Journal of Clinical Virology - Volume 82 - Supplement 1 - September 2016

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S136 Abstracts / Journal of Clinical Virology 82S (2016) S1–S142
Table 1
Nucleic acid test positive CSF samples.
Viruses n Positive (n) Positivity (%)
HSV 1 1333 24* 1.80
HSV 2 1333 1 0.08
CMV 580 19 3.28
EBV 506 22* 4.35
VZV 216 1* 0.46
HHV6 478 5* 1.05
EV 178 6 3.37
Table 2
Dual etiologic agents detected by nucleic acid test in CSF samples.
Viruses n
HSV1 + EBV 3
HSV1 +HHV 6 1
EBV + VZV 1
EBV +HHV 6 1
Only 487 CSF samples were evaluated for EV by viral isolation
(1.1.2009–1.5.2015.) and the remaining 3291 nucleic acid tests
(NAT’s) were done from CSF samples by real time PCR for the other
viruses. Two tests, VZV and EV were done for the last one and five
years respectively.
Results: Nucleic acid test positive CSF samples for all of the
viruses are shown in Dual infections/etiologic agents
detected are shown in Enterovirus was isolated in 30
(6.20%) of 487 CSF samples by viral culture.
When positives were evaluated viral etiology NAT positive sam-
ples were from 44.4% female and 55.6% male patients. Positive
samples came mainly from Pediatric, Neurology and Infectious dis-
eases clinics as expected. The high number of positive results were
found in samples admitted during December (35.3%), July (12.9%)
and November (10.6%). Patient age of positive samples 80% over 18
years.
Conclusion: Positive NAT results obtained in this study with a
total of 14.39% are as other reported results world wide being <20%
when routine diagnosis is done for all CNS infections. Higher pos-
itivity rates are reported for HSV and EV, when only encephalitis
or meningitis cases are investigated. Finland’s VZV rate of 29% in
CNS infections was not observed in this (0.46%) and many other
reported studies. Nine of our 19 CMV DNA positive patients were
immunosuppressed patients as expected in CMV encephalitis. Dual
infections are predominantly seen with EBV and HHV6, that can
show a probable cause of encephalitis because of its latency in
blood cells/nervous system and ability to reactivate as well as acute
infection. Although NAT diagnostic sensitivity for HHV-6 is higher
than 95%, positive predictive value is 30% for immunocompetent
patients. Awide spectrumapproach including other herpes viruses,
adenovirus, influenza virüs, arboviruses (like WNV), measles virus,
etc., bacteria, fungi, protosoa and helmints with tecniques like
microarrays, and multiplexed methods, standardized, quality con-
trolled tests, using increased automation, quantitative approach,
supported with evidence based clinical algorithms will improve
microbiological definite diagnosis for CNS infections.
Abstract no: 183
Presentation at ESCV 2016: Poster 234
CSF: Is it possible to exclude viral infection by
cell count, protein or glucose measurement
C. Lim ∗, M. Turra, T. Sadlon, S. McKessar, M. Qiao,
G. Higgins
SA Pathology, Adelaide, Australia
Background:CSF samples are usually submitted for microscopy
and bacterial culture but a decision on further testing for the pres-
ence of viruses may depend on the presence or absence of elevated
white cell counts in the sample. Normal values for total white cells
(WCC) in CSF are given as 0–5 in adults, ≤10 in children and ≤20
in neonates. However many studies have reported detecting viral
nucleic acid even when cells are absent from the CSF. Further CSF
glucose and protein levels may not be reliable predictors of under-
lying infection nor whether it is viral or bacterial. We undertook
a retrospective review of CSF samples submitted for virological
testing.
Methods: CSF samples (N = 3928) submitted for virological test-
ing in the period from 1/7/2012 to 31/8/2015 were reviewed. All
samples were tested by PCR for Herpes simplex virus type 1 (HSV
1), HSV 2, Varicella zoster virus (VZV) and enterovirus, 1644 by
PCR for Streptoccoccus pneumoniae (Spn), 1451 by PCR for Neisseria
meningititis (Nmen) and 577 by latex agglutination for cryptococcal
antigen. CSF cell counts, glucose and protein levels were extracted
from the records if performed.
Results: Of the 3928 CSF samples, enterovirus was detected
in 312 (7.9%), VZV in 77 (2.0%) HSV 1 27 (0.7%), HSV 2 29 (0.7%)
and in the smaller subsets Spn in 32 (1.9%) and Nmen 36 (2.5%).
Mean WCCs were higher in HSV 2 compared to HSV 1 infections
and mean protein levels were higher in HSV 2 and VZV than in
enterovirus infections. No cells were present in 13.4%, 11.8%, 15%,
8.3% and ≤ 10 cells were present in 32.6%, 17.6%, 30%, 8.3% of sam-
ples frompatients with detectable enterovirus, VZV, HSV 1 and HSV
2 infections respectively.
Conclusion: Neither a cell count within the “normal range” nor
absence of a pleocytosis are able to exclude the presence of viral
nucleic acid within the CSF of patients. Protein and glucose lev-
els are not reliable in excluding viral infections. All samples from
patients with suspected meningitis should be tested for the pres-
ence of viral nucleic acid irrespective of cell counts.
Abstract no: 223
Presentation at ESCV 2016: Poster 235
Congenital rubella syndrome in a country with
high vaccination coverage – Portugal
P. Palminha ∗, E. Vinagre, C. Ribeiro, T. Lourenc¸ o,
C. Roque
National Institute of Health, Dr. Ricardo Jorge,
Portugal
Introduction: The teratogenic properties of rubella virus have
been discovered in Australia in 1941 by Gregg who associated the
occurrence of rubella during pregnancy with the presence of con-
genital cataracts. Anewbornwith congenital rubella syndromemay
present major or minor malformations or be asymptomatic at birth
and later develop clinical manifestations. The introduction of the
rubella vaccine in the Portuguese National Vaccination Plan origi-
nated a decrease in the number of reported rubella and congenital