Troendle-Atkins J, Demmler G J, Buffone G J
Department of Pediatrics, Baylor College of Medicine, Houston 77030.
J Pediatr. 1993 Sep;123(3):376-80. doi: 10.1016/s0022-3476(05)81735-4.
To determine the diagnostic value of the polymerase chain reaction (PCR) in establishing the rapid diagnosis of herpes simplex virus encephalitis (HSE) in the pediatric age group, we performed PCR to detect herpes simplex virus (HSV) in the cerebrospinal fluid of 8 neonates with HSV infection (4 with central nervous system involvement), 11 infants and children with suspected HSE (4 proved, 1 presumed, 6 excluded), and 105 control patients who had cerebrospinal fluid obtained as part of the evaluation for other diagnoses. The HSV DNA was amplified and typed by using primers specific for the DNA polymerase gene of HSV types 1 and 2. Herpes simplex virus DNA was detected in the cerebrospinal fluid of 3 of 4 neonates with CNS involvement (all with HSV type 2) and 3 of the 4 patients with proved HSE (all with HSV type 1). No HSV DNA was detected in the 4 neonates without CNS disease, the 1 patient with presumed HSE, the 6 patients who had HSE excluded from the diagnosis, and the 105 control patients. Overall, HSV PCR had a sensitivity of 75%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 98%. These results indicate that PCR is a useful noninvasive test in establishing the diagnosis of acute HSE, but a negative result did not exclude the diagnosis.
为确定聚合酶链反应（PCR）在小儿单纯疱疹病毒性脑炎（HSE）快速诊断中的价值，我们对8例单纯疱疹病毒（HSV）感染的新生儿（4例累及中枢神经系统）、11例疑似HSE的婴幼儿（4例确诊，1例疑似，6例排除）以及105例因其他诊断接受评估而获取脑脊液的对照患者的脑脊液进行了PCR检测，以检测HSV。采用针对HSV 1型和2型DNA聚合酶基因的特异性引物对HSV DNA进行扩增和分型。4例累及中枢神经系统的新生儿中有3例（均为HSV 2型）以及4例确诊HSE的患者中有3例（均为HSV 1型）的脑脊液中检测到HSV DNA。4例无中枢神经系统疾病的新生儿、1例疑似HSE的患者、6例排除HSE诊断的患者以及105例对照患者的脑脊液中均未检测到HSV DNA。总体而言，HSV PCR的敏感性为75%，特异性为100%，阳性预测值为100%，阴性预测值为98%。这些结果表明，PCR是诊断急性HSE的一种有用的非侵入性检测方法，但阴性结果不能排除诊断。
