Franzen-Röhl Elisabeth, Tiveljung-Lindell Annika, Grillner Lena, Aurelius Elisabeth
Infectious Diseases Unit, Department of Medicine, Solna, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden.
J Clin Microbiol. 2007 Aug;45(8):2516-20. doi: 10.1128/JCM.00141-07. Epub 2007 Jun 13.
Efficient and sensitive diagnostic methods are needed in the management of virus infections in the central nervous system. There is a demand for an evaluation of the sensitivity of PCR methods for early diagnosis of meningitis due to herpes simplex type 2 (HSV-2) and varicella-zoster virus (VZV). The objective of this study was to evaluate real-time PCR in the detection of HSV-2 and VZV DNA from cerebrospinal fluid (CSF) for etiological diagnoses in clinically well-characterized cases of primary and recurrent aseptic meningitis. Samples from 110 patients, 65 of whom were diagnosed with or were strongly suspected of having HSV-2 meningitis and 45 with acute aseptic meningitis of unknown causes, were analyzed. Results were compared with the outcome of nested PCR for HSV-2 infection. Clinical parameters were analyzed in relation to CSF viral load. With real-time PCR, HSV-2 DNA was found in CSF from 80% (52/65) of patients with clinical HSV-2 meningitis compared to 72% (47/65) found by nested PCR. The sensitivity of real-time HSV-2 PCR was found to be 87% (33/38) in primary and 70% (19/27) in recurrent meningitis. The HSV-2 viral load was significantly higher in primary than in recurrent meningitis and correlated with the degree of inflammation. VZV DNA was detected in 2 of 45 samples (4.4%). Real-time PCR for the diagnosis of HSV-2 meningitis was evaluated in a large, clinically well-characterized sample of material and found to identify more cases than nested PCR in the group of patients with recurrent meningitis. Quantification of DNA enables further research of disease prognosis and treatment.
在中枢神经系统病毒感染的管理中，需要高效且灵敏的诊断方法。对于评估聚合酶链反应（PCR）方法对2型单纯疱疹病毒（HSV - 2）和水痘 - 带状疱疹病毒（VZV）所致脑膜炎早期诊断的敏感性存在需求。本研究的目的是评估实时PCR在检测原发性和复发性无菌性脑膜炎临床特征明确病例的脑脊液（CSF）中HSV - 2和VZV DNA以进行病因诊断方面的效果。分析了110例患者的样本，其中65例被诊断为或高度怀疑患有HSV - 2脑膜炎，45例患有病因不明的急性无菌性脑膜炎。将结果与HSV - 2感染的巢式PCR结果进行比较。分析了临床参数与脑脊液病毒载量的关系。采用实时PCR，临床诊断为HSV - 2脑膜炎的患者中，80%（52/65）的脑脊液中检测到HSV - 2 DNA，而巢式PCR检测到的比例为72%（47/65）。实时HSV - 2 PCR在原发性脑膜炎中的敏感性为87%（33/38），在复发性脑膜炎中的敏感性为70%（19/27）。原发性脑膜炎中的HSV - 2病毒载量显著高于复发性脑膜炎，且与炎症程度相关。45份样本中有2份（4.4%）检测到VZV DNA。在一个临床特征明确的大样本材料中评估了实时PCR诊断HSV - 2脑膜炎的效果，发现在复发性脑膜炎患者组中，实时PCR比巢式PCR能检测出更多病例。DNA定量有助于进一步研究疾病预后和治疗。
