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Updated: Mar 6, 2026
Plaquing of Herpes Simplex Viruses
Published on: November 5, 2021
Impact of a Rapid Herpes Simplex Virus PCR Assay on Duration of Acyclovir Therapy
Tam T Van1, Kanokporn Mongkolrattanothai2,3, Melissa Arevalo1
1Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.
Insights
Implementing rapid herpes simplex virus (HSV) PCR testing significantly reduced diagnostic turnaround times and shortened unnecessary acyclovir treatment duration in children with suspected central nervous system (CNS) infections.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Clinical Diagnostics
Background:
- Herpes simplex virus (HSV) central nervous system (CNS) infections pose significant risks to children.
- Prompt diagnosis and treatment are crucial for managing pediatric CNS infections.
Purpose of the Study:
- To evaluate the impact of a direct HSV (dHSV) PCR assay on diagnostic speed and acyclovir therapy duration.
- To assess the clinical utility of rapid PCR testing in pediatric meningitis and encephalitis cases.
Main Methods:
- Retrospective analysis of 363 pediatric patients with cerebrospinal fluid (CSF) HSV PCR results.
- Comparison of a preimplementation (laboratory-developed PCR) and postimplementation (direct sample-to-answer dHSV PCR) testing groups.
- Analysis of turnaround times and acyclovir treatment durations.
Main Results:
- The direct HSV PCR assay reduced average test turnaround time by 14.5 hours.
- Rapid dHSV PCR results (<4 hours) were achieved for 43.6% of patients in the postimplementation group.
- Mean time to acyclovir discontinuation decreased by 17.1 hours, and median therapy duration was significantly reduced.
Conclusions:
- Rapid HSV PCR testing implementation effectively shortens diagnostic turnaround times.
- Faster results facilitate reduced duration of unnecessary acyclovir therapy in pediatric CNS infections.
- This approach improves efficiency in managing suspected HSV CNS disease in children.
Abstract:
Herpes simplex virus (HSV) infections of the central nervous system (CNS) are associated with significant morbidity and mortality rates in children. This study assessed the impact of a direct HSV (dHSV) PCR assay on the time to result reporting and the duration of acyclovir therapy for children with signs and symptoms of meningitis and encephalitis. A total of 363 patients with HSV PCR results from cerebrospinal fluid (CSF) samples were included in this retrospective analysis, divided into preimplementation and postimplementation groups. For the preimplementation group, CSF testing was performed using a laboratory-developed real-time PCR assay; for the postimplementation group, CSF samples were tested using a direct sample-to-answer assay. All CSF samples were negative for HSV. Over 60% of patients from both groups were prescribed acyclovir. The average HSV PCR test turnaround time for the postimplementation group was reduced by 14.5 h (23.6 h versus 9.1 h; P < 0.001). Furthermore, 79 patients (43.6%) in the postimplementation group had dHSV PCR results reported <4 h after specimen collection. The mean time from specimen collection to acyclovir discontinuation was 17.1 h shorter in the postimplementation group (31.1 h versus 14 h; P < 0.001). The median duration of acyclovir therapy was also significantly reduced in the postimplementation group (29.2 h versus 14.3 h; P = 0.01). Our investigation suggests that implementation of rapid HSV PCR testing can decrease turnaround times and the duration of unnecessary acyclovir therapy.
