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Clinical application of viral cerebrospinal fluid PCR testing for diagnosis of central nervous system disorders: a retrospective 11-year experience.
Diagn Microbiol Infect Dis. 2014 Nov; 80(3):207-15.DM

Abstract

The cerebrospinal fluid (CSF) polymerase chain reaction (PCR) is the gold standard to detect cerebral viral activity. As positive findings do not prove an impact on the neurological disorder, data interpretation is difficult. To better assess the impact of positive CSF PCR findings in different neurological diseases and to identify coherences facilitating CSF PCR data interpretation, we performed this retrospective analysis of CSF PCR data of 481 pediatric and 2604 adult patients, including herpes simplex virus (HSV), varicella zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus 6 (HHV-6), and enteroviruses (EV). Nucleic acid of EBV was detected in 1.6% (39/2449), of VZV in 1.3% (34/2624), of HSV in 1.24% (37/2994), of EV in 0.4% (10/2364), of HHV-6 in 0.17% (4/2417), and of CMV in 0.2% (5/2514) of the patients. Newborns and elderly people showed highest infection rates. HSV, VZV, and EV prevailed in typical infectious central nervous system (CNS) diseases; EBV, in further inflammatory neurological diseases; HSV and EBV, in immunocompromised patients; and EBV, HSV, and HHV-6, in further non-inflammatory neurological diseases. Analysis of successive PCR studies revealed delayed viral detection for EBV (6/147) and HSV (1/217), respectively. Rapid viral clearance was typical for HSV, VZV, CMV, and EV infections, although the maximum duration of viral detection was 15days for HSV and 12days for VZV, respectively. This suggests that the detection of HSV, VZV, CMV, and EV strongly indicates symptomatic viral CNS disease. Secondary viral reactivation mostly underlies positive EBV and HHV-6 findings. Their detection does not rule out clinical impact but recommends searching for additional underlying conditions.

Authors+Show Affiliations

Division of Virology, Medical University of Innsbruck, Innsbruck, Austria. Electronic address: mkleines@ukaachen.de.Department of Infection Control and Infectious Diseases, RWTH Aachen University Hospital, Aachen, Germany. Electronic address: sscheithauer@ukaachen.de.Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany. Electronic address: jschiefer@ukaachen.de.Department of Pediatrics, Division of Pediatric Neurology and Social Pediatrics, RWTH Aachen University Hospital, Aachen, Germany. Electronic address: haeusler@rwth-aachen.de.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25178670

Citation

Kleines, Michael, et al. "Clinical Application of Viral Cerebrospinal Fluid PCR Testing for Diagnosis of Central Nervous System Disorders: a Retrospective 11-year Experience." Diagnostic Microbiology and Infectious Disease, vol. 80, no. 3, 2014, pp. 207-15.
Kleines M, Scheithauer S, Schiefer J, et al. Clinical application of viral cerebrospinal fluid PCR testing for diagnosis of central nervous system disorders: a retrospective 11-year experience. Diagn Microbiol Infect Dis. 2014;80(3):207-15.
Kleines, M., Scheithauer, S., Schiefer, J., & Häusler, M. (2014). Clinical application of viral cerebrospinal fluid PCR testing for diagnosis of central nervous system disorders: a retrospective 11-year experience. Diagnostic Microbiology and Infectious Disease, 80(3), 207-15. https://doi.org/10.1016/j.diagmicrobio.2014.07.010
Kleines M, et al. Clinical Application of Viral Cerebrospinal Fluid PCR Testing for Diagnosis of Central Nervous System Disorders: a Retrospective 11-year Experience. Diagn Microbiol Infect Dis. 2014;80(3):207-15. PubMed PMID: 25178670.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical application of viral cerebrospinal fluid PCR testing for diagnosis of central nervous system disorders: a retrospective 11-year experience. AU - Kleines,Michael, AU - Scheithauer,Simone, AU - Schiefer,Johannes, AU - Häusler,Martin, Y1 - 2014/08/06/ PY - 2013/12/06/received PY - 2014/07/27/revised PY - 2014/07/28/accepted PY - 2014/9/3/entrez PY - 2014/9/3/pubmed PY - 2015/7/15/medline KW - Cerebrospinal fluid analysis KW - Cytomegalovirus KW - Enteroviruses KW - Epstein–Barr virus KW - Herpes simplex virus KW - Human herpesvirus type 6 KW - Human immunodeficiency virus infection KW - PCR KW - Stroke KW - Virobiome SP - 207 EP - 15 JF - Diagnostic microbiology and infectious disease JO - Diagn Microbiol Infect Dis VL - 80 IS - 3 N2 - The cerebrospinal fluid (CSF) polymerase chain reaction (PCR) is the gold standard to detect cerebral viral activity. As positive findings do not prove an impact on the neurological disorder, data interpretation is difficult. To better assess the impact of positive CSF PCR findings in different neurological diseases and to identify coherences facilitating CSF PCR data interpretation, we performed this retrospective analysis of CSF PCR data of 481 pediatric and 2604 adult patients, including herpes simplex virus (HSV), varicella zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus 6 (HHV-6), and enteroviruses (EV). Nucleic acid of EBV was detected in 1.6% (39/2449), of VZV in 1.3% (34/2624), of HSV in 1.24% (37/2994), of EV in 0.4% (10/2364), of HHV-6 in 0.17% (4/2417), and of CMV in 0.2% (5/2514) of the patients. Newborns and elderly people showed highest infection rates. HSV, VZV, and EV prevailed in typical infectious central nervous system (CNS) diseases; EBV, in further inflammatory neurological diseases; HSV and EBV, in immunocompromised patients; and EBV, HSV, and HHV-6, in further non-inflammatory neurological diseases. Analysis of successive PCR studies revealed delayed viral detection for EBV (6/147) and HSV (1/217), respectively. Rapid viral clearance was typical for HSV, VZV, CMV, and EV infections, although the maximum duration of viral detection was 15days for HSV and 12days for VZV, respectively. This suggests that the detection of HSV, VZV, CMV, and EV strongly indicates symptomatic viral CNS disease. Secondary viral reactivation mostly underlies positive EBV and HHV-6 findings. Their detection does not rule out clinical impact but recommends searching for additional underlying conditions. SN - 1879-0070 UR - https://www.unboundmedicine.com/medline/citation/25178670/Clinical_application_of_viral_cerebrospinal_fluid_PCR_testing_for_diagnosis_of_central_nervous_system_disorders:_a_retrospective_11_year_experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0732-8893(14)00316-2 DB - PRIME DP - Unbound Medicine ER -