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PMID: 8890768 Published · ppublish English Journal Article Review

The role of laboratory investigation in the diagnosis and management of patients with suspected herpes simplex encephalitis: a consensus report. The EU Concerted Action on Virus Meningitis and Encephalitis.

Journal of neurology, neurosurgery, and psychiatry ·Vol. 61 ·No. 4 ·1996-10-00 ·Pages 339-45

Cinque P, Cleator GM, Weber T, Monteyne P, Sindic CJ, van Loon AM

Abstract

As effective therapies for the treatment of herpes simplex encephalitis (HSE) have become available, the virology laboratory has acquired a role of primary importance in the early diagnosis and clinical management of this condition. Several studies have shown that the polymerase chain reaction (PCR) of CSF for the detection of herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2) DNA provides a reliable method for determining an aetiological diagnosis of HSE. The use of PCR in combination with the detection of a specific intrathecal antibody response to HSV currently represents the most reliable strategy for the diagnosis and monitoring of the treatment of adult patients with HSE. The use of these techniques has also led to the identification of atypical presentations of HSV infections of the nervous system and permits the investigation of patients who develop a relapse of encephalitic illness after an initial episode of HSE. A strategy for the optimal use of the investigative laboratory in the diagnosis of HSE and subsequent management decisions is described.

MeSH Terms
Acyclovir/administration & dosage,therapeutic use Antibody Formation Antiviral Agents/therapeutic use Biopsy Brain/physiopathology,virology Cerebrospinal Fluid/virology DNA, Viral Electroencephalography Encephalitis, Viral/drug therapy,etiology,virology Herpesviridae Infections/complications,physiopathology Humans Injections, Intravenous Magnetic Resonance Imaging Polymerase Chain Reaction Tomography, X-Ray Computed
Chemicals
Antiviral Agents DNA, Viral Acyclovir
Authors & Affiliations
6 authors, click to expand affiliations / ORCID
Cinque P
Universita di Roma La Sapienza, Italy.
Cleator G M
Weber T
Monteyne P
Sindic C J
van Loon A M
References (83)
83 references, click to expand
  1. Avoiding false positives with PCR.
    Nature. 1989 May 18;339(6221):237-8 PMID: 2716852
  2. Characterization of encephalitis in adult mice induced by intracerebral inoculation of herpes simplex virus type 1 (KOS) and comparison with mutants showing decreased virulence.
    Lab Invest. 1989 Jun;60(6):822-30 PMID: 2543866
  3. Diagnosis of herpes simplex virus encephalitis by detection of virus-specific immunoglobulins A and G in serum and cerebrospinal fluid by using an antibody-capture enzyme-linked immunosorbent assay.
    J Clin Microbiol. 1989 Sep;27(9):1983-7 PMID: 2550516
  4. Herpes simplex virus (HSV) DNA in microglial nodular brainstem encephalitis.
    J Neuropathol Exp Neurol. 1989 Nov;48(6):645-52 PMID: 2552027
  5. Prevalence of antibodies to herpes simplex virus types 1 and 2 in pregnant women, and estimated rates of infection.
    J Epidemiol Community Health. 1989 Mar;43(1):53-60 PMID: 2556492
  6. Non-invasive diagnosis of herpes simplex encephalitis.
    Lancet. 1990 Feb 10;335(8685):357-8 PMID: 1967796
  7. Herpes simplex virus glycoproteins E and I facilitate cell-to-cell spread in vivo and across junctions of cultured cells.
    J Virol. 1994 Feb;68(2):834-45 PMID: 8289387
  8. Herpes simplex: a possible cause of brain-stem encephalitis.
    Pediatrics. 1977 Feb;59(2):240-3 PMID: 189282
  9. Adenine arabinoside therapy of biopsy-proved herpes simplex encephalitis. National Institute of Allergy and Infectious Diseases collaborative antiviral study.
    N Engl J Med. 1977 Aug 11;297(6):289-94 PMID: 195208
  10. Herpes-simplex infection presenting as brainstem encephalitis.
    Lancet. 1977 Nov 5;2(8045):977-8 PMID: 72311
  11. Herpes-simplex infection presenting as brainstem encephalitis.
    Lancet. 1978 Jan 28;1(8057):212-3 PMID: 74638
  12. Rapid detection of herpes-simplex-virus DNA in cerebrospinal fluid of patients with herpes simplex encephalitis.
    Lancet. 1990 Feb 24;335(8687):440-1 PMID: 1968171
  13. Primary and recurrent herpes simplex virus type 2-induced meningitis.
    J Infect Dis. 1990 Aug;162(2):322-30 PMID: 2165105
  14. Herpes simplex virus type 2 meningitis without genital lesions: an immunoblot study.
    J Neurol. 1990 Aug;237(5):285-9 PMID: 2172470
  15. Use of brain biopsy for diagnostic evaluation of patients with suspected herpes simplex encephalitis: a statistical model and its clinical implications. NIAID Collaborative Antiviral Study Group.
