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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1993 May;56(5):520–525. doi: 10.1136/jnnp.56.5.520

A polymerase chain reaction assay of cerebrospinal fluid in patients with suspected herpes simplex encephalitis.

N E Anderson 1, K F Powell 1, M C Croxson 1
PMCID: PMC1015012  PMID: 8389398

Abstract

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.

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Selected References

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  1. Aurelius E., Johansson B., Sköldenberg B., Staland A., Forsgren M. Rapid diagnosis of herpes simplex encephalitis by nested polymerase chain reaction assay of cerebrospinal fluid. Lancet. 1991 Jan 26;337(8735):189–192. doi: 10.1016/0140-6736(91)92155-u. [DOI] [PubMed] [Google Scholar]
  2. Brick J. F., Brick J. E., Morgan J. J., Gutierrez A. R. EEG and pathologic findings in patients undergoing brain biopsy for suspected encephalitis. Electroencephalogr Clin Neurophysiol. 1990 Jul;76(1):86–89. doi: 10.1016/0013-4694(90)90060-w. [DOI] [PubMed] [Google Scholar]
  3. Greenberg S. B., Taber L., Septimus E., Kohl S., Puck J., Bryan R. N. Computerized tomography in brain biopsy-proven herpes simplex encephalitis. Early normal results. Arch Neurol. 1981 Jan;38(1):58–59. doi: 10.1001/archneur.1981.00510010084019. [DOI] [PubMed] [Google Scholar]
  4. Hayward G. S., Frenkel N., Roizman B. Anatomy of herpes simplex virus DNA: strain differences and heterogeneity in the locations of restriction endonuclease cleavage sites. Proc Natl Acad Sci U S A. 1975 May;72(5):1768–1772. doi: 10.1073/pnas.72.5.1768. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Kahlon J., Chatterjee S., Lakeman F. D., Lee F., Nahmias A. J., Whitley R. J. Detection of antibodies to herpes simplex virus in the cerebrospinal fluid of patients with herpes simplex encephalitis. J Infect Dis. 1987 Jan;155(1):38–44. doi: 10.1093/infdis/155.1.38. [DOI] [PubMed] [Google Scholar]
  6. Kimura H., Aso K., Kuzushima K., Hanada N., Shibata M., Morishima T. Relapse of herpes simplex encephalitis in children. Pediatrics. 1992 May;89(5 Pt 1):891–894. [PubMed] [Google Scholar]
  7. Klapper P. E., Cleator G. M., Dennett C., Lewis A. G. Diagnosis of herpes encephalitis via Southern blotting of cerebrospinal fluid DNA amplified by polymerase chain reaction. J Med Virol. 1990 Dec;32(4):261–264. doi: 10.1002/jmv.1890320413. [DOI] [PubMed] [Google Scholar]
  8. Kohl S., James A. R. Herpes simplex virus encephalitis during childhood: importance of brain biopsy diagnosis. J Pediatr. 1985 Aug;107(2):212–215. doi: 10.1016/s0022-3476(85)80127-x. [DOI] [PubMed] [Google Scholar]
  9. Kwok S., Higuchi R. Avoiding false positives with PCR. Nature. 1989 May 18;339(6221):237–238. doi: 10.1038/339237a0. [DOI] [PubMed] [Google Scholar]
  10. Lakeman F. D., Koga J., Whitley R. J. Detection of antigen to herpes simplex virus in cerebrospinal fluid from patients with herpes simplex encephalitis. J Infect Dis. 1987 Jun;155(6):1172–1178. doi: 10.1093/infdis/155.6.1172. [DOI] [PubMed] [Google Scholar]
  11. Landry M. L., Booss J., Hsiung G. D. Duration of vidarabine therapy in biopsy-negative herpes simplex encephalitis. JAMA. 1982 Jan 15;247(3):332–334. [PubMed] [Google Scholar]
  12. Peterslund N. A. Herpesvirus infection: an overview of the clinical manifestations. Scand J Infect Dis Suppl. 1991;80:15–20. [PubMed] [Google Scholar]
  13. Pohl-Koppe A., Dahm C., Elgas M., Kühn J. E., Braun R. W., ter Meulen V. The diagnostic significance of the polymerase chain reaction and isoelectric focusing in herpes simplex virus encephalitis. J Med Virol. 1992 Feb;36(2):147–154. doi: 10.1002/jmv.1890360213. [DOI] [PubMed] [Google Scholar]
  14. Powell K. F., Anderson N. E., Frith R. W., Croxson M. C. Non-invasive diagnosis of herpes simplex encephalitis. Lancet. 1990 Feb 10;335(8685):357–358. doi: 10.1016/0140-6736(90)90648-o. [DOI] [PubMed] [Google Scholar]
  15. Puchhammer-Stöckl E., Popow-Kraupp T., Heinz F. X., Mandl C. W., Kunz C. Establishment of PCR for the early diagnosis of herpes simplex encephalitis. J Med Virol. 1990 Oct;32(2):77–82. doi: 10.1002/jmv.1890320202. [DOI] [PubMed] [Google Scholar]
  16. Rowley A. H., Whitley R. J., Lakeman F. D., Wolinsky S. M. Rapid detection of herpes-simplex-virus DNA in cerebrospinal fluid of patients with herpes simplex encephalitis. Lancet. 1990 Feb 24;335(8687):440–441. doi: 10.1016/0140-6736(90)90667-t. [DOI] [PubMed] [Google Scholar]
  17. Rozenberg F., Lebon P. Amplification and characterization of herpesvirus DNA in cerebrospinal fluid from patients with acute encephalitis. J Clin Microbiol. 1991 Nov;29(11):2412–2417. doi: 10.1128/jcm.29.11.2412-2417.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Saiki R. K., Gelfand D. H., Stoffel S., Scharf S. J., Higuchi R., Horn G. T., Mullis K. B., Erlich H. A. Primer-directed enzymatic amplification of DNA with a thermostable DNA polymerase. Science. 1988 Jan 29;239(4839):487–491. doi: 10.1126/science.2448875. [DOI] [PubMed] [Google Scholar]
  19. Schroth G., Gawehn J., Thron A., Vallbracht A., Voigt K. Early diagnosis of herpes simplex encephalitis by MRI. Neurology. 1987 Feb;37(2):179–183. doi: 10.1212/wnl.37.2.179. [DOI] [PubMed] [Google Scholar]
  20. Sköldenberg B., Forsgren M., Alestig K., Bergström T., Burman L., Dahlqvist E., Forkman A., Frydén A., Lövgren K., Norlin K. Acyclovir versus vidarabine in herpes simplex encephalitis. Randomised multicentre study in consecutive Swedish patients. Lancet. 1984 Sep 29;2(8405):707–711. doi: 10.1016/s0140-6736(84)92623-0. [DOI] [PubMed] [Google Scholar]
  21. Whitley R. J., Cobbs C. G., Alford C. A., Jr, Soong S. J., Hirsch M. S., Connor J. D., Corey L., Hanley D. F., Levin M., Powell D. A. Diseases that mimic herpes simplex encephalitis. Diagnosis, presentation, and outcome. NIAD Collaborative Antiviral Study Group. JAMA. 1989 Jul 14;262(2):234–239. [PubMed] [Google Scholar]
  22. Whitley R. J. Viral encephalitis. N Engl J Med. 1990 Jul 26;323(4):242–250. doi: 10.1056/NEJM199007263230406. [DOI] [PubMed] [Google Scholar]

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