Molecular diagnosis of neurological herpes virus infection in patients from Medellín

Main Article Content

Olga Lucía Rincón Caballero
Beatriz Helena Aristizábal Bernal

Abstract

Objective: To describe the frequency and the clinical and laboratory characteristics of infections with cytomegalovirus (CMV), Epstein-Barr (EBV) and herpes simplex virus 1 and 2 (HSV 1 and HSV 2) in central nervous system in both immunocompetent and immunocompromised patients.


Methods: A total of 204 cerebrospinal fluid samples were tested for CMV, EBV or HSV 1 and 2 using real time PCR as a molecular diagnostic tool for detection of infection.


Results: Sixteen percent of cerebrospinal fluid was positive for at least one of the viruses, and Epstein Barr virus was detected in 22.8% of cases, which is above the infections caused by HSV and CMV. 61.9% of positive patients had some form of immune compromise.


Conclusions: The use of real-time PCR identifies the causative agent of infection in the central nervous system and is of great help in immunocompromised patients where clinical and laboratory variations are inconclusive; this will also help to implement a specific therapy.

Keywords:
meningitis, aseptic, encephalitis, viral, cytomegalovirus, Epstein-Barr virus infections, implexvirus, polymerase chain reaction, cerebrospinal fluid

Article Details

Author Biographies

Olga Lucía Rincón Caballero, Hospital Pablo Tobon Uribe

Pablo Tobón Uribe Hospital. Medellin Colombia.

Beatriz Helena Aristizábal Bernal, Hospital Pablo Tobon Uribe

Pablo Tobón Uribe Hospital. Medellin Colombia.

References

Freire MC, Cisterna DM, Rivero K, Palacios GF, Casas I, Tenorio A, et al. Analysis of an outbreak of viral meningitis in the province of Tucuman, Argentina. Rev Panam Salud Publica. 2003 Jul;14(1):24.

Debiasi R, Tyler K. Molecular methods for diagnosis of viral encephalitis. Clin Microbiol Rev. 2004 Oct;17(4):903-25.

Irani D. Aseptic meningitis and viral myelitis. Neurol Clin. 2008 Aug;26(3):635-55, vii-viii.

Davis L, Tyler K. Molecular diagnosis of CNS viral infections. J Neurol Neurosurg Psychiatry. 2005 Jan;76(1):10.

Morales Bedoya A, Alonso Palacio LM. Epidemiologia de la meningitis. Salud Uninorte. 2006;22(2):105-20.

Doja A, Bitnun A, Ford Jones E, Richardson S, Tellier R, Petric M, et al. Pediatric Epstein-Barr virus-associated encephalitis: 10-year review. J Child Neurol. 2006 May;21(5):384-91.

Weber B, Berger A, Rabenau H. Human cytomegalovirus infection: diagnostic potential of recombinant antigens for cytomegalovirus antibody detection. J Virol Methods. 2001 Aug;96(2):157-70.

Busse C, Strubel A, Schnitzler P. Combination of native and recombinant cytomegalovirus antigens in a new ELISA for detection of CMV-specific antibodies. J Clin Virol. 2008 Oct;43(2):137-41.

Kimura H, Ihira M, Enomoto Y, Kawada J, Ito Y, Morishima T, et al. Rapid detection of herpes simplex virus DNA in cerebrospinal fluid: comparison between loop-mediated isothermal amplification and real-time PCR. Med Microbiol Immunol. 2005 Aug;194(4):181-5.

Sauerbrei A, Wutzler P. Novel recombinant ELISA assays for determination of type-specific IgG antibodies against HSV-1 and HSV-2. J Virol Methods. 2007 Sep;144(1-2):138-42.

Bowles R, Yedowitz J, Blaho J. Reconsideration of viral protein immunoblotting for differentiation of human herpes simplex viruses. Diagn Microbiol Infect Dis. 2008 Oct;62(2):167-76.

Soler-CH M, Vergara-F R, Silva-V M, Collao-F X, Navarrete-B E. Detección de enterovirus mediante transcripción reversa y reacción de polimerasa en cadena en líquido cefalorraquídeo de niños con meningitis aséptica. Rev Chil Infectol. 2001;18(3):175- 181.

Romero JR. Reverse-transcription polymerase chain reaction detection of the enteroviruses. Arch Pathol Lab Med. 1999 Dec;123(12):1161-9.

