SIGNIFICANCE AND CLINICAL RELEVANCE OF THE DETECTION OF HERPES-SIMPLEX VIRUS-DNA BY THE POLYMERASE CHAIN-REACTION IN CEREBROSPINAL-FLUID FROM PATIENTS WITH PRESUMED ENCEPHALITIS

The polymerase chain reaction (PCR) was used to detect DNA of herpes s implex virus (HSV) in 38 samples of cerebrospinal fluid (CSF) obtained from 22 patients (7 children and 15 adults) 1-20 days after the onset of encephalitis. The results were best with amplification on the pell et of the CSF-extracted DNA and with analysis of the amplified product s by dot-blotting (sensitivity, 100%). A highly significant difference was evident in the chi(2) test when PCR was compared with specific an tigen detection or antibody evaluation (n = 19; chi(2) = 7; sensitivit y = 100% vs. 63%) or with interferon alpha determination (n = 20; chi( 2) = 11; sensitivity = 95% vs. 42%). PCR was positive as early as 1 da y after onset of disease and was often the first test to become positi ve. The detection of HSV DNA by PCR is the most specific, rapid, and s ensitive tool for early diagnosis and therapeutic management of acute HSV encephalitis.