Enterovirus infections in Germany: Comparative evaluation of different laboratory diagnostic methods

Background: The diagnosis of an enterovirus infection may be achieved throu gh direct virus detection from fecal or cerebrospinal fluid (CSF) samples b y virus isolation or PCR, Serologically, a significant rise in antibody tit er may be detected and different enteroviral types can be differentiated us ing the neutralization assay. Patients and Methods: We investigated the contribution of these different L aboratory parameters to the diagnosis of enterovirus infections occurring i n the Frankfurt am Main area during the years 1997 to 1999, including an ec hovirus 30 outbreak in a group of children with aseptic meningitis in 1997, Samples were referred from 1,013 patients; virus isolation was attempted f rom 579 CSF specimens and from 400 stool samples. 208 CSF samples were test ed by PCR. Results: During the echovirus 30 outbreak we identified 22.3% of samples as positive, almost exclusively echovirus 30, In 1998 only 7.1% of samples we re positive and a rather broad range of agents was isolated. In 1999 10.4% were positive, predominantly coxsackie B5 and echovirus 11, We could show t hat in acute enterovirus infections, virus detection by cell culture and PC R is superior to serological methods (neutralization assay and ISM assay), For virus isolation, there was a higher rate of positives from stool compar ed to CSF (1997: 27.8% versus 25%; 1998: 14.4% versus 3%; 1999: 17.9% versu s 8.5%), When comparing PCR and virus isolation from the CSF, the former yi elded a higher rate of positive results but was not clearly superior to vir us isolation from CSF. Conclusion: The recommended method for the diagnosis of acute enterovirus i nfections is virus isolation from feces. In cases of suspected aseptic meni ngitis virus isolation and PCR are valuable for the direct detection of vir us in CSF.