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Journal of Clinical Microbiology, August 1998, p. 2229-2234, Vol. 36, No. 8
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Application of Competitive PCR to Cerebrospinal Fluid Samples from Patients with Herpes Simplex Encephalitis

R. B. Domingues,1 F. D. Lakeman,2,* M. S. Mayo,3 and R. J. Whitley2

Experimental Neuropathology Laboratory, Department of Pathology, University of São Paulo, São Paulo, Brazil,1 and Department of Pediatrics2 and Biostatistics Unit, Comprehensive Cancer Center,3 University of Alabama at Birmingham, Birmingham, Alabama

Received 12 February 1998/Returned for modification 21 March 1998/Accepted 28 April 1998

The purpose of the present study was to determine if the quantity of herpes simplex virus (HSV) DNA in the cerebrospinal fluid (CSF) of patients with herpes encephalitis would be useful in establishing the prognosis of the disease and to determine the effect of antiviral therapy on the clearance of viral DNA from the CSF. Quantitation of HSV DNA was done by constructing an internal standard (IS) from the glycoprotein B amplicon which had a 25-bp deletion between primer annealing sites. Each CSF specimen was coamplified with the IS and the ratio of the amount of HSV/amount of IS was compared to the ratios on a standard curve constructed with the same IS plus known amounts of HSV DNA. CSF specimens were available from 16 patients who were treated with intravenous acyclovir, and the amount of HSV DNA ranged from <25 to 18,000 copies per µl in CSF obtained before or within 4 days of the initiation of acyclovir therapy. Patients with >100 copies of HSV DNA per µl were older, were found by computed tomography to have lesions, and had poorer outcomes than patients with <100 copies. Follow-up CSF specimens were available from seven patients. In six of these seven patients, the HSV DNA levels decreased during therapy. One patient had a twofold increase in HSV DNA levels after 1 week of therapy and died on day 8. The application of this assay may be helpful in establishing the prognosis and in the monitoring of patients with herpes simplex encephalitis.

* Corresponding author. Mailing address: 309 BBRB, 845 19th St., South, Birmingham, AL 35294. Phone: (205) 934-6750. Fax: (205) 934-5758. E-mail: flakeman{at}peds.uab.edu.

Journal of Clinical Microbiology, August 1998, p. 2229-2234, Vol. 36, No. 8
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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