METHODS: We will search PubMed, MEDLINE, EMBASE, Web of Science (WoS), Scopus and Cochrane Library databases for studies evaluating the diagnostic accuracy of multiplex PCR for the diagnosis of encephalitis caused by viruses from January 2014 to December 2024. Observational study designs with full text will be exported and included. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Analyses will be performed using the "mada" package of R software (R Foundation for Statistical Computing, Vienna, Austria), and the Summary Receiver Operating Characteristic (SROC) will be calculated using the "midas" package of STATA version 15.0 (Stata Corp., College Station, TX, USA). Certainty of evidence will be performed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) software.
RESULTS: The results will provide clinical evidence for the diagnostic accuracy of the multiplex PCR assay for the detection of viruses that cause encephalitis, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-). Finally, we intent to submit this systematic review and meta-analysis to a peer-reviewed journal for publication.
CONCLUSION: This systematic review aims to provide current evidence for multiplex PCR assay for the diagnosis of viruses causing encephalitis. Importantly, this study focuses on the use of multiplex PCR for viral diagnosis and helps clinicians and patients to better understand its role in the diagnosis of CNS diseases.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number: CRD42023485942.
OBJECTIVES AND METHODS: An epidemiological surveillance study was conducted from Oct 2015 to April 2016 to investigate the outbreak. EI virus strains were isolated in embryonated eggs from suspected equines swab samples and were subjected to genome sequencing using M13 tagged segment specific primers. Phylogenetic analyses of the nucleotide sequences were concluded using Geneious. Haemagglutinin (HA), Neuraminidase (NA), Matrix (M) and nucleoprotein (NP) genes nucleotide and amino acid sequences of the isolated viruses were aligned with those of OIE recommended, FC-1, FC-2, and contemporary isolates of influenza A viruses from other species.
RESULTS: HA and NA genes amino acid sequences were very similar to Tennessee/14 and Malaysia/15 of FC-1 and clustered with the contemporary isolates recently reported in the USA. Phylogenetic analysis showed that these viruses were mostly identical (with 99.6% and 97.4% nucleotide homology) to, and were reassortants containing chicken/Pakistan/14 (H7N3) and Canine/Beijing/10 (H3N2) like M and NP genes. Genetic analysis indicated that A/equine/Pakistan/16 viruses were most probably the result of several re-assortments between the co-circulating avian and equine viruses, and were genetically unlike the other equine viruses due to the presence of H7N3 or H3N2 like M and NP genes.
CONCLUSION: Epidemiological data analysis indicated the potential chance of mixed, and management such as mixed farming system by keeping equine, canine and backyard poultry together in confined premises as the greater risk factors responsible for the re-assortments. Other factors might have contributed to the spread of the epidemic, including low awareness level, poor control of equine movements, and absence of border control disease strategies.
METHODOLOGY: A combination of nucleic acid-based assays, including in house generic polymerase chain reaction (PCR) assays for enteroviruses, flaviviruses and phleboviruses, a commercial real-time PCR assay for herpesviruses and a commercial real time multiplex PCR, enabling detection of frequently-observed viral, bacterial and fungal agents were employed for screening.
RESULTS: The microbial agent could be characterized in 10 (10%) of the 100 specimens. Viral etiology could be demonstrated in 7 (70%) specimens, which comprises Human Herpesvirus 6 (4/7), Herpes Simplex virus type1 (2/7) and Enteroviruses (1/7). In 3 specimens (30%), Streptococcus pneumoniae, Listeria monocytogenes and Staphylococcus aureus were detected via the multiplex PCR, which were also isolated in bacteriological media. All specimens with detectable viral nucleic acids, as well as unreactive specimens via nucleic acid testing remained negative in bacteriological cultures.
CONCLUSIONS: Herpes and enteroviruses were identified as the primary causative agents of central nervous system infections in children. Enterovirus testing must be included in the diagnostic work-up of relevant cases.