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Pfefferle S, Christner M, Aepfelbacher M, Lütgehetmann M, Rohde H. Implementation of the FilmArray ME panel in laboratory routine using a simple sample selection strategy for diagnosis of meningitis and encephalitis. BMC Infect Dis 2020; 20:170. [PMID: 32087681 PMCID: PMC7036261 DOI: 10.1186/s12879-020-4904-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 02/18/2020] [Indexed: 12/13/2022] Open
Abstract
Background Infectious meningitis is a serious disease and patient outcome relies on fast and reliable diagnostics. A syndromic panel testing approach like the FilmArray ME can accelerate diagnosis and therefore decrease the time to pathogen specific therapy. Yet, its clinical utility is controversial, mainly because of a remaining uncertainty in correct interpretation of results, limited data on its performance on clinical specimens and its relatively high costs. The aim of this study was to analyze clinical performance of the assay in a real life setting at a tertiary university hospital using a pragmatic and simple sample selection strategy to reduce the overall cost burden. Methods Over a period of 18 months we received 4623 CSF samples (2338 hospitalizations, 1601 individuals). FilmArray ME analysis was restricted to CSF-samples with a high pretest probability of infectious meningitis, e.g. positive Gram-stain, samples in which leukocytes and/or bacteria were evident or urgent suspicion of infection was communicated by clinicians. N = 171 samples matched to our risk criteria and were subjected to FilmArray ME analysis. Those samples were also analyzed by reference methods: culture only (n = 45), PCR only (n = 20) or both methods (n = 106). Results 56/171 (32.75%) were FilmArray ME positive. Bacterial pathogens were detected in 30/56 (53.57%), viral pathogens were detected in 27/56 (48.21%) and yeast DNA was detected in 1/56 (1.79%) of positive samples. Double detection occurred in 2/56 samples. In 52/56 (92.86%) FilmArray ME positive samples, results could be confirmed by the reference assays (sensitivity = 96.30%, specificity =96.58%). Conclusion The FilmArray ME assay is a fast and reliable diagnostic tool for the management of infectious meningitis and can easily be implemented in routine diagnostic workflows. However, correlation of test results and underlying clinical symptoms requires experienced users and the awareness of potentially false negative or false positive results. Moreover, considering the need for antimicrobial susceptibility testing, the use of molecular tests as a stand-alone diagnostic cannot be recommended.
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Affiliation(s)
- Susanne Pfefferle
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Martin Christner
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martin Aepfelbacher
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marc Lütgehetmann
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Holger Rohde
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Smatti MK, Al-Sadeq DW, Ali NH, Pintus G, Abou-Saleh H, Nasrallah GK. Epstein-Barr Virus Epidemiology, Serology, and Genetic Variability of LMP-1 Oncogene Among Healthy Population: An Update. Front Oncol 2018; 8:211. [PMID: 29951372 PMCID: PMC6008310 DOI: 10.3389/fonc.2018.00211] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/24/2018] [Indexed: 12/14/2022] Open
Abstract
The Epstein-Barr virus (EBV) is a DNA lymphotropic herpesvirus and the causative agent of infectious mononucleosis. EBV is highly prevalent since it affects more than 90% of individuals worldwide and has been linked to several malignancies including PTLDs, which are one of the most common malignancies following transplantation. Among all the EBV genes, most of the recent investigations focused on studying the LMP-1 oncogene because of its high degree of polymorphism and association with tumorigenic activity. There are two main EBV genotypes, Type 1 and 2, distinguished by the differences in the EBNA-2 gene. Further sub genotyping can be characterized by analyzing the LMP-1 gene variation. The virus primarily transmits through oral secretions and persists as a latent infection in human B-cells. However, it can be transmitted through organ transplantations and blood transfusions. In addition, symptoms of EBV infection are not distinguishable from other viral infections, and therefore, it remains questionable whether there is a need to screen for EBV prior to blood transfusion. Although the process of leukoreduction decreases the viral copies present in the leukocytes, it does not eliminate the risk of EBV transmission through blood products. Here, we provide a review of the EBV epidemiology and the genetic variability of the oncogene LMP-1. Then, we underscore the findings of recent EBV seroprevalence and viremia studies among blood donors as a highly prevalent transfusion transmissible oncovirus.
