阅读说明：本技术 肠道病毒和双埃柯病毒的分子检测 (Molecular detection of enteroviruses and echoviruses ) 是由 P·李 L·奈尔 A·卡斯特罗 M·维斯塔 M·塔布 于 2015-04-28 设计创作，主要内容包括：本文提供了用于在生物样品中确定肠道病毒(enterovirus)和双埃柯病毒(parechovirus)存在或不存在的方法。所述方法涉及使用直接从生物样品扩增而无核苷酸提取步骤来鉴定来自所述病毒的靶核苷酸的存在或不存在,但基本上保持与测定提取核苷酸的方法相同的特异性和敏感性。还提供了使用提供的方法的诊断方法和用于实践所述方法的组合物和试剂盒。(Provided herein are methods for determining the presence or absence of enteroviruses (enteroviruses) and coxoviruses (parecoxivirus) in a biological sample. The methods involve the use of amplification directly from a biological sample without a nucleotide extraction step to identify the presence or absence of a target nucleotide from the virus, but retain substantially the same specificity and sensitivity as the methods of determining extracted nucleotides. Diagnostic methods using the provided methods and compositions and kits for practicing the methods are also provided.)

1. A composition comprising a non-nucleic acid detectable label linked, directly or indirectly, to a primer having a primer element comprising a nucleotide sequence at least 90% identical to SEQ ID No. 1, the full complement of SEQ ID No. 1, SEQ ID No. 2, or the full complement of SEQ ID No. 2.

2. The composition of claim 1, which is a primer-probe, further comprising a probe element directly or indirectly linked to said primer element through a polymerase blocking group, wherein said probe element comprises a nucleic acid sequence that is at least 90% identical to SEQ ID No. 3 or the complete complement of SEQ ID No. 3.

3. The composition of claim 2, wherein the primer-probe further comprises a quencher dye, and wherein the detectable label is a fluorophore.

4. The composition of claim 2, wherein the probe element further comprises two self-complementary stem sequences, wherein each stem sequence is at least 4, 5, 6, or 7 nucleotides in length.

5. A composition comprising a non-nucleic acid detectable label linked, directly or indirectly, to a primer having a primer element comprising a nucleotide sequence at least 90% identical to SEQ ID No. 4, the full complement of SEQ ID No. 4, SEQ ID No. 5, or the full complement of SEQ ID No. 5.

6. The composition of claim 5, which is a primer-probe, further comprising a probe element directly or indirectly linked to said primer element via a polymerase blocking group, wherein said probe element comprises a nucleic acid sequence that is at least 90% identical to SEQ ID No. 6 or the complete complement of SEQ ID No. 6.

7. The composition of claim 6, wherein the primer-probe further comprises a quenching dye, wherein the detectable label is a fluorophore.

8. The composition of claim 5, wherein the probe element further comprises two self-complementary stem sequences, wherein each stem sequence is at least 4, 5, 6, or 7 nucleotides in length.

Technical Field

The present invention relates to a method for detecting and differentiating enteroviruses and coxsackieviruses in a biological sample.

Background

The following discussion of the background of the invention is provided merely to aid the reader in understanding the invention and is not an admission that the invention is prior art or constitutes prior art.

Enteroviruses belong to the picornavirus (Picornaviridae) family of viruses. It is transmitted from person to person by direct contact with viruses shed from the gastrointestinal or upper respiratory tract, affecting millions of people worldwide each year. It is common in respiratory secretions such as saliva, sputum or nasal mucus, feces and cerebrospinal fluid of infected persons. Enteroviral infections can cause a variety of symptoms ranging from mild respiratory disease (common cold), hand-foot-and-mouth disease, acute hemorrhagic conjunctivitis, aseptic meningitis, myocarditis, severe neonatal sepsis-like disease, and acute flaccid paralysis. Historically, polio was the most significant disease caused by the enterovirus poliovirus. However, there are also at least 62 non-polio enteroviruses that can cause disease in humans, including Coxsackie virus a (Coxsackie a virus), Coxsackie virus B (Coxsackie B virus), and echovirus (echovirus).

The echoviruses are a genus of viruses of the small RNA virus family, which is a large family of non-enveloped, positive-sense, single-stranded RNA viruses with an icosahedral capsid. The capsid is an arrangement of 60 protomers (protomers), each formed of 4 proteins (VP1-VP4), and encloses a linear RNA genome. The genus echovirus consists of two species: human echovirus and Ljungan virus. Human echoviruses are widespread and cause mild gastrointestinal or respiratory diseases, but are also implicated in the cases of myocarditis and encephalitis. More than 95% of people are infected with human echovirus early in life (within the age of 2-5 years).

Clinical testing of viruses is typically accomplished using any of a variety of methods. For example, viral particles or nucleic acids can be isolated from a biological sample (e.g., cerebrospinal fluid, nasopharyngeal aspirate, throat swab, blood, stool, urine, etc.). Retrospective diagnosis can be accomplished by serology. Although hemagglutination inhibition (HAI) and Enzyme Immunoassay (EIA) can be used to give type-specific diagnosis, the most widely used in this method is the Complement Fixation Test (CFT). For more rapid diagnosis, antigen detection or RNA detection can be performed. However, due to the large number of viruses in these families, screening for multiple antigens or nucleotide sequences is necessary. Furthermore, it is often necessary to extract nucleic acids from a crude biological sample and to accurately detect the presence of nucleic acids from microorganisms.

Given the high complexity associated with the preparation and processing of viral nucleic acids from biological samples for detection, diagnosis and/or quantification in the context of rapid diagnosis, methods involving fewer steps, less technical requirements and shorter durations are needed. Furthermore, there is a further need for methods that can detect and distinguish the various types of enteroviruses and coxsackieviruses from other viruses in humans with a minimum number of steps and without the need to extract nucleic acids from the sample.

Brief description of the invention

Provided herein are methods for determining the presence or absence of enterovirus and/or echovirus in a biological sample.

In one aspect, the present invention provides a method for determining the presence or absence of an enterovirus in a sample, the method comprising: amplifying an enterovirus nucleic acid using at least one pair of primers if enterovirus is present in the sample, wherein a first primer of said pair of primers has a primer element that specifically hybridizes under stringent conditions to a nucleic acid comprising or consisting of SEQ ID NO. 1 or its complete complement and a second primer of said pair of primers has a primer element that specifically hybridizes under stringent conditions to a nucleic acid comprising or consisting of SEQ ID NO. 2 or its complete complement.

In some embodiments, a method for determining the presence or absence of an enterovirus in a sample comprises: (a) heating a biological sample to a first predetermined temperature for a first predetermined time to isolate RNA secondary structures present in the sample, (b) contacting the sample with a reaction mix to form a reaction mixture, wherein the reaction mix comprises a primer pair, a DNA polymerase, a reverse transcriptase, and a plurality of free nucleotides comprising adenine, thymine, cytosine, and guanine, wherein one primer of the primer pair has a primer element that specifically hybridizes under stringent conditions to a nucleic acid comprising or consisting of SEQ ID No. 1 or the entire complement thereof, and the other primer of the primer pair has a primer element that specifically hybridizes under stringent conditions to a nucleic acid comprising or consisting of SEQ ID No. 2 or the entire complement thereof, (c) cooling the reaction mixture to a second predetermined temperature for a second predetermined time under conditions that allow reverse transcription of the RNA, (d) amplifying a target nucleic acid sequence, wherein the amplifying comprises the steps of: cooling the reaction mixture to a third predetermined temperature for a third predetermined time under conditions that allow the primer elements of the primers to hybridize to their complementary sequences on the first and second strands of the cDNA (if present) and allow the DNA polymerase to extend the primers, and (e) repeating step (d). Determining the presence of an enterovirus in the sample if an enterovirus target sequence is amplified in the reaction mixture to produce an amplicon. In some embodiments, step (a) is performed before step (b) (e.g., heating the biological sample and contacting the heated sample with a reaction mixture to form a reaction mixture). In some embodiments, step (b) is performed prior to step (a) (e.g., contacting the biological sample with a reaction mixture to form a reaction mixture, and subsequently heating the reaction mixture comprising the biological sample).

In some embodiments, the first primer of the primer pair for detecting enteroviruses has a primer element that is at least 90% identical to SEQ ID No. 1 or the full complement of SEQ ID No. 1 and a detectable label that is not a nucleic acid. In some embodiments, the first primer is a primer-probe. In some embodiments, the primer-probe has a probe element comprising a nucleotide sequence that is at least 90% identical to SEQ ID No. 3 or the full complement of SEQ ID No. 3. The probe element can further comprise a quencher, a fluorophore, and two self-complementary stem sequences, wherein each stem sequence is at least 4, 5, 6, or 7 nucleotides in length. Furthermore, the second primer of the primer pair may have a primer element comprising a nucleotide sequence which is at least 90% identical to SEQ ID NO. 2 or the complete complement of SEQ ID NO. 2.

In some embodiments, a first primer of a primer pair for detecting enteroviruses has a primer element comprising a nucleotide sequence at least 90% identical to SEQ ID No. 2 or the complete complement of SEQ ID No. 2 and a detectable label that is not a nucleic acid. In some embodiments, the first primer is a primer-probe. In some embodiments, the primer-probe has a probe element comprising a nucleotide sequence that is at least 90% identical to SEQ ID No. 3 or the full complement of SEQ ID No. 3. In some embodiments, the probe element further comprises a quencher, a fluorophore, and two self-complementary stem sequences, wherein each stem sequence is at least 4, 5, 6, or 7 nucleotides in length. In some embodiments, the second primer of a primer pair may have a primer element that is at least 90% identical to SEQ ID NO. 1 or the full complement of SEQ ID NO. 1.

