3-04-02 Evaluation of the severity of herpes simplex encephalitis diagnosed by polymerase chain reaction assay of cerebrospinal fluid (original) (raw)
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Journal of Neurology, Neurosurgery & Psychiatry, 1993
A polymerase chain reaction (PCR) was used to detect herpes simplex virus (HSV) deoxyribonucleic acid (DNA) in CSF of 109 patients with possible herpes simplex encephalitis. HSV DNA was found in 20/109 patients. In 14 of these patients the diagnosis was confirmed by a rise in CSF antibodies, isolation of HSV from the brain, or both. In 3 patients CSF antibodies did not rise and 3 patients did not have a follow up lumbar puncture or a brain biopsy. In 19/20 patients HSV DNA was present in the first CSF specimen. The virus was identified as HSV I in 15 patients and HSV II in 4; the virus was not typed in the other patient. A possible diagnosis of herpes simplex encephalitis was not confirmed in the 89 PCR-negative patients. HSV DNA was present in CSF of 3 patients who had meningitis with herpetic genital infections but it was not found in 24 patients with other neurological diseases. The results suggest that the detection of HSV DNA in CSF using a PCR assay will be an accurate method of early diagnosis of herpes simplex encephalitis.
Journal of the Neurological Sciences, 1998
The early diagnosis of herpes simplex encephalitis (HSE) is essential because early introduction of antiviral therapy can significantly reduce the mortality of this disease. Herpes simplex virus (HSV) DNA detection in cerebrospinal fluid (CSF) samples is a rapid, noninvasive, specific, and highly sensitive method for HSE diagnosis. Neurodiagnostic methods have also been studied for noninvasive diagnosis of HSE. Magnetic resonance imaging (MRI) seems to be the most sensitive of them but it has not been compared to PCR in terms of efficacy for HSE diagnosis. In this study, 17 patients with focal encephalitis were prospectively evaluated by PCR analysis of CSF samples and MRI examination. MRI lesions involving the inferomedial region of one or both temporal lobes were observed in all PCR-positive patients but one. No PCR-negative patient presented with the same pattern of MRI lesions. MRI was also important for the establishment of an alternative diagnosis in three of eight PCR-negative patients. Both methods should be routinely applied in the evaluation of presumed HSE cases.
Establishment of PCR for the early diagnosis of herpes simplex encephalitis
Journal of Medical Virology, 1990
The early detection of herpes simplex encephalitis (HSE) represents a major problem in viral diagnostics. We have now established a test system based on PCR for the specific amplification of HSV-DNA in cerebrospinal fluid (CSF) samples followed by oligonucleotide hybridization. The test proved to be very sensitive. Five molecules of HSV 1 DNA still yielded positive signals after hybridization. The assay was applied to CSF samples from 6 patients with confirmed HSE. All except one CSF sample obtained from the 2nd to the 8th day after onset of neurological symptoms yielded positive results. The primers used also exhibit a certain degree of crossreactivity with HSV 2, as revealed by testing of a CSF sample from an HSV2-infected child. No positive signals were obtained with human DNA and with DNA from CMV-and VZV-infected fibroblasts. Also 42 CSF samples of patients suffering from other diseases of the CNS yielded negative results. The present results indicate that the detection of HSV DNA in CSF by PCR represents a valuable tool for the early diagnosis of HSE.
Detection of Herpes Simplex Virus Infection in Cerebrospinal Fluid
Medical Laboratory Journal, 2016
Background and Objective: Herpes simplex encephalitis is a life-threatening consequence of the central nervous system (CNS) infection with Herpes simplex virus (HSV). Although it is a rare disease, mortality rates reach 70% in the absence of therapy and only a minority of individuals can return to normal function. The aim of this study was to determine possible correlation between HSV infection and the incidence of encephalitis in patients with neurological signs. Methods: Overall, 152 CSF samples were tested from patients with neurological signs referred to Mahdieh Clinical Laboratory in Isfahan from 2010 to 2013. After cerebrospinal fluid (CSF) collection, DNA was extracted and real-time polymerase chain reaction (PCR) was performed for HSV detection. Results: Of 152 patients tested, 50 were diagnosed with encephalitis. HSV DNA was present in the CSF of 13 patients with encephalitis. HSV was significantly higher (p< 0.05) in patients with encephalitis, which shows the significance of infection as an etiological factor of this disease. About 60% of the encephalitis cases were in age range of 1-24 months. Conclusion: According to the findings of the present study, Cesarean section is recommended for HSV-positive mothers. A routine real-time PCR test is suggested for HSV detection in patients with encephalitis to avoid unnecessary antiviral treatments.
