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Herpes simplex virus (HSV) types 1 (HSV-1) and 2 (HSV-2) cause various clinical syndromes. Anatomic sites infected include the skin, oral mucosa, oral cavity, eyes, genital tract, and central nervous system (CNS).(1,2) Systemic involvement may also occur.
HSV infections are common, with data suggesting that the seroprevalence of HSV-1 and HSV-2 in the United States (2005-2010) is 53.9% and 15.7%, respectively.(3) Although HSV-1 has historically been believed to cause recurrent oral lesions, it is an increasingly important cause of genital herpes. Both HSV-1 and HSV-2 can cause CNS disease, with infection in neonates being considered a medical emergency.
Diagnostic methods for HSV have included routine viral culture, molecular testing by PCR, and serology. It is difficult to recover HSV from cerebrospinal fluid (CSF) specimens using viral culture, and the serologic diagnosis of HSV is limited by the inability to distinguish between primary and reactivated disease. Detection of HSV by real-time PCR is now recognized as the most sensitive approach to diagnose HSV infection, especially CNS-associated HSV disease. However, performing viral culture for HSV in neonates being evaluated for potential congenital herpes is still recommended.(4)
An aid in the diagnosis of congenital herpes simplex virus (HSV) infection through the recovery of HSV using viral culture (shell-vial)
Recovery of herpes simplex virus (HSV) from clinical specimens supports the diagnosis of congenital infection due to the virus. A negative result by rapid culture should be interpreted in the context of the patient’s clinical presentation and exposure history. Furthermore, testing by real-time PCR for this virus should be considered prior to ruling out HSV disease.
This test should not be performed on patients older than 4 weeks of age. It is intended for the recovery of herpes simplex virus (HSV) in suspected cases of congenital herpes. For patients older than 4 weeks of age, detection of HSV by real-time PCR is recommended.
A negative result does not rule out the possibility of congenital HSV infection.
Real-time PCR for HSV is the recommended test for all cases of central nervous system disease caused by this virus. Viral culture is an insensitive approach for detection of HSV in cerebrospinal fluid.
No virus isolated
1. Schiffer JT, Corye L: New concepts in understanding genital herpes. Curr Infect Dis Rep Nov 2009;11(6):457-464
2. Sauerbrei A, Eichhorn U, Hottenrott G, Wutzler P: Virological diagnosis of herpes simplex encephalitis. J Clin Virol 2000;17(1):31-36
3. American Academy of Pediatrics. Red Book: 2012 Report of the Committee on Infectious Diseases. Herpes Simplex. Edited by LK Pickering. 29th edition. Elk Grove Village, IL: American Academy of Pediatrics, 2012
4. Bradley H, Markowitz LE, Gibson T, McQuillan GM: Seroprevalence of Herpes Simplex Virus types 1 and 2-United States, 1999-2010. J Infect Dis 2014 Feb 1;209(3):325-333
5. Stranska R, Schuurman R, de Vos M, van Loon AM: Routine use of a highly automated and internally controlled real-time PCR assay for the diagnosis of herpes simplex and varicella-zoster virus infections. J Clin Virol 2004 May;30(1):39-44
6. Espy MJ, Uhl JR, Mitchell PS, et al: Diagnosis of herpes simplex virus infections in the clinical laboratory by LightCycler PCR. J Clin Microbiol 2000;38(2):795-799