Virological testing of cerebrospinal fluid in children aged less than 14 years with a suspected central nervous system infection: A retrospective study on 304 consecutive children from January 2012 to May 2015

• Published in: European journal of paediatric neurology 2016-07, Vol.20 (4), p.588-596
• Main Authors: Parisi, Saverio G., Basso, Monica, Del Vecchio, Claudia, Andreis, Samantha, Franchin, Elisa, Bello, Federico Dal, Pagni, Silvana, Biasolo, Maria Angela, Manganelli, Riccardo, Barzon, Luisa, Palù, Giorgio
• Format: Article
• Language: English
• Subjects: Adenoviridae - genetics; Adenoviridae Infections - cerebrospinal fluid; Adenoviridae Infections - epidemiology; Adenovirus; Central Nervous System Infections - cerebrospinal fluid; Central Nervous System Infections - epidemiology; Central Nervous System Infections - virology; Child; Child, Preschool; CSF; Cytomegalovirus; Cytomegalovirus - genetics; Cytomegalovirus Infections - cerebrospinal fluid; Cytomegalovirus Infections - epidemiology; DNA, Viral - cerebrospinal fluid; Encephalitis, Herpes Simplex - cerebrospinal fluid; Encephalitis, Herpes Simplex - epidemiology; Encephalitis, Varicella Zoster - cerebrospinal fluid; Encephalitis, Varicella Zoster - epidemiology; Enterovirus; Enterovirus - genetics; Enterovirus Infections - cerebrospinal fluid; Enterovirus Infections - epidemiology; Epstein-Barr virus; Epstein-Barr Virus Infections - cerebrospinal fluid; Epstein-Barr Virus Infections - epidemiology; Female; Herpes Simplex - genetics; Herpesviridae Infections - cerebrospinal fluid; Herpesviridae Infections - epidemiology; Herpesvirus; Herpesvirus 3, Human - genetics; Herpesvirus 4, Human - genetics; Herpesvirus 6, Human - genetics; Herpesvirus 7, Human - genetics; Herpesvirus 8, Human - genetics; HHV-7; Human herpesvirus 6; Human herpesvirus 7; Human herpesvirus 8; Humans; In house real time PCR; Infant, Newborn; Italy - epidemiology; Male; Parechovirus - genetics; Parvoviridae Infections - cerebrospinal fluid; Parvoviridae Infections - epidemiology; Parvovirus; Parvovirus B19, Human - genetics; Picornaviridae Infections - cerebrospinal fluid; Picornaviridae Infections - epidemiology; Prevalence; Real-Time Polymerase Chain Reaction; Retrospective Studies; RNA, Viral - cerebrospinal fluid; Roseolovirus Infections - cerebrospinal fluid; Roseolovirus Infections - epidemiology; Streptococcus pneumoniae; Varicella-zoster virus; Virus Diseases - cerebrospinal fluid; Virus Diseases - epidemiology; Virus Diseases - virology
• ISSN: 1090-3798; 1532-2130
• DOI: 10.1016/j.ejpn.2016.04.002

The study aimed to describe the prevalence of HSV DNA, VZV DNA, Enterovirus RNA, Parechovirus RNA, CMV DNA, EBV DNA, adenovirus DNA, HHV-6 DNA, HHV-7 DNA, HHV-8 DNA and Parvovirus B19DNA in children aged less 14 years with a suspected viral infection of the central nervous system in a clinical practice setting. Between January 2012 and May 2015, cerebrospinal fluids from 304 children were tested with an in-house real-time PCR method. A positive PCR was detected in 64 subjects (21%): the mean number of tests performed in patients who showed a viral infection was 7.5, significantly higher (p = 0.001) with respect to that reported in negative samples (6.4). Enterovirus is the leading virus detected: 12 out of the 37 positive children reported were newborns (85.7% of all the newborns with a positive result). The second most frequently identified virus was HHV-7 (5 positive PCR out of 105 samples tested, 4.8%, if we excluded a child with a concomitant S. pneumoniae isolated), a prevalence significantly higher with respect to VZV (p = 0.02) and to CMV (p = 0.04). HHV-6 was the third most commonly identified aetiology (4.2%). All children were immunocompetent. Only a minority of children had a specific viral aetiology identified: the rate of HHV-7 positivity suggests a routine testing of these viruses within the diagnostic algorithm in immunocompetent paediatric patients. This approach could help to define the clinical role of this herpesvirus. •Viral detection rate in CSF in case of suspected CNS infection is low.•Enterovirus is the most frequent aetiology in newborns.•HHV-7 is the second most commonly virus detected in CSF of immunocompetent children.