Metzger C, Terletskaia-Ladwig E, Hess R D, Enders G
Labor Prof. G.Enders & Partner u. Institut für Virologie, Infektiologie und Epidemiologie e.V. S Stuttgart.
Dtsch Med Wochenschr. 2001 Mar 16;126(11):289-93. doi: 10.1055/s-2001-11880.
Demonstration of the causative pathogen by isolating the virus in cell culture is taken as the standard in the diagnosis of diseases caused by enterovirus. When diagnosing the virus in cerebrospinal fluid (CSF), isolation of the virus has been largely replaced by the rapid demonstration of the virus using the reverse transcriptase polymerase chain reaction (RT-PCR), because of its greater sensitivity. The serological diagnosis is mostly made with the complement binding reaction (CBR). A new enzyme immunoassay for demonstrating anti-enterovirus IGM antibodies (IgM-EIA) allows a more rapid diagnosis from a single serum sample. It was the aim of this study to compare the diagnostic value of these various tests.
Several methods for demonstrating virus from faeces, swabs and CSF (virus isolation in cell culture and RT-PCR) and of antibodies in serum (IgM-EIA and CBR) were compared. The clinical material was obtained largely from children under the age of 10 years, many of whom had serous meningitis, flu-like symptoms or enteritis. In one cohort (C1), only stool or throat swabs were available for each of 154 patients. In the other cohort (C2) of 164 patients, CSF and at least one serum sample were available in addition to occasional stool samples.
From C1 enteroviruses were isolated from 32 patients. rotavirus twice from stool or throat swab and rotavirus once from stool or throat swab, and herpes simplex once from throat swab. RT-PCR was positive 55 times for enterovirus, five times false-negative when the virus had been isolated. In C2 enterovirus nucleic acid was demonstrated in 43 patients from CSF. Parallel serological tests gave positive IgM values for 15 patients, while CBR titres were raised in nine.
Complementary tests of CSF, stool, swabs and serum samples by all possible combinations of viral isolation, RT-PCR and IgM-EIA improve the diagnosis of enterovirus-associated diseases. RT-PCR is the method of choice. The serological diagnosis should be confirmed by the demonstration of virus in stool or swab.
通过在细胞培养中分离病毒来证明致病病原体，被视为肠道病毒所致疾病诊断的标准。在诊断脑脊液（CSF）中的病毒时，由于逆转录聚合酶链反应（RT-PCR）的敏感性更高，病毒分离法在很大程度上已被其快速检测病毒的方法所取代。血清学诊断大多采用补体结合反应（CBR）。一种用于检测抗肠道病毒IgM抗体的新型酶免疫测定法（IgM-EIA）能从单个血清样本中实现更快速的诊断。本研究的目的是比较这些不同检测方法的诊断价值。
比较了从粪便、拭子和脑脊液中检测病毒的几种方法（细胞培养中的病毒分离和RT-PCR）以及血清中抗体的检测方法（IgM-EIA和CBR）。临床材料主要取自10岁以下儿童，其中许多人患有浆液性脑膜炎、流感样症状或肠炎。在一个队列（C1）中，154例患者每人仅提供粪便或咽拭子。在另一个164例患者的队列（C2）中，除偶尔有粪便样本外，还可获得脑脊液和至少一份血清样本。
从C1中分离出32例患者的肠道病毒。从粪便或咽拭子中分离出2次轮状病毒，从粪便或咽拭子中分离出1次轮状病毒，从咽拭子中分离出1次单纯疱疹病毒。RT-PCR检测肠道病毒阳性55次，其中病毒分离时出现5次假阴性。在C2中，43例患者的脑脊液中检测到肠道病毒核酸。平行血清学检测显示15例患者IgM值为阳性，而9例患者CBR滴度升高。
通过病毒分离、RT-PCR和IgM-EIA的所有可能组合对脑脊液、粪便、拭子和血清样本进行补充检测，可提高肠道病毒相关疾病的诊断。RT-PCR是首选方法。血清学诊断应通过在粪便或拭子中检测到病毒来确认。
