Why are young infants tested for herpes simplex virus?
Kara L Davis1, Samir S Shah, Gary Frank
1Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA.
Pediatric Emergency Care
|February 27, 2009
Summary
Physicians ordered herpes simplex virus (HSV) PCR tests in infants for seizures or other PCR tests, not typical infection signs. The low yield suggests careful consideration of widespread testing in this population.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Virology
- Diagnostic Microbiology
Background:
- Polymerase chain reaction (PCR) is the preferred method for detecting herpes simplex virus (HSV) genome in cerebrospinal fluid (CSF).
- The effectiveness of HSV PCR testing in infants presenting with sepsis symptoms is not well-established.
Purpose of the Study:
- To determine factors influencing physician decisions to order HSV PCR in infants undergoing lumbar puncture.
- To assess the impact of HSV PCR testing on patient management in this demographic.
Main Methods:
- A case-control study was conducted over five years at a children's hospital.
- Infants aged 0-60 days with lumbar punctures were divided into cases (HSV PCR ordered) and controls (HSV PCR not ordered).
Main Results:
- Seizures, concurrent enteroviral PCR testing, and ordering hepatic transaminases were associated with ordering HSV PCR.
- Herpes simplex virus infection was diagnosed in 3.4% of cases.
- Healthcare resource utilization for PCR testing was significant.
Conclusions:
- Physician decisions to order HSV PCR were linked to seizures, enteroviral PCR, and hepatic transaminase tests, not traditional neonatal infection indicators.
- The diagnostic yield of HSV PCR in this infant population was low.
- Clinicians must balance early diagnosis benefits against the costs of extensive testing.
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