Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group

J Infect Dis. 1995 Apr;171(4):857-63. doi: 10.1093/infdis/171.4.857.


Isolation of herpes simplex virus (HSV) from brain tissue after biopsy has been considered the reference standard for the diagnosis of herpes simplex encephalitis (HSE). During the evaluation of antiviral treatment of HSE, cerebrospinal fluid (CSF) was obtained from patients with clinical disease indicative of HSE who underwent diagnostic brain biopsy. HSV DNA was detected by polymerase chain reaction (PCR) in CSF of 53 (98%) of 54 patients with biopsy-proven HSE and was detected in all 18 CSF specimens obtained before brain biopsy from patients with proven HSE. Four of 19 CSF specimens were positive after 2 weeks of antiviral therapy. Positive results were found in 3 (6%) of 47 patients whose brain tissue was culture-negative. Detection of HSV DNA in the CSF correlated significantly with age and focal radiographic findings. Thus, PCR detection of HSV DNA should be the standard for diagnosis of HSE.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Base Sequence
  • Brain / virology
  • DNA, Viral / cerebrospinal fluid*
  • DNA-Directed DNA Polymerase / genetics
  • Encephalitis, Viral / cerebrospinal fluid
  • Encephalitis, Viral / diagnosis*
  • Encephalitis, Viral / drug therapy
  • Herpes Simplex / cerebrospinal fluid
  • Herpes Simplex / diagnosis*
  • Herpes Simplex / drug therapy
  • Humans
  • Molecular Sequence Data
  • Polymerase Chain Reaction / methods*
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Simplexvirus / genetics
  • Simplexvirus / isolation & purification*
  • Vidarabine / therapeutic use
  • Viral Envelope Proteins / genetics


  • DNA, Viral
  • Viral Envelope Proteins
  • glycoprotein B, Simplexvirus
  • DNA-Directed DNA Polymerase
  • Vidarabine