Fodor P A, Levin M J, Weinberg A, Sandberg E, Sylman J, Tyler K L
Department of Neurology, University of Colorado Health Sciences Center, Denver Veterans Affairs Medical Center, 80220, USA.
Neurology. 1998 Aug;51(2):554-9. doi: 10.1212/wnl.51.2.554.
To determine the frequency of mild/atypical herpes simplex virus encephalitis (HSVE) among patients with CSF specimens submitted to a university diagnostic virology laboratory for HSV PCR.
HSVE is the most commonly recognized cause of acute sporadic encephalitis in the United States. Recognized clinical features are based on autopsy- or brain biopsy-confirmed cases. This is likely to produce ascertainment bias for features associated with severe disease and under-recognition of mild or atypical cases. Amplification of HSV DNA by PCR from CSF provides a sensitive and specific method for diagnosis of HSVE.
Results of all HSV CSF PCR tests sent to a university diagnostic virology laboratory (January 1, 1993, to December 31, 1996) were reviewed. Clinical information was prospectively collected and retrospectively reviewed. Patients with positive HSV CSF PCR tests were classified as having meningitis, encephalitis, or neonatal infection. Encephalitis was considered typical or atypical based on published criteria.
A total of 7.6% of 1,224 CSF specimens were positive for HSV DNA. CSF HSV DNA-positive patients had meningitis (52%), encephalitis (26%), neonatal infection (17%), or nonclassifiable disease (5%). A total of 17% of HSVE patients had mild or atypical disease characterized by the absence of focal findings and slow progression in the absence of antiviral therapy. Atypical HSVE was associated with HSV-2 infection (two of the four patients), immunosuppression by steroid therapy or coexisting HIV infection (three of the four patients), or disease predominantly involving the nondominant temporal lobe (two of the four patients).
Approximately one-fifth of HSVE patients have mild or atypical disease. CSF PCR for HSV DNA should be performed in patients with febrile encephalopathy even in the absence of focal features, initial CSF pleocytosis, or abnormal CT. Mild or atypical HSVE may be associated with infection with either HSV-1 or HSV-2. Mild or atypical HSVE was frequently associated with immunocompromise or asymmetric HSV infection affecting predominantly the nondominant temporal lobe.
确定提交至大学诊断病毒学实验室进行单纯疱疹病毒（HSV）聚合酶链反应（PCR）检测的脑脊液标本患者中轻度/非典型单纯疱疹病毒性脑炎（HSVE）的发生率。
在美国，HSVE是急性散发性脑炎最常见的病因。公认的临床特征基于尸检或脑活检确诊的病例。这可能会对与严重疾病相关的特征产生确诊偏倚，并导致对轻度或非典型病例认识不足。通过PCR从脑脊液中扩增HSV DNA为HSVE的诊断提供了一种敏感且特异的方法。
回顾了1993年1月1日至1996年12月31日送至大学诊断病毒学实验室的所有HSV脑脊液PCR检测结果。前瞻性收集并回顾性分析临床信息。HSV脑脊液PCR检测呈阳性的患者被分类为患有脑膜炎、脑炎或新生儿感染。根据已发表的标准，将脑炎分为典型或非典型。
1224份脑脊液标本中，共有7.6%的标本HSV DNA呈阳性。脑脊液HSV DNA阳性患者患有脑膜炎（52%）、脑炎（26%）、新生儿感染（17%）或无法分类的疾病（5%）。共有17%的HSVE患者患有轻度或非典型疾病，其特征为无局灶性表现且在未进行抗病毒治疗的情况下病情进展缓慢。非典型HSVE与HSV - 2感染（4例患者中的2例）、类固醇治疗导致的免疫抑制或合并HIV感染（4例患者中的3例）或主要累及非优势颞叶的疾病（4例患者中的2例）相关。
约五分之一的HSVE患者患有轻度或非典型疾病。即使在没有局灶性特征、初始脑脊液细胞增多或CT异常的情况下，对于发热性脑病患者也应进行脑脊液HSV DNA的PCR检测。轻度或非典型HSVE可能与HSV - 1或HSV - 2感染有关。轻度或非典型HSVE常与免疫功能低下或主要影响非优势颞叶的不对称HSV感染有关。