    J Infect Dis. 1991 Jan;163(1):17-22 PMID: 1984464
  16. Neurovirulence of herpes simplex virus types 1 and 2 isolates in diseases of the central nervous system.
    Eur J Clin Microbiol Infect Dis. 1990 Oct;9(10):751-7 PMID: 2175706
  17. Rapid diagnosis of herpes simplex encephalitis by nested polymerase chain reaction assay of cerebrospinal fluid.
    Lancet. 1991 Jan 26;337(8735):189-92 PMID: 1670839
  18. Establishment of PCR for the early diagnosis of herpes simplex encephalitis.
    J Med Virol. 1990 Oct;32(2):77-82 PMID: 2177775
  19. Diagnosis of herpes encephalitis via Southern blotting of cerebrospinal fluid DNA amplified by polymerase chain reaction.
    J Med Virol. 1990 Dec;32(4):261-4 PMID: 1964477
  20. Acute confusion--an unusual form of cerebral herpes simplex virus infection?
    Acta Paediatr Scand. 1991 Feb;80(2):252-4 PMID: 2035318
  21. SPECT and MR imaging in herpes simplex encephalitis.
    J Comput Assist Tomogr. 1991 Sep-Oct;15(5):811-5 PMID: 1885800
  22. Herpes simplex virus type 1 DNA in cerebrospinal fluid of a patient with Mollaret's meningitis.
    N Engl J Med. 1991 Oct 10;325(15):1082-5 PMID: 1653900
  23. Amplification and characterization of herpesvirus DNA in cerebrospinal fluid from patients with acute encephalitis.
    J Clin Microbiol. 1991 Nov;29(11):2412-7 PMID: 1663508
  24. Intra-blood-brain barrier synthesis of IgG: comparison of IgG synthesis formulas in a computer model and in 1,629 consecutive specimens.
    Neurology. 1992 Mar;42(3 Pt 1):510-5 PMID: 1549210
  25. Accuracy of computed tomography in the diagnosis of herpes simplex encephalitis.
    Acta Radiol Suppl. 1986;369:192-6 PMID: 2980448
  26. Relapse of herpes simplex encephalitis in children.
    Pediatrics. 1992 May;89(5 Pt 1):891-4 PMID: 1315949
  27. Herpes simplex virus encephalitis in pediatrics: diagnosis by detection of antibodies and DNA in cerebrospinal fluid.
    Pediatr Infect Dis J. 1993 Dec;12(12):1001-6 PMID: 8108205
  28. Herpes simplex encephalitis in the temporal cortex and limbic system after trigeminal nerve inoculation.
    J Infect Dis. 1994 Apr;169(4):782-6 PMID: 8133092
  29. Herpes simplex virus infection as a cause of benign recurrent lymphocytic meningitis.
    Ann Intern Med. 1994 Sep 1;121(5):334-8 PMID: 8042822
  30. Significance and clinical relevance of the detection of herpes simplex virus DNA by the polymerase chain reaction in cerebrospinal fluid from patients with presumed encephalitis.
    Clin Infect Dis. 1994 May;18(5):744-9 PMID: 8075263
  31. Cytokines and other markers of intrathecal immune response in patients with herpes simplex encephalitis.
    J Infect Dis. 1994 Sep;170(3):678-81 PMID: 8077727
  32. The intrathecal synthesis of virus-specific oligoclonal IgG in multiple sclerosis.
    J Neuroimmunol. 1994 Oct;54(1-2):75-80 PMID: 7523446
  33. Differentiation of herpes simplex virus 1 and 2 in cerebrospinal fluid of patients with HSV encephalitis and meningitis by stringent hybridization of PCR-amplified DNAs.
    J Neurol. 1994 Aug;241(9):526-30 PMID: 7799000
  34. Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group.
    J Infect Dis. 1995 Apr;171(4):857-63 PMID: 7706811
  35. Recurrent meningitis and encephalitis associated with herpes simplex type 2: demonstration by polymerase chain reaction.
