Enteroviral meningoencephalitis is the most prevalent meningoencephalitis, which usually subsequent a well prognosis and low mortility;but enterovirus 71 infections manifested as hand-foot-mouth disease or herpangina with encephalitis that subsequent neurological pulmonary edema and substantial mortality in Taiwan since its breakout in 1998. Tentative diagnosis of enterovirus 71 meningoencephalitis depends on individual clinical symptoms, cerebral spinal fluid (CSF) and neurological images. Final confirmation of virus infection includes virus culture, reverse transcription-polymerase chain reaction (RT-PCR) and serology. The aim of this study was to speculate the application of RT-PCR with universal pan-enteroviral and enteroviral 71(EV71) type- specific primers for direct detections of enterovirus in clinical specimens. Here also review the clinical manifestation and findings of neurological MR imagings in enterovirtus 71 encephalitis.
This project enrolled patients diagnosed of erterovirus central nerve system infection, who admitted to the pediatric intensive care unite of China Medical University Hospital between 2000,Jan to 2005,Dec.Four paired of specimens, including throat/recta swabs, cerebral spinal fluid and blood were collected when admitted; one set were sent for RT-PCR and another were for virus culture.
There were total sixty-six patients who met the diagnostic criteria, with specimens conducted both RT-PCR and virus culture. The results showed the positive rate of RT-PCR were higher in throat swabs (74.2%), rectum swabs (68.2%) than in CSF (34.9%) and blood (27.7%). The same results also showed in virus culture, which consisted of throat swabs (30.3%), rectum swabs (16.7%), CSF (1.5%) and blood (3.0%).Also the positive rate in RT-PCR were demonstrated superior to virus culture in each paired of specimens. Identification of enterovirus infection with RT-PCR was as high as 92% with four specimens, in which 65% were subtyped as enterovirus 71.
We concluded the sensitivity of RT-PCR is superior to viral culture, which works with a well identification in clinical diagnosis of pan-EV and EV71 infection.
