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PCR for the diagnosis of enteroviral meningitis
1Department of Infectious Diseases, University of Lund, Malmö General Hospital, Sweden.
Abstract:
A 2-step 'semi-nested' enterovirus PCR was developed and applied to CSF and serum specimens from 27 consecutive patients with aseptic meningitis. CSF and sera from 8 patients with non-enteroviral diagnoses were included as negative clinical controls. Enterovirus RNA was detected in CSF by PCR in 15 of the patients with aseptic meningitis, compared with 6 by virus culture. Acute-phase sera proved positive for enterovirus RNA in 11 patients, thus increasing the number of PCR-positive patients to 18. Convalescent-phase sera were all negative by PCR. The correlation of a positive or negative PCR result in CSF and/or serum versus combined conventional virology (serology and isolation from 1-3 sites, i.e. CSF, stool and throat) was 78%. All negative controls were negative by PCR. PCR is a reliable and sensitive diagnostic tool for the detection of enteroviral infections. Both CSF and acute-phase serum should be considered for testing.
Insights
A new PCR test accurately detects enterovirus RNA in cerebrospinal fluid (CSF) and acute-phase serum. This molecular diagnostic method improves upon traditional virus culture for aseptic meningitis diagnosis.
Area of Science:
- Virology
- Molecular Diagnostics
- Infectious Diseases
Background:
- Aseptic meningitis is often caused by enteroviruses, but conventional diagnostic methods can be slow or have low sensitivity.
- Early and accurate diagnosis is crucial for patient management and understanding disease epidemiology.
Purpose of the Study:
- To develop and evaluate a sensitive semi-nested enterovirus polymerase chain reaction (PCR) assay.
- To compare the diagnostic yield of PCR in cerebrospinal fluid (CSF) and serum with conventional methods.
Main Methods:
- A 2-step semi-nested enterovirus PCR assay was developed.
- The assay was applied to CSF and serum samples from 27 patients with aseptic meningitis and 8 control patients.
- Results were compared with virus culture, serology, and isolation from multiple sites.
Main Results:
- Enterovirus RNA was detected by PCR in 15/27 CSF samples, compared to 6/27 by culture.
- PCR detected enterovirus RNA in acute-phase sera from 11/27 patients, increasing the total PCR-positive cases to 18.
- The PCR assay showed 78% correlation with combined conventional virology and correctly identified all negative controls.
Conclusions:
- Semi-nested enterovirus PCR is a reliable and sensitive diagnostic tool for aseptic meningitis.
- Testing both CSF and acute-phase serum enhances diagnostic yield.
- PCR offers a significant improvement over traditional methods for enterovirus detection.