Marque Juillet S, Lion M, Pilmis B, Tomini E, Dommergues M-A, Laporte S, Foucaud P
Laboratoire de microbiologie du département de biologie, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France.
Arch Pediatr. 2013 Jun;20(6):589-93. doi: 10.1016/j.arcped.2013.03.012. Epub 2013 Apr 28.
Enteroviruses (EV) are a common cause of aseptic meningitis in children. Virological diagnosis of EV meningitis is currently based on the detection of the viral genome in the cerebrospinal fluid (CSF). This study attempted to determine the correlation and the temporality of the polymerase chain reaction (PCR) assay in serum and CSF and to evaluate the possibility of diagnosing EV infection only on the serum PCR. The EV genome was sought by RT real-time PCR (Smart Cycler EV Primer and Probe Set(®), Cepheid) in CSF and serum, collected at the same time, for all children who underwent a lumbar puncture for suspected meningitis, between 1 June and 31 July 2010 at the Versailles Hospital. Forty-four patients were included in the study. EV infection was documented for 22 of them. In 10 patients, the EV genome was detected in CSF only; in 3 patients in serum only, and in 9 patients in both. Among patients with acute EV neurological infection, viremic children were significantly younger (1.6 months versus 5.8 years; P<0.001). Viremia was detected when the serum was sampled within 30 h after the beginning of symptoms. These results confirm previous reports of early and transient viremia in young children. This preliminary study shows the limits and added value of EV PCR in serum. It suggests that in some children and under certain conditions (age >3 months, clinical and biological compatibility with a viral infection, no previous antibiotic therapy, time from symptom onset to blood sampling <30 h, PCR in serum analyzed within 3h), PCR in serum, when positive, is a possible alternative. Therefore, it may be possible to diagnose EV infection without performing a lumbar puncture in a limited number of young children (11.4% of our suspected cases). This study needs to be reinforced by a multicenter study with a broader panel of patients.
肠道病毒（EV）是儿童无菌性脑膜炎的常见病因。目前，EV脑膜炎的病毒学诊断基于脑脊液（CSF）中病毒基因组的检测。本研究旨在确定血清和脑脊液中聚合酶链反应（PCR）检测的相关性和时效性，并评估仅通过血清PCR诊断EV感染的可能性。2010年6月1日至7月31日期间，在凡尔赛医院，对所有因疑似脑膜炎接受腰椎穿刺的儿童，同时采集脑脊液和血清，采用逆转录实时PCR（Smart Cycler EV引物和探针套装（®），赛沛公司）检测EV基因组。44例患者纳入研究，其中22例确诊为EV感染。10例患者仅在脑脊液中检测到EV基因组；3例仅在血清中检测到；9例在脑脊液和血清中均检测到。急性EV神经系统感染患者中，病毒血症患儿年龄显著更小（1.6个月对5.8岁；P<0.001）。症状出现后30小时内采集血清时检测到病毒血症。这些结果证实了先前关于幼儿早期和短暂病毒血症的报道。这项初步研究显示了血清中EV PCR检测的局限性和附加值。研究表明，在某些儿童及特定条件下（年龄>3个月、临床和生物学特征符合病毒感染、未接受过抗生素治疗、症状出现至采血时间<30小时、血清PCR检测在3小时内分析），血清PCR检测结果为阳性时，可能是一种替代方法。因此，在少数幼儿中（我们疑似病例的11.4%），有可能不进行腰椎穿刺而诊断EV感染。本研究需要通过一项纳入更广泛患者群体的多中心研究加以强化。
