Información del artículo
El diagnóstico rápido de las infecciones agudas del sistema nervioso central (meningitis y encefalitis), tanto virales como bacterianas, tiene gran trascendencia en el tratamiento clínico del paciente, lo cual ayuda a plantear de forma temprana tratamientos que pueden resolver situaciones con afectación vital, evitar tratamientos empíricos innecesarios, disminuir la estancia hospitalaria y facilitar las actuaciones pertinentes en el ámbito de la salud pública.
Las técnicas moleculares, sobre todo la reacción en cadena de la polimerasa a tiempo real, se han convertido en nuestro medio en el procedimiento diagnóstico más rápido y sensible en el caso de meningitis y encefalitis virales autóctonas, y cada día tienen más protagonismo en el diagnóstico y el control de las meningitis bacterianas agudas más frecuentes.
La automatización y la utilización de sistemas cerrados pueden facilitar la generalización del uso de las técnicas moleculares a la mayoría de los laboratorios para el diagnóstico de estos procesos neurológicos.
Palabras clave:
Meningitis aguda
Encefalitis aguda
Virus
Bacterias
Rapid diagnosis of acute viral and bacterial infections of the central nervous system (meningitis and encephalitis) is highly important for the clinical management of the patient and helps to establish early therapy that may solve life-threatening situations, to avoid unnecessary empirical treatments, to reduce hospital stay, and to facilitate appropriate interventions in the context of public health. Molecular techniques, especially real-time polymerase chain reaction, have become the fastest and most sensitive diagnostic procedures for autochthonous viral meningitis and encephalitis, and their role is becoming increasingly important for the diagnosis and control of most frequent acute bacterial meningitides.
Automatic and closed systems may encourage the widespread and systematic use of molecular techniques for the diagnosis of these neurological syndromes in most laboratories.
Key words:
Acute meningitis
Acute encephalitis
Virases
Bacteria
El Texto completo está disponible en PDF
Bibliografía
[1.]
M.A. Gutiérrez Rodríguez, L. García Comas, I. Rodero Garduño, C. García Fernández, M. Ordobás Gavín, R. Ramírez Fernández.
Red de Vigilancia Epidemiólogica de la Comunidad de Madrid Increase in viral meningitis cases reported in the Autonomous Region of Madrid, Spain, 2006.
Euro Surveill, 11 (2006), pp. E061103.3
[2.]
J.M. Navarro, C. Fernández-Roldán, M. Pérez-Ruiz, S. Sanbonmatsu, M. De la Rosa, M.P. Sánchez-Seco.
Meningitis por virus de la Toscana en España: descripción de 17 casos.
Med Clin (Barc), 122 (2004), pp. 420-422
[3.]
A. De la Loma, G. Trallero, F. De Ory, A. Tenorio, M. Sanz, J.M. Echevarría.
Meningitis linfocitaria. en España: posible situación epidémica en el año 2000.
Med Clin (Barc), 118 (2002), pp. 694-695
[4.]
D. Kaptoul, P.F. Viladrich, C. Domingo, J. Niubó, S. Martínez-Yélamos, F. De Ory, et al.
West Nile virus in Spain: report of the first diagnosed case (in Spain) in a human with aseptic meningitis.
Scand J Infect Dis, 39 (2007), pp. 70-71
[5.]
J. Ledesma, G. Fedele, F. Carro, M.I. Gegúndez, M.P. Sánchez-Seco, L. Lledó, et al.
Caracterización genómica del virus de la coriomeningitis linfocitaria (LCMV) detectado en roedores en España.
IX Congreso Nacional de Virología, pp. 174
[6.]
G. Boivin.
Diagnosis of herpesvirus infections of the central nervous system.
Herpes, 11 (2004), pp. 48A-56A
[7.]
R.L. Debiasi, K.L. Tyler.
Molecular methods for diagnosis of viral encephalitis.
Clin Microbiol Rev, 17 (2004), pp. 903-925
[8.]
