Correspondence

Diagnosis of Viral Infections of the Central Nervous System

N Engl J Med 1999; 340:483-484February 11, 1999

Article

To the Editor:

The polymerase chain reaction (PCR) is now the preferable method of detecting infections of the central nervous system due to herpesvirus.1 It is at least as good as cell culture for detecting such infections caused by enteroviruses.2 There is, however, limited information on the usefulness of this technology when it is applied to arboviral infections or on the use of a battery of PCR tests against a broad range of viruses.3 Since July 1997, we have been studying these issues.

The initial set of PCR assays we used was designed to be applied to cerebrospinal fluid or fresh brain tissue to detect herpes simplex virus, varicella–zoster virus, enteroviruses, eastern equine encephalitis virus, California serogroup viruses (e.g., LaCrosse and Jamestown Canyon viruses), Cache Valley virus, and rabies (in saliva). Over the course of a year, St. Louis encephalitis virus, Powassan virus, cytomegalovirus, and Epstein–Barr virus were added to the panel. In the first 17 months (July 1997 to November 1998), specimens from 106 patients were tested, with a detection rate of 35.8 percent (Table 1Table 1Use of PCR Results to Diagnose Central Nervous System Infection in 106 Patients.). More than 95 percent of the specimens received were of cerebrospinal fluid. It was the source of 37 of the 38 positive results, the sole exception being an enterovirus that was detected in brain tissue.

The records of our virologic diagnostic services show that between 1985 and 1997 isolation of virus in cell culture was attempted in the cerebrospinal fluid of 1546 patients, with 156 (10.1 percent) specimens testing positive: 154 for enteroviruses and 2 for herpes simplex viruses. A review of the serologic data collected over a period of four years (1985 to 1988) showed that serum samples from 35 of 305 (11.5 percent) patients were positive when tested for possible infection with arbovirus (eastern equine encephalitis, western equine encephalitis, St. Louis encephalitis, Powassan, LaCrosse, and Jamestown Canyon viruses): 34 were considered to be “probably” infected on the basis of the result of a single serum test, and 1 was confirmed positive (there was a fourfold change in titer between serum samples from the acute and convalescent phases). Thus, in comparison with cell culture and serologic testing, each of which had detection rates of about 10 percent, PCR was a much more accurate method of diagnosing viral central nervous system infections. PCR has the additional advantage of speed; the whole test panel can usually be completed within 72 hours of the receipt of the specimen. Other benefits of PCR relate to its ability to allow targeting of antiviral therapy and to reduce the need for brain biopsy.1

Cinnia Huang, Ph.D.
Nando K. Chatterjee, Ph.D.
Leo J. Grady, Ph.D.
New York State Department of Health, Albany, NY 12201-0509

5 References

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