Amplicor enterovirus polymerase chain reaction in patients with aseptic meningitis: a sensitive test limited by amplification inhibitors.
OBJECTIVE
To evaluate the sensitivity and specificity of reverse-transcription polymerase chain reaction (RT-PCR) and routine cell culture for the detection of enterovirus in cerebrospinal fluid.


METHODS
Thirty-eight cerebrospinal fluid specimens were included. Cell culture was inoculated immediately and incubated for 14 days. An aliquot was kept frozen for Amplicor RT-PCR. Chart review was performed to determine the validity of the results.


RESULTS
Nine of 38 specimens were positive for enterovirus by culture, and 14 were positive by RT-PCR. There were 7 discrepancies between the 2 methods. Six specimens were positive by RT-PCR and negative by the culture method. The 1 culture-positive but RT-PCR--negative specimen was determined to contain PCR inhibitors. All discrepant results were confirmed as true positives by chart review. Patients whose cerebrospinal fluid was negative by both methods had a final diagnosis other than enterovirus infection.


CONCLUSIONS
Amplicor PCR is more sensitive than cell culture (93.3% vs. 60%) and is very specific. With the incorporation of appropriate controls for the detection of amplification inhibitors, RT-PCR could be a valuable tool in the diagnosis of enteroviral meningitis.
Hadziyannis
E
E
Department of Clinical Pathology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Cornish
N
N
Starkey
C
C
Procop
G W
GW
Yen-Lieberman
B
B
D018929:Cell Culture Techniques / Q000379:methods; D002461:Cell Line, Transformed; D002555:Cerebrospinal Fluid / Q000821:virology*; D004770:Enterovirus / Q000235:genetics* / Q000302:isolation & purification; D004769:Enterovirus Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D005069:Evaluation Studies as Topic; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D008582:Meningitis, Aseptic / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D012367:RNA, Viral / Q000032:analysis*; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods*; D012680:Sensitivity and Specificity; D014776:Virus Cultivation
D012367:RNA, Viral