Reply to Galen, “Screening Cerebrospinal Fluid Prior to Herpes Simplex Virus PCR Testing Might Miss Cases of Herpes Simplex Encephalitis”

Hauser, Ronald G.; Campbell, Sheldon; Brandt, Cynthia; Wang, Shi Yi

doi:10.1128/jcm.01144-17

J Clin Microbiol

2017

DOI: 10.1128/jcm.01144-17

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Reply to Galen, “Screening Cerebrospinal Fluid Prior to Herpes Simplex Virus PCR Testing Might Miss Cases of Herpes Simplex Encephalitis”

Ronald G. Hauser

Sheldon Campbell

Cynthia Brandt

et al.

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“…This assumption was later validated by another group (5) and was shown to be a cost-effective and safe approach to HSV testing (6). However, the safety of the aforementioned criteria has recently been disputed (7) and counterarguments against it have been put forward (8). The main concern is that a misclassification could delay the administration of acyclovir (7); nevertheless, the application of the Reller criteria was shown not to be harmful (5).…”

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Missing Cases of Herpes Simplex Virus (HSV) Infection of the Central Nervous System When the Reller Criteria Are Applied for HSV PCR Testing: a Multicenter Study

et al. 2019

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Previous studies suggested that herpes simplex virus (HSV) PCR testing can be safely deferred in patients with normal cerebrospinal fluid (CSF) white blood cell (WBC) counts and protein levels as long as they are older than 2 years of age and are not immunocompromised, the so-called Reller criteria. In this multicenter study, we retrospectively assessed the validity of these screening criteria in our setting. A total of 4,404 CSF specimens submitted for HSV PCR testing to the respective microbiology laboratories at the participating hospitals between 2012 and 2018 were included. Six commercially available HSV PCR assays were used across the participating centers. Ninety-one of the 4,404 CSF specimens (2.1%) tested were positive for HSV DNA (75 samples for HSV-1 and 16 for HSV-2). Nine patients failed to meet the Reller criteria, of whom seven were deemed to truly have HSV encephalitis. Overall, no significant correlation between HSV PCR cycle threshold (C T ) values and WBC counts or total protein levels was found. In addition, median HSV PCR C T s were comparable between patients who met the Reller criteria and those who did not (P ϭ 0.531). In summary, we show that HSV DNA may be detected in CSF specimens with normal WBC and protein levels collected from immunocompetent individuals older than 2 years with HSV encephalitis. Nevertheless, the data also indicate that the number of cases detected could be lowered at least by half if CSF specimens with borderline WBC counts (4 cells/mm 3 ) as well as children of any age are systematically tested. KEYWORDS central nervous system infections, cerebrospinal fluid, herpes simplex virusH erpes simplex virus (HSV) is among the commonest etiological agents of sporadic central nervous system (CNS) infection in immunocompetent patients (1). Timely diagnosis and prompt initiation of acyclovir are crucial for patient survival and recovery (1). Requests for cerebrospinal fluid (CSF) HSV PCR testing, the diagnostic gold standard (1), can be a burden on molecular microbiology laboratory resources; moreover, the results are often noncontributory. Based on previous studies (2, 3), Hanson and Cerebrospinal fluid specimens. A total of 4,404 CSF specimens submitted to the respective microbiology laboratories at the participating hospitals between 2012 and 2018 for HSV PCR testing were included in this study. No restrictive acceptance criteria for testing were in place at any of the centers. Specifically, 1,474 specimens were received at

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confidence: 98%

Missing Cases of Herpes Simplex Virus (HSV) Infection of the Central Nervous System When the Reller Criteria Are Applied for HSV PCR Testing: a Multicenter Study

et al. 2019

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Reply to Galen, “Screening Cerebrospinal Fluid Prior to Herpes Simplex Virus PCR Testing Might Miss Cases of Herpes Simplex Encephalitis”

Cited by 1 publication

References 6 publications

Missing Cases of Herpes Simplex Virus (HSV) Infection of the Central Nervous System When the Reller Criteria Are Applied for HSV PCR Testing: a Multicenter Study

Missing Cases of Herpes Simplex Virus (HSV) Infection of the Central Nervous System When the Reller Criteria Are Applied for HSV PCR Testing: a Multicenter Study

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