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
Por:
Albert E, Alberola J, Bosque M, Camarena JJ, Clari MÁ, Domínguez Márquez MV, Gil-Fortuño M, Gimeno M, Nogueira JM, Ocete MD, Orta N, Prat J, Rodriguez J, Valero I, Gimeno Cardona C and Navarro D
Publicada:
1 feb 2019
Ahead of Print:
30 ene 2019
Categoría:
Microbiology (medical)
Resumen:
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 = 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.
Filiaciones:
Albert E:
Microbiology Service, Hospital Clínico Universitario, Instituto de Investigación INCLIVA, Valencia, Spain
:
Microbiology Service, Hospital Universitario Dr. Peset, Valencia, Spain
:
Microbiology Service, Hospital Arnau de Vilanova, Valencia, Spain
:
Microbiology Service, Hospital Universitario Dr. Peset, Valencia, Spain
:
Microbiology Unit, Hospital Francesc de Borja, Gandía, Spain
:
Microbiology Service, Hospital Arnau de Vilanova, Valencia, Spain
:
Microbiology Service, Hospital General Universitario, Castellón
Gimeno M:
Microbiology Service, Hospital General Universitario, Alicante, Spain
:
Microbiology Service, Hospital Universitario Dr. Peset, Valencia, Spain
Ocete MD:
Microbiology Service, Consorcio Hospital General Universitario, Valencia, Spain
:
Microbiology Unit, Hospital Francesc de Borja, Gandía, Spain
:
Microbiology Unit, Hospital de Sagunto, Valencia, Spain
Rodriguez J:
Microbiology Service, Hospital General Universitario, Alicante, Spain
Valero I:
Microbiology Service, Consorcio Hospital General Universitario, Valencia, Spain
Gimeno Cardona C:
Microbiology Service, Consorcio Hospital General Universitario, Valencia, Spain
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