Herpes simplex encephalitis. A study of seven patients and their immunological response prior to routine acyclovir treatment.
OBJECTIVE
A retrospective study on cerebrospinal fluid (CSF) samples was made possible by access to a large CSF bank, which has been supplemented by the well characterised prior collection of CSF from patients with Herpes simplex encephalitis (including serial samples from some patients and kindly donated by Professor Maurice Longson, Manchester). These samples are of particular interest because they were collected prior to the routine administration of acyclovir.


METHODS
Although an earlier study had shown that there was indeed a correlation between higher titres of antibody and a better outcome, the data did not emerge with statistical significance. The current study was based upon an improved method, which demonstrates the antigen-specific clonality of the immune response.


RESULTS
The primitive polyclonal anamnestic response was contrasted with the strong antigen-specific response, which was manifested by a monoclonal pattern in some patients. A clear distinction emerged between two sub-groups of patients on the basis of these findings, which showed a statistically significant (P<0.03) correlation with outcome.


CONCLUSIONS
This has allowed us to further support the hypothesis that a strong immunological response has positive prognostic value during the course of the disease.
Bell
J B
JB
Department of Clinical Biochemistry, National Hospital for Neurology and Neurosurgery, London, UK.
Davies
R A
RA
Thompson
E J
EJ
D000212:Acyclovir / Q000627:therapeutic use*; D000914:Antibodies, Viral / Q000134:cerebrospinal fluid; D000956:Antigens, Viral / Q000134:cerebrospinal fluid; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006561:Herpes Simplex / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies
D000914:Antibodies, Viral; D000956:Antigens, Viral; D000998:Antiviral Agents; D000212:Acyclovir