Encephalitis in immunocompetent patients due to herpes simplex virus type 1 or 2 as determined by type-specific polymerase chain reaction and antibody assays of cerebrospinal fluid.
A herpes simplex virus type 2 (HSV 2) etiology was sought in 93 consecutive cases of herpes simplex encephalitis (HSE) in immunocompetent post neonate patients. Antibodies to HSV 2 glycoprotein G antigen were determined by an enzyme-linked immunosorbent assay (ELISA) and HSV 2 DNA in cerebrospinal fluid (CSF) by a nested polymerase chain reaction (PCR) assay with primer pairs in the glycoprotein G gene. Evidence of HSV 2 infection was found in 6 patients; HSV 2 DNA was demonstrated in CSF and the intrathecal HSV 2 antibody response confirmed the findings. Five of the 6 patients with HSV 2 encephalitis presented a clinical picture, CSF, EEG, and CT findings characteristic of severe HSE. An atypically mild clinical course was seen in one patient. HSV 2 should be considered as an etiological agent in the viral diagnosis of HSE. With a combination of nested PCR assays for HSV 1 (primer pairs in the glycoprotein D gene) and HSV 2 in 10 microliters of CSF with no other preparation than freeze-thawing, HSV 1 or HSV 2 DNA was detected in 88 out of 93 (95%) of the first CSF specimens collected after the onset of neurological HSV disease. These findings extend and confirm previous results with PCR as a rapid and sensitive tool for early diagnosis of HSE.
Department of Virology, Central Microbiological Laboratory of the Stockholm County Council, Sweden.
E
E
Aurelius
B
B
Johansson
B
B
Sköldenberg
M
M
Forsgren
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000134:cerebrospinal fluid; D001483:Base Sequence; D002648:Child; D002675:Child, Preschool; D015342:DNA Probes; D004279:DNA, Viral / Q000235:genetics; D004660:Encephalitis / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction; D012008:Recurrence; D018139:Simplexvirus / Q000145:classification / Q000235:genetics* / Q000276:immunology
D000914:Antibodies, Viral; D015342:DNA Probes; D004279:DNA, Viral