Laboratory diagnosis of herpesvirus infections of the cns
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Laboratory diagnosis of herpesvirus infections of the cns
- 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)
Notas do Editor
- Jubelt B. Neuro Clin 2:187, 1984.
- because : -Mortality in untreated patients is in excess of 70%. Only 2.5% of all patients return to normal neurologic function. -The therapy to be successful has to be started as soon as possible Cerebrospinal fluid examination elevated levels of cells and protein red blood cells are found in most CSF obtained from patients EEG) spike and slow-wave activity to the temporal lobe (Burst suppression pattern) Scanning procedures technetium, CT, MRI