Another aspect of the invention provides a method for determining the presence or absence of a coxsackievirus in a sample, the method comprising: (ii) amplifying the echovirus nucleic acid using at least one pair of primers if echovirus is present in the sample, wherein a first primer of said pair of primers has a primer element which specifically hybridizes under stringent conditions to a nucleic acid comprising or consisting of SEQ ID No. 4 or the complete complement thereof and a second primer of said pair of primers has a primer element which specifically hybridizes under stringent conditions to a nucleic acid comprising or consisting of SEQ ID No. 5 or the complete complement thereof.

In some embodiments, the method for determining the presence or absence of a coxsackievirus in a sample comprises: (a) heating a biological sample to a first predetermined temperature for a first predetermined time to isolate RNA secondary structures present in the sample, providing a reaction mixture comprising the sample, a primer pair, a DNA polymerase, (b) contacting the sample with a reaction mixture to form the reaction mixture, wherein the reaction mixture comprises the primer pair, the DNA polymerase, a reverse transcriptase, and a plurality of free nucleotides comprising adenine, thymine, cytosine, and guanine, wherein one primer of the primer pair has a primer element that specifically hybridizes under stringent conditions to a nucleic acid comprising or consisting of SEQ ID No. 4 or the entire complement thereof, and the other primer of the primer pair has a primer element that specifically hybridizes under stringent conditions to a nucleic acid comprising or consisting of SEQ ID No. 5 or the entire complement thereof, (c) cooling the reaction mixture to a second predetermined temperature for a second predetermined time under conditions that allow reverse transcription of the RNA, (d) amplifying the target nucleic acid sequence, wherein the amplification comprises the steps of: cooling the reaction mixture to a third predetermined temperature for a third predetermined time under conditions that allow the primer elements of the primers to hybridize to their complementary sequences on the first and second strands of the cDNA (if present) and allow the DNA polymerase to extend the primers, and (e) repeating step (d). Determining that the dianechovirus is present in the sample if the target sequence of the dianechovirus is amplified in the reaction mixture to produce an amplicon. In some embodiments, step (a) is performed before step (b) (e.g., heating the biological sample and contacting the heated sample with a reaction mixture to form a reaction mixture). In some embodiments, step (b) is performed prior to step (a) (e.g., contacting the biological sample with a reaction mixture to form a reaction mixture, and subsequently heating the reaction mixture comprising the biological sample).

In some embodiments, the first primer of the primer pair for detecting a dianechovirus has a primer element comprising a nucleotide sequence at least 90% identical to SEQ ID No. 4 or the full complement of SEQ ID No. 4 and a detectable label that is not a nucleic acid. In some embodiments, the first primer is a primer-probe. In some embodiments, the primer-probe has a probe element comprising a nucleotide sequence that is at least 90% identical to SEQ ID No. 6 or the full complement of SEQ ID No. 6. In some embodiments, the probe element can further comprise a quencher, a fluorophore, and two self-complementary stem sequences, wherein each stem sequence is at least 4, 5, 6, or 7 nucleotides in length. Furthermore, in some embodiments, the second primer of the primer pair may have a primer element comprising a nucleotide sequence that is at least 90% identical to SEQ ID NO. 5 or the full complement of SEQ ID NO. 5.

In some embodiments, the first primer of the primer pair for detecting a dianechovirus has a detectable label comprising a primer element that is at least 90% identical to SEQ ID No. 5 or the full complement of SEQ ID No. 5 and a non-nucleic acid. In some embodiments, the first primer is a primer-probe. In some embodiments, the primer-probe has a primer-probe comprising a nucleotide sequence that is at least 90% identical to SEQ ID No. 6 or the full complement of SEQ ID No. 6. The probe element can further comprise a quencher, a fluorophore, and two self-complementary stem sequences, wherein each stem sequence is at least 4, 5, 6, or 7 nucleotides in length. Furthermore, the second primer of the primer pair may have a primer element comprising a nucleotide sequence which is at least 90% identical to SEQ ID NO. 4 or the complete complement of SEQ ID NO. 4.

In some embodiments, the disclosed methods are used to determine the presence or absence of enteroviruses and bi-echoviruses in a sample that is a biological sample selected from the group consisting of: cerebrospinal fluid, blood, feces, throat swab, rectal swab, nasal-throat swab, plasma, serum, and urine. In some embodiments, nucleic acids are not extracted from the biological sample prior to reverse transcription and amplification. In some embodiments, the sample comprises cDNA reverse transcribed from RNA. In some embodiments, the sample comprises RNA, the reaction mixture further comprises a reverse transcriptase, and the reaction mixture is heated to a predetermined temperature for a predetermined time to isolate RNA secondary structures in the sample and then cooled to reverse transcribe the RNA in the sample into cDNA in the presence of the reverse transcriptase.

Another aspect of the invention provides a method for detecting the presence or absence of an enterovirus and a coxsackievirus in a sample, comprising: (a) heating the biological sample to a first predetermined temperature for a first predetermined time to isolate RNA secondary structures present in the sample, (b) contacting the sample with a reaction mixture to form a reaction mixture, wherein the reaction mixture comprises a first and a second primer pair, a DNA polymerase, a reverse transcriptase, and a plurality of free nucleotides comprising adenine, thymine, cytosine, and guanine, wherein one primer of the first primer pair has a primer element that specifically hybridizes under stringent conditions to a nucleic acid comprising or consisting of SEQ ID NO:1 or the complete complement thereof, and the other primer of the first primer pair has a primer element that specifically hybridizes under stringent conditions to a nucleic acid comprising or consisting of SEQ ID NO:2 or the complete complement thereof, and wherein one primer of the second primer pair has a primer element, the primer element specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID No. 4 or the complete complement thereof and the other primer of the second primer pair has a primer element that specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID No. 5 or the complete complement thereof, (c) cooling the reaction mixture to a second predetermined temperature for a second predetermined time under conditions that allow reverse transcription of the RNA, (d) amplifying the target nucleic acid sequence, wherein the amplifying comprises the steps of: cooling the reaction mixture to a third predetermined temperature for a third predetermined time under conditions that allow the primer elements of the primers to hybridize to their complementary sequences on the first and second strands of the cDNA (if present) and allow the DNA polymerase to extend the primers, and (e) repeating step (d). Determining the presence of an enterovirus in the sample if the enterovirus target sequence is amplified in the reaction mixture to produce an amplicon, and determining the presence of a coxsackievirus in the sample if the coxsackievirus target sequence is amplified in the reaction mixture to produce an amplicon. In some embodiments, step (a) is performed before step (b) (e.g., heating the biological sample and contacting the heated sample with a reaction mixture to form a reaction mixture). In some embodiments, step (b) is performed prior to step (a) (e.g., contacting the biological sample with a reaction mixture to form a reaction mixture, and subsequently heating the reaction mixture comprising the biological sample).

Another aspect of the invention provides a composition comprising a primer having a primer element that is at least 90% identical to a sequence selected from the group consisting of seq id no:1, the full complement of SEQ ID NO. 1, 2, 4, 5 and 5. In some embodiments, the primer is linked directly or indirectly to a detectable label. The composition may be a primer-probe further comprising a probe element directly or indirectly linked to the primer element through a polymerase blocking group, wherein the probe element comprises a nucleic acid sequence at least 90% identical to: 3, the full complement of SEQ ID NO 3, 6 or the full complement of SEQ ID NO 6. In some embodiments, the primer-probe further comprises a quencher dye, and the detectable label is a fluorophore.

In a specific embodiment, the primer-probe comprises a 5' quencher dye, SEQ ID NO 3 flanked by two self-complementary nucleotide sequences of at least 4 nucleotides in length, a fluorophore and/or a nucleic acid comprising SEQ ID NO 2. In another specific embodiment, the primer-probe comprises a 5' fluorophore, a nucleic acid of SEQ ID NO. 6 comprising two self-complementary nucleotide sequences flanking each other by at least 4 nucleotides in length, a quencher dye, and a nucleic acid comprising SEQ ID NO. 5. In some embodiments, the primer-probe further comprises a spacer consisting of polyethylene glycol. In some embodiments, the spacer comprises an 18 atom polyethylene glycol-based linker. In some embodiments, the spacer is comprised of a non-nucleotide material (i.e., a non-nucleotide spacer). In some embodiments, the spacer can be immediately 5' to the primer element.

The invention also provides kits comprising the oligonucleotides, primers, and primer-probes disclosed herein. In one embodiment, the kit comprises a first primer having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID No. 1 or the complete complement thereof and a second primer having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID No. 2, wherein at least one of the primers is labeled with a detectable label that is not a nucleic acid. In one embodiment, the kit comprises a first primer having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID No. 4 or the complete complement thereof and a second primer having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID No. 5 or the complete complement thereof, wherein at least one of the primers is labeled with a detectable label that is not a nucleic acid.

In one embodiment, the kit comprises (a) a first primer pair comprising a first primer having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID No. 1 or the complete complement thereof and a second primer having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID No. 2 or the complete complement thereof; and (b) a second primer pair comprising a first primer having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID NO. 3 or the complete complement thereof and a second primer having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID NO. 5, wherein at least one of the primers of the first and second primer pairs is labeled with a detectable label that is not a nucleic acid.

In one embodiment, a kit is provided comprising a primer pair for detecting enteroviruses and a primer pair for detecting coxsackieviruses as described herein. Another embodiment provides a kit comprising a primer pair for detecting at least 64 enterovirus serotypes and a primer pair for detecting at least 8 echovirus serotypes.

Another aspect of the invention provides a method for amplifying a target nucleotide sequence comprising providing a target DNA comprising double stranded, a primer pair wherein a first primer specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID NO. 1 or the complete complement thereof and a second primer specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID NO. 2, a DNA polymerase and a plurality of free nucleotides comprising adenine, thymine, cytosine and guanine; heating the reaction mixture to a first predetermined temperature for a first predetermined time to separate strands of the double-stranded DNA from each other; the reaction is cooled to a second predetermined temperature for a second predetermined time under conditions that allow the first and second primers to hybridize to their complementary sequences on the first and second strands of the target DNA and allow the DNA polymerase to extend the primers, and the above steps are repeated. In some embodiments, at least one of the primers is a primer-probe comprising a detectable label that is not a nucleic acid. In some embodiments, the primer is a primer as described herein. In some embodiments, the DNA is cDNA.

