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Utilization of herpes simplex PCR assays for cerebrospinal fluid in a pediatric health care setting
1Department of Pathology and Laboratory Medicine, The University of British of Columbia, Vancouver, Canada. ncimolai@cw.bc.ca
Insights
Polymerase chain reaction (PCR) testing for herpes simplex viruses (HSV) in children impacts antiviral treatment decisions, despite low positive rates and assay inhibition challenges. This diagnostic tool influences acyclovir use in pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Virology
- Molecular Diagnostics
Background:
- Herpes simplex virus (HSV) infections in children can cause severe neurological conditions.
- Accurate and timely diagnosis is crucial for effective antiviral treatment.
- Polymerase chain reaction (PCR) assays offer a sensitive method for detecting HSV DNA.
Purpose of the Study:
- To evaluate the utilization and clinical impact of a diagnostic HSV PCR assay in a Canadian pediatric setting.
- To assess the turnaround time and inhibition rates of the HSV PCR assay.
- To determine how HSV PCR results influence antiviral therapy decisions in children.
Main Methods:
- Retrospective analysis of 103 HSV PCR assays performed on cerebrospinal fluid samples from pediatric patients (newborn to 16 years).
- Data collected on patient demographics, clinical indications, assay results, turnaround time, and antiviral treatment.
- Assessment of assay inhibition using seeded control specimens.
Main Results:
- Only 1.9% of HSV PCR assays were positive (1 HSV-1, 1 HSV-2).
- Significant assay inhibition rates were observed (up to 24.3% for HSV-1).
- Mean turnaround time was 2.5 days; 90.3% completed within 5 days.
- HSV PCR results impacted treatment for 36 patients, but 16.5% received extended antiviral therapy despite negative results.
Conclusions:
- HSV PCR testing significantly influences antiviral use in pediatric patients, guiding treatment initiation and modification.
- Reducing PCR inhibition rates and turnaround times are areas for improvement.
- Despite limitations, HSV PCR is a valuable tool in managing suspected HSV infections in children.
Abstract:
An assessment was made of the utilization and impact of a diagnostic polymerase chain reaction (PCR) assay for the diagnosis of herpes simplex viruses (HSV) 1 and 2 in cerebrospinal fluid of children who attended a Canadian pediatric referral centre. One hundred and three assays were performed on specimens from 103 patients during the period August 1997 to September 1998. Patient ages ranged from newborn to 16 years. Indications for HSV PCR included seizures with or without fever (56.3%), aseptic meningitis (16.5%), and encephalopathy with or without fever (10.7%). Only 2 of 103 (1.9%) assays were positive, including one each for HSV1 and HSV2. Control specimens that were seeded with virus indicated inhibition for 24.3, 8.8, and 6.8% of assays for HSV1, HSV2, and both HSV1 and HSV2, respectively. The mean turn-around time for HSV PCR was 2.5 days, and 90.3% were completed in less than 5 days. Acyclovir was administered to 78.6% of the patients overall; the results of the HSV PCR impacted on the treatment courses for 36 individuals. Nevertheless, 16.5% of patients continued to receive extended courses of antiviral therapy despite negative HSV PCR assays. Although it is desirable to decrease the frequency of PCR inhibitions and to further decrease the interval to assay completion, HSV PCR does have a significant impact on antiviral use in this setting.