[Value of the polymerase chain reaction in the diagnosis of herpes infections of the nervous system].
OBJECTIVE
To assess the performance of a polymerase chain reaction (PCR) method in cerebrospinal fluid (CSF) for the diagnosis of nervous system infections caused by herpesvirus, and to estimate the incidence of encephalitis due to herpes simplex virus type 1 in the adult population of the island of Gran Canaria.


METHODS
We studied 330 CSF specimens from 312 patients (281 HIV-negative and 31 HIV-positive) remitted to investigate clinically suspected encephalitis or meningitis, or to study neuropathy or demyelinating disease. A multiplex PCR technique was used to detect herpes simplex virus types 1 and 2 (HSV-1 and HSV-2), varicella-zoster virus (VZV), human cytomegalovirus (CMV), Epstein-Barr virus and human herpesvirus type 6. The patients' clinical records were reviewed to establish the definite diagnosis.


RESULTS
Nine samples from eight patients (2.6%) showed positive results (9.7% of patients with pathological CSF and none with normal CSF). The eight patients had clinical and analytic findings of herpesvirus nervous system infection: HSV-1 DNA in four patients with encephalitis, HSV-2 DNA in one patient with meningitis, VZV DNA in two patients with meningitis and CMV DNA in one HIV-positive patient with encephalitis. Herpesvirus was the cause of 50% of encephalitis cases and 10% of meningitis cases. The incidence of HSV-1 encephalitis was five cases per million inhabitants per year.


CONCLUSIONS
Diagnosis of herpesvirus nervous system infections by PCR in CSF is not appropriate when CSF parameters are normal. We found a higher incidence of herpesvirus encephalitis than has been reported in other studies.
Servicio de Microbiología, Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.
Diana
D
García-Bardeci
María José
MJ
Pena
Pino
P
Suárez-Bordón
Yolanda
Y
Aladro
Carmen
C
Pérez-González
Bernardo
B
Lafarga
D000328:Adult; D000368:Aged; D002555:Cerebrospinal Fluid / Q000821:virology; D015897:Comorbidity; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D004279:DNA, Viral / Q000032:analysis*; D020803:Encephalitis, Herpes Simplex / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D020804:Encephalitis, Varicella Zoster / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D018792:Encephalitis, Viral / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006561:Herpes Simplex / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D006566:Herpesviridae Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000302:isolation & purification; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015203:Reproducibility of Results; D013030:Spain / Q000453:epidemiology
D004279:DNA, Viral