PubMed · 13854996
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J T SYVERTON. 1959. Enteroviruses.. https://pubmed.ncbi.nlm.nih.gov/13854996/
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The objective of the present study was the development of a diagnostic reverse transcription (RT)-PCR for the specific detection of enterovirus (EV) RNA in clinical specimens controlled by an internal control (IC) RNA. The IC RNA contains the same primer binding sites as EV RNA but has a different probe region. The IC RNA was packaged into an MS2 phage core particle (armored) and was added to the clinical sample to allow monitoring of both extraction efficiency and RT-PCR efficiency. Serial dilutions of the IC RNA were made, and the detection limit of the RT-PCR was tested in a background of EV RNA-negative cerebrospinal fluid. The sensitivity and specificity of the RT-PCR assay were tested by using all 64 known EV serotypes, several non-EV serotypes, and two Quality Control for Molecular Diagnostics (QCMD) Program EV proficiency panels from 2001 and 2002. In total, 322 clinical specimens were tested by RT-PCR, and to establish the clinical utility of the RT-PCR, a comparison of the results of viral culture and RT-PCR was done with 87 clinical specimens. The lower limit of sensitivity was reached at about 150 copies of IC RNA/ml. All 64 EV serotypes were positive, while all non-EV serotypes were negative. All culture-positive samples of the 2001 QCMD proficiency panel (according to the 50% tissue culture infective doses per milliliter) were positive by RT-PCR. Invalid results, i.e., negativity for both EV RNA and IC RNA, due to inhibition of RT-PCR were observed for 33.3% of the members of the 2002 QCMD proficiency panel and 3.1% of the clinical specimens. Inhibition of RT-PCR could be relieved by the addition of 400 ng of bovine alpha-casein per microl to both the RT reaction mixture and the PCR mixture. With this optimized protocol, the results for all samples of the 2002 QCMD proficiency panel and all clinical specimens except one fecal sample (0.3%) were valid. Evaluation of the clinical samples demonstrated that EV infection could be detected in 12 of 87 samples (13.8%) by RT-PCR, while viral culture was negative. Our data show that the RT-PCR with armored IC RNA offers a very reliable and rapid diagnostic tool for the detection of EV in clinical specimens and that the addition of bovine alpha-casein relieved inhibition of the RT-PCR for 99.7% of clinical specimens.
A method of a modified nest-type polymerase chain reaction (MN-PCR), made in one tube, was elaborated that enhances the sensitivity and cuts the risk of cross-contamination in enteroviruses (EV) detection. The method, as described in detail above, was used to detect EV RNA in 76.9% and 31.25% of examined autopsy samples (13 liquor and 16 cardiac-tissue samples, respectively). It enabled the detection of EV RNA in 6.25% of samples that used to be negative, when tested by MN-PCR in 2 tubes. MN-PCR with one tube is a reliable, sensitive and specific diagnostic tool; it can be recommended for the routine diagnostics of enterovirus infection.
Quantification of virus-like RNA sequences in biological fluids, like serum and cerebrospinal fluid, requires an RNA extraction method that is both reproducible and fast. Three RNA extraction methods were tested on enteroviruses: (1) the acid guanidine thiocyanate-phenol/chloroform (AGPC) method; (2) a method based on differential precipitation of the RNA and (3) a 'bind-wash-elute' system based on silica-gel membrane binding. The latter two methods yielded a comparable detection limit as measured by RT-PCR ELISA. The detection limit for the AGPC method was 10 times higher. The relative standard deviation for the bind-wash-elute method (3%) was superior to that of the other methods tested (both 20%) and provides a reliable and fast method to extract (viral) RNA from biological fluids for quantification by RT-PCR.