Varıcı Balcı Fatma Kamer, Sayıner Ayça Arzu
Dokuz Eylul University Faculty of Medicine, Department of Medical Microbiology, Division of Medical Virology, İzmir, Turkey.
Mikrobiyol Bul. 2019 Oct;53(4):434-441. doi: 10.5578/mb.68012.
Identification of viral agents causing central nervous system (CNS) infections increased by the application of nucleic acid tests. In this study, the results of polymerase chain reaction (PCR) for viral agents were evaluated in cerebrospinal fluid (CSF) samples taken from patients with CNS infection. CSF samples taken from 1185 patients between 2010 and 2017 were tested for the presence of Herpes simplex virus (HSV) type 1 and 2, Varicella Zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), adenovirus ve enterovirus by PCR in Dokuz Eylul University Hospital. Tests were performed according to the clinicians' orders and results were evaluated retrospectively. The number of tests performed were 1038 for HSV, 882 for adenovirus, 865 for enterovirus, 496 for VZV, 100 for EBV and 92 for CMV. Commercial tests were used for EBV, CMV (Artus QS-RGQ Kits, Qiagen, Germany) and enterovirus (GeneXpert, Cepheid, USA) while the other viruses (HSV, VZV, adenovirus) were tested by in-house real-time PCR assays. Ninety-one CSF (7.7%) samples were positive. The mean age was 13 (<1 to 76 years) while median was seven. The most frequently detected pathogens were enterovirus (63/91, 69%) and HSV-1 (14/91,15%). The number of patients positive for adenovirus, VZV, EBV and CMV were five, four, three and two, respectively. In one patient, both enterovirus (Ct: 29.5) and EBV (Ct: 38.53) were positive. The number of positive samples were increased in summer months. Enterovirus RNA positive patients (n= 60/63, 95.2%) were ≤ 18 years old while 29% were younger than one year of age. Enterovirus positive samples peaked in 2012 and 2014 and detected mainly in summer (60.3%) and autumn (20.6%) months. VZV was mostly detected in patients greater than 65 years of age. Mean Ct of the positive reactions was 31.87 ± 3.5 (22.88-40.32). The lowest and the highest Ct values were detected in HSV-1 assay. The mean Ct value of enterovirus assay (30.4; 25.7-35.9) was lower than the other pathogens' values. In the seven-year period, 7.7% of the1185 patients' CSF samples were positive for viral nucleic acids. As expected, enteroviruses were the most common pathogens in children and detected mainly in summer-autumn period. Syndromic approach in CNS infections could increase the viral pathogen detection.
核酸检测的应用增加了引起中枢神经系统（CNS）感染的病毒病原体的检出率。在本研究中，对从CNS感染患者采集的脑脊液（CSF）样本进行了病毒病原体的聚合酶链反应（PCR）检测。2010年至2017年间从1185例患者采集的CSF样本在多库兹艾吕尔大学医院通过PCR检测1型和2型单纯疱疹病毒（HSV）、水痘带状疱疹病毒（VZV）、爱泼斯坦-巴尔病毒（EBV）、巨细胞病毒（CMV）、腺病毒和肠道病毒的存在情况。检测根据临床医生的医嘱进行，结果进行回顾性评估。进行检测的次数分别为：HSV检测1038次、腺病毒检测882次、肠道病毒检测865次、VZV检测496次、EBV检测100次、CMV检测92次。EBV、CMV（德国Qiagen公司的Artus QS-RGQ试剂盒）和肠道病毒（美国Cepheid公司的GeneXpert）采用商业检测试剂盒，而其他病毒（HSV、VZV、腺病毒）通过内部实时PCR检测方法进行检测。91份CSF样本（7.7%）呈阳性。平均年龄为13岁（1岁以下至76岁），中位数为7岁。最常检测到的病原体是肠道病毒（63/91，69%）和HSV-1（14/91，15%）。腺病毒、VZV、EBV和CMV呈阳性的患者人数分别为5例、4例、3例和2例。1例患者的肠道病毒（Ct值：29.5）和EBV（Ct值：38.53）均呈阳性。夏季月份阳性样本数量增加。肠道病毒RNA阳性患者（n = 60/63，95.2%）年龄≤18岁，其中29%小于1岁。肠道病毒阳性样本在2012年和2014年达到峰值，主要在夏季（60.3%）和秋季（20.6%）月份检测到。VZV大多在65岁以上患者中检测到。阳性反应的平均Ct值为31.87±3.5（22.88 - 40.32）。最低和最高Ct值在HSV-1检测中出现。肠道病毒检测的平均Ct值（30.4；25.7 - 35.9）低于其他病原体的值。在这7年期间，1185例患者的CSF样本中有7.7%的病毒核酸呈阳性。正如预期的那样，肠道病毒是儿童中最常见的病原体，主要在夏秋季节检测到。CNS感染的症状学方法可提高病毒病原体检测率。
