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Test Code MISC2MAYOHSVC Herpes Simplex Virus (HSV), Molecular Detection, PCR, Spinal Fluid

Secondary ID

63434

Useful For

Aiding in the rapid diagnosis of herpes simplex virus (HSV)-1 and HSV-2 infections of the central nervous system

Method Name

Real-Time Polymerase Chain Reaction (RT-PCR)

Reporting Name

Herpes Simplex Virus, PCR, CSF

Specimen Type

CSF


Specimen Required


Supplies: Sarstedt Aliquot Tube, 5 mL (T914)

Container/Tube: Plastic vial

Specimen Volume: 0.2 mL

Collection Instructions:

1. Submit from second spinal fluid collection vial.

2. Transfer into aliquot vial using sterile technique.

3. Do not centrifuge or heat inactivate.

Additional Information:

1. The high sensitivity of amplification by polymerase chain reaction (PCR) requires the specimen to be processed in an environment in which contamination of the specimen by herpes simplex virus DNA is not likely.

2. Specimens that are received with less than the minimum volume required for all testing requested will be canceled.


Specimen Minimum Volume

0.1 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
CSF Refrigerated (preferred) 7 days
  Frozen  7 days

Reject Due To

Heat-treated spinal fluid Reject

Clinical Information

Herpes simplex virus (HSV)-1 and HSV-2 are members of the Alpha herpesviridae subfamily. HSV is an enveloped virus with a capsid containing viral DNA. Although HSV-1 and HSV-2 are closely related, the 2 viruses are serologically and genetically distinct.(1,2)

 

HSV-1 and -2 are common causes of dermal and genital infections; however, in some cases, infection with HSV may result in central nervous system (CNS) disease that is considered a medical emergency. HSV infection of the CNS may result in encephalitis (more commonly associated with HSV-1) or meningitis (more commonly associated with HSV-2).

 

Encephalitis is inflammation of the brain associated with clinical evidence of neurologic dysfunction. Of the pathogens reported to cause encephalitis, the majority are viruses.(3) In general, the most frequently identified etiologies in the United States are HSV, West Nile virus, and the enteroviruses, followed by other herpesviruses.(3)

 

HSV causes about 5% to 10% of all encephalitis cases and is one of the most common causes of identified sporadic encephalitis globally.(3) HSV encephalitis occurs in all ages, and during all seasons. HSV-1 encephalitis is more common in adults, and HSV-2 encephalitis is more common in neonates.(3) One study reported a neonatal herpes rate of 1 case per 3200 live births in the United States.(4)

 

Clinical features involved with HSV encephalitis include fever, hemicranial headache, language and behavioral abnormalities, memory impairment, and seizures.(3)

Reference Values

Negative

Interpretation

A positive result suggests the presence of herpes simplex virus (HSV)-1 and/or HSV-2 DNA in the cerebrospinal fluid (CSF) sample.

 

A negative result suggests that HSV-1 and HSV-2 DNA are not present in the CSF sample.

 

An invalid result points to the inability to determine presence or absence of HSV-1 or HSV-2 DNA in the CSF sample.

Method Description

The Simplexa HSV (herpes simplex virus)-1 and -2 Direct assay system is a real-time polymerase chain reaction (PCR) that enables the direct amplification, detection, and differentiation of HSV-1 and HSV-2 DNA from unprocessed spinal fluid specimens without nucleic acid extraction.

 

In this assay, bifunctional fluorescent probe primers are used together with corresponding reverse primers to amplify HSV-1, HSV-2, and internal control targets. Well-conserved regions of the HSV-1 and HSV-2 DNA polymerase genes are targeted to identify HSV-1 and HSV-2 DNA, respectively, in the specimen. An internal control is used to detect PCR failure or inhibition.(Binnicker MJ, Espy MJ, Irish CL. Rapid and direct detection of herpes simplex virus in cerebrospinal fluid using a commercial real-time PCR assay. J Clin Microbiol. 2014;52(12):4361-4362; Package insert: Simplexa HSV 1 & 2 Direct. Diasorin; REF MOL2150. Rev 05. 09/05/2018)

Day(s) Performed

Monday through Sunday

Report Available

Same day/1 to 2 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

87529 x 2

87529 (if appropriate for government payers)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
HSVC Herpes Simplex Virus, PCR, CSF 92865-5

 

Result ID Test Result Name Result LOINC Value
36858 HSV 1 PCR, C 16952-4
36859 HSV 2 PCR, C 16960-7

Testing Algorithm

For more information see Meningitis/Encephalitis Panel Algorithm.

Forms

If not ordering electronically, complete, print, and send a Microbiology Test Request (T244) with the specimen.