Hauser Ronald George, Brandt Cynthia A, Martinello Richard A
Department of Laboratory Medicine, School of Medicine, Yale University, New Haven, CT, USA.
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.
J Pathol Inform. 2017 Feb 28;8:4. doi: 10.4103/2153-3539.201113. eCollection 2017.
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.
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.
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.
The algorithm to screen HSV tests had no propensity to harm.
研究人员通过实验室标准（脑脊液白细胞计数和蛋白质正常）和临床标准（年龄≥2岁，无人类免疫缺陷病毒或实体器官移植病史），在脑脊液中未检测到单纯疱疹脱氧核糖核酸（即单纯疱疹病毒聚合酶链反应[PCR]）的情况下，排除了单纯疱疹病毒（HSV）感染。与所有样本的HSV PCR检测相比，该算法节省了检测成本，并且通过说明患者感染HSV的可能性较低，可能减少了阿昔洛韦的暴露。有人担心，使用该算法可能会因改变真正HSV中枢神经系统感染患者的经验性阿昔洛韦治疗而造成伤害。
确定了2000年至2013年间退伍军人事务部所有脑脊液HSV PCR检测呈阳性的患者，并查阅了他们的病历，以确定该算法遗漏HSV PCR检测的程度和可能的影响。
在6357份检测结果中，有101例患者在研究期间脑脊液HSV PCR检测呈阳性。在脑脊液HSV PCR检测呈阳性的结果中，该算法排除了7例（7%）进行PCR检测。病历审查表明，这7例未通过该算法进行检测但脑脊液HSV PCR检测呈阳性的患者，其主治医生认为他们没有活动性HSV感染。
筛选HSV检测的算法没有造成伤害的倾向。