M.L. Landry, R. Garner, D. Ferguson.
Real-time nucleic acid sequence-based amplification using molecular beacons for detection of enterovirus RNA in clinical specimens.
J Clin Microbiol, 43 (2005), pp. 3136-3139
[9.]
L.E. Nigrovic, V.W. Chiang.
Cost analysis of enteroviral polymerase chain reaction in infants with fever and cerebrospinal fluid pleocytosis.
Arch Pediatr Adolesc Med, 154 (2000), pp. 817-821
[10.]
J.F. Modlin.
Coxsackieviruses, echoviruses, and newer enteroviruses.
Principles and practice of infectious diseases, 6th ed., pp. 2148-2161
[11.]
D.R. Chadwick.
Viral meningitis.
Br Med Bull, 75-76 (2005), pp. 1-14
[12.]
J.L. Melnick.
Enteroviruses: polioviruses, coxsackieviruses, echoviruses, and newer enteroviruses.
Fields Virology, 3rd ed., pp. 655-712
[13.]
M.S. Oberste, K. Maher, S.M. Michele, G. Belliot, M. Uddin, M.A. Pallansch.
Enteroviruses 76, 89, 90 and 91 represent a novel group within the species Human enterovirus A.
J Gen Virol, 86 (2005), pp. 445-451
[14.]
F.S. Nolte.
Case studies in cost effectiveness of molecular diagnostics for infectious diseases: pulmonary tuberculosis, enteroviral meningitis and BK virus nephropathy.
Clin Infect Dis, 43 (2006), pp. 1463-1467
[15.]
C.B. Kost, B. Rogers, S. Oberste, C. Robinson, B.L. Eaves, K. Leos, et al.
Multicenter beta trial of the GeneXpert Enterovirus assay.
J Clin Microbiol, 45 (2007), pp. 1081-1086
[16.]
H.A. Rotbart, M.H. Sawyer, S. Fast, C. Lewinski, N. Murphy, E.F. Keyser, et al.
Diagnosis of enteroviral meningitis by using PCR with a colorimetric microwell detection assay.
J Clin Microbiol, 32 (1994), pp. 2590-2592
[17.]
M.S. Oberste, K. Maher, D.R. Kilpatrick, M.R. Flemister, B.A. Brown, M.A. Pallansch.
Typing of human enteroviruses by partial sequencing of VP1.
J Clin Microbiol, 37 (1999), pp. 1288-1293
[18.]
I. Casas, G.F. Palacios, G. Trallero, D. Cisterna, M.C. Freire, A. Tenorio.
Molecular characterization of human enteroviruses in clinical samples: comparison between VP2, VP1, and RNA polymerase regions using RT nested PCR assays and direct sequencing of products.
J Med Virol, 65 (2001), pp. 138-148
[19.]
E. Terletskaia-Ladwig, C. Metzger, G. Schalasta, G. Enders.
A new enzyme immunoassay for the detection of enteroviruses in faecal specimens.
J Med Virol, 60 (2000), pp. 439-445
[20.]
I. Casas, F. Pozo, G. Trallero, J.M. Echevarría, A. Tenorio.
Viral diagnosis of neurological infection by RT multiplex PCR: a search for entero- and herpesviruses in a prospective study.
J Med Virol, 57 (1999), pp. 145-151
[21.]
A. Avellón, G. Rubio, G. Palacios, I. Casas, N. Rabella, G. Reina, et al.
Enterovirus 75 and aseptic meningitis, Spain, 2005.
Emerg Infect Dis, 12 (2006), pp. 1609-1610
[22.]
J.M. Echevarría, I. Casas, F. De Ory, A. Tenorio, C. Echevarría, A. Lozano.
Diagnóstico de laboratorio en casos de encefalitis aguda y subaguda de posible etiología vírica.
Neurología, 12 (1997), pp. 381-383
[23.]
Y.W. Tang, P.S. Mitchell, M.J. Espy, T.F. Smith, D.H. Persing.