Another aspect of the invention provides a method for amplifying a target nucleotide sequence comprising providing a reaction mixture comprising a double-stranded target DNA, a primer pair wherein a first primer specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID NO. 4 or the complete complement thereof and a second primer specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID NO. 5 or the complete complement thereof, a DNA polymerase and a plurality of free nucleotides comprising adenine, thymine, cytosine and guanine; heating the reaction mixture to a first predetermined temperature for a first predetermined time to separate strands of the double-stranded DNA from each other; the reaction is cooled to a second predetermined temperature for a second predetermined time under conditions that allow the first and second primers to hybridize to their complementary sequences on the first and second strands of the target DNA and allow the DNA polymerase to extend the primers, and the above steps are repeated. In some embodiments, at least one of the primers is a primer-probe comprising a detectable label that is not a nucleic acid. In some embodiments, the primer is a primer as described herein. In some embodiments, the DNA is cDNA.

The methods disclosed herein may additionally be used to diagnose an individual as infected with an enterovirus or a coxovirus.

Detailed Description

The present invention is directed to diagnostic methods for detecting enteroviruses and coxsackieviruses using a multiplex complex analyte detection system. This method does not require an extraction or purification step to isolate the viral (i.e., target) nucleic acid prior to PCR. The disclosed method can detect 64 enterovirus serotypes and dianechovirus serotypes 1-8 in unextracted human biological samples.

More specifically, the sample-to-response (sample-to-answer) assay of the present disclosure is designed as a moderately complex multiplex analyte detection system, where the initiation isSample preparation followed by reverse transcription and real-time Polymerase Chain Reaction (PCR) detection and differentiation of target enterovirus and biegavirus analytes. In some embodiments, both reverse transcription and real-time PCR are performed in centrifugal microfluidic disks (centrifugal microfluidic disks) such as consumable Universal or Direct amplification disks (Focus Diagnostics (Cypress, CA, USA) and 3M corporation (st. paul, MN, USA)). In this embodiment, the biological sample is loaded directly into the sample to the response tray without separate front end sample preparation. Qualitative detection and differentiation of enteroviruses from Diechoviruses subsequently using primer-probes such asChemical primers and real-time PCR to amplify and detect target analytes on a cycling system such as a 3M Integrated Cycler system. In some embodiments, the target viral genomic RNA is reverse transcribed and specifically amplified and simultaneously detected by fluorescently labeled probes in the same reaction well. The presence of each pathogen is determined by a different corresponding fluorescent signal. In some embodiments, RNA in the sample is reverse transcribed in a first reaction (which may or may not be performed in a depletion tray), and real-time PCR is performed in a separate assay.

Primers, probes and/or primer-probes specific for amplification and detection of the internal control can be included in the same reaction mix to monitor potential PCR inhibition. Reagents required for amplification and detection of the target and RNA internal controls can be formulated as an integrated reaction mix, which is provided as a single reaction aliquot.

As used herein, the singular forms "a", "an" and "the" include plural referents unless otherwise indicated. Thus, for example, reference to "an oligonucleotide" includes a plurality of oligonucleotide molecules, and reference to "a nucleic acid" refers to one or more nucleic acids.

As used herein, "about" means plus or minus 10%.

A primer pair that "hybridizes specifically under stringent conditions" to a target gene need not hybridize to the entire gene. Thus, the primer pair can amplify the entire gene amplified or only a segment of the gene, depending on the portion of the gene that specifically hybridizes to the primer.

The term "amplifying" or "performing amplification" as used herein includes methods for copying a target nucleic acid thereby increasing the copy number of a selected nucleic acid sequence. Amplification may be exponential or linear. The target nucleic acid can be DNA (such as, for example, genomic DNA and cDNA) or RNA. The sequences amplified in this manner form "amplicons". Although the exemplary methods described below involve amplification using the Polymerase Chain Reaction (PCR), a variety of other methods for amplifying nucleic acids are known in the art (e.g., isothermal methods, rolling circle methods, etc.). Those skilled in the art will appreciate that these other methods may be used in place of or in addition to the PCR method. See, e.g., Saiki, "Amplification of Genomic DNA" in PCR Protocols, Innis et al, eds., Academic Press, San Diego, CA 1990, pp 13-20; wharam, et al, Nucleic Acids Res.2001Jun 1; 29(11) E54-E54; hafner, et al, Biotechniques 2001 Apr; 30(4):852-860.

The terms "complementary", "complementary" or "complementarity" (i.e., a nucleotide sequence such as an oligonucleotide or a target nucleic acid) as used herein with reference to polynucleotides refer to the standard Watson/Crick pairing rules. The complementarity of nucleic acid sequences, such as the pairing of the 5 'end of one sequence with the 3' end of the other, is "antiparallel association". For example, the sequence "5 '-A-G-T-3'" is complementary to the sequence "3 '-T-C-A-5'". Some bases not normally found in natural nucleic acids may be included in the nucleic acids described herein; these include, for example, inosine, 7-deazaguanine, Locked Nucleic Acid (LNA) and Peptide Nucleic Acid (PNA). The complementarity need not be perfect; a stable duplex may contain mismatched base pairs, denatured or mismatched bases. One skilled in the art of nucleic acid technology can empirically determine duplex stability taking into account a variety of variables including, for example, the length of the oligonucleotide, base composition and sequence of the oligonucleotide, ionic strength, and incidence of mismatched base pairs. The complement sequence may also be an RNA sequence complementary to a DNA sequence or a complement thereof, and may also be a cDNA. The term "substantially complementary" as used herein means that two sequences specifically hybridize (defined below). It will be appreciated by those skilled in the art that substantially complementary sequences need not hybridize along their entire length. A nucleic acid that is "the complete complement" or "fully complementary" to a reference sequence consists of a nucleotide sequence that is 100% complementary (under Watson/Crick pairing rules) to the reference sequence along the entire length of the nucleic acid that is the complete complement. The complete complement contains no mismatches to the reference sequence.

As used herein, the term "detecting" used in the context of detecting a signal from a detectable label to indicate the presence of a target nucleic acid in a sample does not require a method that provides 100% sensitivity and/or 100% specificity. As is known, "sensitivity" is the likelihood of a test being positive given that the patient has the target nucleic acid, and "specificity" is the likelihood of a test being negative given that the patient does not have the target nucleic acid. A sensitivity of at least 50% is preferred, although sensitivities of at least 60%, at least 70%, at least 80%, at least 90% and at least 99% are clearly more preferred. A specificity of at least 50% is preferred, although specificities of at least 60%, at least 70%, at least 80%, at least 90% and at least 99% are clearly more preferred. Detection also encompasses assays with false positives and false negatives. The false negative rate may be 1%, 5%, 10%, 15%, 20% or even higher. The false positive rate may be 1%, 5%, 10%, 15%, 20% or even higher.

A "fragment" in the context of a nucleic acid refers to a sequence of nucleotide residues that is at least about 5 nucleotides, at least about 7 nucleotides, at least about 9 nucleotides, at least about 11 nucleotides, or at least about 17 nucleotides. Fragments are typically less than about 300 nucleotides, less than about 100 nucleotides, less than about 75 nucleotides, less than about 50 nucleotides, or less than about 30 nucleotides. In some embodiments, fragments can be used in Polymerase Chain Reaction (PCR), various hybridization methods, or microarray methods to identify or amplify the same or related portions of RNA or DNA molecules. The fragments or segments can uniquely identify each polynucleotide sequence of the invention.

As used herein, "kit" refers to a collection of components packaged for a particular purpose. Non-limiting examples of materials from which the kit can be packaged include boxes, bags, envelopes, and tubes, but the kit components can be supplied to the consumer in other types of packaging materials. In some embodiments, the primers and/or probes included in the kit are isolated polynucleotides and may be supplied in tubes, vials, or other types of containers within the kit. In some embodiments, the kit further comprises instructions for using the kit components. The instructions may be printed on the material within the kit or provided in electronic form. In some embodiments, the printed instructions describe how to use the reagents contained within the kit to detect the presence or absence of an enterovirus and/or a bi-echovirus in a sample.

The term "multiplex PCR" as used herein refers to the simultaneous amplification of two or more products in the same reaction vessel. Each product was primed using a different primer pair. The multiplex reaction may further comprise a specific probe for each product labeled with a detectable moiety. In some embodiments, multiplex PCR reactions employ primer pairs, where one primer is a primer-probe such as, for exampleAnd (3) a primer.

The term "oligonucleotide" as used herein refers to short polymers of deoxyribonucleotides, ribonucleotides, or any combination thereof. The oligonucleotide is generally at least about 10, 11, 12, 13, 14, 15, 20, 25, 40 or 50 to up to about 100, 110, 150 or 200 nucleotides in length, more preferably about 10, 11, 12, 13, 14 or 15 to up to about 70 or 85nt, and most preferably about 18 to up to about 26nt in length. The one-letter codes for nucleotides are described in the U.S. patent office review guide, section 2422, table 1. In this aspect, the nucleotide designation "R" means a purine such as guanine or adenine, "Y" means a pyrimidine such as cytosine or thymine (uracil if RNA); and "M" means adenine or cytosine. Oligonucleotides may be used as primers or as probes.

