title: [Investigation of herpes simplex virus (HSV) by three different methods in the clinical specimens of patients with suspected HSV infections].
abstract: Herpes simplex virus (HSV) infections are a common clinical problem worldwide. HSV infections have a severe and rapidly progressive course especially in immunocompromised patients, leading to significant morbidity and mortality. Therefore, rapid and reliable laboratory diagnosis of HSV infections is of crucial importance for the initiation of early antiviral therapy. In this study the aim was to investigate the presence of HSV type 1 and type 2 in clinical specimens by cell culture, in-house polymerase chain reaction (PCR) and direct fluorescein antibody (DFA) methods. The study was conducted at Erciyes University Gevher Nesibe Hospitals between March 2006 and june 2007. A total of 65 clinical specimens, 38 of them being cerebrospinal fluid (CSF) samples obtained from meningoencephalitis suspected cases and 27 being vesicular/conjunctival/genital swabs obtained from patients with different clinical presentations (13 herpes labialis, 5 keratoconjunctivitis, 4 gingivostomatitis, 3 eczama herpeticum, 1 herpetic whitlow, 1 genital ulcer). The age range of the 65 patients varied between 1-68 years, 20 being children. All the samples except CSF were investigated by 3 of the test methods, however, CSF samples were tested only by cell culture and PCR since DFA is not recommended. HSV was found positive in 48.1% (13/27) of the 27 swab specimens by DFA, in 66.6% (18/27) by PCR and in 51.8% (14/27) cytopathic effect consistent with HSV was observed. HSV positivity was detected in 7.8% (3/38) of the 38 CSF specimens by cell culture and in 47.4% (18/38) by in-house PCR. Viral growth in cell cultures showing cytopathic effect were further confirmed by DFA method using HSV-1 and HSV-2 specific fluorescein monoclonal antibodies (Monofluo, Bio-Rad Laboratories, USA). Agreement between the methods were investigated by Kappa analysis. Moderate level agreement was determined for both swab (K = 0.7) and CSF (K = 0.6) specimens for the tested methods when cell culture was considered as the reference method. In conclusion for swab specimens, primarily DFA which is a practical and rapid method, could be applied. This step might be followed by PCR and cell culture techniques sequentially. On the other hand CSF specimens should be investigated by the rapid and more sensitive PCR method.
authors.affiliation: Kayseri Kadin Dogum ve Cocuk Hastaliklari Hastanesi, Kayseri. gyagmur1970@hotmail.com
authors.forename: Gülhan
authors.initials: G
authors.lastname: Yağmur
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Ozbal
authors.forename: Selma
authors.initials: S
authors.lastname: Gökahmetoğlu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002555:Cerebrospinal Fluid / Q000821:virology; D002648:Child; D002675:Child, Preschool; D019085:Fluorescent Antibody Technique, Direct; D006561:Herpes Simplex / Q000175:diagnosis* / Q000821:virology; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D013997:Time Factors; D014421:Turkey; D055815:Young Adult