Prospective comparison of culture vs genome detection for diagnosis of enteroviral meningitis in childhood
R. E. Tanel, S. Y. Kao, T. M. Niemiec, M. J. Loeffelholz, D. T. Holland, L. A. Shoaf, E. R. Stucky and J. C. Burns
Department of pediatrics, School of Medicine, University of California-San Diego, La Jolla, USA.
OBJECTIVE: To assess the sensitivity and specificity of a new polymerase
chain reaction (PCR) assay with uninterrupted reverse transcription and
complementary DNA amplification (RT-PCR) for the diagnosis of enteroviral
(EV) meningitis in children. DESIGN: A prospective, cohort study. SETTINGS:
Two medical centers: 1 university hospital and 1 children's hospital in San
Diego County, California, during a 5-week period. PATIENTS: All pediatric
patients younger than 16 years who underwent a lumbar puncture for
evaluation of possible meningitis. MAIN OUTCOME MEASURES: The results of
cerebrospinal fluid (CSF) RT-PCR were compared with viral cultures and
clinical histories. RESULTS: During the 5-week period, 90 patients were
entered into the study. Nonpolio EVs were cultured from 10% (9/90) of the
patients from the following sites: CSF, 6.7% (6/90) of the patients; stool,
19% (4/21) of the patients; and throat swabs, 5.6% (1/18) of the patients.
The EV genome was detected in the CSF by using RT-PCR in 7 of 9 EV
culture-positive patients. The sensitivity and specificity of the CSF
RT-PCR assay to detect EV meningitis were 77.8% and 100%, respectively.
This compared with a sensitivity of 66.7% for detection of EV in CSF by
viral culture alone. CONCLUSION: The new RT-PCR assay is a rapid and
reliable method for the detection of EV infection in childhood.