As used herein, a "primer" for amplification includes a primer element, wherein the primer element is an oligonucleotide that is complementary to and hybridizes to a target nucleotide sequence and results in the addition of a nucleotide to the 3' end of the primer in the presence of a DNA or RNA polymerase. In some embodiments, the primer consists of a primer element. However, a primer as used herein may comprise other elements in addition to the primer element. For example, a primer may comprise a primer element and a detectable label such as a fluorophore. In addition, a primer may comprise a probe element in addition to a primer element. As used herein, the entire molecule is referred to as a primer. Primer-probes are exemplary primers. For optimal expression and amplification, the 3' nucleotide of the primer element in the primer should generally be identical to the target nucleic acid sequence at the corresponding nucleotide position. The term "primer" as used herein includes all forms of primers that can be synthesized, including peptide nucleic acid primers, locked nucleic acid primers, phosphorothioate modified primers, labeled primers, and the like. As used herein, a "forward primer" has a primer element that is complementary to the antisense strand of dsDNA. The "reverse primer" has a primer element that is complementary to the sense strand of dsDNA. An "exogenous primer" refers specifically to a primer that is added to a reaction vessel containing a sample and/or target nucleic acid to be amplified (i.e., not resulting from amplification in the reaction vessel).

The primer element in the primer is typically at least 10, 12, 15, 18 or 30 nucleotides in length up to about 25, 50, 60, 100, 110, 125 or 200 nucleotides in length, preferably at least 15 up to about 60 nucleotides in length, and most preferably at least 25 up to about 40 nucleotides in length. In some embodiments, the primer, primer element, or probe is 15 to 35 nucleotides in length. There is no standard length for optimal hybridization or polymerase chain reaction amplification. The optimal length for a particular primer Application can be readily determined in the manner described by H.Erlich, PCR Technology, Principles and Application for DNA Amplification, (1989). The primer element may be linked directly or indirectly to another component, for example a probe element and/or a fluorophore. Indirectly joined means that the two components are joined by one or more additional components that are positioned between the two indirectly joined components. When they are directly linked to each other without intermediate components, the two components are directly linked.

A "primer pair" is a pair of primers with primer elements directed to different regions of a target nucleic acid sequence. The primer pair comprises a forward primer and a reverse primer, each having a primer element that hybridizes under stringent conditions to different strands of a double-stranded target nucleic acid sequence. The forward primer elements are complementary to the antisense strand of dsDNA and the reverse primer elements are complementary to the sense strand. One primer of the primer pair may be a primer-probe (i.e., a bifunctional molecule comprising a PCR primer element covalently linked to a probe element by a polymerase blocking group, further, the bifunctional molecule may comprise a fluorophore that interacts with a quencher).

As used herein, a "probe" is an oligonucleotide that specifically hybridizes to a target nucleotide sequence and is separate from a primer element. A probe sequence is not extended like a primer element and as used herein a probe is distinct from a "probe element" which does not include a primer sequence element. However, the probe may comprise additional non-hybridizing elements, such as, for example, additional nucleotides or fluorophores.The probe is an exemplary probe.The probe comprises a donor and a quencher fluorophore at either end of the probe and are sufficiently close to each other that the fluorophore of the donor is occupied by the quencher. However, when the probe hybridizes to the amplified segment, the 5 'to 3' exonuclease activity of the Taq polymerase cleaves the probe thereby allowing the donor fluorophore to emit detectable fluorescence.

As used herein "PCR monitoring system "refers to a method for real-time PCR. In this method, the amplified nucleic acid segment is hybridizedThe probe is included in the amplification master mix.

As used herein, "probe element" or "probe sequence element" refers to a stretch of nucleotides in the probe portion of a primer-probe and associated with a primer sequence, in which stretch the probe is attached or adjacent to the primer nucleic acid sequence and specifically hybridizes under stringent conditions to a target nucleic acid sequence to be detected. In some embodiments, the probe sequence is fully complementary to the target sequence to which it is intended to hybridize under stringent conditions. In some embodiments. The probe element is 10, 15, 20, 21, 22, 23, 24, 25, 26, 27 or 28 bases in length. In some embodiments, the probe element further comprises a self-complementary stem sequence.

The term "primer-probe" as used herein is a bifunctional molecule, such as for exampleA primer comprising a PCR primer element covalently linked at its 5' end to a probe element by a polymerase blocking group. The probe element comprises a probe target sequence (which specifically binds to the amplified product) -flanked by self-complementary stem sequences and is capable of forming a hairpin structure with a fluorophore at one end and a quencher at the other end. Sometimes, the fluorophore interacts with a quencher to reduce background fluorescence. The primer sequence portion of the primer-probe is modified at the 5' end to contain a PCR blocker at the beginning of the hairpin loop (typically HEG monomers are added as a blocker).

In the initial PCR cycle, the primer portion of the primer-probe hybridizes to the target and extension occurs due to the action of the polymerase. During PCR, polymerase extension into the probe tail is blocked by the inclusion of hexaethylene glycol (HEG) or equivalent substances. In the first round of amplification, the 3 'target specific primer anneals to the target nucleic acid and extends, and the primer-probe now incorporates a newly synthesized strand with the newly synthesized target region for the 5' probe. In the next round of denaturation and annealing, the probe region of the primer-probe hairpin loop hybridizes to the target, thus separating the fluorophore and quencher and generating a measurable signal. Such primer-probes are described in Whitcombe et al, Nature Biotech 17:804-807(1999), which is incorporated herein by reference in its entirety.

As used herein, a "primer-probe detection system" refers to a system for real-time PCR that employs primers in which at least one primer of a primer pair is a primer-probe, such as, for exampleSuch asAnd (3) a primer.

An oligonucleotide (e.g., a probe or primer) specific for a target nucleic acid will "hybridize" to the target nucleic acid under stringent conditions. As used herein, "hybridization" or "hybridizing" refers to the process by which a single strand of an oligonucleotide anneals to a complementary strand through base pairing under defined hybridization conditions.

"specific hybridization" is the phenomenon of high complementarity of two nucleic acid sequences. Specific hybridization complexes are formed under relaxed annealing conditions and remain after any subsequent washing steps. The relaxed conditions for annealing of nucleic acid sequences can be routinely determined by those skilled in the art and can occur, for example, in the presence of about 6 XSSC at 65 ℃. The stringency of hybridization can be expressed in part by reference to the temperature at which the washing step is carried out. The temperature is typically selected to be about 5 ℃ to 20 ℃ below the thermal melting point (Tm) of the particular sequence at a defined ionic strength and pH. The Tm is the temperature (at defined ionic strength and pH) at which 50% of the target nucleic acid dissociates from a perfectly matched probe. Equations for calculating Tm and conditions for nucleic acid hybridization are known in the art. Specific hybridization preferably occurs under stringent conditions, which are known in the art. Stringent hybridization conditions are hybridization in 50% formamide, 1M NaCl, 1% SDS at 37 ℃ and washing in 0.1 XSSC at 60 ℃. Hybridization procedures are known in the art and are described, for example, in Ausubel et al, Current Protocols in Molecular Biology, John Wiley & Sons Inc., 1994.

As used herein, an oligonucleotide is "specific" for a nucleic acid if the oligonucleotide has at least 50% sequence identity to the nucleic acid when the oligonucleotide is aligned with the nucleic acid. An oligonucleotide specific for a nucleic acid is one that is capable of hybridizing to a target of interest and does not substantially hybridize to a nucleic acid that is not of interest under suitable hybridization or wash conditions. Higher levels of sequence identity are preferred and include at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, and more preferably at least 98% sequence identity. Sequence identity can be determined using commercially available computer programs with default settings using algorithms known in the art. As used herein, a sequence with "high sequence identity" has at least about 50% of the nucleotides at aligned nucleotide positions with the same nucleotides, preferably at least about 60% of the aligned nucleotide positions, and more preferably at least about 75% of the aligned nucleotide positions with the same nucleotides.

Oligonucleotides used as primers or probes for specific amplification (i.e., amplification of a particular target nucleic acid) or specific detection (i.e., detection of a particular target nucleic acid sequence) are generally capable of specifically hybridizing to a target nucleic acid under stringent conditions.

As used herein, the term "sample" or "test sample" may comprise a biological sample, an isolated nucleic acid, or an isolated microorganism. In some embodiments, the sample is obtained from a biological source (i.e., a "biological sample"), such as tissue, bodily fluid, or microorganisms collected from a subject. Sample sources include, but are not limited to, sputum (treated or untreated), bronchoalveolar lavage (BAL), Bronchial Wash (BW) blood, body fluids, cerebrospinal fluid (CSF), urine, plasma, serum, or tissue (e.g., biopsy material). Preferred sample sources include nasal and throat swabs, wound swabs and nasal washes and CSF. The term "patient sample" as used herein refers to a sample obtained from a human seeking diagnosis and/or treatment of a disease. In some embodiments, the sample comprises an isolated nucleic acid. In some embodiments, the sample comprises a crude biological sample from which nucleic acids have not been extracted. In some embodiments, the sample may be a biological sample that has been subjected to reverse transcription such that it comprises cDNA.

The reagent mixture comprises the sample, primers and reagents required for PCR and/or Reverse Transcription (RT).

The "amplification master mix" or "RT amplification master mix" contains all the reagents (including primers) used for PCR amplification and/or reverse transcription, but does not contain the sample or target nucleic acid to be amplified.

The term "target nucleic acid", "target nucleic acid sequence" or "target sequence" as used herein refers to a sequence comprising a segment of nucleotides of interest to be amplified and detected. Copies of the target sequence that are generated during the amplification reaction are referred to as amplification products, amplicons or amplicons. The target nucleic acid can be composed of: a segment of a chromosome, a complete gene with or without intergenic sequences, a segment or portion of a gene with or without intergenic sequences, or a nucleic acid sequence for which a probe or primer is designed. The target nucleic acid may include a wild-type sequence, a mutation, a deletion or a duplication, a tandem repeat region, a gene of interest, a region of a gene of interest, or any upstream or downstream region thereof such as a 5' untranslated region (UTR). The target nucleic acid may represent an alternative sequence or an allele of a particular gene. The target nucleic acid may be derived from genomic DNA, cDNA or genomic RNA. A target nucleic acid as used herein can be DNA (e.g., genomic DNA or cDNA) or RNA. In some embodiments, the target sequence is a viral RNA sequence and/or cDNA equivalent thereof. In some embodiments, the target nucleic acid is an enterovirus sequence or a di-echovirus sequence.

