR inhibitors that must be sought in case of negative results. This preliminary study shows that the Herpes Consensus method should be of value for rapid diagnosis of herpesvirus infections on condition that it is performed on purified DNA extracts.
Collapse
MESH Headings
- Aqueous Humor/virology
- Central Nervous System Infections/virology
- Cerebrospinal Fluid/virology
- Cytomegalovirus/genetics
- Cytomegalovirus/isolation & purification
- DNA, Viral/analysis
- Ethanol
- Eye Infections, Viral/virology
- Freezing
- Herpesviridae/genetics
- Herpesviridae/isolation & purification
- Herpesviridae Infections/virology
- Herpesvirus 1, Human/genetics
- Herpesvirus 1, Human/isolation & purification
- Herpesvirus 2, Human/genetics
- Herpesvirus 2, Human/isolation & purification
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/isolation & purification
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 6, Human/genetics
- Herpesvirus 6, Human/isolation & purification
- Humans
- Polymerase Chain Reaction/methods
- Retrospective Studies
- Sensitivity and Specificity
- Sodium Chloride
Collapse
|
44
|
Johnson G, Nelson S, Petric M, Tellier R. Comprehensive PCR-based assay for detection and species identification of human herpesviruses. J Clin Microbiol 2000; 38:3274-9. [PMID: 10970370 PMCID: PMC87373 DOI: 10.1128/jcm.38.9.3274-3279.2000] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2000] [Accepted: 06/26/2000] [Indexed: 11/20/2022] Open
Abstract
The description and evaluation of a PCR-based assay for the detection and species identification of the eight known human herpesviruses are presented. Two primer pairs targeting well-conserved regions of the genome allowed the amplification of the DNAs of all known human herpesviruses at a high level of sensitivity (10 to 100 genome copies for most viruses). Identification of the virus species was achieved through restriction enzyme digestion with BamHI and BstUI, which yielded fragment sizes that were characteristic for each herpesvirus. Furthermore, it was demonstrated that this restriction enzyme panel allowed the discrimination between human herpesvirus 6 variant A and variant B. This assay format was validated over the course of 1 year in a clinical virology laboratory setting, where it was shown that it readily detected human herpesviruses, including occasional multiple infections, in a variety of clinical samples. The PCR assay was compared to isolation and electron microscopy for the detection of herpes simplex (HSV) and varicella-zoster virus (VZV) in clinical samples. All specimens positive by conventional methods were also positive by PCR. However, in a number of clinical specimens in which HSV or VZV could not be detected by conventional methods, PCR was able to demonstrate the presence of the virus.
Collapse
Affiliation(s)
- G Johnson
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
45
|
Pitkäranta A, Piiparinen H, Mannonen L, Vesaluoma M, Vaheri A. Detection of human herpesvirus 6 and varicella-zoster virus in tear fluid of patients with Bell's palsy by PCR. J Clin Microbiol 2000; 38:2753-5. [PMID: 10878079 PMCID: PMC87020 DOI: 10.1128/jcm.38.7.2753-2755.2000] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human herpesvirus 6 DNA was detected by PCR in the tear fluid of 7 (35%) of 20 patients with Bell's palsy and of 1 (5%) of 20 healthy controls. Varicella-zoster virus was detected by PCR in the tear fluid of 2 of 20 Bell's palsy patients but in none of the tear fluids from 20 healthy controls. These findings suggest an association between human herpesviruses and Bell's palsy.
Collapse
Affiliation(s)
- A Pitkäranta
- Department of Otorhinolaryngology, University of Helsinki, Helsinki, Finland.
| | | | | | | | | |
Collapse
|
46
|
Abstract
Human herpesvirus-6 (HHV-6) and -7 (HHV-7) infections typically are silent or manifested as mild febrile illnesses including classic roseola. In addition, case reports and epidemiologic data support the rare occurrence of HHV-6 encephalitis in immunocompromised as well as immunocompetent subjects. Although many other diseases have been putatively associated with HHV-6 or HHV-7, these associations are not well documented due to small numbers, use of tests incapable of distinguishing latent from replicating virus, potential virus cross-reactivity, or contradictory results. Further careful studies are needed to confirm these disease associations. Laboratory tests for diagnosing active HHV-6 and HHV-7 infections include virus culture, antigen detection, and polymerase chain reaction of cell-free biologic fluid. Although HHV-6 and HHV-7 are inhibited by several antiviral drugs in the laboratory, including ganciclovir and foscarnet, no clinical trials have assessed their benefit. Nevertheless, treatment may be considered for patients with serious HHV-6- or HHV-7-associated disease confirmed with accurate virologic tests.