    Eur Neurol. 1996;36(3):176-7 PMID: 8738952
  36. Herpes simplex virus infections of the nervous system. Problems in laboratory diagnosis.
    Arch Neurol. 1968 Mar;18(3):260-4 PMID: 4296079
  37. Ascending myelitis in association with herpes-simplex virus.
    N Engl J Med. 1972 Jul 27;287(4):182-4 PMID: 4338243
  38. Brain stem encephalitis caused by Herpesvirus hominis.
    Br Med J. 1972 Nov 18;4(5837):405-6 PMID: 4344352
  39. Different patterns of neurologic involvement with herpes simplex virus types 1 and 2: isolation of herpes simplex virus type 2 from the buffy coat of two adults with meningitis.
    J Infect Dis. 1973 Apr;127(4):365-72 PMID: 4348495
  40. Herpes encephalitis with catatonic stupor.
    Arch Gen Psychiatry. 1974 Oct;31(4):544-6 PMID: 4370982
  41. The diagnostic significance of the polymerase chain reaction and isoelectric focusing in herpes simplex virus encephalitis.
    J Med Virol. 1992 Feb;36(2):147-54 PMID: 1316425
  42. The diagnostic significance of antibody specificity indices in multiple sclerosis and herpes virus induced diseases of the nervous system.
    Clin Investig. 1992 Jan;70(1):28-37 PMID: 1318123
  43. Evaluation of the polymerase chain reaction for diagnosis of herpes simplex virus encephalitis.
    J Clin Microbiol. 1993 Jan;31(1):146-8 PMID: 8380180
  44. A prospective study of the polymerase chain reaction for detection of herpes simplex virus in cerebrospinal fluid submitted to the clinical virology laboratory.
    Mol Cell Probes. 1992 Oct;6(5):367-73 PMID: 1335547
  45. 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.