As used herein, a "positive control nucleic acid" or "internal control" is a nucleic acid that is known to be present in a sample at a certain amount or level. In some embodiments, the positive control nucleic acid is not naturally present in the sample and is added to the sample prior to subjecting the reaction sample mixture to the real-time polymerase chain reaction in the methods of the invention for determining the presence or absence of an enterovirus and/or a dianechovirus. As used herein, the "cycle threshold" (Ct) of an analyte is the PCR cycle in which the fluorescence signal crosses a particular fluorescence threshold. The Ct depends on the amplification reaction efficiency, which includes initial template copy number, biological lysate, PCR amplification, cleavage of hybridization or fluorescent probes, and sensitivity of detection.

As used herein, a "stem sequence" is a self-complementary pair of nucleotide sequences that flank a probe or probe element that hybridizes to a nucleotide sequence. Each stem sequence is 4, 5, 6, 7, 8, 9, or 10 nucleotides in length. In some embodiments, the stem sequence is 6-7 nucleotides in length. The stem sequence flanking the probe element allows the probe element to form a hairpin loop.

Biological samples and sample preparation

The samples in which enteroviruses and coxsackieviruses are detected can be from sterile and/or non-sterile locations using the disclosed methods. The sample may be a biological sample, including bodily fluids such as whole blood, plasma, serum, acellular plasma, urine, cerebrospinal fluid (CSF), synovial fluid, pleural fluid, pericardial fluid, ocular fluid, and sputum. Typical samples are serum, plasma, throat or rectal swabs in transport media, faeces and CSF. Other suitable biological samples include tissue biopsies, stool samples, endotracheal aspirates, throat and rectal swab samples, nasopharyngeal samples (nasal swabs). As used herein, "cell-free plasma" means plasma comprising less than 1% cells by volume.

In some embodiments, the biological sample is suspected of comprising enterovirus and/or echovirus nucleic acid and/or it may be obtained from an individual suspected of being infected with enterovirus and/or echovirus. In some embodiments, the sample is a biological sample that has been subjected to reverse transcription such that RNA (including enterovirus and/or echovirus RNA, if present) originally present in the biological sample is reverse transcribed to cDNA. In this embodiment, the sample comprises the target cDNA. In some embodiments, the cDNA is not extracted from the sample prior to RT-PCR or other detection assays.

Although the disclosed methods preferably employ an untreated biological sample to obtain a direct, streamlined sample to response approach, the detection methods disclosed herein are also effective if used in purifying isolated nucleic acids (DNA and/or RNA) from a biological sample according to any method known to those of skill in the art. Samples can be collected and concentrated, if desired, by centrifugation or the like. Alternatively, the biological sample may be processed using a commercially available nucleic acid extraction kit.

Reverse transcription and real-time PCR

In the methods of the invention, the presence of an enterovirus and/or a di-echovirus target RNA in a sample is tested by reverse transcription and polymerase chain reaction (RT-PCR). When used together, reverse transcription and polymerase chain reaction may be performed sequentially in two steps, or together in one step with the addition of all RT and PCR reaction composition reagents to the sample.

In a two-step process, incubation of the sample in the reverse transcription reaction composition allows synthesis of RNA from the targetA copy of the DNA. The RT reagent mix includes primers that hybridize to the target RNA to prime the synthesis of copy DNA. In addition, the RT reagent mixture comprises dNTP and MgC1₂KCl, reverse transcriptase and reverse transcriptase buffer. More than one primer may be included if it is desired to make copies of DNA from more than one target RNA. However, RNase inhibitors are not generally used. The product of the reverse transcription reaction may optionally be subsequently transferred to another assay tube, where PCR is performed according to protocols known in the art. The amplification master mix typically includes a primer pair that initiates synthesis of the desired DNA segment from the reverse transcription template. In addition, the amplification master mix typically comprises dntps, a DNA polymerase such as a thermostable DNA polymerase such as Taq polymerase and a polymerase buffer. In some embodiments, the amplification master mix further comprises a cationic surfactant. If multiple target sequences are expected to be synthesized, more than one pair of primers is included. Furthermore, in some embodiments, a single new primer may be added that will amplify a DNA segment using the original RT primer as the second primer of the primer pair. Other reverse transcriptases that may be used in viral samples include, but are not limited to, HIV reverse transcriptase (Ambion), transcription factor reverse transcriptase (Roche), Thermoscript reverse transcriptase (Invitrogen). Other DNA polymerases that may be used include, but are not limited to, Pfu, Vent, and Sequitherm DNA polymerase (EPICENTRE).

In some embodiments of the methods of the invention, the biological sample is combined with a RT amplification master mix comprising DNA polymerase, reverse transcriptase, rnase inhibitors, salts, deoxynucleotides, internal controls and probes and primers for the target and internal controls, and then RT and PCR can be performed in a single assay. In some embodiments, a biological sample is heated to isolate RNA secondary structures present in the sample, and the heated sample is contacted with an RT amplification master mix to form a reaction mixture. In some embodiments, a biological sample is contacted with an RT amplification master mix to form a reaction mixture, and the reaction mixture comprising the biological sample is subsequently heated to isolate RNA secondary structures present in the sample.

Whether RT-PCR is performed as two steps or one step, the RT step is run first and usually consists of a single temperature incubation. In some embodiments, the single temperature is from about 42 ℃ to about 60 ℃. Different temperatures are suitable for different RT enzymes and different primers, as known to those skilled in the art, and the temperature should be sufficient to allow reverse transcription of RNA into cDNA. The subsequent PCR reaction typically consists of an initial incubation at a predetermined temperature sufficient to denature the cDNA and also activate heat-activated Taq polymerase. This is followed by multiple cycles of cDNA target amplification. In some embodiments, the heating and cooling cycle is repeated at least 12, 13, 14, 15, 18, 19, 20, 21, 22, or 23 times up to 15, 20, 25, 30, 35, 40 or more times. In some embodiments, three operations are performed during each cycle: target denaturation, primer annealing and primer extension. In some embodiments, target denaturation occurs above about 90 ℃. The primer annealing temperature is determined by the melting temperature of the specific primer used in the reaction and primer extension may be performed at a temperature ranging from about 56 ℃ to about 72 ℃. When primer annealing and extension are performed at the same temperature, this is a two temperature PCR as compared to a three temperature PCR in which each of the three steps occurs at a different temperature. After the amplification stage is complete, a final extension time is typically added to ensure synthesis of the entire amplification product.

The PCR is preferably a multiplex PCR reaction. The reaction mixture may comprise a primer pair for enterovirus and a primer pair for echovirus. Internal Controls (IC) may also be included in the sample using oligonucleotide primers, probes, and/or primer-probes.

In some embodiments, PCR and/or RT-PCR is performed in a centrifugal microfluidic disc. As used herein, a "centrifugal microfluidic disc" is a disk that rotates on its axis within a thermal cycler and contains a chamber in which a biological sample can be stored. Exemplary centrifugal microfluidic disks are Direct Amplification disks (8-well) and Universal disks (96-well) from Focus Diagnostics, which are compatible with 3M^TM3M for sale^TMAn Integrated Cycler thermal Cycler is used in combination. 3M^TMAn Integrated Cycler can accept either Universal or Direct Amplification Disc and can perform multiple assays per Disc. In some embodiments, the biological sample is stored in a genetic rotor disk. As used herein, a "GeneDisk" is a retentive energyA centrifuge rotor insert capable of housing tubes or other chambers for samples and/or sample amplification mixtures. Examples of genetic Rotor disks are Qiagen Rotor disks and/or Gene disks, which are used with Qiagen Rotor-Gene Q thermocyclers.

Target nucleic acids and primers

In accordance with the present invention, oligonucleotide primers and/or probes are used in the methods described herein to amplify and detect target enterovirus and/or echovirus nucleic acids, such as all or part of an enterovirus and/or echovirus-specific marker gene. In one embodiment, the method involves the use of a primer pair directed to the 5 'untranslated region (UTR) of the enterovirus genome and a primer pair directed to the 5' UTR of the echovirus genome (including fragments of either or both of these regions). The enterovirus primer pair is capable of detecting and/or hybridizing to the 5' UTR of at least 64 serotypes of enterovirus. The pair of dicer primers is capable of detecting and/or hybridizing to the 5' UTR of at least 8 serotypes of dicer. In some embodiments, the enterovirus primer specifically hybridizes to a sequence (or the complement thereof) set forth in GenBank accession No. KC436272 within nucleotide 452-599 of the 5' UTR of the enterovirus genome. In some embodiments, the dual echovirus primer specifically hybridizes to a sequence (or the complement thereof) set forth in GenBank accession AJ005695 within position 535-599 of the 5' UTR of the dual echovirus genome.

In addition, primers can be used to amplify one or more control nucleic acid sequences.

The target nucleic acids described herein can be detected individually or in multiplex format using separate labels for each target. In a specific embodiment, the multiplex reaction comprises fluorescently labeled primer-probes such as used in primer pairs specific for the 5' UTR of the enterovirus genomePrimer-probe and another fluorescently labeled primer-probe such as used in a primer pair specific for the 5' UTR of the genome of a DiechovirusPrimer-probe. In some embodiments, the fluorescent label of the enterovirus primer pair is different from the pair of echovirus primers.

In some embodiments, a primer mix is provided that is degenerate at one or more nucleotide positions. Degenerate primers are used in PCR where there is variability in the target nucleic acid sequence, i.e., the sequence information is polymorphic. Typically, a degenerate primer will exhibit variability at no more than about 4, no more than about 3, preferably no more than about 2, and most preferably no more than about 1 nucleotide positions within the primer.