Collapse
Affiliation(s)
- C T Leach
- Department of Pediatrics, University of Texas Health Science Center at San Antonio 78229-3900, USA
| |
Collapse
|
47
|
De Almeida Rodrigues G, Nagendra S, Lee CK, De Magalhães-Silverman M. Human herpes virus 6 fatal encephalitis in a bone marrow recipient. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1999; 31:313-5. [PMID: 10482064 DOI: 10.1080/00365549950163644] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Human herpes virus 6 (HHV-6) has been implicated as a human pathogen in both normal and immunocompromised hosts. It has been associated with interstitial pneumonitis and bone marrow suppression after transplantation. We report here a case of fatal encephalitis in a bone marrow transplant recipient. This case illustrates the importance of considering HHV6 as an emerging pathogen in immunocompromised hosts.
Collapse
Affiliation(s)
- G De Almeida Rodrigues
- Division of Hematology, Oncology, Blood and Marrow Transplantation, University of Iowa, Iowa City, USA
| | | | | | | |
Collapse
|
48
|
Tang YW, Mitchell PS, Espy MJ, Smith TF, Persing DH. Molecular diagnosis of herpes simplex virus infections in the central nervous system. J Clin Microbiol 1999; 37:2127-36. [PMID: 10364574 PMCID: PMC85100 DOI: 10.1128/jcm.37.7.2127-2136.1999] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Y W Tang
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | | | | | | | | |
Collapse
|
49
|
Minjolle S, Michelet C, Jusselin I, Joannes M, Cartier F, Colimon R. Amplification of the six major human herpesviruses from cerebrospinal fluid by a single PCR. J Clin Microbiol 1999; 37:950-3. [PMID: 10074507 PMCID: PMC88630 DOI: 10.1128/jcm.37.4.950-953.1999] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We used a novel type of primer system, a system that uses stair primers, in which the primer sequences are based on consensus sequences in the DNA polymerase gene of herpesvirus to detect herpesviruses by PCR. A single PCR in a single tube detected the six major herpesviruses that infect the central nervous system: herpes simplex virus type 1 (HSV-1), and type 2 (HSV-2), cytomegalovirus (CMV), Epstein-Barr virus (EBV), varicella-zoster virus (VZV), and human herpesvirus 6 (HHV-6). We used the technique to analyze 142 cerebrospinal fluid (CSF) samples that had been stored at -80 degrees C and compared the results with those obtained previously for the same samples by standard, targeted PCR. Four hundred one targeted PCR tests had been run with the 142 samples to detect HSV-1, HSV-2, CMV, and VZV; screening for EBV and HHV-6 was not prescribed when the samples were initially taken. Eighteen CSF samples tested positive by classic targeted PCR. The herpesvirus consensus PCR detected herpesviruses in 37 samples, including 3 samples with coinfections and 17 viral isolates which were not targeted. Two samples identified as infected by the targeted PCR tested negative by the consensus PCR, and eight samples that tested positive by the consensus PCR were negative by the targeted PCR. One hundred three samples scored negative by both the targeted and the consensus PCRs. This preliminary study demonstrates the value of testing for six different herpesviruses simultaneously by a sensitive and straightforward technique rather than screening only for those viruses that are causing infections as suggested by clinical signs.
Collapse
MESH Headings
- Consensus Sequence
- Cytomegalovirus/genetics
- Cytomegalovirus/isolation & purification
- DNA, Viral/cerebrospinal fluid
- DNA, Viral/genetics
- Diagnostic Errors
- Evaluation Studies as Topic
- Herpesviridae/classification
- Herpesviridae/genetics
- Herpesviridae/isolation & purification
- Herpesviridae Infections/cerebrospinal fluid
- Herpesviridae Infections/diagnosis
- Herpesviridae Infections/virology
- Herpesvirus 1, Human/genetics
- Herpesvirus 1, Human/isolation & purification
- Herpesvirus 2, Human/genetics
- Herpesvirus 2, Human/isolation & purification
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/isolation & purification
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 6, Human/genetics
- Herpesvirus 6, Human/isolation & purification
- Humans
- Polymerase Chain Reaction/methods
- Polymerase Chain Reaction/statistics & numerical data
- Sensitivity and Specificity
Collapse
Affiliation(s)
- S Minjolle
- Laboratoire de Bactériologie-Virologie, CHU Pontchaillou, Rennes, France
| | | | | | | | | | | |
Collapse
|
50
|
Abstract
Human herpesvirus (HHV) 6 is a beta-herpes, DNA virus. This virus shows closest homology with cytomegalovirus and HHV-7. Infection usually occurs in infants 6 to 24 months of age, and primary infection may result in roseola. HHV-6 infection in infants is the commonest cause of fever-induced seizures. Infection in adults is seen primarily in immunocompromised hosts with solid organ transplants or in those with human immunodeficiency virus infection. The virus is capable of pronounced interaction in vitro with cytomegalovirus and human immunodeficiency virus and induces immunosuppression and apoptosis. The importance of these interactions in vivo necessitates further investigation. HHV-6 infection may contribute to the pathogenesis of multiple sclerosis. HHV-6 may be diagnosed by viral culture, serology, or polymerase chain reaction.
Collapse
Affiliation(s)
- D H Dockrell
- Division of Infectious Diseases and Internal Medicine, Mayo Clinic Rochester, Minnesota 55905, USA
| | | | | |
Collapse
|