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.
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.
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