Thus, in some embodiments, at least one primer of each primer pair in an amplification reaction comprises a detectable moiety. The detectable moiety may be on a probe covalently linked to the primer, such as on a primer-probe. The probe may be detectably labeled by methods known in the art. Useful labels include, for example, fluorophores (e.g.FITC, rhodamine, xanthate fluorophor, Texas Red, carboxyfluorescein fluorophor such as fluorescein imide (FAM), JOE^TMXanthene dyes fluoresce e.g. in the red region of the visible spectrum and can be quenched by quenchers such as dark black Hole Quencher^TM(BHQ^TM) Cal Fluor Red with efficient quenching("CFR 610"), I-BHQ2 dye, Quasar ³²P、³⁵S、³H、¹⁴C、¹²⁵I、¹³¹I. Electron density reagents (e.g., gold), enzymes such as those commonly used in ELISA (e.g., horseradish peroxidase, beta-galactosidase, luciferase, alkaline phosphatase), colorimetric labels (e.g., colloidal gold), magnetic labels (e.g., Dynabeads)^TM) Biotin, digoxigenin or haptens and antisera or haptens against themProteins of monoclonal antibodies. Fluorophores have the ability to absorb energy from light, internally transfer that energy, and emit that energy as a characteristic wavelength of light. Upon absorption of energy (photons) from the light, the fluorophore will rise from its ground state to a higher vibrational level that excites the singlet state. In the next phase, some energy is lost as heat, returning the fluorophore to the lowest vibrational level that excites the singlet state. The lowest vibration level that excites the singlet state is relatively stable and has a longer lifetime. From this excited singlet state, the fluorophore can return to its ground state, either by emission of light (a photon) or by a non-radiative energy transition. The light emitted from the excited singlet state is called fluorescence. Other labels include ligands or oligonucleotides capable of forming complexes with the corresponding receptor or oligonucleotide complement, respectively. The label may be incorporated directly into the nucleic acid to be detected, or it may be attached to a probe (e.g., an oligonucleotide) or antibody that hybridizes or binds to the nucleic acid to be detected.

Thus, after and/or during amplification, if present, the enterovirus and/or bi-echovirus target segment amplicons can be identified by using different detectable moieties, such as by size and/or color. Although the target is referred to as an "enterovirus target segment amplicon" or "dicetovirus target segment amplicon," it should be noted that the amplicon is actually generated from a cDNA equivalent of the viral genomic RNA sequence (and thus the target amplicon differs from the viral RNA target sequence by the presence of thymine rather than uracil). The detectable moiety may be a fluorescent dye. In some embodiments, different primer pairs are labeled with different distinguishable detectable moieties. Thus, for example, CFR610 and FAM fluorescent dyes can be present on different primers in multiplex PCR and bind to different amplicon sequences obtained. In other embodiments, the forward primer is labeled with one detectable moiety and the reverse primer is labeled with a different detectable moiety, e.g., a FAM dye is used for the forward primer and a HEX dye is used for the reverse primer. The use of different detectable moieties is useful for distinguishing between amplification products of the same length or very similar in length.

In some embodiments, the probe portion of the primer employed is detectably labeled and detected byDetecting the label of each amplification product. The quencher can further be associated with a detectable label that prevents detection of the label prior to target amplification of the probe element. SCORPION^TMThe primer comprises such a probe element.

In some embodiments, at least one primer of each primer pair is a primer-probe. In these embodiments, the primer-probe further comprises a fluorophore associated with a quencher to reduce background fluorescence. After PCR extension using this fluorophore-labeled primer-probe, the synthesized target region is attached to the same strand as the probe. Upon denaturation, the probe portion of the primer-probe hybridizes to a portion of the newly generated PCR product, physically separating the fluorophore from the quencher, thereby generating a detectable signal. Thus, in some embodiments, one primer of each primer pair can be a primer-probe comprising a probe sequence element at the 5' end of the primer, wherein the probe element further comprises a fluorophore and a quencher.

The inventors of the present invention have found that the detection of a specific region of the 5 'UTR of the enterovirus genome (i.e.nucleotide 452-599 of the 5' UTR) allows the detection of any of the 64 serotypes of enteroviruses and allows the differentiation of samples comprising enteroviruses from samples comprising other virus species or strains of non-enteroviruses. Furthermore, the inventors have found that detection of a specific region of the 5 'UTR of the genome of a coxiella diplocarina (i.e.nucleotide 535-599 of the 5' UTR) allows detection of any of the 8 serotypes of a coxiella diplocarina and distinguishes samples containing a coxiella diplocarina from those containing other viral species or strains other than a coxiella diplocarina.

Enterovirus detection

The primers of the primer pairs for detecting and/or amplifying enteroviruses have a primer element which hybridizes to a region within nucleotide 452-599 of the 5' UTR of the enterovirus genome. In some embodiments, a primer pair comprises a primer having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of sequence 5'-AATTGTCACCATAAGCAGCCA-3' (SEQ ID NO:1) or the full complement thereof. In some embodiments, one primer of a primer pair comprises or consists of a primer element sequence that is at least 90% identical to SEQ ID No. 1 or at least 90% identical to the full complement of SEQ ID No. 1 and specifically hybridizes under stringent conditions to SEQ ID No. 1 or its full complement. In some embodiments, the primer element is at least 16, 17, 18, 19 nucleotides and/or at most 18, 19, 20, 22, 25, 30, 40, or 50 nucleotides in length and is at least 84, 85, 86, or 90% identical to SEQ ID No. 1. The primer element may comprise or consist of at least 16, 17, 18, 19, 20 or 21 consecutive nucleotides of SEQ ID NO. 1 or the complete complement of SEQ ID NO. 1 and hybridizes to a nucleic acid comprising or consisting of SEQ ID NO. 1 or the complete complement thereof under stringent conditions.

In some embodiments, a primer pair for detecting and/or amplifying an enterovirus comprises a primer having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of sequence 5'-CCCCTGAATGCGGCTAATC-3' (SEQ ID NO:2) or the complete complement thereof. In some embodiments, the primer element comprises a sequence that is at least 90% identical to SEQ ID No. 2 or at least 90% identical to the full complement of SEQ ID No. 2 and specifically hybridizes under stringent conditions to a nucleic acid comprising or consisting of SEQ ID No. 2 or the full complement thereof. In some embodiments, the primer element is at least 16, 17, 18, 19 nucleotides in length and/or up to 18, 19, 20, 22, 25, 30, 40, or 50 nucleotides in length and is at least 84, 85, 86, or 90% identical to SEQ ID No. 2. The primer element may comprise or consist of at least 16, 17, 18, 19, 20 or 21 nucleotides of SEQ ID NO. 2 or the complete complement of SEQ ID NO. 2 and hybridizes with a nucleic acid comprising or consisting of SEQ ID NO. 2 or the complete complement of SEQ ID NO. 2 under stringent conditions.

In some embodiments, the primers used to detect and/or amplify the enterovirus nucleic acid are primer-probes. The primer-probe may comprise a primer element as discussed above, and a probe element comprising a nucleotide sequence that is at least 90% identical to SEQ ID No. 3 or at least 90% identical to the full complement of SEQ ID No. 3. In some embodiments, the probe element comprises at least 19, 20, 21, 22, 23, or 24 consecutive nucleotides of SEQ ID No. 3 or the complement of SEQ ID No. 3. The probe element hybridizes specifically to the corresponding region of SEQ ID NO. 3 or to the complement of SEQ ID NO. 3 under stringent hybridization conditions.

In a specific embodiment, the pair of enterovirus primers comprises two of the above enterovirus primers, i.e.primers having a primer element that specifically hybridizes to a nucleic acid comprising (or consisting of) SEQ ID NO:1 or its complement and primers having a primer element that specifically hybridizes to a nucleic acid comprising (or consisting of) SEQ ID NO:2 or its complement.

In another specific embodiment, one primer of the enterovirus primer pair comprises or consists of SEQ ID NO 1 and the other primer of the enterovirus primer pair is a primer-probe comprising or consisting of (in 5 'to 3' direction): a quencher moiety linked to a nucleotide sequence consisting of a first stem sequence followed by ACACGGACACCCAAAGTAGTCGGT (SEQ ID NO:3) and a second stem sequence complementary to the first stem sequence, linked at its 3' end to a fluorophore and a nucleotide spacer which is a polyethylene glycol-based linker of 10, 14, 15, 16, 17, 18, 19, 20, 21 or 25 atoms, followed by SEQ ID NO: 2.

A specific enterovirus primer pair consists of:

enterovirus primer 1: 5'd AATTGTCACCATAAGCAGCCA 3' (SEQ ID NO:1) Enterovirus primer 2 (primer-probe): 5'd BHQ-1-agcgcACACGGACACCCAAAGTAGTCGGTgcgct-FAM-spacer 18-CCCCTGAATGCGGCTAATC 3'

Where "BHQ-1" is a black hole quencher moiety (black hole quencher), the underlined sequence is a self-complementary stem sequence, "FAM" is an imidofluorescein, and "spacer 18" is a spacer comprising an 18 atom hexaethylene glycol linker.

Dual echovirus detection

The primers of the primer pairs for detecting and/or amplifying a coxiella bisporus comprise a primer element that hybridizes to a region within nucleotides 535-599 of the 5' UTR of the genome of the coxiella bisporus. In some embodiments, one primer of a primer pair comprises or consists of a primer element sequence that is at least 90% identical to 5 'GTTGTAAGGCCCACGAA 3' (SEQ ID NO:4) or at least 90% identical to the full complement of SEQ ID NO:4 and that specifically hybridizes under stringent conditions to SEQ ID NO:4 or its full complement. In some embodiments, the primer element is at least 16, 17, 18, 19 bases in length and/or up to 18, 19, 20, 22, 25, 30, 40, or 50 bases in length and is at least 84, 85, 86, or 90% identical to SEQ ID No. 4. The primer element may comprise or consist of at least 16, 17, 18, 19, 20 or 21 consecutive nucleotides of SEQ ID NO. 4 or the complete complement of SEQ ID NO. 4 and hybridizes to SEQ ID NO. 4 or its complete complement under stringent conditions.

