Neonatal herpes simplex virus infections: HSV DNA in cerebrospinal fluid and serum

Abstract

Aim-To investigate the diagnostic potential of herpes simplex virus (HSV) DNA in cerebrospinal fluid and serum; to correlate the findings with outcome in the child and with type of maternal infection. Methods-Cerebrospinal fluid and serum specimens from 36 children with verified neonatal HSV infections, diagnosed between 1973 and 1996, were examined using the polymerase chain reaction technique (PCR). Results-In 21 children for whom both cerebrospinal fluid and sera were available, HSV DNA was found in one or both specimens in 19 (90%). Overall, HSV DNA was found in the cerebrospinal fluid of 74% of 27 children, and in the sera of 20 out of 30 children (67%). In two children HSV DNA was not demonstrable in either serum or cerebrospinal fluid. In sequential specimens from four children, the persistence of HSV DNA after the end of intravenous treatment was associated with a poor prognosis. Conclusions-These findings indicate that HSV DNA detection in CSF and serum is highly sensitive for the diagnosis of neonatal HSV infections but does not replace the detection of virus in other locations using virus isolation and antigen detection. (Arch Dis Child Fetal Neonatal Ed 1999;81:F24-F29)

Guidance on Management of Asymptomatic Neonates Born to Women With Active Genital Herpes Lesions

“…The diagnosis of neonatal HSV CNS disease has been greatly enhanced by PCR testing of cerebrospinal fluid (CSF) specimens, [32][33][34][35][36][37][38] and PCR assay is now the method of choice for documenting CNS involvement in an infant…”

“…33,36,38 PCR analysis of CSF also should play a role in determining the duration of antiviral therapy, because available data suggest that having HSV DNA detected in CSF at or after completion of intravenous therapy is associated with poor outcomes. 36,37 All infants with a positive CSF PCR assay result for HSV DNA at the beginning of antiviral therapy should have a repeat lumbar puncture near the end of treatment to determine that HSV DNA has been cleared from the CNS. 24 Infants whose PCR assay result remains positive should continue to receive intravenous antiviral therapy until the CSF PCR assay result is negative.…”

Persistence of herpes simplex virus DNA in cerebrospinal fluid of neonates with herpes simplex virus encephalitis

“…In recent years, the diagnosis of HSV encephalitis has been greatly improved and facilitated by the development of PCR that detects HSV DNA in CSF. Its sensitivity and specificity range from 75 to 100% and 71 to 100%, respectively [10][11][12] but its validity is complicated by interlaboratory variability.…”

Polymerase chain reaction in neonatal HSV encephalitis: an assay to count on?

“…Polymerase chain reaction has long been documented as useful in the evaluation of neonatal HSV disease; 3,[11][12][13] however, problems with the reliability of this technique in its current state may limit its utility in future investigations. The lack of interlaboratory standards for HSV PCR 1,14 and the use of single-labdeveloped assays (termed 'home-brew' protocols by one major textbook 1 ) raises the possibility that the same sample tested in different laboratories may provide different results, leading to inappropriate management strategies.…”

“…Original studies used to generate the recognized utility (sensitivity 75 to 100%, specificity 71 to 100% 1,2 ) of HSV PCR in neonatal HSV CNS disease were done on small groups of patients [11][12][13] or on retrospective analysis of stored CSF from a large NIAID (National Institute of Allergy and Infectious Diseases) study, 3 in which <20% of the CSF samples assayed were obtained before antiviral therapy. These limitations, as well as differences in design among the studies and complications in specimen preservation, have been previously discussed.…”