Validation of laboratory screening criteria for herpes simplex virus testing of cerebrospinal fluid
Open accessAbstract
Most patients with herpes simplex virus (HSV) central nervous system (CNS) infection have abnormal cerebrospinal fluid (CSF) indices. Therefore, we implemented screening criteria based on CSF values and host immune status to guide testing. All CSF samples submitted for HSV PCR analysis from January 1999 through December 2004 were included in the study. Specimens from patients with human immunodeficiency virus, a history of transplants, an age of <2 years, a CSF white blood cell count of >5 cells/mm(3), or a protein level of >50 mg/dl were tested upon request. All other samples were rejected and frozen. To validate our screening criteria, rejected specimens were pooled and tested retrospectively. Electronic medical records were also reviewed. A total of 1,659 HSV PCR requests from 1,458 patients were screened. Of the 1,296 specimens (78.1%) accepted for testing, 1,213 were negative, 7 were positive for HSV type 1 (HSV-1), 26 were positive for HSV-2, and 50 had unavailable results. Sixteen requests were rejected because an alternative microbiologic diagnosis had been established. Of the 347 samples rejected based on criteria, 222 (64.0%) remained available for pooled testing. No HSV-1-positive samples were identified in the rejected specimens. Two rejected specimens tested positive for HSV-2 DNA, but both met acceptance criteria which had not been communicated to the laboratory. Few patients (7.8%) with rejected specimens were treated with acyclovir, which suggests a low clinical concern for HSV encephalitis. Acceptance criteria based on CSF parameters and host immune status saved time and cost and did not miss patients with HSV CNS infection. Communication between the clinician and the laboratory is imperative for a successful screening program.
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Previous studies showed a safe reduction in herpes virus testing using a cutoff of 10×10^6 CSF leukocytes per liter in non-immunocompromised patients.
“In these studies, the authors showed a safe reduction in herpes virus testing using a cutoff of 10 × 106 CSF leukocytes pro liter in non-immunocompromised patients (23, 25).”
From Utilization of a Meningitis/Encephalitis PCR panel at the University Hospital Basel – a retrospective study to develop a diagnostic decision rule (2024) · cites this paper as [25]
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“These criteria were based on previous studies using similar strategies to safely reduce the ME panel use or CSF herpes virus testing (23–25).”
BackgroundMethodAlbert, E., Alberola, J., Bosque, M., Camarena, J. J., Clari, M. Á., Domínguez Márquez, M. V., Gil-Fortuño, M., Gimeno, A., Nogueira, J. M., Ocete, M. D., et al. (2019) · Journal of Clinical Microbiology · doi:10.1128/jcm.01719-18 · Cited by 14 · see citing works
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McCreery, R., Nielsen, L., Clarey, D., Murphy, C., & Van Schooneveld, T. C. (2022) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/j.diagmicrobio.2021.115605 · Cited by 11 · see citing works
- Authors
- Hanson, K. E., Alexander, B. D., Woods, C., Petti, C., & Reller, L. B.
- Affiliations
- Duke University (US)
- University of Utah (US)
- Corresponding author
- Hanson, Kimberly E.
- Venue
- Journal of Clinical Microbiology
- Publisher
- American Society for Microbiology
- Published
- 2007-03
- Volume
- 45
- Issue
- 3
- Pages
- 721-724
- ISSN
- 0095-1137 (ISSN-L)
- 1098-660X
- PMC
- PMC1829123
- OpenAlex
- W2080456556
- Cited by
- 56
- References
- 19
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 4 · 2021: 2 · 2020: 1 · 2019: 4 · 2018: 3 · 2017: 3 · 2016: 6 · 2015: 1 · 2014: 4 · 2013: 5 · 2012: 2
- FWCI
- 2.76
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Clinical Microbiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Pittsburgh
- National Institutes of Health
- National Cancer Institute (T32 CA93245-03, T32CA093245)
- National Center for Research Resources (K12RR017630, K12 RR17630-03)
- Topics
- Health Sciences › Medicine › Epidemiology › Herpesvirus Infections and Treatments
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Keywords
- herpes simplex virus, herpes simplex encephalitis, cerebrospinal fluid, PCR testing, specimen rejection, group testing, CSF white blood cell count, cerebrospinal fluid protein, host immune status, herpes simplex virus type 1, herpes simplex virus type 2, acyclovir, clinician-laboratory communication
- MeSH terms
- Adult, Aged, Aged, 80 and over, DNA, Viral, Herpes Simplex, Humans, Infant, Newborn, Mass Screening, Polymerase Chain Reaction, Simplexvirus, Herpesvirus 2, Human, Central Nervous System Viral Diseases
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