    J Med Virol. 1993 Mar;39(3):179-86 PMID: 8385702
  46. A polymerase chain reaction assay of cerebrospinal fluid in patients with suspected herpes simplex encephalitis.
    J Neurol Neurosurg Psychiatry. 1993 May;56(5):520-5 PMID: 8389398
  47. Rapid diagnosis of herpes simplex virus encephalitis by using the polymerase chain reaction.
    J Pediatr. 1993 Sep;123(3):376-80 PMID: 8394900
  48. Mollaret's meningitis associated with herpes simplex type 2 infection.
    Neurology. 1993 Sep;43(9):1722-7 PMID: 8414021
  49. Recurrent ascending myelitis: an unusual presentation of herpes simplex virus type 1 infection.
    Ann Neurol. 1993 Oct;34(4):625-7 PMID: 8215253
  50. Persistent intrathecal immune activation in patients with herpes simplex encephalitis.
    J Infect Dis. 1993 Nov;168(5):1248-52 PMID: 8228358
  51. Detection and typing of human herpesviruses by multiplex polymerase chain reaction.
    J Virol Methods. 1993 Oct;44(2-3):261-9 PMID: 8263120
  52. Herpes simplex type 2 in a patient with Mollaret's meningitis: demonstration by polymerase chain reaction.
    Ann Neurol. 1994 Jan;35(1):112-6 PMID: 8285581
  53. Herpetic brainstem encephalitis.
    Neurology. 1980 Sep;30(9):981-5 PMID: 6252516
  54. Transolfactory spread of virus in herpes simplex encephalitis.
    Br Med J. 1980 Nov 22;281(6252):1392 PMID: 7437807
  55. Herpes simplex encephalitis: vidarabine therapy and diagnostic problems.
    N Engl J Med. 1981 Feb 5;304(6):313-8 PMID: 6255332
  56. Herpes simplex virus encephalitis: new diagnostic and clinical features and results of therapy.
    Arch Neurol. 1980 Dec;37(12):763-7 PMID: 6255909
  57. Diagnosis of herpes encephalitis by elisa.
    Lancet. 1981 Nov 28;2(8257):1228-9 PMID: 6118650
  58. Isolation of herpes simplex virus type I in recurrent (Mollaret) meningitis.
    Ann Neurol. 1982 Jan;11(1):17-21 PMID: 6277234
  59. Herpes simplex virus encephalitis: laboratory evaluations and their diagnostic significance.
    J Infect Dis. 1982 Jun;145(6):829-36 PMID: 6282983
  60. Herpes simplex encephalitis. An immunohistological study of the distribution of viral antigen within the brain.
    J Neurol Sci. 1982 May;54(2):209-26 PMID: 6284882
  61. Herpes simplex type 2 virus encephalitis presenting as psychosis.
    Am J Med. 1982 Sep;73(3):445-8 PMID: 7124772
  62. Cerebrospinal fluid IgG bands and virus-specific IgG, IgM, and IgA antibodies in herpes simplex virus encephalitis.
    J Neuroimmunol. 1982 Dec;3(4):247-61 PMID: 6294136
  63. Detection of HSV-1 genome in central nervous system of latently infected mice.
    Nature. 1983 Apr 7;302(5908):523-5 PMID: 6300686
  64. Experience with brain biopsy for suspected herpes encephalitis: a review of forty consecutive cases.
    Neurosurgery. 1983 Jun;12(6):654-7 PMID: 6308497
  65. Acyclovir versus vidarabine in herpes simplex encephalitis. Randomised multicentre study in consecutive Swedish patients.
    Lancet. 1984 Sep 29;2(8405):707-11 PMID: 6148470
  66. Mild forms of herpes encephalitis.
    J Neurol Neurosurg Psychiatry. 1984 Nov;47(11):1247-50 PMID: 6094737
  67. Concurrent herpes simplex and cytomegalovirus retinitis and encephalitis in the acquired immune deficiency syndrome (AIDS).
    Ophthalmology. 1984 Dec;91(12):1669-77 PMID: 6097855
  68. Long-term persistence of intrathecal virus-specific antibody responses after herpes simplex virus encephalitis.
    J Neurol. 1985;231(6):307-12 PMID: 2983032
  69. A new complication of AIDS: thoracic myelitis caused by herpes simplex virus.
    Neurology. 1985 Jul;35(7):1071-4 PMID: 2989730
  70. Chronic encephalitis possibly due to herpes simplex virus: two cases.
    Neurology. 1985 Oct;35(10):1470-2 PMID: 4033928
  71. Cytomegalovirus and herpes simplex virus ascending myelitis in a patient with acquired immune deficiency syndrome.
    Ann Neurol. 1985 Jul;18(1):74-9 PMID: 2994553
  72. Psychosis and herpes simplex encephalitis.
    South Med J. 1985 Nov;78(11):1347-50 PMID: 4071143
  73. Vidarabine versus acyclovir therapy in herpes simplex encephalitis.
    N Engl J Med. 1986 Jan 16;314(3):144-9 PMID: 3001520
  74. Production of specific antibodies by cerebrospinal fluid lymphocytes in patients with herpes zoster, mumps meningitis and herpes simplex virus encephalitis.
    Scand J Immunol. 1986 Sep;24(3):261-71 PMID: 3018917
  75. Relapse of herpes simplex encephalitis.
    Neuropediatrics. 1987 Feb;18(1):3-7 PMID: 3561702
  76. Detection of antigen to herpes simplex virus in cerebrospinal fluid from patients with herpes simplex encephalitis.
    J Infect Dis. 1987 Jun;155(6):1172-8 PMID: 3033092
  77. Concomitant herpes simplex virus type 1 and cytomegalovirus ventriculoencephalitis in acquired immunodeficiency syndrome.
    Arch Neurol. 1987 Aug;44(8):843-7 PMID: 2820361
  78. Acute ascending necrotizing myelopathy caused by herpes simplex virus type 2.
    Neurology. 1987 Nov;37(11):1791-4 PMID: 3670617
  79. Non-herpes simplex encephalitis is early exclusion of herpes simplex etiology possible?
    Eur Arch Psychiatry Neurol Sci. 1987;236(6):372-8 PMID: 2824204
  80. Interferon gamma in acute and subacute encephalitis.
    Br Med J (Clin Res Ed). 1988 Jan 2;296(6614):9-11 PMID: 2827836
  81. Relapse of herpes simplex encephalitis after conventional acyclovir therapy.
    JAMA. 1988 Feb 19;259(7):1051-3 PMID: 3339802
  82. Acyclovir treatment of herpes simplex encephalitis: experience in a district hospital.
    Postgrad Med J. 1987 Dec;63(746):1037-41 PMID: 3451230
  83. Specific IgG subclass reactivity in herpes simplex encephalitis.
    J Neurol. 1988 Sep;235(7):400-6 PMID: 3221245
Article Info
Journal
Journal of neurology, neurosurgery, and psychiatry
Abbr.
J Neurol Neurosurg Psychiatry
ISSN
0022-3050
DOI
10.1136/jnnp.61.4.339
Published
1996-10-00
Pages
339-45
Language
English
Region
England
NLM ID
2985191R
PMCID
PMC486570
Subset
IM
External Links
PubMed source DOI: 10.1136/jnnp.61.4.339 PMC Full Text View journal details
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