title: Human herpesvirus infections of the central nervous system: laboratory diagnosis based on DNA detection by nested PCR in plasma and cerebrospinal fluid samples.
abstract: Infections of the central nervous systems (CNS) present a diagnostic problem for which an accurate laboratory diagnosis is essential. Invasive practices, such as cerebral biopsy, have been replaced by obtaining a polymerase chain reaction (PCR) diagnosis using cerebral spinal fluid (CSF) as a reference method. Tests on DNA extracted from plasma are noninvasive, thus avoiding all of the collateral effects and patient risks associated with CSF collection. This study aimed to determine whether plasma can replace CSF in nested PCR analysis for the detection of CNS human herpesvirus (HHV) diseases by analysing the proportion of patients whose CSF nested PCR results were positive for CNS HHV who also had the same organism identified by plasma nested PCR. In this study, CSF DNA was used as the "gold standard," and nested PCR was performed on both types of samples. Fifty-two patients with symptoms of nervous system infection were submitted to CSF and blood collection. For the eight HHV, one positive DNA result-in plasma and/or CSF nested PCR-was considered an active HHV infection, whereas the occurrence of two or more HHVs in the same sample was considered a coinfection. HHV infections were positively detected in 27/52 (51.9%) of the CSF and in 32/52 (61.5%) of the plasma, difference not significant, thus nested PCR can be performed on plasma instead of CSF. In conclusion, this findings suggest that plasma as a useful material for the diagnosis of cases where there is any difficulty to perform a CSF puncture.
authors.affiliation: Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, SP, Brazil.
authors.forename: Carla Aparecida Tavares
authors.initials: CA
authors.lastname: Rimério
authors.forename: Renato Souza
authors.initials: RS
authors.lastname: De Oliveira
authors.forename: Murilo Queiroz
authors.initials: MQ
authors.lastname: de Almeida Bonatelli
authors.forename: Anamarli
authors.initials: A
authors.lastname: Nucci
authors.forename: Sandra Cecília Botelho
authors.initials: SC
authors.lastname: Costa
authors.forename: Sandra Helena Alves
authors.initials: SH
authors.lastname: Bonon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020805:Central Nervous System Viral Diseases / Q000175:diagnosis* / Q000821:virology; D002555:Cerebrospinal Fluid / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000379:methods*; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D006564:Herpesviridae / Q000235:genetics / Q000302:isolation & purification*; D006566:Herpesviridae Infections / Q000175:diagnosis* / Q000821:virology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000821:virology*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D004279:DNA, Viral
keywords: CSF; central nervous systems; diagnosis; herpesvirus; nested PCR; plasma