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Affiliation(s)
- Maria K Smatti
- Biomedical Research Center, Qatar University, Doha, Qatar
| | - Duaa W Al-Sadeq
- Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Nadima H Ali
- Biomedical Research Center, Qatar University, Doha, Qatar
| | - Gianfranco Pintus
- Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Haissam Abou-Saleh
- Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Gheyath K Nasrallah
- Biomedical Research Center, Qatar University, Doha, Qatar.,Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
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Chen Y, Wang Z, Liu Y, Wang X, Li Y, Ma P, Gu B, Li H. Recent advances in rapid pathogen detection method based on biosensors. Eur J Clin Microbiol Infect Dis 2018; 37:1021-1037. [DOI: 10.1007/s10096-018-3230-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/12/2018] [Indexed: 12/28/2022]
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Patel P, Tuke P, Tettmar K, Cloutman-Green E, Hartley J, Klein N, Veys P, Tedder RS. No evidence of transfusion transmission of Adenovirus and Epstein-Barr virus infections in paediatric recipients post-bone marrow transplant. Vox Sang 2015; 109:95-7. [PMID: 25827634 DOI: 10.1111/vox.12256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/16/2014] [Accepted: 01/12/2015] [Indexed: 11/30/2022]
Abstract
Adenovirus and Epstein-Barr virus can cause significant morbidity and mortality in paediatric patients post-bone marrow transplant. The source of infection is thought to be either reactivation of latent viruses or primary infection. We have investigated whether transfusion of blood components from viraemic donors could provide a route of primary infection in these patients and sought the prevalence of viraemia in the blood donor population from England. In 32 linked donor/recipient samples and 300 unselected blood donors, we found no evidence to suggest that these infections in paediatric bone marrow transplant recipients had been acquired from transfused blood components.
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Affiliation(s)
- P Patel
- R & D Transfusion Microbiology, NHS Blood and Transplant, London, UK.,Blood Borne Virus Unit, Public Health England, London, UK
| | - P Tuke
- R & D Transfusion Microbiology, NHS Blood and Transplant, London, UK.,Blood Borne Virus Unit, Public Health England, London, UK
| | - K Tettmar
- R & D Transfusion Microbiology, NHS Blood and Transplant, London, UK.,Blood Borne Virus Unit, Public Health England, London, UK
| | - E Cloutman-Green
- Camelia Botnar Laboratory, Great Ormond Street Hospital, London, UK
| | - J Hartley
- Camelia Botnar Laboratory, Great Ormond Street Hospital, London, UK
| | - N Klein
- Infectious Diseases and Microbiology, Institute of Child Health, London, UK
| | - P Veys
- Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, UK
| | - R S Tedder
- R & D Transfusion Microbiology, NHS Blood and Transplant, London, UK.,Blood Borne Virus Unit, Public Health England, London, UK
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Broccolo F, Toniolo A. Detection of human herpesviruses (HHVs) DNA in blood samples: a true marker of Fever of Unknown Origin (FUO)? J Clin Virol 2014; 61:617-8. [PMID: 25453576 DOI: 10.1016/j.jcv.2014.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 08/30/2014] [Accepted: 09/25/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Francesco Broccolo
- Department of Health Sciences, University of Milano-Bicocca, Milano, Italy.
| | - Antonio Toniolo
- Laboratory of Clinical Microbiology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
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Russo D, Malnati MS. Absolute quantification of viral DNA: the quest for perfection. Methods Mol Biol 2014; 1160:75-86. [PMID: 24740222 DOI: 10.1007/978-1-4939-0733-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In spite of the impressive technical refinement of the PCR technology, new-generation real-time PCR assays still suffer from two major limitations: the impossibility to control both for PCR artifacts (with the important caveat of false-negative results) and for the efficiency of nucleic acid recovery during the preliminary extraction phase of DNA from the biological sample. The calibrator technology developed at the Unit of Human Virology overcomes both of these limitations, leading to a substantially higher degree of accuracy and reproducibility in the quantification, which is especially useful for the measurement of pathogen loads in sequential samples and for the reliable detection of low-copy pathogens.