Quereda C, Corral I, Laguna F, Valencia M, Tenorio A, Echeverria J, et al. Diagnostic utility of a multiplex herpesvirus PCR assay performed with cerebrospinal fluid from human immunodeficiency virus-infected patients with neurological disorders. J Clin Microbiol. 2000 Aug;38(8):3061-7.

Glaser C, Gilliam S, Schnurr D, Forghani B, Honarmand S, Khetsuriani N, et al. In search of encephalitis etiologies: diagnostic challenges in the California Encephalitis Project, 1998-2000. Clin Infect Dis. 2003 Mar;36(6):731-42.

Pérez-Ruiz M, Vicente D, Navarro-Marí J. [Autochthonous acute viral and bacterial infections of the central nervous system (meningitis and encephalitis]. Enferm Infecc Microbiol Clin. 2008 Jul;26 Suppl 9:8-14.

Davies NW, Brown LJ, Gonde J, Irish D, Robinson RO, Swan AV, et al. Factors influencing PCR detection of viruses in cerebrospinal fluid of patients with suspected CNS infections. J Neurol Neurosurg Psychiatry. 2005 Jan;76(1):82-7.

García Moncó JC. Encefalitis agudas. Neurolgía. 2010;25:11-7.

Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J. 2008;5:47

DeBiasi RL, Kleinschmidt-DeMasters BK, RichardsonBurns S, Tyler KL. Central nervous system apoptosis in human herpes simplex virus and cytomegalovirus encephalitis. J Infect Dis. 2002 Dec;186(11):1547-57.

Okano M. Epstein-Barr virus in patients wiht immunodeficiecy disorders. Biomed Pharmacother. 2001;55: 353-61.

Chesky M, Scalco R, Failace L, Read S, Jobim LF. Polymerase chain reaction for the laboratory diagnosis of aseptic meningitis and encephalitis. Arq Neuropsiquiatr. 2000 Sep;58(3B):836-42

Chadwick DR. Viral meningitis. Br Med Bull. 2006 Feb 10;75-76:1-14.

Bulakbasi N, Kocaoglu M. Central nervous system infections of herpesvirus family. Neuroimaging Clin N Am. 2008 Feb;18(1):53-84; viii.

Read SJ, Jeffery KJ, Bangham CR. Aseptic meningitis and encephalitis: the role of PCR in the diagnostic laboratory. J Clin Microbiol. 1997 Mar;35(3):691-6.

Mendoza LP, Bronzoni RV, Takayanagui OM, Aquino VH, Figueiredo LT. Viral infections of the central nervous system in Brazil. J Infect. 2007 Jun;54(6):589-96.

Big C, Reineck LA, Aronoff DM. Viral infections of the central nervous system:a case-based review. Clin Med Res. 2009 Dec;7(4):142-6.

Pinto Junior VL, Rebelo MC, Costa EV, Silva EE, Bóia MN. Description of a widespread outbreak of aseptic meningitis due to echovirus 30 in Rio de Janeiro state, Brazil. Braz J Infect Dis. 2009 Oct;13(5):367-70.

DeBiasi RL, Kleinschmidt-DeMasters BK, Weinberg A, Tyler KL. Use of PCR for the diagnosis of herpesvirus infections of the central nervous system. J ClinVirol. 2002 Jul;25 Suppl 1:S5-11.

Kashyap RS, Kainthla RP, Mudaliar AV, Purohit HJ, Taori GM, Daginawala HF. Cerebrospinal fluid adenosine deaminase activity: a complimentary tool in the early diagnosis of tuberculous meningitis. Cerebrospinal Fluid Res. 2006;3:5.

Moghtaderi A, Niazi A, Alavi-Naini R, Yaghoobi S, Narouie B. Comparative analysis of cerebrospinal fluid adenosine deaminase in tuberculous and nontuberculous meningitis. Clin Neurol Neurosurg. 2010 Jul;112(6):459-62.

Saddawi-Konefka R, Crawford JR. Chronic viral infection and primary central nervous system malignancy. J Neuroimmune Pharmacol. 2010 Sep;5(3):387-403.

Tunkel A, Glaser C, Bloch K, Sejvar J, Marra C, Roos K, et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008 Aug;47(3):303-27.

Rincón Caballero OL, Aristizábal Bernal BH. Utilidad diagnóstica de la amplificación isotérmica con la formación de asas (LAMP) para la detección de ADN de citomegalovirus, Epstein Barr y herpes simple 1 y 2 en muestras biológicas: revisión sistemática. Hechos Microbiológicos. 2010;1(1):41-8.

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