Challenges in Interpreting Cerebrospinal Fluid Viral Polymerase Chain Reaction Results: Understanding the Results Related to HHV6, HHV-7, and Enterovirus Beyin Omurilik Sıvısında Viral Polimeraz Zincir Reaksiyonu Sonuçlarının Yorumlanmasındaki Zorluklar: HHV-6, HHV-7 ve Enterovirüs ile İlgili Sonuçların Anlaşılması

Creative Commons License

Böncüoğlu E., DEVRİM İ., Kıymet E., Şahinkaya Ş., Akaslan Kara A., Ötiken Oktay K., ...Daha Fazla

Journal of Behcet Uz Children's Hospital, cilt.15, sa.1, ss.35-41, 2025 (ESCI, Scopus, TRDizin)

Özet

Objective: We have aimed to evaluate our experience in interpreting polymerase chain reaction (PCR) test results of cerebrospinal fluid (CSF) samples for human herpesvirus (HHV)-6, HHV-7, and enterovirus in children with suspected viral meningoencephalitis. Method: Children aged 1 month to 5 years underwent PCR analyses. Samples were collected via lumbar puncture and assessed using real-time PCR for the identification of enterovirus, HHV-6, and HHV-7. Results: Most (79.8%) of 109 CSF samples analyzed did not show the presence of any viral particles. Among the positive samples, 8.3% were positive only for HHV-6, 6.4% for HHV-7, and 1.9% for enterovirus. Two samples showed positivity for both HHV-6 and HHV-7; one sample for HHV-7 and enterovirus; and another sample for HHV-6, HHV-7, and enterovirus. Among the PCR-positive patients, fever (77%) and seizures (59%) were the most prevalent presenting symptoms. A statistically significantly higher incidence of seizures was observed in patients with HHV-7 positivity compared to those in whom no virus was detected (p=0.003). At discharge, three patients received alternative diagnoses. Conclusion: The most frequently detected virus was HHV-6, followed by HHV-7. Enterovirus was detected at a lower frequency than expected, most probably due to the rapid clearance of enterovirus from the CSF and coronavirus disease 2019 mitigation. Considering the possible latency or chromosomal integration (for HHV-6), clinical presentations, CSF findings, and patient-specific additional diagnostic work-up were influential on the decision-making process for diagnosis. In the absence of advanced molecular techniques, it is crucial to recognize that HHV-6 and HHV-7 may be bystanders, and other potential pathogens and diagnoses should be considered.