Laboratory Diagnosis of Common Viral Infections of the Central Nervous System by Using a Single Multiplex PCR Screening Assay

ABSTRACT A multiplex PCR assay that detects the four commonest causes of viral meningitis and encephalitis in the United Kingdom (herpes simplex virus [HSV] type 1 [HSV-1], HSV type 2 [HSV-2], varicella-zoster virus [VZV], and enteroviruses) was developed, and its sensitivity was compared with those of similar assays described previously for this application. Compared to the previous assays, this single multiplex PCR assay had higher molecular sensitivities for the detection for each of the viruses and improved utility for routine use in a diagnostic laboratory. The assay was used to test a series of 1,683 consecutive cerebrospinal fluid (CSF) samples between June 1997 and March 1998 inclusively. Viral nucleic acid was detected in 138 (8.2%) of the CSF samples, including enteroviruses in 51 samples, HSV-2 in 33 samples, VZV in 28 samples, and HSV-1 in 25 samples. Compared to the accepted relative incidence of viral etiologies, aseptic meningitis due to HSV-2 infection was high, and in adult female patients with symptoms of aseptic meningitis, HSV-2 was the virus most commonly detected in the CSF.

[1]  R. Pounder,et al.  Detection of herpesvirus DNA in the large intestine of patients with ulcerative colitis and Crohn's disease using the nested polymerase chain reaction , 1992, Journal of medical virology.

[2]  U. Desselberger,et al.  The development of an antigen capture polymerase chain reaction assay to detect and type human enteroviruses. , 1997, Journal of virological methods.

[3]  I. Crawford,et al.  Central nervous system syndromes of "vital" etiology. A study of 713 cases. , 1960, The American journal of medicine.

[4]  K. Jeffery,et al.  Aseptic meningitis and encephalitis: the role of PCR in the diagnostic laboratory , 1997, Journal of clinical microbiology.

[5]  D. Leonard,et al.  Polymerase chain reaction detection and clinical significance of varicella-zoster virus in cerebrospinal fluid from human immunodeficiency virus-infected patients. , 1997, The Journal of infectious diseases.

[6]  A. Widell,et al.  PCR for the diagnosis of enteroviral meningitis. , 1994, Scandinavian journal of infectious diseases.

[7]  T. Niemiec,et al.  Prospective comparison of culture vs genome detection for diagnosis of enteroviral meningitis in childhood. , 1996, Archives of pediatrics & adolescent medicine.

[8]  T. Peto,et al.  Diagnosis of viral infections of the central nervous system: clinical interpretation of PCR results , 1997, The Lancet.

[9]  D. Hober,et al.  Significance and clinical relevance of the detection of herpes simplex virus DNA by the polymerase chain reaction in cerebrospinal fluid from patients with presumed encephalitis. , 1994, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  R. Whitley,et al.  Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. , 1995, The Journal of infectious diseases.

[11]  D. Persing,et al.  Laboratory diagnosis of central nervous system infections with herpes simplex virus by PCR performed with cerebrospinal fluid specimens , 1997, Journal of clinical microbiology.

[12]  P. Tebas,et al.  Herpes simplex virus type 2 meningitis in the absence of genital lesions: improved recognition with use of the polymerase chain reaction. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[13]  S. Yerly,et al.  Rapid and sensitive detection of enteroviruses in specimens from patients with aseptic meningitis , 1996, Journal of clinical microbiology.

[14]  K. Tyler,et al.  Herpes Simplex Virus Infection as a Cause of Benign Recurrent Lymphocytic Meningitis , 1994, Annals of Internal Medicine.

[15]  A. Vaheri,et al.  Herpes encephalitis is a disease of middle aged and elderly people: polymerase chain reaction for detection of herpes simplex virus in the CSF of 516 patients with encephalitis. The Study Group. , 1996, Journal of neurology, neurosurgery, and psychiatry.

[16]  M. Sawyer,et al.  Diagnosis of enteroviral central nervous system infection by polymerase chain reaction during a large community outbreak. , 1994, The Pediatric infectious disease journal.

[17]  M. Salimans,et al.  Rapid and simple method for purification of nucleic acids , 1990, Journal of clinical microbiology.

[18]  P. Martínez-Martín,et al.  Detection of varicella‐zoster virus‐specific DNA sequences in cerebrospinal fluid from patients with acute aseptic meningitis and no cutaneous lesions , 1994, Journal of medical virology.