HERPES-SIMPLEX VIRUS ENCEPHALITIS IN PEDIATRICS - DIAGNOSIS BY DETECTION OF ANTIBODIES AND DNA IN CEREBROSPINAL-FLUID

Between 1983 and 1991, 16 cases of herpes simplex encephalitis were di agnosed at the Royal Children's Hospital, Melbourne by virus isolation from the brain or cerebrospinal fluid (CSF) (2 cases), by detection o f herpes simplex virus-specific IgM, IgA or IgG by enzyme immunoassay (12 cases) or by polymerase chain reaction (PCR) and herpes simplex vi rus-specific antibodies (2 cases). Specific antibody was detected in 4 of 13 CSF samples taken on Days 1 to 4 after onset of neurologic symp toms compared with 15 of 17 samples taken after the fourth day of illn ess. PCR was retrospectively applied to 20 stored CSF samples from 11 patients; 5 of 8 samples taken less than 4 days after onset of symptom s were positive compared with 2 of 12 taken after Day 4. In contrast a ll 5 fresh unfrozen CSF samples taken from Days 2 to 21 were positive by PCR. These results indicate that PCR is more sensitive for early di agnosis of herpes simplex encephalitis than detection of specific anti body in CSF which is most useful after the fourth day of illness.