In some embodiments, a primer pair for detecting and/or amplifying a echovirus comprises a primer having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of sequence 5 '-TCAGATCCATAGTGTCICTTGTTA-3' (SEQ ID NO:5) or the full complement thereof. In some embodiments, the primer element comprises a sequence that is at least 90% identical to SEQ ID NO. 5 or at least 90% identical to the full complement of SEQ ID NO. 5 and specifically hybridizes under stringent conditions to SEQ ID NO. 5 or its full complement. In some embodiments, the primer element is at least 16, 17, 18, 19 nucleotides and/or at most 18, 19, 20, 22, 25, 30, 40 or 50 nucleotides in length and is at least 84, 85, 86 or 90% identical to SEQ ID No. 5. The primer element may comprise or consist of at least 16, 17, 18, 19, 20 or 21 nucleotides of SEQ ID NO. 5 or the complete complement of SEQ ID NO. 5 and hybridizes to SEQ ID NO. 5 or its complete complement under stringent conditions.

In some embodiments, the primers used to detect and/or amplify a dicocovirus nucleic acid are primer-probes. The primer-probe can comprise a primer element sequence (discussed above) and a probe element comprising a nucleotide sequence at least 90% identical to 5'-ATGCCCAGAAGGTACCCG-3' (SEQ ID NO:6) or a nucleotide sequence at least 90% identical to the full complement of SEQ ID NO: 6. In some embodiments, the probe element comprises 19, 20, 21, 22, 23, or 24 consecutive nucleotides of SEQ ID No. 6 or the complement of SEQ ID No. 6. The probe element specifically hybridizes under stringent conditions to the region of SEQ ID NO. 6 that corresponds to the complement of SEQ ID NO. 6.

In a specific embodiment, a pair of duplex echovirus primers comprises two of the above duplex echovirus primers (i.e., a primer having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID NO:4 or the complement thereof and a primer having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID NO: 5).

In another specific embodiment, one primer of the echovirus primer pair comprises or consists of SEQ ID NO 4 and the other primer of the echovirus primer pair is a primer-probe comprising or consisting of (in the 5 'to 3' direction): a fluorophore linked to a nucleotide sequence consisting of a first stem sequence (followed by SEQ ID NO:5) and a second stem sequence complementary to the first stem sequence, linked at its 3' end to a quencher and a spacer that is a 10, 14, 15, 16, 17, 18, 19, 20, 21 or 25 atom polyethylene glycol linker, followed by SEQ ID NO: 6.

The specific pair of primers for the double echoviruses consists of:

diechovirus primers 1: 5'd GTTGTAAGGCCCACGAA 3' (SEQ ID NO:4) Diechovirus primer 2 (primer-Probe): 5' d Spacer group 18-TCAGATCCATAGTGTCICTTGTTA 3'

Wherein "CFR 610" is the xanthene dye Cal Fluor RedThe in-frame sequence is a self-complementary stem sequence, "BHQ-2" is a black hole quencher and "spacer 18"Is a spacer comprising a hexaethylene glycol linker of 18 atoms.

The inventors of the present invention have found that the above primer pair surprisingly outperforms other primer pairs in multiplex direct amplification reactions in human biological samples and is capable of detecting 64 serotypes of enteroviruses as well as the serotypes 1-8 of echoviruses.

Product detection

The methods of the invention for determining the presence or absence of an enterovirus and/or a coxsackievirus in a sample involve (among other steps) determining whether an enterovirus or a coxsackievirus nucleotide sequence is amplified in the sample. The determining step may be performed during and/or after the PCR amplification. In some embodiments, at least one primer of each primer pair (i.e., a primer pair for enterovirus and a primer pair for echovirus) is a primer-probe and generates a fluorescent signal during PCR amplification. A signal is detected for enterovirus sequence amplification and/or for duechovirus sequence amplification, thus indicating the presence of virus in the sample.

Real-time PCR methods that do not require a preparation step prior to detection of the amplified sample are preferred for use in the present invention. Most real-time methods detect the formation of amplified products by monitoring the change in fluorescence during thermal cycling. In some embodiments, the amplification of the di-echovirus sequence generates a different fluorescent signal than the amplification of the enterovirus sequence, thus allowing the observer to distinguish the two viruses.

Detectably labeled primer-probes can be used for real-time PCR. For primer-probes such asSuitable detectable labels for primer-probes include fluorophores such as fluorescein bioconjugates and amine-reactive succinimidyl esters of carboxyfluorescein (commonly referred to as FAM). The primer-probe further comprises a quencher. In the absence of the target, the quencher absorbs almost all of the fluorescence emitted by the fluorophore. During the Scorpion PCR reaction, the fluorophore and quencher are separated in the presence of the target, which results in an increase in emitted fluorescence. Fluorescence can be detected and measured in the reaction tube. Suitable quenchers include Black Hole(Biosearch Technologies). Dark quenchers such as DABCYL are dyes that do not have natural fluorescence. BHQ dyes are true dark quenchers, with no natural emission due to their polyaromatic azo backbone. Substitution of electron donating and electron absorbing groups on aromatic rings produces a complete series of quenchers with a broad absorption curve that spans visible wavelengths: BHQ-0(493nm), BHQ-1(534nm), BHQ-2(579nm) and BHQ-3(672 nm). These quenchers can be paired with all universal acceptor dyes to construct efficiently quenched qPCR probes for multiplex assays. In addition to quenching by FRET, BHQ dyes have also been shown to efficiently quench fluorescence by static quenching via formation of a ground-state complex with a reporter dye. Other fluorophores and quenchers having a variety of absorbance and emission values are known in the art.

Examples

Thus, the methods of the present invention generally described will be more readily understood by reference to the following examples, which are provided by way of illustration and are not intended to limit the methods and kits of the present invention.

Example 1

A collection of clinical cerebrospinal fluid (CSF) samples or a collection of artificial synthetic CSFs was tested and the results were compared to real-time PCR results to determine the clinical performance of the Simplexa enterovirus and coxsackievirus Direct assays compared to real-time PCR methods using conventional nucleic acid extraction.

Simplexa Direct assay: the Simplexa Direct kit (Focus Diagnostics, Cypress, Calif.) contains all the reagents used for on-board extraction and real-time PCR. For each reaction on the Direct Amplification Disc, the untreated CSF sample was loaded directly into the sample well of one of the wedge-shaped structures of the Disc without any sample preparation steps. Pipetting amplification reaction mix into wedge-shaped reaction wells, wherein the amplification reaction mix packageContaining enterovirus primers 1 and 2 and echovirus primers 1 and 2 as described below:

enterovirus primer 1: 5'd AATTGTCACCATAAGCAGCAC 3' (SEQ ID NO:1)

Enterovirus primer 2 (primer-probe) of 5'd BHQ-1-agcgcACACGGACACCCAAAGTAGTCGGTgcgct-FAM-spacer 18-CCCCTGAATGCGGCTAATC 3'

Double echovirus primers 1: 5'd GTTGTAAGGCCCACGAA 3' (SEQ ID NO:4)

Diechovirus primer 2 (primer-probe) 5'd CFR 610-cgcgcgATGCCCAGAAGGTACCCGcgcg-BHQ-2-spacer 18-TCAGATCCATAGTGTCICTTGTTA 3'

The reaction mix further comprises DNA polymerase, reverse transcriptase, rnase inhibitors, salts, deoxynucleotides, internal controls and probes, and primers for the internal controls. Wedge structure sealed with foil and then Direct Amplification Disc inserted into 3M^TMIntegrated cycler (3M, st. paul, MN, USA) and reverse transcription and real-time PCR were started in the cycler. The PCR cycling conditions included the following steps: i) the sample was preheated at 75 ℃, 180 seconds, 1 cycle, ii) reverse transcription at 50 ℃, 720 seconds, 1 cycle, iii) polymerase activation at 97 ℃, 120 seconds, 1 cycle, iv) denaturation at 97 ℃, 10 seconds and annealing/extension/detection at 56 ℃, 10 seconds and 58 ℃, 30 seconds, 45 cycles. The target DNA (derived from enterovirus and/or echovirus genomic RNA) is specifically amplified and simultaneously detected in the same reaction by fluorescently labeled primer-probes. Data collection and analysis were performed using Integrated Cycler Studio software.

Virus strain:the following strains were used in the LoD study: CVA1, CVA17 and CVA9, and Ericoviruses HPEV-1 and HPEV-3(ZeptoMetrix, Buffalo, NY). The following strains of echovirus were used in the specificity study: HPEV1, HPEV2, HPEV3, HPEV4, HPEV5 and HPEV6(ZeptoMetrix, Buffalo, NY).

Limit of detection (LoD) study: LoD studies were performed to determine the analytical sensitivity of the assay. The putative LoD for each virus stock was determined as the lowest concentration using 4/4 replicates detected in synthetic CSF (Golden West Biologicals, Temecula, CA).

Study of sensitivity and specificity: clinical performance of the Simplexa enterovirus and dianechovirus Direct assays was evaluated using a set of 154 CSF samples including 7 dianechoviruses positive, 74 enterovirus positive, and 74 dianechovirus/enterovirus negative as reported by the real-time PCR assay. In addition, an artificial 24-biegavirus positive sample set in synthetic CSF was used. The artificial collection was prepared using a 10X, 4X, 2X and 1X concentration of a quantitative viral stock of the double echovirus serotypes 1-6 of Simplexa LoD.

Cross-reactivity study:cross-reactivity was assessed using a diverse collection of bacteria and viruses. The biological collection (with which infection may give similar clinical symptoms as an enterovirus and/or echovirus infection) is used to determine cross-reactivity. In synthetic CSF the sequence of 10 is assembled⁶Bacteria of CFU/mL or 10⁵TCID₅₀Viral composition per ml.

Results: LoD: LoD studies using synthetic CSF showed that Simplexa enterovirus and Direct, a di-echovirus, detected enterovirus and di-echovirus strains in<1X10³TCID₅₀and/mL. The positive and negative identities of Simplexa enterovirus and Direct were compared to 95.6% (65/68) and 89% (65/73) for enterovirus and 92.6% (25/27) and 92.2% (71/77) for echovirus, respectively, as determined by real-time PCR using conventional extraction procedures.

