Davis Kara L, Shah Samir S, Frank Gary, Eppes Stephen C
Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA.
Pediatr Emerg Care. 2008 Oct;24(10):673-8. doi: 10.1097/PEC.0b013e318188773a.
The polymerase chain reaction (PCR)-based test to detect herpes simplex virus (HSV) genome in cerebrospinal fluid (CSF) has become the test of choice for diagnosing this infection. The utility of this test in young infants undergoing sepsis evaluations is unknown.
We sought to identify the factors that prompted physicians to include HSV PCR in their evaluation of young infants undergoing lumbar puncture. In addition, the impact of ordering this test on patient management was assessed.
This case-control study included infants 0 to 60 days who were evaluated by lumbar puncture at the Alfred I. duPont Hospital for Children over a 5-year period. Case patients had CSF HSV PCR ordered as part of their evaluation and control patients did not.
Eighty-eight case patients and 83 control patients were identified. The median patient age was 12 days and most patients (55%) were male. Both groups were similar in demographics. Herpes simplex virus infection was diagnosed by PCR in 3.4% of cases. The occurrence of a seizure (adjusted odds ratio [OR], 8.3; 95% confidence interval [CI], 1.7-41.0), the performance of CSF enteroviral PCR testing (adjusted OR, 4.7; 95% CI, 1.4-15.8), and the decision to obtain hepatic transaminases (adjusted OR, 5.6; 95% CI, 2.7-11.8) were associated with the decision to perform CSF HSV PCR testing. Use of health care resources associated with PCR testing was considerable.
The occurrence of a seizure, the performance of CSF enteroviral PCR testing, and the decision to obtain hepatic transaminases were independently associated with the decision to perform CSF HSV PCR testing. Features traditionally associated with neonatal HSV infection, such as elevated numbers of CSF white blood cells or red blood cells, did not appear to influence the decision to perform CSF HSV PCR testing. The yield of testing in this population was low. Clinicians should weigh the benefits of early diagnosis in a few patients against the consequences of excessive testing in this population.
基于聚合酶链反应（PCR）检测脑脊液（CSF）中单纯疱疹病毒（HSV）基因组的检测方法已成为诊断该感染的首选检测方法。该检测方法在接受败血症评估的幼儿中的效用尚不清楚。
我们试图确定促使医生在对接受腰椎穿刺的幼儿进行评估时纳入HSV PCR检测的因素。此外，评估了开具此项检测对患者管理的影响。
这项病例对照研究纳入了0至60天的婴儿，这些婴儿在5年期间于阿尔弗雷德·I·杜邦儿童医院接受了腰椎穿刺评估。病例组患者在评估时进行了CSF HSV PCR检测，对照组患者未进行。
确定了88例病例组患者和83例对照组患者。患者的中位年龄为12天，大多数患者（55%）为男性。两组在人口统计学特征方面相似。通过PCR诊断为单纯疱疹病毒感染的病例占3.4%。惊厥的发生（调整后的优势比[OR]，8.3；95%置信区间[CI]，1.7 - 41.0）、CSF肠道病毒PCR检测的进行（调整后的OR，4.7；95% CI，1.4 - 15.8）以及获取肝转氨酶的决定（调整后的OR，5.6；95% CI，2.7 - 11.8）与进行CSF HSV PCR检测的决定相关。与PCR检测相关的医疗资源使用相当可观。
惊厥的发生、CSF肠道病毒PCR检测的进行以及获取肝转氨酶的决定与进行CSF HSV PCR检测的决定独立相关。传统上与新生儿HSV感染相关的特征，如CSF白细胞或红细胞数量升高，似乎并未影响进行CSF HSV PCR检测的决定。该人群的检测阳性率较低。临床医生应权衡少数患者早期诊断的益处与该人群过度检测的后果。
