EFNS-ENS Guidelines/CME Article
EFNS-ENS guidelines for the use of PCR technology for the diagnosis of infections of the nervous system
This is a Continuing Medical Education article, and can be found with corresponding questions on the Internet at http://www.efns.org/EFNSContinuing-Medical-Education-online.301.0.html. Certificates for correctly answering the questions will be issued by the EFNS.
Correspondence: Dr I. Steiner, Department of Neurology, Rabin Medical Center, Beilinson Campus 49100, Petach Tikva, Israel (tel.: 972 3 9376351; fax: 972 3 9193565; e-mail: email@example.com).
Polymerase chain reaction (PCR) as a means to amplify nucleic acids has become an essential element in diagnosis of infections. It has evolved into a simple and rapid, easy- to- use approach. At present there are no published guidelines for the usage of PCR technology for the diagnosis of infections of the nervous system.
We reviewed the advantages and pitfalls of PCR in order to guide neurologists and infectious diseases experts in its application for the diagnosis of infections of the nervous system. Medical reference systems were searched, and original papers, meta-analyses, review papers, book chapters and guidelines recommendations were reviewed. The final literature search was performed in May 2012. Recommendations were reached by consensus.
The reliability of PCR technology for the diagnosis of neurological infections is currently based on the pathogens. The main contribution of PCR is to the diagnosis of viral infections followed by bacterial CNS infections with the notable exception of tuberculous meningitis. Efficacy for the diagnosis of protozoal infections and helminthic infestations has also been established in many instances. Unfortunately, current molecular PCR technology is far from becoming routine in resource-poor countries where such infections are prevalent. Despite the importance of fungal infections in the context of the immune-compromised host, there is not enough data to recommend the routine use of PCR.
PCR technology is currently a reliable method for the diagnosis of viral and bacterial (except tuberculosis) infections, and only for some protozoal infections and helminthic infestations.