Molecular diagnosis of herpes simplex virus infections in the central nervous system.
J Clin Microbiol, 37 (1999), pp. 2127-2136
[24.]
M.J. Espy, R. Teo, T.K. Ross, K.A. Svien, A.D. Wold, J.R. Uhl, et al.
Diagnosis of Varicella-Zoster Virus Infections in the Clinical Laboratory by LightCycler PCR.
J Clin Microbiol, 38 (2000), pp. 3187-3189
[25.]
M.P. Sánchez-Seco, J.M. Navarro.
Infecciones por el virus Toscana, el virus del Nilo Occidental y otros arbovirus de interés en Europa.
Enferm Infecc Microbiol Clin, 23 (2005), pp. 560-568
[26.]
S. Sanbonmatsu-Gámez, M. Pérez-Ruiz, X. Collao, M.P. Sánchez-Seco, F. Morillas-Márquez, M. De la Rosa-Fraile, et al.
Toscana virus in Spain.
Emerg Infect Dis, 11 (2005), pp. 1701-1707
[27.]
M. Valassina, M.G. Cusi, P.E. Valensin.
Rapid identification of Toscana virus by nested PCR during an outbreak in the Siena area of Italy.
J Clin Microbiol, 34 (1996), pp. 2500-2502
[28.]
M. Pérez-Ruiz, X. Collao, J.M. Navarro-Marí, A. Tenorio.
Reverse transcription, real-time PCR assay for detection of Toscana virus.
J Clin Virol, 39 (2007), pp. 276-281
[29.]
M.P. Sánchez-Seco, J.M. Echevarría, L. Hernández, D. Estévez, J.M. Navarro-Marí, A. Tenorio.
Detection and identification of Toscana and other phleboviruses by RT-nested-PCR assays with degenerated primers.
J Med Virol, 71 (2003), pp. 140-149
[30.]
J. Figuerola, R. Soriguer, G. Rojo, C. Gómez Tejedor, M.A. Jiménez-Clavero.
Seroconversion in Wild Birds and Local Circulation of West Nile Virus, Spain.
Emerg Infect Dis, 13 (2007), pp. 1915-1917
[31.]
D. Weiss, D. Carr, J. Kellachan, C. Tan, M. Phillips, E. Bresnitz, et al.
Clinical findings of West Nile virus infection in hospitalized patients, New York and New Jersey, 2000.
Emerg Infect Dis, 7 (2001), pp. 654-658
[32.]
P. Cinque, S. Bossolasco, A. Lundkvist.
Molecular analysis of cerebrospinal fluid in viral diseases of the central nervous system.
J Clin Virol, 26 (2003), pp. 1-27
[33.]
J.M. Marimón Ortiz de Zárate, G. Cilla Eguiluz, E. Pérez-Trallero.
Biología molecular en el diagnóstico de la infección respiratoria aguda de origen bacteriano.
Enferm Infecc Microbiol Clin, 26 (2008), pp. 26-32
[34.]
World Health Organization Laboratory Methods for the Diagnosis of Meningitis Caused by Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. [Acceso 29 de febrero de 2008] Disponible en: http://www.who.int/csr/resources/publications/meningitis/WHO_CDS_CSR_EDC_99_7_EN/en/
[35.]
Enfermedades de Declaración Obligatoria Centro Nacional de Epidemiología. Instituto de Salud Carlos III. [Acceso 17 de marzo de 2008]. Disponible en: http://www.isciii.es/jsps/centros/epidemiologia/seriesTemporalesAnuales.jsp
[36.]
E. Pérez-Trallero, L. Aldamiz-Echeverria, E.G. Pérez-Yarza.
Meningococci with increased resistance to penicillin.
Lancet, 335 (1990), pp. 1096
[37.]
Invasive Neisseria meningitidis in Europe-2002. [Acceso 17 de marzo de 2008] Disponible en: http://www.euibis.org/documents/2002_meningo.pdf.
[38.]
