Herpes Simplex Virus (HSV-1 & HSV-2), Qualitative PCR, CSF
Test Mnemonic
HSPCRC
CPT Codes
- 87529 - QTY (2)
LOINC ®
5013-8
Aliases
- HSPCRC
- HSV
- SQHSPCRC
Performing Laboratory
Cleveland Clinic Laboratories
Specimen Requirements
| Volume | Type | Container | Collect Temperature | Transport Temperature | Special Instructions |
|---|---|---|---|---|---|
| 0.5 mL | Cerebrospinal fluid (CSF) | Sterile container | Refrigerated | Collect CSF using standard protocol. CSF from any tube of collection (Tubes 1-4) may be used for this assay. Make a dedicated aliquot into a sterile tube using sterile technique in a biosafety cabinet. Residual specimen from non-Microbiology laboratories is NOT acceptable. |
Minimum Specimen Requirements
| Volume | Type | Container | Collect Temperature | Transport Temperature | Special Instructions |
|---|---|---|---|---|---|
| 0.2 mL | Collect CSF using standard protocol. CSF from any tube of collection (Tubes 1-4) may be used for this assay. Make a dedicated aliquot into a sterile tube using sterile technique in a biosafety cabinet. Residual specimen from non-Microbiology laboratories is NOT acceptable. |
Stability
| Environmental Condition | Description |
|---|---|
| Refrigerated | 7 days at 2-8C |
| Frozen | 1 month at -70C |
Days Performed
7 days a week
Turnaround Time
1 - 3 days
Methodology
| Name | Description |
|---|---|
| Qualitiative Real-Time PCR |
Clinical Info
Herpes simplex viruses (HSV-1 and HSV-2) are enveloped DNA viruses that are members of the alpha-herpesviridae subfamily. HSV causes about 5–10% of all encephalitis cases, and is one of the most common causes of identified sporadic encephalitis globally. HSV-1 encephalitis is more common in adults; and HSV-2 encephalitis is more common in neonates. Clinical features involved with HSV encephalitis include fever, hemicranial headache, language and behavioral abnormalities, memory impairment, and seizures. HSV can also be associated with meningitis. Nucleic acid amplification testing of CSF specimens has greatly increased the ability to diagnose infections of the CNS, especially viral infections caused by the herpesviruses. The FDA-cleared DiaSorin Molecular Simplexa HSV 1 & 2 Direct is a multiplex qualitative real-time PCR assay that targets HSV-1 and HSV-2 DNA polymerase genes, and is intended for use as an aid in the diagnosis of HSV-1 and HSV-2 infections of the CNS. For encephalitis patients with a negative herpes simplex PCR result, consideration should be given to repeating the test 3–7 days later for patients demonstrating a compatible clinical syndrome or temporal lobe localization on neuroimaging. This standalone HSV-1 and HSV-2 PCR test has been shown to have greater analytic sensitivity for HSV detection as compared to large multiplex panels, and should be considered for patients with high pre-test probability of HSV encephalitis.
Clinical Limitation
Negative results do not preclude HSV-1 or HSV-2 infection and should not be used as the sole basis for treatment or other patient management decisions, especially if performed very early in the course of illness. For encephalitis patients with a negative herpes simplex PCR result, consideration should be given to repeating the test 3–7 days later for patients demonstrating a compatible clinical syndrome or temporal lobe localization on neuroimaging. As with other tests, false-positive results may occur. Repeat testing or testing with a different device may be indicated in some settings. A positive result by this test cannot rule out infections caused by other viral or bacterial pathogens. Viral nucleic acids may persist in vivo independent of virus viability. Detection of target analyte(s) does not imply that the corresponding viruses are infectious or are the causative agent for clinical symptoms.
Clinical Reference
Vaugon E, Mircescu A, Caya C, Yao M, Gore G, Dendukuri N, Papenburg J. Diagnostic accuracy of rapid one-step PCR assays for detection of herpes simplex virus-1 and -2 in cerebrospinal fluid: a systematic review and meta-analysis. Clin Microbiol Infect. 2022 Dec;28(12):1547-1557. doi: 10.1016/j.cmi.2022.06.004. Epub 2022 Jun 17. PMID: 35718347.