Rapid diagnosis of herpes simplex virus encephalitis by using the polymerase chain reaction

Troendle-Atkins, Jane; Demmler, Gail J.; Buffone, Gregory J.

doi:10.1016/s0022-3476(05)81735-4

Cited by 110 publications

(33 citation statements)

References 17 publications

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“…The diagnosis of neonatal HSV CNS disease has been greatly enhanced by PCR testing of cerebrospinal fluid (CSF) specimens, [32][33][34][35][36][37][38] and PCR assay is now the method of choice for documenting CNS involvement in an infant…”

Section: Diagnosis Of Neonatal Hsv Diseasementioning

confidence: 99%

“…The sensitivity of CSF PCR testing in neonatal HSV disease ranges from 75% to 100%. 33,36,38 PCR analysis of CSF also should play a role in determining the duration of antiviral therapy, because available data suggest that having HSV DNA detected in CSF at or after completion of intravenous therapy is associated with poor outcomes. 36,37 All infants with a positive CSF PCR assay result for HSV DNA at the beginning of antiviral therapy should have a repeat lumbar puncture near the end of treatment to determine that HSV DNA has been cleared from the CNS.…”

Section: Figurementioning

confidence: 99%

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Guidance on Management of Asymptomatic Neonates Born to Women With Active Genital Herpes Lesions

Kimberlin¹,

Baley²,

Newborn³

2013

Pediatrics

116

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Herpes simplex virus (HSV) infection of the neonate is uncommon, but genital herpes infections in adults are very common. Thus, although treating an infant with neonatal herpes is a relatively rare occurrence, managing infants potentially exposed to HSV at the time of delivery occurs more frequently. The risk of transmitting HSV to an infant during delivery is determined in part by the mother's previous immunity to HSV. Women with primary genital HSV infections who are shedding HSV at delivery are 10 to 30 times more likely to transmit the virus to their newborn infants than are women with recurrent HSV infection who are shedding virus at delivery. With the availability of commercial serological tests that reliably can distinguish type-specific HSV antibodies, it is now possible to determine the type of maternal infection and, thus, further refine management of infants delivered to women who have active genital HSV lesions. The management algorithm presented herein uses both serological and virological studies to determine the risk of HSV transmission to the neonate who is delivered to a mother with active herpetic genital lesions and tailors management accordingly. The algorithm does not address the approach to asymptomatic neonates delivered to women with a history of genital herpes but no active lesions at delivery. Pediatrics 2013;131:e635-e646

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Section: Diagnosis Of Neonatal Hsv Diseasementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Guidance on Management of Asymptomatic Neonates Born to Women With Active Genital Herpes Lesions

Kimberlin¹,

Baley²,

Newborn³

2013

Pediatrics

116

View full text Add to dashboard Cite

show abstract

“…4,5 HSV polymerase chain reaction tests, which allow for accurate diagnosis, are widely available. [6][7][8] Therefore, HSV testing is commonly performed for neonates undergoing evaluation with lumbar puncture. 1,9 Intravenously administered acyclovir improves outcomes, 10 and administration often is initiated at the time of HSV testing.…”

mentioning

confidence: 99%

Delayed Acyclovir Therapy and Death Among Neonates With Herpes Simplex Virus Infection

Shah

Aronson²,

Mohamad³

et al. 2011

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:Neonatal herpes simplex virus (HSV) infection, although uncommon, is associated with significant mortality and neurologic morbidity. Acyclovir therapy reduces mortality rates. The association between the timing of acyclovir treatment initiation and mortality is not known. WHAT THIS STUDY ADDS:In this multicenter observational study of neonates with HSV infection, delayed initiation of acyclovir therapy was associated with in-hospital death. Our data support the use of empiric acyclovir therapy for neonates undergoing testing for HSV infection. abstract OBJECTIVE: To determine the association of delayed acyclovir therapy with death among neonates with herpes simplex virus (HSV) infection. METHODS:A multicenter, retrospective, cohort study was conducted between January 1, 2003, and December 31, 2009, with 1086 neonates (age: Յ28 days) with HSV infection from 41 tertiary care children's hospitals. Early acyclovir therapy was defined as initiation of intravenous acyclovir treatment within 1 day after hospital admission, and delayed acyclovir therapy was defined as initiation of treatment Ͼ1 and Յ7 days after hospital admission. Multivariate logistic regression models determined the association between delayed acyclovir therapy and death, with the use of propensity scores for each neonate's likelihood of receiving delayed acyclovir treatment to control for differences in illness severity between groups. RESULTS:The median age was 10 days. Delayed acyclovir therapy was administered to 262 neonates (24.1%). In most cases (86.2%) of delayed receipt, acyclovir administration occurred on the second or third day of hospitalization. The overall mortality rate was 7.3% (95% confidence interval: 5.8%-9.0%); 9.5% of those who received delayed acyclovir treatment and 6.6% of those who received early acyclovir treatment died. In a multivariate analysis, delayed acyclovir therapy was associated with significantly greater odds of death (adjusted odds ratio: 2.63 [95% confidence interval: 1.36 -5.08]) compared with early acyclovir therapy. CONCLUSIONS:In this multicenter observational study of neonates with HSV infection, delayed initiation of acyclovir therapy was associated with in-hospital death. Our data support the use of empiric acyclovir therapy for neonates undergoing testing for HSV infection.

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“…Polymerase chain reaction has long been documented as useful in the evaluation of neonatal HSV disease; 3,[11][12][13] however, problems with the reliability of this technique in its current state may limit its utility in future investigations. The lack of interlaboratory standards for HSV PCR 1,14 and the use of single-labdeveloped assays (termed 'home-brew' protocols by one major textbook 1 ) raises the possibility that the same sample tested in different laboratories may provide different results, leading to inappropriate management strategies.…”

mentioning

confidence: 99%

“…Original studies used to generate the recognized utility (sensitivity 75 to 100%, specificity 71 to 100% 1,2 ) of HSV PCR in neonatal HSV CNS disease were done on small groups of patients [11][12][13] or on retrospective analysis of stored CSF from a large NIAID (National Institute of Allergy and Infectious Diseases) study, 3 in which <20% of the CSF samples assayed were obtained before antiviral therapy. These limitations, as well as differences in design among the studies and complications in specimen preservation, have been previously discussed.…”

mentioning

confidence: 99%

Polymerase chain reaction in neonatal HSV encephalitis: an assay to count on?

Golden

2009

J Perinatol

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Rapid diagnosis of herpes simplex virus encephalitis by using the polymerase chain reaction

Cited by 110 publications

References 17 publications

Guidance on Management of Asymptomatic Neonates Born to Women With Active Genital Herpes Lesions

Guidance on Management of Asymptomatic Neonates Born to Women With Active Genital Herpes Lesions

Delayed Acyclovir Therapy and Death Among Neonates With Herpes Simplex Virus Infection

Polymerase chain reaction in neonatal HSV encephalitis: an assay to count on?

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