1. Laboratory diagnosis of herpesvirus infections of the CNS Giorgio Palù, MD Padova University, Italy

5. Sensitivity and Specificity of PCR 98.5% sensitive and 100% specific as a tumour marker EBV Excellent sensitivity, but poor positive predictive value in clinical disease (30–40% of asymptomatic controls positive) HHV-6 Sensitivity nearly 100% in immunosuppressed patients with neurological symptoms; can be quantitated (range:10–10 4 copies/ml); possible use to monitor therapy. Positive results in 60% of affected infants; correlates with poor neurological outcome CMV Sensitivity and specificity >95% VZV >95% sensitivity and specificity; quantitative PCR available; potential use in determining course of iv therapy (especially in neonatal disease) HSV-1 and 2 Sensitivity and specificity Virus

7. 0% 20% 40% 60% 80% 100% 0% 10% 20% 30% anti-HSV-2 prevalence Positive Predictive Value Gull MRL POCkit (Palù et al. Scand.J.Infect.Dis. 2001) Positive predictive values at different anti-HSV-2 prevalence in the population

12. Diagnostic accuracy indexes Mengoli et al., 2003

14. mannitol ampicillin, acyclovir doxycycline ceftizoxime, netilmicin EEG: diffuse irritation chest x-ray: lung consolidation CT: normal LP: bacterial / viral cultures, PCR CT: diffuse edema LP extubation EEG: fewer signs chest x-ray: normal CT: normal LP 1 2 3 4 5 6 12 Days 225 100 75 CSF cells/  l 39.0 38.5 38.0 37.5 37.0 M. pneumoniae : 1:5,120 °C HHV-6/7: DNA+ M. pneumoniae : DNA+, mRNA - HHV-6/7: mRNA - ( Sgarabotto D. et al, Scand J Infect Dis 2000, 32(6):689-92 ) A TWO PATHOGEN CASE OF MENINGOENCEPHALITIS

16. EBV DECAY, RAPID (EARLY) AND SLOW (LATE) COMPONENT t 1/2 early = 29.6 hr t 1/2 late = 111.6 hr ( Biasolo et al, JMedVirol. 2003)