Laboratory diagnosis of herpesvirus infections of the central nervous system

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Laboratory diagnosis of herpesvirus infections of the central nervous system

Presented by G Palů, Padova University, Italy

All human herpesviruses (HHVs) are responsible for numerous infections of the central nervous system (CNS). Herpes simplex virus types 1 and 2 (HSV-1 and 2) are the most common causes of sporadic, fatal encephalitis. Varicella zoster virus, HHV-6, -7, Epstein–Barr virus and human cytomegalovirus have been more occasionally associated with encephalitis, meningitis, myelitis, polyradiculopathy, seizures, ventriculitis, CNS demyelization, and brain lymphoma, especially in children, bone marrow transplant recipients and immunosuppressed subjects.

Historically, the diagnosis of viral encephalitis has been cumbersome, while that of meningitis has been insensitive. Clinicians failed to identify an agent in 33 to 75% of presumed CNS infections. Polymerase chain reaction (PCR) and molecular techniques on cerebrospinal fluid (CSF) and nervous tissue are rapidly becoming the standard methods for diagnosing viral CNS infections. PCR demonstrated a sensitivity greater than 95% and a specificity approaching 100%, much greater than viral isolation or serological tests (intrathecal antibodies).

The use of CSF-PCR has expanded the awareness of mild or atypical HSV encephalitis that can constitute 16% to 25% of the cases. Newly developed quantitative real-time assays are providing valuable information about the prognosis of infection, offering the opportunity to monitor the ongoing therapy from the virological viewpoint. Analysis of specific gene transcripts in selected CNS cell preparations can disclose whether virus is passively carried by bystander inflammatory cells, is latent or in an active replication state.

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