TABLE 1 detection limits of Enterovirus and Biechovirus strains

The identity of the relative positives and negatives of Simplexa enterovirus and Direct are shown in tables 2 and 3.

TABLE 2 Enterovirus identity of CSF samples

TABLE 3-BIS ECHO VIRUS CONDITIONS OF CSF SAMPLES

Cross-reactivity: no cross-reactivity was detected for the pathogens in table 4.

TABLE 4 Cross-reactive pathogens tested in synthetic CSF

The ability to detect selected enterovirus types was further confirmed in subsequent studies. Exemplary enteroviruses detected in subsequent studies using Simplexa enterovirus and dianechovirus Direct assays are shown in table 5.

TABLE 5 selected enterovirus strains examined in subsequent studies

Conclusion: simplexa enterovirus and Direct were able to detect and distinguish enterovirus from Diechovirus directly from unextracted CSF samples with comparable performance to conventional PCR assays using nucleic acid extraction. By targeting the 5' UTR and the bis of enterovirusesThe 5' UTR of echoviruses, 64 serotypes of enteroviruses and serotypes 1-6 in human CSF are effectively detected in this rapid "sample-to-response" assay. HPEV7 and HPEV8 were not commercially available for testing, but bioinformatics (in silico) analysis showed that these serotypes could be detected. The performance of the Simplexa enterovirus and coxsackievirus Direct assay in centrifugal microfluidic disks using an integrated thermal cycler capable of holding the disks provides a compact system for rapid detection of enteroviruses and coxsackieviruses directly from human biological samples.

Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs.

The illustratively described invention may suitably be practiced in the absence of any element or elements, limitation or limitations which is not specifically disclosed herein. Furthermore, the terms and expressions which have been employed herein are used as terms of description and not of limitation, and there is no intention in the use of such terms and expressions of excluding any equivalents of the features shown and described or portions thereof, but it is recognized that various modifications are possible within the scope of the invention claimed.

Thus, it should be understood that although the present invention has been specifically disclosed by preferred embodiments and optional features of the invention, modification, improvement and variation of the invention herein disclosed may be resorted to by those skilled in the art, and that such modifications, improvements and variations are considered to be within the scope of this invention. The materials, methods, and examples provided herein are representative of preferred embodiments, are exemplary, and are not intended as limitations on the scope of the invention.

The present invention has been described broadly and generically herein. Each of the narrower species and subgeneric groupings falling within the generic disclosure also form part of the invention. This includes the use of the dependent (genus) to remove any subject matter from the definition or reverse limitation to the general description of the invention, whether or not the excluded material is specifically recited herein.

Furthermore, where features or aspects of the invention are described in terms of markush groups, those skilled in the art will recognize that the invention is also thereby described in terms of any individual member or subgroup of members of the markush group.

All publications, patent applications, patents, and other references mentioned herein are expressly incorporated by reference in their entirety to the same extent as if each was incorporated by reference individually. In case of conflict, the present specification, including definitions, will control.

Other embodiments are set forth within the following claims.

In summary, the present application includes, but is not limited to, the following:

1. a method for determining the presence or absence of enterovirus and/or echovirus in a sample, the method comprising:

(a) amplifying the nucleic acid of the enterovirus using at least one first primer pair if the enterovirus is present in the sample, wherein the first primer of the first pair has a primer element that specifically hybridizes under stringent conditions to a nucleic acid comprising or consisting of SEQ ID NO. 1 or the complete complement thereof and the second primer of the first pair has a primer element that specifically hybridizes under stringent conditions to a nucleic acid comprising or consisting of SEQ ID NO. 2 or the complete complement thereof; and/or

(b) (ii) amplifying the nucleic acid of the echovirus using at least one second primer pair if the echovirus is present in said sample, wherein the first primer of the second pair has a primer element that specifically hybridizes under stringent conditions to a nucleic acid comprising or consisting of SEQ ID No. 4 or the complete complement thereof and the second primer of the second pair has a primer element that specifically hybridizes under stringent conditions to a nucleic acid comprising or consisting of SEQ ID No. 5 or the complete complement thereof.

2. The method according to item 1, wherein the first primer of the first pair has a primer element comprising a nucleotide sequence that is at least 90% identical to SEQ ID NO:2 or the complete complement of SEQ ID NO:2 and a non-nucleic acid detectable label.

3. The method according to item 2, wherein the first primer of the first pair is a primer probe.

4. The method according to item 3, wherein the primer probe has a probe element comprising a nucleotide sequence that is at least 90% identical to SEQ ID NO. 3 or the complete complement of SEQ ID NO. 3.

5. The method according to clause 4, wherein the probe element further comprises a quencher, a fluorophore, and two self-complementary stem sequences, wherein each stem sequence is at least 4 nucleotides in length.

6. The method according to item 2, wherein the second primer of the first pair has a primer element comprising a nucleotide sequence that is at least 90% identical to SEQ ID NO. 1 or the complete complement of SEQ ID NO. 1.

7. The method according to item 1, wherein the first primer of the first pair has a primer element comprising a nucleotide sequence that is at least 90% identical to SEQ ID NO:1 or the complete complement of SEQ ID NO:1 and a non-nucleic acid detectable label.

8. The method according to item 7, wherein the first primer of the first pair is a primer probe.

9. The method according to item 8, wherein the primer probe has a probe element comprising a nucleotide sequence that is at least 90% identical to SEQ ID NO. 3 or the complete complement of SEQ ID NO. 3.

10. The method according to clause 9, wherein the probe element further comprises a quencher, a fluorophore, and two self-complementary stem sequences, wherein each stem sequence is at least 4 nucleotides in length.

11. The method according to item 7, wherein the second primer of the first pair has a primer element comprising a nucleotide sequence that is at least 90% identical to SEQ ID NO. 2 or the complete complement of SEQ ID NO. 2.

12. The method according to item 1, wherein the first primer of the second pair has a primer element comprising a nucleotide sequence that is at least 90% identical to SEQ ID NO. 5 or the complete complement of SEQ ID NO. 5 and a non-nucleic acid detectable label.

13. The method according to item 12, wherein the first primer of the second primer pair is a probe.

14. The method according to item 13, wherein the primer probe has a probe element comprising a nucleotide sequence that is at least 90% identical to SEQ ID NO 6 or the complete complement of SEQ ID NO 6.

15. The method of clause 14, wherein the probe element further comprises a quencher, a fluorophore, and two self-complementary stem sequences, wherein each stem sequence is at least 5 nucleotides in length.

16. The method according to item 12, wherein the second primer of the second primer pair has a primer element comprising a nucleotide sequence that is at least 90% identical to SEQ ID No. 4 or the complete complement of SEQ ID No. 4.

17. The method according to item 1, wherein the first primer of the second pair has a primer element comprising a nucleotide sequence that is at least 90% identical to SEQ ID NO. 4 or the complete complement of SEQ ID NO. 4 and a non-nucleic acid detectable label.

18. The method of item 17, wherein the first primer of the second primer pair is a primer probe.

19. The method according to item 18, wherein the primer probe has a probe element comprising a nucleotide sequence that is at least 90% identical to SEQ ID No. 6 or the complete complement of SEQ ID No. 6.

20. The method of item 19, wherein the probe element further comprises a quencher, a fluorophore, and two self-complementary stem sequences, wherein each stem sequence is at least 5 nucleotides in length.

21. The method according to item 17, wherein the second primer of the second pair has a primer element comprising a nucleotide sequence that is at least 90% identical to SEQ ID No. 5 or the complete complement of SEQ ID No. 5.

22. The method according to item 1, wherein the sample is a biological sample selected from the group consisting of: cerebrospinal fluid, blood, feces, throat swab, rectal swab, nasal-throat swab, plasma, serum, and urine.

23. The method of clause 22, wherein nucleic acids are not extracted from the biological sample.

24. A composition comprising a non-nucleic acid detectable label linked, directly or indirectly, to a primer having a primer element comprising a nucleotide sequence at least 90% identical to SEQ ID No. 1, the full complement of SEQ ID No. 1, SEQ ID No. 2, or the full complement of SEQ ID No. 2.

25. The composition of item 24, which is a primer-probe, further comprising a probe element directly or indirectly linked to the primer element through a polymerase blocking group, wherein the probe element comprises a nucleic acid sequence that is at least 90% identical to SEQ ID No. 3 or the complete complement of SEQ ID No. 3.

26. The primer-probe of item 25, further comprising a quenching dye, wherein the detectable label is a fluorophore.

27. A composition comprising a non-nucleic acid detectable label linked, directly or indirectly, to a primer having a primer element comprising a nucleotide sequence at least 90% identical to SEQ ID No. 4, the full complement of SEQ ID No. 4, SEQ ID No. 5, or the full complement of SEQ ID No. 5.

28. A composition according to item 27, which is a primer-probe, further comprising a probe element directly or indirectly linked to said primer element via a polymerase blocking group, wherein said probe element comprises a nucleic acid sequence that is at least 90% identical to SEQ ID No. 6 or the complete complement of SEQ ID No. 6.

29. The primer-probe of item 28, further comprising a quenching dye, wherein the detectable label is a fluorophore.

30. A kit, comprising:

(a) a first primer of a first primer pair having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID NO. 1 or its complete complement and a second primer of a first primer pair having a primer element that specifically hybridizes to a nucleotide comprising or consisting of SEQ ID NO. 2 or its complete complement, wherein at least one primer of the first primer pair is linked to a detectable label that is not a nucleic acid; and

(b) a first primer of a second primer pair having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID NO. 4 or the complete complement thereof and a second primer of a second primer pair having a primer element that specifically hybridizes to a nucleic acid comprising or consisting of SEQ ID NO. 5 or the complete complement thereof, wherein at least one primer of the second primer pair is directly or indirectly linked to a detectable label that is not a nucleic acid.