Kahraman Hasip, Tünger Alper, Şenol Şebnem, Gazi Hörü, Avcı Meltem, Örmen Bahar, Türker Nesrin, Atalay Sabri, Köse Şükran, Ulusoy Sercan, Işıkgöz Taşbakan Meltem, Sipahi Oğuz Reşat, Yamazhan Tansu, Gülay Zeynep, Alp Çavuş Sema, Pullukçu Hüsnü
Sabuncuoglu Serefeddin Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Amasya, Turkey.
Mikrobiyol Bul. 2017 Jul;51(3):277-285. doi: 10.5578/mb.57358.
In this multicenter prospective cohort study, it was aimed to evaluate the bacterial and viral etiology in community-acquired central nervous system infections by standart bacteriological culture and multiplex polymerase chain reaction (PCR) methods. Patients hospitalized with central nervous system infections between April 2012 and February 2014 were enrolled in the study. Demographic and clinical information of the patients were collected prospectively. Cerebrospinal fluid (CSF) samples of the patients were examined by standart bacteriological culture methods, bacterial multiplex PCR (Seeplex meningitis-B ACE Detection (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes, Group B streptococci) and viral multiplex PCR (Seeplex meningitis-V1 ACE Detection kits herpes simplex virus-1 (HSV1), herpes simplex virus-2 (HSV2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein Barr virus (EBV) and human herpes virus 6 (HHV6)) (Seeplex meningitis-V2 ACE Detection kit (enteroviruses)). Patients were classified as purulent meningitis, aseptic meningitis and encephalitis according to their clinical, CSF (leukocyte level, predominant cell type, protein and glucose (blood/CSF) levels) and cranial imaging results. Patients who were infected with a pathogen other than the detection of the kit or diagnosed as chronic meningitis and other diseases during the follow up, were excluded from the study. A total of 79 patients (28 female, 51 male, aged 42.1 ± 18.5) fulfilled the study inclusion criteria. A total of 46 patients were classified in purulent meningitis group whereas 33 were in aseptic meningitis/encephalitis group. Pathogens were detected by multiplex PCR in 41 patients. CSF cultures were positive in 10 (21.7%) patients (nine S.pneumoniae, one H.influenzae) and PCR were positive for 27 (58.6%) patients in purulent meningitis group. In this group one type of bacteria were detected in 18 patients (14 S.pneumoniae, two N.meningitidis, one H.influenzae, one L.monocytogenes). Besides, it is noteworthy that multiple pathogens were detected such as bacteria-virus combination in eight patients and two different bacteria in one patient. In the aseptic meningitis/encephalitis group, pathogens were detected in 14 out of 33 patients; single type of viruses in 11 patients (seven enterovirus, two HSV1, one HSV2, one VZV) and two different viruses were determined in three patients. These data suggest that multiplex PCR methods may increase the isolation rate of pathogens in central nervous system infections. Existence of mixed pathogen growth is remarkable in our study. Further studies are needed for the clinical relevance of this result.
在这项多中心前瞻性队列研究中，旨在通过标准细菌培养和多重聚合酶链反应（PCR）方法评估社区获得性中枢神经系统感染的细菌和病毒病因。2012年4月至2014年2月期间因中枢神经系统感染住院的患者被纳入该研究。前瞻性收集患者的人口统计学和临床信息。患者的脑脊液（CSF）样本通过标准细菌培养方法、细菌多重PCR（Seeplex脑膜炎 - B ACE检测（肺炎链球菌、脑膜炎奈瑟菌、流感嗜血杆菌、单核细胞增生李斯特菌、B组链球菌））和病毒多重PCR（Seeplex脑膜炎 - V1 ACE检测试剂盒检测单纯疱疹病毒1型（HSV1）、单纯疱疹病毒2型（HSV2）、水痘带状疱疹病毒（VZV）、巨细胞病毒（CMV）、爱泼斯坦 - 巴尔病毒（EBV）和人类疱疹病毒6型（HHV6））（Seeplex脑膜炎 - V2 ACE检测试剂盒（肠道病毒））进行检测。根据患者的临床、脑脊液（白细胞水平、主要细胞类型、蛋白质和葡萄糖（血液/脑脊液）水平）及头颅影像学结果，将患者分为化脓性脑膜炎、无菌性脑膜炎和脑炎。在随访期间感染了试剂盒检测以外的病原体或被诊断为慢性脑膜炎及其他疾病的患者被排除在研究之外。共有79例患者（28例女性，51例男性，年龄42.1±18.5岁）符合研究纳入标准。共有46例患者被分类为化脓性脑膜炎组，而33例在无菌性脑膜炎/脑炎组。通过多重PCR在41例患者中检测到病原体。脑脊液培养在10例（21.7%）患者中呈阳性（9例肺炎链球菌，1例流感嗜血杆菌），化脓性脑膜炎组中PCR在27例（58.6%）患者中呈阳性。在该组中，18例患者检测到一种细菌（14例肺炎链球菌，2例脑膜炎奈瑟菌，1例流感嗜血杆菌，1例单核细胞增生李斯特菌）。此外，值得注意的是，8例患者检测到多种病原体，如细菌 - 病毒组合，1例患者检测到两种不同细菌。在无菌性脑膜炎/脑炎组中，33例患者中有14例检测到病原体；11例患者检测到单一类型病毒（7例肠道病毒，2例HSV1，1例HSV2，1例VZV），3例患者检测到两种不同病毒。这些数据表明多重PCR方法可能提高中枢神经系统感染中病原体的分离率。在我们的研究中混合病原体生长的存在很显著。需要进一步研究该结果的临床相关性。
