Detection and Quantification of Enterovirus 71 Genome from Cerebrospinal Fluid of an Encephalitis Patient by PCR Applications

Enterovirus 71 (EV71) is one of the causative agents of hand, foot, and mouth disease (HFMD) and is known to cause encephalitis, but several reports have identified EV71 in cerebrospinal fluid (CSF). We detected EV71 in CSF from a 20-month-old infant. The patient was diagnosed with brainstem encephalitis associated with HFMD. The clinical features of the patient were high fever (39.1C) and myoclonic jerks, and magnetic resonance imaging of the brain showed a bright signal area around the 4th ventricle. From a nasopharyngeal swab and rectal swab, EV71 was detected using reverse transcription (RT)-nested polymerase chain reaction (PCR). From CSF, the EV71 genome was identified using pan-enterovirus RT-nested PCR and sequencing. By real-time PCR, the nasopharyngeal swab, rectal swab, and CSF contained 1.8 x 10(4), 9.8 x 10(4), and 1.8 x 10 copies of the EV71 genome/microL, respectively. The enterovirus could only be isolated by cell culture from the rectal swab, and it was identified by a neutralization test using EV71-specific antiserum. RT-nested PCR and real-time PCR are considered to be sensitive tools for EV71 diagnosis in CSF.