1170. CSF HSV PCR testing in adults and children with meningitis and encephalitis
Session: Poster Abstract Session: Diagnostics: Viral
Friday, October 6, 2017
Room: Poster Hall CD
Posters
  • Herpes simplex virus CSF PCR testing in adults and children with meningitis and encephalitis.pdf (384.7 kB)
  • Background: Herpes simplex virus (HSV) is a common treatable cause of meningitis and encephalitis. Delayed antiviral therapy is associated with worse clinical outcomes in HSV encephalitis.

    Objectives: To determine the utilization of a cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) and identify predictors for a positive HSV PCR result.

    Methods: A retrospective review of 751 adults and children with meningitis and encephalitis at 9 hospitals in Houston TX from January 1 2005 - December 31 2010.

    Results: Of 751 patients, 331 (44%) underwent CSF HSV PCR testing. Adults were more commonly tested than children (84% vs 69%, P <0.0001). Additionally, patients with more comorbidities and clinical findings of encephalitis (e.g., altered mental status, focal neurological findings, seizures) were more commonly tested for HSV (P <0.001). Patients tested for HSV were also more likely to be evaluated for West Nile Virus, receive empiric acyclovir and have worse outcomes (P<0.001). In total, 48 of 331 (14.5%) patients tested had a positive CSF HSV PCR. Predictors for a positive CSF HSV PCR on logistic regression analysis were stiff neck (odds ratio [OR], 2.181 [1.090-4.366]; P= 0.028, lymphocytic pleocytosis >50% lymphocytes (OR, 6.187 [1.412-27.11] P= 0.016, and CSF protein > 100mg/dl (OR, 3.279 [1.105-9.731] P=0.032.

    Conclusion:

    CSF HSV PCR is underutilized in community acquired meningitis and encephalitis and is done more frequently in adults and in those with an encephalitis presentation.

    Liliana Parra, MS1, Rodrigo Hasbun, MD, MPH2, Lucrecia Salazar, MD3, Elizabeth Aguilera, MD4 and Susan Wootton, MD4, (1)Infectious Diseases, University of Texas Health Science Center, Houston, TX, (2)Division of Infectious Diseases, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, (3)Division of Infectious Diseases, University of Texas McGovern Medical School at Houston, Houston, TX, (4)Pediatrics, University of Texas Health Science Center, Houston, TX

    Disclosures:

    L. Parra, None

    R. Hasbun, Biomeriaux: Consultant , Consulting fee
    Biofire: Speaker's Bureau , Speaker honorarium
    Merck: Speaker's Bureau , Speaker honorarium
    Pfizer: Speaker's Bureau , Speaker honorarium
    Medicine's Co: Speaker's Bureau , Speaker honorarium

    L. Salazar, None

    E. Aguilera, None

    S. Wootton, None

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