Comparative study between chemiluminescence assay and two different sensitive polymerase chain reactions on the diagnosis of serial herpes simplex virus encephalitis

摘要

OBJECTIVE—Aprospective study was undertaken on the diagnosis of herpes simplexencephalitis (HSVE) by comparing chemiluminescence assay (CL) and twodifferent sensitive polymerase chain reactions (PCRs).
METHODS—The materialscomprised 53 serial CSF samples from 31 patients with acuteencephalitis with suspected HSVE. Each CSF was distributed to threeindependent laboratories to perform quantitative measurements by CL,the low sensitive (single) PCR, and high sensitive (nested) PCR. The CLprovided a method of detecting HSV itself and the small fragment withHSV antigenicity which was composed of viral component proteins. Theserial CSFs were found retrospectively to comprise 24 samples from 11 patients with HSVE due to HSV1 and 29 samples from 20 patients withnon-HSVE.
RESULTS— the CL showed50 to 48 000 pfu/ml in all samples of HSVE (except one) taken from the3rd to the 25th day. The low sensitive PCR demonstrated 50 to 47 000pfu/ml in only six samples of HSVE. The high sensitive PCR disclosedless than 100 to 120 000 copies/ml in 11 samples of HSVE. At the acutestage from the 1st to 7th day, the sensitivities of CL and the highsensitive PCR were 100%, but that of the low sensitive PCR was 75%.The sensitivity of CL was significantly higher than those of both PCRsafter the acute stage on the 15th to 32nd day. The specificities andpositive predictive values of the three methods were 100%. However,the negative predictive value of CL was significantly higher than thatof the low sensitive PCR.
CONCLUSIONS—Thesensitivity of CL is equivalent to that of the high sensitive PCRduring the acute stage and significantly higher than that of the highsensitive PCR after the acute stage. A clear difference in sensitivityexists between the different PCRs. A combination of the PCR,chemiluminescence assay, and serological antibody diagnosis iscurrently considered the most effective approach for the clinicaldiagnosis of HSVE.