K. Kesanopoulos, G. Tzanakaki, S. Levidiotou, C. Blackwell, J. Kremastinou.
Evaluation of touch-down real-time PCR based on SYBR Green I fluorescent dye for the detection of Neisseria meningitidis in clinical samples.
FEMS Immunol Med Microbiol, 43 (2005), pp. 419-424
[39.]
J.A. Vázquez, R. Enriquez, R. Abad, B. Alcalá, C. Salcedo, L. Arreaza.
Antibiotic resistant meningococci in Europe: any need to act?.
FEMS Microbiol Rev, 31 (2007), pp. 64-70
[40.]
P. Kriz, J. Kalmusova, J. Felsberg.
Multilocus sequence typing of Neisseria meningitidis directly from cerebrospinal fluid.
Epidemiol Infect, 128 (2002), pp. 157-160
[41.]
Control of epidemics of meningococcal meningitis. WHO practical guidelines. [Acceso 17 de marzo de 2008] Disponible en: http://w3.whosea.org/EN/Section23/Section1108/info-kit/who-meningitis-guidelines.pdf
[42.]
A.J. Fox, M.K. Taha, U. Vogel.
Standardized nonculture techniques recommended for European referente laboratories.
FEMS Microbiol Rev, 31 (2007), pp. 84-88
[43.]
M.K. Taha, A. Fox.
Quality assessed nonculture techniques for detection and typing of meningococci.
FEMS Microbiol Rev, 31 (2007), pp. 37-42
[44.]
M. Guiver, R. Borrow.
PCR diagnosis.
Meningococcal Disease, pp. 23-40
[45.]
S.J. Hacket, M. Guiver, J. Marsh, J.A. Sills, A.P.J. Thomson, E.B. Kaczmarski, et al.
Meningococcal bacterial DNA load at presentation correlates with disease severity.
Arch Dis Child, 86 (2002), pp. 44-46
[46.]
D. Vicente, O. Esnal, A. Valiente, P. Idígoras, E. Pérez-Trallero.
Detección de Neisseria meningitidis en el LCR de pacientes con meningitis meningocócica correctamente tratada.
XI Congreso SEIMC,
[47.]
F. Sidikou, S. Djibo, M.K. Taha, J.M. Alonso, A. Djibo, K.K. Kairo, et al.
Polymerase chain reaction assay and bacterial meningitis surveillance in remote areas, Niger.
Emerg Infect Dis, 9 (2003), pp. 1486-1488
[48.]
M.K. Taha, J.M. Alonso, M. Cafferkey, D.A. Caugant, S.C. Clarke, M.A. Diggle, et al.
Interlaboratory comparison of PCR-based identification and genogrouping of Neisseria meningitidis.
J Clin Microbiol, 43 (2005), pp. 144-149
[49.]
C.E. Corless, M. Guiver, R. Borrow, V. Edwards-Jones, A.J. Fox, E.B. Kaczmarski.
Simultaneous detection of Neisseria meningitidis, Haemophilus influenzae and Streptococcus pneumoniae in suspected cases of meningitis and septicemia using real-time PCR.
J Clin Microbiol, 39 (2001), pp. 1553-1558
[50.]
M. Guiver, R. Borrow, J. Marsh, S.J. Gray, E.B. Kaczmarski, D. Howells, et al.
Evaluation of the Applied Biosystems automated Taqman polymerase chain reaction system for the detection of meningococcal DNA.
FEMS Immunol Med Microbiol, 28 (2000), pp. 173-179
[51.]
M.K. Taha.
Simultaneous approach for nonculture PCR-based identification and serogroup prediction of Neisseria meningitidis.
J Clin Microbiol, 38 (2000), pp. 855-857
[52.]
Oxford Centre for Evidence-Based Medicine Levels of Evidence. Grades of Recommendation. [Acceso 13 de marzo de 2008] Disponible en: http://www.cebm.net/levels_of_evidence.asp
Copyright © 2008. Elsevier España S.L.. Todos los derechos reservados
