Challenges in laboratory diagnosis of acute viral central nervous system infections in the era of emerging infectious diseases: the syndromic approach

Abstract

In the current article, the main parameters playing a role for a successful etiological diagnosis of acute CNS infections are analysed and the syndromic approach based on clinical and demographic data combined with surrogated indicators is discussed. For the development of a relevant test panel, knowledge on the microbes causing CNS infections in a particular geographic region is essential. The modern screening strategies covering a large panel of potential causative agents are described. Examples of the successful application of next generation sequencing in the identification of etiological agents, including novel and emerging viruses, are given. Expert commentary: Knowledge on epidemiology of the viruses, expertise on syndromic grouping of the etiological agents and advances in technology enable the laboratory diagnosis of acute CNS infections, and the rapid identification, containment and mitigation of probable outbreaks.

Emerging arboviral human diseases in Southern Europe

“…Since several factors are involved into the epidemiology of arboviral diseases, all available clinical, demographic, and ecological data have to be taken into consideration for the clinical and laboratory diagnosis of such cases. This kind of syndromic approach will facilitate the early detection of the pathogen and the containment and mitigation of probable outbreaks . The application of new technologies, including the new high‐throughput sequencing, enables the testing for many pathogens simultaneously and contributes to the prompt identification of the pathogen.…”

“…This kind of syndromic approach will facilitate the early detection of the pathogen and the containment and mitigation of probable outbreaks. 99 The application of new technologies, including the new high-throughput sequencing, enables the testing for many pathogens simultaneously and contributes to the prompt identification of the pathogen. Since the emergence of new pathogens in the Southern European countries is not unexpected, preparedness and surveillance will make life easier.…”

Acute viral infections of the central nervous system, 2014‐2016, Greece

“…Viruses of several families cause acute infections of the central nervous system (CNS), with non‐polio enteroviruses and herpesviruses accounting for the majority of the cases . The etiological diagnosis of acute viral CNS infections is challenging due to a plethora of viral pathogens and the non‐specific symptomatology . However, diagnosis is critical in herpes simplex virus (HSV) infections since the clinical outcome is largely dependent on the prompt initiation of the specific treatment .…”

“…The application of molecular methods enables the prompt detection of the pathogen, especially during the very acute phase of the disease when antibodies are not detectable yet. In order to improve the laboratory diagnosis of acute CNS infections, a syndromic approach based on clinical and demographic data combined with surrogated indicators was proposed . The application of multiplex PCRs (PCR capable to detect a variety of pathogens simultaneously in one run) enables the syndromic approach, while the de novo next generation sequencing is expected to solve several diagnostic problems.…”

“…1,2 The etiological diagnosis of acute viral CNS infections is challenging due to a plethora of viral pathogens and the non-specific symptomatology. 3 However, diagnosis is critical in herpes simplex virus (HSV) infections since the clinical outcome is largely dependent on the prompt initiation of the specific treatment. 4 Diagnosis is also important from the public health point of view, allowing assessment of potential risk for additional cases and outbreaks.…”