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Affiliation(s)
- Domenico Russo
- Human Virology Unit, Division of Immunology, Transplantation and Infectious Diseases, Fondazione Centro San Raffaele, via Olgettina 60, Milan, 20132, Italy
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Calibration technologies for correct determination of Epstein-Barr Virus, human herpesvirus 6 (HHV-6), and HHV-8 antiviral drug susceptibilities by use of real-time-PCR-based assays. J Clin Microbiol 2013; 51:2013. [PMID: 23682102 DOI: 10.1128/jcm.00504-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Broccolo F, Drago F, Cassina G, Fava A, Fusetti L, Matteoli B, Ceccherini-Nelli L, Sabbadini MG, Lusso P, Parodi A, Malnati MS. Selective reactivation of human herpesvirus 6 in patients with autoimmune connective tissue diseases. J Med Virol 2013; 85:1925-34. [DOI: 10.1002/jmv.23670] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 02/03/2023]
Affiliation(s)
- Francesco Broccolo
- Department of Health Sciences; University of Milano-Bicocca; Milano Italy
| | - Francesco Drago
- Di.S.E.M, Department of Endocrinologic and Metabolic Sciences, Section of Dermatology; University of Genoa; Genova Italy
| | - Giulia Cassina
- Unit of Human Virology; San Raffaele Scientific Institute; Milano Italy
| | - Andrea Fava
- Unit of Medicine and Clinical Immunology, Division of Immunology, Transplantation and Infectious Diseases; San Raffaele Scientific Institute; Milano Italy
| | - Lisa Fusetti
- Department of Experimental Pathology; B.M.I.E, University of Pisa; Pisa
| | - Barbara Matteoli
- Department of Experimental Pathology; B.M.I.E, University of Pisa; Pisa
| | | | - Maria Grazia Sabbadini
- Unit of Medicine and Clinical Immunology, Division of Immunology, Transplantation and Infectious Diseases; San Raffaele Scientific Institute; Milano Italy
| | - Paolo Lusso
- Section of Viral Pathogenesis; Laboratory of Immunoregulation NIAID; NIH; Bethesda Maryland
| | - Aurora Parodi
- Di.S.E.M, Department of Endocrinologic and Metabolic Sciences, Section of Dermatology; University of Genoa; Genova Italy
| | - Mauro S. Malnati
- Unit of Human Virology; San Raffaele Scientific Institute; Milano Italy
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Zhang X, Li A, Shuai J, Dai Y, Zhu Z, Wu S, He Y. Validation of an internally controlled multiplex real time RT-PCR for detection and typing of HEV genotype 3 and 4. J Virol Methods 2013; 193:432-8. [PMID: 23850697 DOI: 10.1016/j.jviromet.2013.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/25/2013] [Accepted: 07/03/2013] [Indexed: 12/31/2022]
Abstract
Hepatitis E virus (HEV) genotypes 1 and 2 are restricted to humans, whereas genotypes 3 (HEV 3) and genotype 4 (HEV 4) infect humans and a variety of animal species. Cross-species infections by animal strains raise potential public health concerns for zoonotic HEV transmission. Therefore, a real-time reverse transcription polymerase chain reaction (RT-qPCR) combining the HEV 3-tpye specific RT-qPCR assay with the HEV 4-tpye specific assay was developed. Furthermore, a heterologous RNA, an in vitro transcript of the enhanced green fluorescent protein (EGFP) gene, was introduced as an internal control. The data showed that EGFP gene provided a very reliable and simple way of monitoring both the sample manipulation and amplification procedures. The final multiplex RT-qPCR assay showed a high analytical sensitivity of less than 50 copies RNA per reaction for both HEV genotypes. The specificity and amplification efficiency of the multiplex assay for the respective HEV were confirmed by co-amplification of the other target. By comparing with the results of mono-specific assay and nested PCR as well as sequencing, HEV infection in a panel of clinical samples was reliably detected and typed, which indicated that the novel multiplex RT-qPCR assay could be used for sensitive detection and rapid differentiation of zoonotic HEV genotype 3 and 4.
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Affiliation(s)
- Xiaofeng Zhang
- Zhejiang Entry-Exit Inspection and Quarantine Bureau, 126 Fuchun Road, Hangzhou 310016, China; Yiwu Entry-Exit Inspection and Quarantine Bureau, 299 Chengbei Road, Yiwu 322000, China.
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Cassina G, Russo D, De Battista D, Broccolo F, Lusso P, Malnati MS. Calibrated real-time polymerase chain reaction for specific quantitation of HHV-6A and HHV-6B in clinical samples. J Virol Methods 2013; 189:172-9. [PMID: 23391825 DOI: 10.1016/j.jviromet.2013.01.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 01/23/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
Abstract
The recent classification of human herpesvirus 6 (HHV-6) A and B, previously considered as two variants of the same virus, as two distinct herpesvirus species, emphasizes the need to develop and standardize specific methods for their detection and quantitation for clinical use. The development of two highly sensitive calibrated real-time PCR to quantify HHV-6A and -6B variants in clinical specimen is described. Both assays displayed the same wide linear dynamic range from 10(0) to 10(6) copies of viral DNA in a single reaction and sensitivity of one copy/reaction. These systems allow for HHV-6A/B DNA load quantitation in different types of clinical specimens: blood or tissue cells when combined with the CCR5 assay; cell-free samples (plasma or other biological fluids) in combination with the calibrator technology. Due to the absence of cross-amplification and cross-hybridization, these methods detect minute amounts of one viral species even in the presence of a large excess of the other, allowing a specific quantitation of both viruses in the case of mixed infections. The new qPCR methods provide sensitive and specific tool for monitoring HHV-6A/B DNA load in clinical samples, facilitating the study of these viruses in human diseases.
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Affiliation(s)
- Giulia Cassina
- Unit of Human Virology Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Via Olgettina 58, 20132 Milan, Italy
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