Herpes Simplex Virus Encephalitis: Laboratory Evaluations and Their Diagnostic Significance

• Published in: The Journal of infectious diseases 1982-06, Vol.145 (6), p.829-836
• Main Authors: Nahmias, A. J., Whitley, R. J., Visintine, A. N., Takei, Y., Alford, C. A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antibodies; Antibodies, Viral - analysis; Antibodies, Viral - cerebrospinal fluid; Biopsies; Biopsy; Brain; Brain - microbiology; Cerebrospinal fluid; Child; Encephalitis; Encephalitis - diagnosis; Encephalitis - immunology; Fluorescent Antibody Technique; Herpes Simplex - diagnosis; Herpes Simplex - immunology; herpes simplex virus; Human herpesvirus 1; Humans; Infant; Infections; Recurrence; Simplexvirus; Simplexvirus - immunology; Simplexvirus - isolation & purification; Specimens; Viral Disease; Viruses
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/145.6.829

Laboratory procedures were compared with brain biopsy findings in 113 biopsy-proven patients with herpes simplex virus (HSV) encephalitis and 93 biopsy-negative individuals. Examinations of brain tissue by histopathology, immunofluorescence, and electron microscopy demonstrated evidence of HSV infection in 56%, 70%, and 45% of proven cases and apparently false-positive results in 14%,9%, and 2% of those biopsynegative. Serologic assessments revealed that HSV encephalitis occurred as both a primary (30%) and recurrent (70%) infection. Among patients with HSV encephalitis, 28% failed to seroconvert or seroboost within one month of the onset of disease. Titers of passive hemagglutinating and IgG immunofluorescent antibodies increased fourfold in the cerebrospinal fluid in 74% and 94%, respectively, of patients with proven disease. Similar percentages of patients had antibody ratios in serum and cerebrospinal fluid of ≤20 over the same interval. These data indicate the need for development of noninvasive diagnostic procedures.