Key result
Multiplex PCR demonstrated a higher sensitivity (76.1% vs 65.9%) and significantly fewer false-negatives (P=0.013) compared to real-time RT-PCR for detecting enterovirus in pediatric patients.
Why the study?
Viral encephalitis is common in childhood with enterovirus accounting for the majority, and atypical clinical manifestations make pathogenic testing important for diagnosis. The study evaluated the performance of multiplex PCR compared with quantitative real-time PCR for enterovirus detection.
Does multiplex PCR improve the diagnostic sensitivity for enterovirus detection in cerebrospinal fluid compared to real-time RT-PCR in children with suspected viral encephalitis?
Case-Control (n=103)
No
Does multiplex PCR improve the diagnostic sensitivity for enterovirus detection in cerebrospinal fluid compared to real-time RT-PCR in children with suspected viral encephalitis?
Multiplex PCR is more sensitive and clinically consistent than single-target real-time PCR for identifying enterovirus and co-infections in pediatric cerebrospinal fluid.
May support multiplex PCR for improved enterovirus detection in pediatric CSF; leaves open need for prospective validation before practice change.
BACKGROUND: Viral encephalitis is common in childhood. It is an acute brain parenchymal inflammation caused by a variety of viral infection, and enterovirus accounts for the majority. Due to atypical clinical manifestations, pathogenic testing is important for assisting clinical diagnosis. The purpose of this study was to evaluate the performance of the multiplex PCR assay compared with quantitative real-time PCR for enterovirus detection. METHODS: A prospective case-control study was performed involving 103 pediatric patients suspected for viral encephalitis and cerebrospinal fluid (CSF) samples were collected and tested for 9 pathogens using multiplex PCR assay during April to November in 2018. In parallel, an aliquot of samples was tested for enterovirus infection by real-time PCR assay. RESULTS: There were 85.4% children were confirmed as viral encephalitis on discharge, the remaining ones were diagnosed as other CNS diseases, such as epilepsy. The specificity of the two methods was the same as that of the clinical diagnosis, but the sensitivity and consistency with clinical diagnosis of multiplex PCR were both higher than the real-time PCR. Besides of enterovirus, multiplex PCR could also detect coinfection of enterovirus with Epstein-Barr virus and mumps virus. CONCLUSION: Results of multiplex PCR method are more consistent with the clinical diagnosis and are superior to real-time PCR for detecting enterovirus in CSF.
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You et al. (2020) conducted a case-control in Suspected viral encephalitis (n=103). Multiplex PCR assay vs. Real-time RT-PCR assay was evaluated on Sensitivity for enterovirus detection in cerebrospinal fluid (p=0.013). Multiplex PCR demonstrated a higher sensitivity (76.1% vs 65.9%) and significantly fewer false-negatives (P=0.013) compared to real-time RT-PCR for detecting enterovirus in pediatric patients.
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