Marí José María Navarro, Ruiz Mercedes Pérez, Anza Diego Vicente
Hospital Universitario Virgen de las Nieves, Granada, España.
Enferm Infecc Microbiol Clin. 2010 Jan;28 Suppl 1:56-61. doi: 10.1016/S0213-005X(10)70010-0.
Lymphocytic meningitis, mainly those with an acute and benign course, are caused by viruses. In our area, the most commonly involved agents are enteroviruses, herpes simplex, varicella zoster and Toscana viruses. Nucleic acids amplification techniques (NAAT) are the methods of choice to diagnose viral meningitis from cerebrospinal fluid (CSF) samples. They are more rapid and sensitive, and indeed, they are not influenced by the viability of the virus in the clinical specimen as traditional methods are. The development of commercial equipments, the degree of automation, and the use of real-time polymerase chain reaction (PCR) systems are the most important premises to choose the molecular method in each laboratory. Recently, commercial kits of real-time PCR are available for the detection of enteroviruses and herpesviruses, which are the most frequently viruses involved in meningitis. Although NAAT from the clinical sample have replaced cell culture for diagnostic purposes, the combination of both methods remain useful. When the detection of the causal agent from the CSF sample is not possible, other specimens (pharyngeal exudates, stools) or serological methods can be used. Serology is the reference method for meningitis caused by West Nile virus and lymphocytic choriomeningitis virus, which are less frequently detected in our area.
淋巴细胞性脑膜炎，主要是那些病程呈急性且良性的，由病毒引起。在我们地区，最常涉及的病原体是肠道病毒、单纯疱疹病毒、水痘带状疱疹病毒和托斯卡纳病毒。核酸扩增技术（NAAT）是从脑脊液（CSF）样本中诊断病毒性脑膜炎的首选方法。它们更快、更灵敏，而且实际上，它们不像传统方法那样受临床标本中病毒活力的影响。商业设备的发展、自动化程度以及实时聚合酶链反应（PCR）系统的使用是每个实验室选择分子方法的最重要前提。最近，有用于检测肠道病毒和疱疹病毒的实时PCR商业试剂盒，它们是脑膜炎中最常涉及的病毒。尽管从临床样本进行的NAAT已取代细胞培养用于诊断目的，但两种方法的联合使用仍然有用。当无法从脑脊液样本中检测到病原体时，可以使用其他标本（咽部分泌物、粪便）或血清学方法。血清学是西尼罗河病毒和淋巴细胞性脉络丛脑膜炎病毒引起的脑膜炎的参考方法，在我们地区较少检测到这两种病毒。
