Schlesinger Y, Buller R S, Brunstrom J E, Moran C J, Storch G A
Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110.
J Pediatr. 1995 Feb;126(2):234-41. doi: 10.1016/s0022-3476(95)70550-3.
We designed a polymerase chain reaction method to detect herpes simplex virus (HSV) DNA in spinal fluid from patients with encephalitis. The polymerase chain reaction amplified a 211 base-pair segment of the HSV DNA polymerase gene. Applying this method, we diagnosed HSV type 1 infection in three young children, aged 7 to 13 months, who had atypical forms of the illness. On the basis of magnetic resonance imaging, their disease was diffuse or multifocal in two cases and, in all three, lacked the temporal lobe involvement considered characteristic of HSV encephalitis beyond the neonatal period. Most of the diffuse or multifocal abnormalities detected by magnetic resonance imaging were not apparent by computed tomography. Restriction enzyme analysis of the polymerase chain reaction products from all three patients indicated that their disease was caused by HSV type 1. We conclude that in preschool-age children beyond the neonatal period, the spectrum of HSV encephalitis includes multifocal or diffuse involvement of the brain, which may be detected most efficiently by magnetic resonance imaging. The polymerase chain reaction method has the potential for providing an early diagnosis, but further studies are required to define the sensitivity and specificity of the polymerase chain reaction before it can be used for routine clinical decision making.
我们设计了一种聚合酶链反应方法，用于检测脑炎患者脑脊液中的单纯疱疹病毒（HSV）DNA。聚合酶链反应扩增了HSV DNA聚合酶基因的一个211碱基对片段。应用该方法，我们诊断出3名7至13个月大的幼儿感染了1型单纯疱疹病毒，他们患有非典型形式的疾病。基于磁共振成像，其中2例患者的疾病为弥漫性或多灶性，且所有3例患者均无新生儿期后HSV脑炎典型的颞叶受累表现。磁共振成像检测到的大多数弥漫性或多灶性异常在计算机断层扫描中并不明显。对所有3例患者聚合酶链反应产物的限制性酶切分析表明，他们的疾病是由1型单纯疱疹病毒引起的。我们得出结论，在新生儿期后的学龄前儿童中，HSV脑炎的范围包括大脑的多灶性或弥漫性受累，磁共振成像可能是检测这种情况最有效的方法。聚合酶链反应方法有提供早期诊断的潜力，但在可用于常规临床决策之前，还需要进一步研究来确定聚合酶链反应的敏感性和特异性。
