title: Criteria to Screen Molecular Tests for the Diagnosis of Herpes Simplex Virus in the Central Nervous System have no Propensity to Harm.
abstract: OBJECTIVE
  Investigators have ruled out herpes simplex virus (HSV) infection without the detection of herpes simplex deoxyribonucleic acid in cerebrospinal fluid (CSF) (i.e., HSV polymerase chain reaction [PCR]) by laboratory (normal CSF white blood cell count and protein) and clinical criteria (age ≥2 years, no history of human immunodeficiency virus or solid-organ transplant). Compared to HSV PCR of all samples, the algorithm saves money in test costs and may decrease exposure to acyclovir by illustrating the low probability that the patient has HSV. Concern exists that algorithm use may cause harm through alteration of empiric acyclovir treatment in patients with true HSV central nervous system infection.
  
  
  METHODS
  All Department of Veterans Affair's patients with a positive HSV PCR of the CSF between 2000 and 2013 were identified and their medical records reviewed to determine the extent and possible impact of omitted HSV PCR testing by the algorithm.
  
  
  RESULTS
  Of 6357 total results, 101 patients had a positive CSF HSV PCR in the study period. Among the positive CSF HSV PCR results, the algorithm excluded 7 (7%) from PCR testing. Record review indicated these seven patients not tested by the algorithm with a positive CSF HSV PCR were considered by their attending physician not to have active HSV.
  
  
  CONCLUSIONS
  The algorithm to screen HSV tests had no propensity to harm.
authors.affiliation: Department of Laboratory Medicine, School of Medicine, Yale University, New Haven, CT, USA.
authors.forename: Ronald George
authors.initials: RG
authors.lastname: Hauser
authors.affiliation: Department of Emergency Medicine, School of Medicine, Yale University, New Haven, CT, USA; Pain Research Informatics Multimorbidities and Education (PRIME) Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Brandt
authors.affiliation: Department of Internal Medicine and Pediatrics, School of Medicine, Yale University, New Haven, CT, USA; Department of Veterans Affairs, Veterans Health Administration, Office of Public Health, Washington, DC, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Martinello
keywords: Deoxyribonucleic acid; herpes simplex virus; polymerase chain reaction; viral encephalitis; viral meningitis