title: Simultaneous detection of 13 viruses involved in meningoencephalitis using a newly developed multiplex PCR Mag-array system.
abstract: BACKGROUND
  The early detection and identification of pathogens in central nervous system viral infections associated with neurological disease increases the survival rate. However, the limitations of current diagnostic methods contribute to a lack of proper diagnosis in 62% of patients. Therefore, a robust method for detecting multiple viruses in a single reaction with high specificity, throughput, and speed is required.
  
  
  METHODS
  A multiplex PCR Mag-Array (MPMA) system was developed that integrates three strategies: chimeric primer design, temperature switch PCR, and MagPlex-TAG techniques. The MPMA was used to amplify 13 target viral sequences simultaneously, with plasmids containing specific viral sequences as standard samples. To evaluate its clinical performance, 177 cerebrospinal fluid (CSF) samples were tested.
  
  
  RESULTS
  The MPMA system presented high specificity and efficiency in detecting a control panel of 13 plasmids. Among 177 CSF samples, consistent results were achieved for 19 samples pre-tested using a commercial kit. Viral pathogens were found in 28/138 undiagnosed samples, with herpes simplex viruses (HSV-1 and HSV-2) being predominant. The 20 non-infectious samples revealed negative results. Compared to sequencing methods, sensitivity for detecting HSV-1 and HSV-2 was 100% and 98.78%, respectively, and specificity was 100% and 98.22%, respectively.
  
  
  CONCLUSIONS
  A robust MPMA system that can simultaneously and reliably detect 13 meningoencephalitis-associated viruses with high specificity, throughput, and speed has been developed.
authors.affiliation: Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Changle-Xi Road 167, Xi'an 710032, China.
authors.forename: Xiaodan
authors.initials: X
authors.lastname: Shi
authors.affiliation: Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Changle-Xi Road 167, Xi'an 710032, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Wu
authors.affiliation: Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Changle-Xi Road 167, Xi'an 710032, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Shi
authors.affiliation: Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Changle-Xi Road 167, Xi'an 710032, China.
authors.forename: Linfu
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Changle-Xi Road 167, Xi'an 710032, China.
authors.forename: Mengli
authors.initials: M
authors.lastname: Wu
authors.affiliation: Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Changle-Xi Road 167, Xi'an 710032, China.
authors.forename: Yining
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Changle-Xi Road 167, Xi'an 710032, China.
authors.forename: Xinyue
authors.initials: X
authors.lastname: An
authors.affiliation: Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Changle-Xi Road 167, Xi'an 710032, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Dai
authors.affiliation: Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Changle-Xi Road 167, Xi'an 710032, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Tian
authors.affiliation: Key Laboratory for Medical Virology, Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No.155, Changbai Road, Changping District, Beijing 100050, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Key Laboratory for Medical Virology, Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No.155, Changbai Road, Changping District, Beijing 100050, China. Electronic address: maxj@ivdc.chinacdc.cn.
authors.forename: Xuejun
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Changle-Xi Road 167, Xi'an 710032, China. Electronic address: zhaogang@fmmu.edu.cn.
authors.forename: Gang
authors.initials: G
authors.lastname: Zhao
mesh_terms: D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D057230:Limit of Detection; D008297:Male; D008590:Meningoencephalitis / Q000821:virology*; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods*; D014780:Viruses / Q000302:isolation & purification*
chemical_list: D004279:DNA, Viral
keywords: Cerebrospinal fluid; MPMA system; Meningoencephalitis viruses