Molecular analysis of cerebrospinal fluid in viral diseases of the central nervous system.
The use of nucleic acid (NA) amplification techniques has transformed the diagnosis of viral infections of the central nervous system (CNS). Because of their enhanced sensitivity, these methods enable detection of even low amounts of viral genomes in cerebrospinal fluid. Following more than 10 years of experience, the polymerase chain reaction or other NA-based amplification techniques are nowadays performed in most diagnostic laboratories and have become the test of choice for the diagnosis of several viral CNS infections, such as herpes encephalitis, enterovirus meningitis and other viral infections occurring in human immunodeficiency virus-infected persons. Furthermore, they have been useful to establish a viral etiology in neurological syndromes of dubious origin and to recognise unusual or poorly characterised CNS diseases. Quantitative methods have provided a valuable additional tool for clinical management of these diseases, whereas post-amplification techniques have enabled precise genome characterisation. Current efforts are aiming at further improvement of the diagnostic efficiency of molecular techniques, their speed and standardisation, and to reduce the costs. The most relevant NA amplification strategies and clinical applications of to date will be the object of this review.
Cinque
Paola
P
Clinic of Infectious Diseases, San Raffaele Hospital, Via Stamira d'Ancona, 20, 20127, Milan, Italy. paola.cinque@hsr.it
Bossolasco
Simona
S
Lundkvist
Ake
A
D017088:AIDS-Related Opportunistic Infections / Q000134:cerebrospinal fluid / Q000821:virology; D002493:Central Nervous System Diseases / Q000134:cerebrospinal fluid* / Q000209:etiology / Q000821:virology; D002555:Cerebrospinal Fluid / Q000821:virology; D016384:Consensus Sequence; D003362:Cost-Benefit Analysis; D017931:DNA Primers; D004279:DNA, Viral / Q000134:cerebrospinal fluid*; D018792:Encephalitis, Viral / Q000134:cerebrospinal fluid / Q000821:virology; D005188:False Negative Reactions; D005189:False Positive Reactions; D006801:Humans; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid / Q000821:virology; D021141:Nucleic Acid Amplification Techniques / Q000191:economics / Q000592:standards; D016133:Polymerase Chain Reaction / Q000379:methods; D011786:Quality Control; D012367:RNA, Viral / Q000134:cerebrospinal fluid*; D012680:Sensitivity and Specificity; D014777:Virus Diseases / Q000134:cerebrospinal fluid*
D017931:DNA Primers; D004279:DNA, Viral; D012367:RNA, Viral