PCR in herpes simplex virus infections of the central nervous system
Serodiagnosis and Immunotherapy in Infectious Disease, 1994
Herpes simplex virus (HSV) infections of the central nervous system (CNS) together comprise a special group of herpetic diseases with respect to residual damage and difficulties in diagnosis. The various syndromes and manifestations are presented, in particular the most common and severe form, herpes simplex virus encephalitis (HSE). The probable reasons for the failure of routine viral methods for establishing a rapid and early diagnosis in HSE are discussed. The technical problems of polymerase chain reaction (PCR) in the diagnosis of HSE and its use as a diagnostic method are reviewed.
A Probable Case of Herpes simplex Encephalitis despite Negative PCR Findings Findings
Infection, 2001
A 54-year-old woman was admitted to the hospital suffering from fever and personality changes. Laboratory examination of her cerebrospinal fluid (CSF) showed 270 mononuclear cells, 30 polynuclear cells and a clinically low number of erythrocytes/mm 3. Empirical clinical findings from this case suggested treatment with acyclovir. Magnetic resonance imaging (MRI) showed bilateral temporal hyperintense signals in T2-weighted images. PCR with specific primer for herpes simplex virus type 1 (HSV-1) and HSV-2 were negative. There was no elevation of oligoclonal antibodies specific to HSV in CSF after 2 weeks. Although we did not prove the presence of the agent microbiologically at the clinical onset of the disease, the MRI and electroencephalogram (EEG) findings, erythrocytes in CSF and the dramatic response to acyclovir therapy are suggestive of a diagnosis of herpes simplex encephalitis (HSE).
Journal of Medical Virology, 2001
The objectives of this study were to evaluate the reliability of herpes simplex virus (HSV) PCR testing in cerebrospinal¯uid (CSF) for the detection of herpes simplex encephalitis. This was done by examining retrospectively the clinical follow-up of a large group of patients tested routinely by HSV-PCR. In addition, an attempt was made to assess the incidence of herpes simplex encephalitis in a central European population. CSF samples from 1,427 patients from all Vienna hospitals were submitted for HSV-PCR testing during a period of 4 years and 8 months. Herpes simplex encephalitis was detected by PCR in 12 cases and by serological methods in one additional patient. Retrospective analysis of the course of disease, which was possible in 799 PCRnegative patients, led to the identi®cation of three additional cases in which herpes simplex encephalitis appears to have occurred despite negative PCR results. Failure of the PCR in these patients is most likely due to the time of obtaining CSF during the course of disease. A high speci®city of the assay was demonstrated by the lack of false positive results in any of the 708 cases in which other causes for the neurological symptoms had been identi®ed in the follow-up. The incidence of herpes simplex encephalitis in the population of Vienna was between 1 case/ 469,000±577,000 individuals/year. The highest annual incidence was detected in the age group between 3 months and 3 years, which, however, could not be con®rmed statistically.
Herpes simplex encephalitis with thalamic, brainstem and cerebellar involvement
The neuroradiology journal, 2017
Herpes simplex virus encephalitis is a common and treatable cause of acute encephalitis in all age groups. Certain radiological features such as temporal parenchymal involvement facilitate the diagnosis. The use of herpes simplex virus polymerase chain reaction has expanded the clinical and imaging spectrum. We report the case of a young patient who presented with a movement disorder and predominant involvement of thalami, brainstem and cerebellum on magnetic resonance imaging, and was diagnosed with herpes simplex virus encephalitis. Differentiation from Japanese encephalitis may be difficult in these patients, especially in endemic areas, and may necessitate the use of relevant investigations in all patients.
An unusual presentation of herpes simplex virus encephalitis
Case reports in medicine, 2012
We present a case of a 65-year-old man with an acute alteration in mental state that was initially diagnosed as a functional psychiatric condition. After extensive workup, herpes simplex virus type 1 (HSV-1) was detected in the patient's cerebrospinal fluid (CSF) by polymerase chain reaction (PCR), and he responded rapidly to treatment with acyclovir. The case illustrates the importance of actively excluding organic causes in such patients, the need to have a low threshold of suspicion for HSV encephalitis, and the central role of CSF PCR testing for the diagnosis of HSV encephalitis, even in the absence of CSF biochemical abnormalities.