Enterovirus, Molecular Detection, PCR
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Enteroviruses are positive-sense RNA viruses in the Picornaviridae family. These viruses were initially classified by serotype as polioviruses (3 types), echoviruses (31 types, including types 22 and 23, which are now classified as parechoviruses), coxsackievirus A (23 types) and coxsackievirus B (6 types). However, genomic studies have demonstrated that there is significant overlap in the biological characteristics of different serotypes and more recently isolated enteroviruses are now named with consecutive numbers (eg, EV68, EV69).
The normal site of enterovirus replication is the gastrointestinal tract where the infection is typically subclinical. However, in a proportion of cases, the virus spreads to other organs, causing systemic manifestations, including mild respiratory disease (eg, the common cold); conjunctivitis; hand, foot, and mouth disease; aseptic meningitis; myocarditis; and acute flaccid paralysis. Collectively, enteroviruses are the most common cause of upper respiratory tract disease in children. In addition, the enteroviruses are the most common cause of central nervous system (CNS) disease; they account for almost all viruses recovered in culture from spinal fluid. Differentiation of enteroviruses from other viruses and bacteria that cause CNS disease is important for the appropriate medical management of these patients.
Traditional cell culture methods require 6 days, on average, for enterovirus detection. In comparison, real-time PCR allows same-day detection. Detection of enterovirus nucleic acid by PCR is also the most sensitive diagnostic method for the diagnosis of CNS infection caused by these viruses.
Aids in diagnosing enterovirus infections
A positive result indicates the presence of enterovirus RNA in the specimen.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
A negative result does not rule out the possibility of enterovirus infection.
This assay may detect virus from a variety of specimen types in asymptomatic individuals, including stool. This assay should only be used for patients with a clinical history and symptoms consistent with enterovirus infection, and must be interpreted in the context of the clinical picture. This test should not be used to screen asymptomatic patients.
This is a qualitative assay and results are reported as either negative or positive for targeted enterovirus RNA.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Clinical References Provides recommendations for further in-depth reading of a clinical nature
1. Enterovirus surveillance-United States, 1970-2005. MMWR Morbidity Mortality Weekly Report Sept 15 2006;55(SS08);1-20
2. Foray S, Pailloud F, Thouvenot D, et al: Evaluation of combining upper respiratory tract swab samples with cerebrospinal fluid examination for the diagnosis of enteroviral meningitis in children. J Med Virology 1999;57(2):193-197
3. Furione M, Zavattoni M, Gatti M, et al: Rapid detection of enteroviral RNA in cerebrospinal fluid (CSF) from patients with aseptic meningitis by reverse transcription-nested polymerase chain reaction. New Microbiol 1998;21(4):343-351